CI2017 Podium Abstracts - cdn.ymaws.com€¦ · CI2017 Podium Abstracts 3 | Page Abstract: Introduction: Preservation of residual hearing during cochlear implantation has well recognized

Ci2017PodiumAbstracts

CI2017PodiumAbstracts

SessionID:S1-2SessionTitle:SurgicalTechnologiesAbstractID:74Title:"Silent"ElectrodeInsertion:DevelopingaTime-BasedGuidelinefromIntracochlearPressureMeasurementsAuthors:ReneeM.BanakisHartl,MD,AuD1,DanielJ.Tollin,PhD2,SamuelP.Gubbels,MD1,StephenP.Cass,MD,MPH1;1DepartmentofOtolaryngology,Univ.ofColorado,Aurora,CO,2DepartmentofPhysiologyandBiophysics,Univ.ofColorado,Aurora,CO.Abstract:“Silent”ElectrodeInsertion:DevelopingaTime-BasedGuidelinefromIntracochlearPressureMeasurementsReneeM.BanakisHartl1,DanielJ.Tollin1,2,SamuelP.Gubbels1,andStephenP.Cass11DepartmentofOtolaryngology,UniversityofColoradoSchoolofMedicine,Aurora,CO2DepartmentofPhysiologyandBiophysics,UniversityofColoradoSchoolofMedicine,Aurora,COAbstract(2,179/3,000characters):Introduction:Withincreasingfocusonhearingpreservationduringcochlearimplantsurgery,atraumaticelectrodeinsertionisoftheutmostimportance.Ithasbeenestablishedpreviouslythatlargepressurespikescanbegeneratedinthecochleaduringtheinsertionofimplantelectrodes1-3.Estimatesofequivalentearcanalpressuresuggestthesepeakpressuresmaybeofsufficientintensitytocausetraumasimilartothatofanacousticblastinjury1andmaybeonesourceforpostoperativelossofresidualhearing.Here,weattempttodevelopastandardrecommendationbasedoninsertiontimefora“Silent”electrodeinsertioninwhichnospikesinintracochlearpressurearenoted.Objective:Todevelopaguidelineforcochlearimplantelectrodeinsertionsbasedontimingofrecordingsthatgeneratethefewesttransientintracochlearpressurespikesequivalenttohighintensityacousticstimuli.Methods:Humancadavericheadsweresurgicallypreparedwithanextendedfacialrecessandimplantedsequentiallywithsevendifferentcochlearimplantelectrodesfromthreemanufacturersviaaroundwindowapproach.Fiber-opticsensorsmeasuredintracochlearpressuresinscalavestibuliandtympanineartheovalandroundwindowsduringtimedinsertionsof10,30,and60secondsforeachelectrode.Results:CIelectrodeinsertionproducedarangeofpressuretransientsinthecochlea(134-155dBSPL),consistentwithresultsfrompreviousstudies.Thesmallestnumberofspikeswasseenwiththelongestinsertions(60seconds).Highintensitypressurespikeswerenotedwithallelectrodesstylestested.Conclusion:Ourresultsconfirmpreviousdatathatsuggestscochlearimplantelectrodeinsertioncancausepressuretransientswithintensitiessimilartothoseelicitedbyhigh-levelsounds.Resultsaffirmtheimportanceofatraumaticsurgicaltechniquesandsuggestthatlongerinsertiontimesareassociatedwithfewerpressuretransients.Basedonthesedata,weproposearecommendationofelectrodeinsertiontimesofatleast60secondstoachievea“Silent”insertionandminimizelikelihoodofgenerationoftransientintracochlearpressurespikes.1.GreeneNT,MattinglyJK,BanakisHartlRM,TollinDJ,CassSP.IntracochlearPressureTransientsDuringCochlearImplantElectrodeInsertion.OtolNeurotol.2016;37:1541-1548.


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2.MittmannP,MittmannM,ErnstA,TodtI.IntracochlearPressureChangesdueto2ElectrodeTypes.OtolaryngolHeadNeckSurg.2016Dec1:194599816684104.3.TodtI,MittmannP,ErnstA.IntracochlearfluidpressurechangesrelatedtotheinsertionalspeedofaCIelectrode.BiomedResInt.2014;2014:507241.Support:R.M.B.H.wasfundedbyNIH5T32DC012280-03.Disclosure:S.P.C.isaconsultanttoCochlearAmericas.Keywords:Electrodeinsertion,Hearingpreservation,IntracochlearpressuresSessionID:S1-2SessionTitle:SurgicalTechnologiesAbstractID:146Title:EffectsofSteroidApplicationwithaCochlearCatheteronImpedancesandElectricallyEvokedCompoundActionPotentialsafterCochlearImplantationAuthors:LutzGaertner,PhD,NilsPrenzler,MD,MelanieLeifholz,B.Eng.,AthanasiaWarnecke,MD,AndreasBüchner,PhD,ThomasLenarz,MD;DepartmentOfOtolaryngology,HannoverMed.Sch.,Hannover,Germany.Abstract:Introduction:Itisknownthatsystemicandlocaladministeredsteroidscanreducetheinsertiontraumaandgrowthoffibroustissueaftercochleaimplantationandthusincreasethechanceforhearingpreservationandlowerimpedances.Severalwaysofadministrationhavebeendescribed,e.g.systemic,diffusionviamiddleearordrugreleasingsurfacecoatings.Themotivationforthedevelopmentofacochlearcatheterwastobringthedrugtomoreapicalregionswithoutstructuralharmofthecochlearmicrostructure.Methods:A20mmsiliconecatheterwasdevelopedforfluiddeliveryintotheinnerear.Thecochlearcatheterconsistsofa20mmlongelectrodedummywithahollowlumenandanopeningatthetiptodeliverfluidsintoapicalregionsofthecochlea.N=5patientswithoutrelevantresidualhearing(>80dBhearinglossat250Hz)receivedacochlearflushingwithdilutedtriamcinolone(4mg/ml)viacochlearcatheterbeforecochlearimplantation.5furtherpatientstreatedwiththesameelectrodeandsamehearinglossreceivingnocatheterorsteroid,wereanalyzedascontrolgroup.Impedancesandtheslopeoftheelectricallyevokedcompoundactionpotential(ECAP)amplitudegrowthfunction(AGF)weremeasureddirectlyafterimplantationintheOR,ondays3,10,17,24andatfirstfitting.Results:Ourfindingsindicatethatimpedancesinthesteroidgrouparestableuntilday10post-OPandrisebetweenday10andday24post-OP.Impedancesinthecontrolgrouprisedirectlyafterimplantationandstaystableuntilfirstfitting.Atfirstfittingbothgroupsshowthesamelevelofimpedance.Theeffectcanbeseenonallelectrodes.Firstresultsofthe3monthmeasurementsandofECAPAGFslopeswillbepresented.Conclusion:Steroidtreatmentwiththecochlearcatheterbeforeimplantinsertionseemstohaveanimpactonthebehaviorofelectrodeimpedances,affectingallregionsoftheCochlea. SessionID:S1-2SessionTitle:SurgicalTechnologiesAbstractID:514Title:RealTimeIntraoperativeMonitoringUsingtheCochlearImplantElectrodeforHearingPreservationAuthors:AanandAcharya,MA(Cantab)MBBSFRCSFRACS,DayseTavora-Vieira,PhD,RobertaMarino,PhDBSc(Sp&H)DipAud,GuneshRajan,MDDMFMHFRACS;FionaStanleyHosp.,Murdoch,Australia.


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Abstract:Introduction:Preservationofresidualhearingduringcