Acoustic Characteristics of the Speech of Young Cochlear Implant Users

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From Am J Otol. 1997 Nov;18(6 Suppl):S99-100: Electrode and device problems: manifestation and management.

A total of 119 children were implanted with the Nucleus 22 implant on the Nottingham program by March 1996. Twenty-five (i.e. 21%) of these had an electrophysiologically confirmed fault on at least 1 channel and 6 (i.e. 5%) had experienced total device failure. How these problems were first manifested and what the subsequent effects were on the child and family were determined by means of questionnaires and detailed examination of clinical notes. Our findings indicated that 76% of all internal device faults were initially detected in tuning or electrophysiological measurement. All parents expressed deep anxiety about the threat of device failure; cases of total failure occurring over a long period of time resulted in the greatest distress and effect on the family. Recommendations are made for companies to assist clinics in minimizing such effects.

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From Br J Audiol, 2000 Oct;34(5):285-92: Audit of 5-year post-implantation routine integrity tests performed on paediatric cochlear implantees.

The Nottingham Paediatric Cochlear Implant Programme (NPCIP) specializes in the implantation of children under 5 years of age. Subsequent tuning of the device and identification of changes in device function for these young children, who may have additional disabilities, can often be challenging. Thus, an objective measure to assess the integrity of the device is desirable. This study compares the device function by both objective and behavioural techniques in 30 children (age at implantation 3-11 years) at five years post-implantation. All children were implanted with the Nucleus Mini 22 device. Objective data were collected from integrity testing (IT) which allowed examination of the functioning of the implant by measuring the electrical stimulus artefact. This does not require the child to give a behavioural response. A protocol for a five-year post-implantation IT is suggested which examines common ground, monopolar and bipolar modes of operation. Behavioural data in the form of threshold (T) and comfort (C) levels were obtained by use of developmental age-appropriate techniques at 5 years post-implantation. Results demonstrate that 43.3% of patients had no electrode faults, 23.3% had potential faults on both behavioural and integrity testing, 6.7% were difficult to assess in terms of defining electrode faults due to partial electrode insertions, 13.3% had potential faults on behavioural testing only and 13.3% of patients had potential faults on IT only. In conclusion, IT is valuable in the identification of faulty electrodes, especially in young children and those with additional disabilities. Implementation of the five-year routine IT affected the management of 30% of patients. This study demonstrates that objective and behavioural techniques are complementary procedures in the ongoing management of paediatric patients.

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From Otolaryngol Head Neck Surg, 2005 May;132(5):746-50: Reliability of cochlear implants.

BACKGROUND: The long-term reliability of cochlear implants over time is an important issue for patients and cochlear implant teams. The calculation of cumulative survival rates including all hard failures of cochlear implants is suitable to report objectively about cochlear implant reliability. METHODS: This is a report of 192 cochlear implants from different manufacturers in adults (n = 58) and children (n = 134). RESULTS: The overall cumulative implant survival rate was 91.7% for a period of 11 years. The main reasons for hard failures were design errors of the products and direct or indirect trauma to the cochlea implant site (especially in children) with consecutive breaks of the implant body or electrodes. CONCLUSIONS: To improve our knowledge about reliability of cochlear implants more studies on cumulative long time survival of cochlear implants are needed, where functional failures and complications for whatever reason (design, mechanical, electronic, medical) are included. Cochlear implant reliability data should be considered during the choice of an implant for each individual patient.

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From Otol Neurotol. 2005 Mar;26(2):183-7: Device nonuse among adult cochlear implant recipients.

OBJECTIVE: To examine the causes and prevalence of previous and current device nonuse among adults who have received cochlear implants. STUDY DESIGN: Retrospective case review. SETTING: Adult tertiary referral center for cochlear implantation. METHODS: Two hundred fourteen consecutively implanted adult patients. The length of implant use ranged from 1 month to 14 years. MAIN OUTCOME MEASURE: A period of 4 consecutive weeks of nonuse of cochlear implant, including both obligatory and elective nonuse. RESULTS: Twenty-nine adults (13.6% of implantees) were identified as having at some stage not used their device for a period of more than 4 consecutive weeks. The main reason was device failure (n = 11). Ten adults are current nonusers (4.7% of implantees). Reasons include surgical complication necessitating explantation (n = 3), comorbid illness (n = 3), elective nonuse (n = 2), audiologic complication (n = 1), and device failure (n = 1). CONCLUSION: The overall prevalence of device nonuse was noted to increase slowly with time. The role of psychologic factors in contributing to the decision of an individual to elect to opt out of device use remains unproven.

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Acta Otolaryngol. 2005 Mar;125(3):228-34: Surgical considerations in cochlear implantation in children and adults: a review of 342 cases in Vienna.

CONCLUSIONS: Our data represent the experience of the largest cochlear implant program in Austria. In conclusion, cochlear implantation is a safe procedure, associated with a low rate of intra- and postoperative complications. Nevertheless, patients should be informed about possible problems and especially about the risk of a reoperation due to device failure. OBJECTIVES: To evaluate the cause of deafness, the intraoperative findings and the complication rate for all cochlear implant operations performed consecutively between 1994 and 2003 at Vienna General Hospital. MATERIAL AND METHODS: Including all surgeries for bilateral implantation and revision, a series of 342 operations performed on 164 adults (age range 14.5-81 years; mean age 50.79 years) and 128 children (age range 0.75-14 years; mean age 5.00 years) was retrospectively analyzed. RESULTS: The etiology of deafness was predominantly congenital or progressive (66.89%). The routine mastoidectomy approach was chosen in 300 patients (87.72%) and the suprameatal approach in 42 (12.28%). Intraoperatively, 4 children (2.53%) had a cerebrospinal fluid fistula and 35 patients (10.23%) showed cochlear ossification. Three adults (1.63%) and two children (1.27%) had facial nerves with an aberrant course. The overall complication rate was 12.2%, the rate of major complications was 4.97% and the rate of minor complications was 4.09%. There were no cases of either postoperative meningitis or facial nerve palsy. Both flap necrosis and electrode dislocation occurred in one adult patient (0.54%), but in none of the children. Formation of cholesteatoma was found in one adult (0.54%) and one child (0.63%). The rate of device failure was 7.07% for adults and 13.92% for children.

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But mechanical problems are not the only worry parents for parents -

From Pediatrics, 2006 Feb;117(2):284-9: Bacterial meningitis among children with cochlear implants beyond 24 months after implantation

BACKGROUND: More than 11000 children in the United States with severe-to-profound hearing loss have cochlear implants. A 2002 investigation involving pediatric cochlear implant recipients identified meningitis episodes from January 1, 1997, through September 15, 2002. The incidence of pneumococcal meningitis in the cohort was 138.2 cases per 100000 person-years, >30 times higher than that for children in the general US population. Children with implants with positioners were at higher risk than children with other implant models. This higher risk of bacterial meningitis continued for up to 24 months after implantation. OBJECTIVE: To evaluate additional reported cases to determine whether the increased rate of bacterial meningitis among children with cochlear implants extended beyond 24 months after implantation. METHODS: Our study population consisted of the cohort of children identified through the 2002 investigation; it included 4265 children who received cochlear implants in the United States between January 1, 1997, and August 6, 2002, and who were <6 years of age at the time of implantation. We calculated updated incidence rates and incidence according to time since implantation. RESULTS: We identified 12 new episodes of meningitis for 12 children. Eleven of the children had implants with positioners; 2 children died. Six episodes occurred >24 months after implantation. When cases identified in the 2002 and 2004 investigations were combined, the incidence rate of > or =24-months postimplantation bacterial meningitis among children with positioners was 450 cases per 100000 person-years, compared with no cases among children without positioners. CONCLUSIONS: Our updated findings support continued monitoring and prompt treatment of bacterial infections by health care providers and parents of children with cochlear implants. This vigilance remains important beyond 2 years after implantation, particularly among children with positioners. The vaccination recommendations for all children with implants, with and without positioners, and all potential recipients of implants continue to apply.

Once again, Kaitlin, great job.
 
We have to have a vaccine. the implant company will pay for that. So they are trying to address this issue. I see research like this as one of the reasons, CI companies and dr have made changes. So I see this as positive. I would like to see the update on this.

As always Kaitlyn, good job with research. When you research do you also look for research that does not support your views or contradite the topic?

Wouldn't finding research to support a contradictory view be the responsibility of the person holding the contradictory view? Kailin not only supports her postion, but offers argument to those holding contractory views through her research. If there is research out there that offers support for the opposing side, it is up to the opposing side to cite such.
 
Here is something to consider. If you need to speak to a hearing child from across the room, you can raise the volume of your voice. If you need to speak to a signing child from across the room, you have no problem doing that. However, if you need to speak to the deaf child who is relying on lipreading from across the room, you are up a creek.

Lipreading under the best of circumstances is loaded with ambiguity and creates much misunderstanding. In a classroom, lipreading is by far, the least effective way for a student to gain the information available in the classroom, and most especially in a mainstream classroom. Lipreading is most effective when the conversation is one on one, the distance between the two parties is 5' or less, and the lighting is ideal, with a minimum of visual distraction. This hardly describes a classroom environment.

It depends on the child. It also depends on the teacher. I am using my own personal experiences as a child and as a teacher.
 
Wouldn't finding research to support a contradictory view be the responsibility of the person holding the contradictory view? Kailin not only supports her postion, but offers argument to those holding contractory views through her research. If there is research out there that offers support for the opposing side, it is up to the opposing side to cite such.

Doesn't that create bias? So if you find research that does not validate your opinion then you just skip it?
 
We have to have a vaccine. the implant company will pay for that. So they are trying to address this issue. I see research like this as one of the reasons, CI companies and dr have made changes. So I see this as positive. I would like to see the update on this.

As always Kaitlyn, good job with research. When you research do you also look for research that does not support your views or contradite the topic?

I believe Kaitin is on the side of truth and she does a good job researching.
 
We have to have a vaccine. the implant company will pay for that. So they are trying to address this issue. I see research like this as one of the reasons, CI companies and dr have made changes. So I see this as positive. I would like to see the update on this.

Updates are good, I agree. But please see this is a study from 2006 so very recent and very big ("4265 children who received cochlear implants in the United States between January 1, 1997, and August 6, 2002") so probably it will be several years before update.

As always Kaitlyn, good job with research. When you research do you also look for research that does not support your views or contradite the topic?

Sometimes I post research that does not support my views. These studies about CI failure did not have results I expect - I thought CI had much much lower rate of failure because failure is such a big problem with maybe another surgery. So I expected very little failure rate (like 1% of real failure and not batteries etc - see Jillio's post I think about real failure) and I find higher numbers. So I post these. I am suspicious of oral and especially oral-only for many reasons and wonder if CI in infants without ASL is like oral-only in some ways. Also now I doubt CI is beneficial to me. But in the past I post some articles positive about CI, including CI in kids and language.

Sometimes I read people's posts and think "this is wrong" and then read research and realize "I am wrong and the post is right". I don't post this because the arguement is in my head only so none cares but me. :P I try to spare people in AD. :)

If I see all the research except 1 or 2 articles are against my views I would not post just the 1 or 2. Or I just find a old book and not a research article - I don't post this when we disagree in a thread. But sometimes I find another point - like the big meningitis article - and post this without searching for a long time for other articles. But the meningitis article was a big, recent research published in a very important journal (Pediatrics) - probably I would research more if it were a tiny study or old or seemed weird.

So usually I try for balance and fairness. But my job is not AD Researcher (but I accept if Alex offers :giggle: - just joking) and now already I spend too much time sometimes reading research for AD threads and often make too big posts. So I don't post everything. And sometimes I think people who disagree can post research also (like Jillio said - good post, Jillio :ty:) so always I provide links for people to read to see 1) I don't change anything in a quote and 2) the actual abstract/article so they can research more if they want.

Last point - if I find research that is 100% against someone's point, I never add "You are WRONG!" or something because it is not helpful and rude. I try to use the polite way when argueing.

So I try to answer questions to me, be fair and polite with open mind, and not just fight in threads. If we can divide the CI threads, IMO some parents of kids with CI are not polite (for example, never respond) or open minds even though I understand kids are very sensitive topic. I hope these people show I am wrong.
 
Lipreading under the best of circumstances is loaded with ambiguity and creates much misunderstanding. In a classroom, lipreading is by far, the least effective way for a student to gain the information available in the classroom, and most especially in a mainstream classroom. Lipreading is most effective when the conversation is one on one, the distance between the two parties is 5' or less, and the lighting is ideal, with a minimum of visual distraction. This hardly describes a classroom environment.

Agree 100%.
 
Updates are good, I agree. But please see this is a study from 2006 so very recent and very big ("4265 children who received cochlear implants in the United States between January 1, 1997, and August 6, 2002") so probably it will be several years before update.



Sometimes I post research that does not support my views. These studies about CI failure did not have results I expect - I thought CI had much much lower rate of failure because failure is such a big problem with maybe another surgery. So I expected very little failure rate (like 1% of real failure and not batteries etc - see Jillio's post I think about real failure) and I find higher numbers. So I post these. I am suspicious of oral and especially oral-only for many reasons and wonder if CI in infants without ASL is like oral-only in some ways. Also now I doubt CI is beneficial to me. But in the past I post some articles positive about CI, including CI in kids and language.

Sometimes I read people's posts and think "this is wrong" and then read research and realize "I am wrong and the post is right". I don't post this because the arguement is in my head only so none cares but me. :P I try to spare people in AD. :)

If I see all the research except 1 or 2 articles are against my views I would not post just the 1 or 2. Or I just find a old book and not a research article - I don't post this when we disagree in a thread. But sometimes I find another point - like the big meningitis article - and post this without searching for a long time for other articles. But the meningitis article was a big, recent research published in a very important journal (Pediatrics) - probably I would research more if it were a tiny study or old or seemed weird.

So usually I try for balance and fairness. But my job is not AD Researcher (but I accept if Alex offers :giggle: - just joking) and now already I spend too much time sometimes reading research for AD threads and often make too big posts. So I don't post everything. And sometimes I think people who disagree can post research also (like Jillio said - good post, Jillio :ty:) so always I provide links for people to read to see 1) I don't change anything in a quote and 2) the actual abstract/article so they can research more if they want.

Last point - if I find research that is 100% against someone's point, I never add "You are WRONG!" or something because it is not helpful and rude. I try to use the polite way when argueing.

So I try to answer questions to me, be fair and polite with open mind, and not just fight in threads. If we can divide the CI threads, IMO some parents of kids with CI are not polite (for example, never respond) or open minds even though I understand kids are very sensitive topic. I hope these people show I am wrong.

thank you that is a sign of a good researcher. I may not agree with all the research, but I do respect the time and effort it takes to find it. I do read it and it does make me think. Good point on the bold part.

About the vaccine part - I agree the research is new, that is good. I think because of the research, now we are required to get a vaccine each 5 years if you have a CI. I like to think that type of research created a positive change. It had companies, doctors and other aware of the risk.
 
thank you that is a sign of a good researcher. I may not agree with all the research, but I do respect the time and effort it takes to find it. I do read it and it does make me think. Good point on the bold part.

About the vaccine part - I agree the research is new, that is good. I think because of the research, now we are required to get a vaccine each 5 years if you have a CI. I like to think that type of research created a positive change. It had companies, doctors and other aware of the risk.

Agree, Vallee. The article was a suprise to me - meningitis risk years after CI surgery?? Before I read this I thought the risk was only probably right after surgery and when I see people in AD talking about meningitis I think this doesn't matter for many with CI because the surgery was old. Mengitis is scary (I read a old article about kids with bacterial meningitis (not just CI) with 12% mortality and 20% long-term problems) so this article is important.
 
Again, good job Kaitin for providing these info. I was questioned in another thread a few months ago about my experience of working with children whose CIs failed and it seemed like the other members didnt believe me because they kept saying that the CIs themselves wouldnt just fail. Your research has shown that it does happen and the numbers were higher than I expected too.
 
Agencies that I work with always have someone available PRN.

And I was talking about cases such as the ones cited in the Hands and Voices article wherein the internal portion of the CI suddenly stopped working.


Do you know what the % of time that happens, I believe last time I checked it was .10%, which it means it is very rare.

With the interpreter it was an agency and it was just one time this past Monday. It was hard for my daughter but we know that things like this happen in life soemtimes.
 
As well as CI users who require oral 'terps, or oral accomondations. Rick and Jackie, you haven't answered why a Sign 'terp creates "dependancy", and yet using oral 'terps and oral accomondations don't.
And yes, rick and jackie, depedance on a service provider isn't the best thing in the world..........but we're just saying that dhh kids should have the CHOICE, and OPTION to utilize a 'terp. We're not saying it should be the ONLY option. Very few of us Deafies are pro-seperatist. You know.....It's ironic. There are a TON of ex-oral only folks who post here,(after all oral only is NOT NEW. It has been around for over a hundred years!) Yet where are the ex Sign folks who are now pro oral only? And I'm NOT talking about those folks who are pro oral after growing up with sign b/c they think that sign only is responsible for the low acheivement of the dhh world. (that's a very superfical way of looking at it, since the low acheivement levels are due to a whole BUNCH of causes)
Besides, oral only is very dependant on things like good technology, people who are good speakers (there are people who I can "hear" even without speechreading at ALL, but then again there are people with soft voices and things like that who I can't hear too well, even when they look right at me) good technology etc.
Hey Jackie.........................I have a question. What if your daughter's C-Print captionist didn't show up? It's exactly the same circumstance. Wouldn't she be in the same sitution b/c she can't function as well without the C-Print?

First it is not C-Print, it is real time captioning. Again just like people have stated in here there is a plan in case that happens. They are using an agency and they have subs to cover. And I am sure it could happen that one is sick on the way to school and she would be alone for a period or two. Her teachers all know her very well and would help her to the best of her ability. Yeah, she will probable miss some stuff but life goes on and I would help her make it up at home.
 
When you wrote that, I wondered if his writing is above average or below average compared to his hearing peers. I have no way of knowing that from your comment.

I think Jackie overreacted to your comment. The other readers have no way of knowing if you think his writing is above average or below average.

In short, your comment was a neutral one.
If you really want to know his writing is at grade level. He write very messy but it is all there. Is writing is his weakness point but it is at grade level.

Is reading is about a year above grade level.

Is Jillo was not trying to be negative what was the point about her mentioning my son. We were talking about writing levels.
 
If you really want to know his writing is at grade level. He write very messy but it is all there. Is writing is his weakness point but it is at grade level.

Is reading is about a year above grade level.

Is Jillo was not trying to be negative what was the point about her mentioning my son. We were talking about writing levels.

Cuz before Jillo made that post, you kept bringing up your son's reading and writing levels and she was just responding that yea, she has seen examples of his writing. That was all. I went back to read it to see if I missed anything negative she said and I realized that she was just responding to your posts regarding your son.
 
Cloggy you didn't ask me but I will answer anyway. We have never had an internal problem. We have had wires going down. In our family this is why my husband works the afternoon shift. Someone is always home in case of our childn'r implant going down. The school knows to call us and we were there within 15 minutes. We have one processor go down and it meant that my son was not hearing for about 16 hours 10 of thoses hours he was sleeping.

Such a misinterpretation.... but that's your MO.. willingly misinterpretating other posts..
I'm not comparing hangover and CI-misfunction. I am saying that missing a week due to illness is happening as well.... how do students cope with that?

You might want to ask me, Rick, or any other parent and user of CI how often they have a malfunction that would make the person helpless...

You make it look as if such a failure is common. It is not.
So, before you start spreading nonsense about all sorts of malfunctions... have a look in the real world.....

As for Lotte, she has never had a malfunction with the CI's that stopped all communication and was any sort of problem...

Rick....
In all your experience of you daughter having CI.... how many times did she have a serious malfunction.?? (Hangovers not included.. :) )
 
Vallee now you disagree with Jillo, she's not going to like you any more.

Are we still in high school or what? This whole "watch out, she wont like u or watch out she will like you" is so silly. I am just laughing cuz it brings back memories of middle school with my friends telling me that if I dont do what they say, they wont like me. Unfortunately, I followed what they said. I wish I had told them to "f#8ck off"! LOL!
 
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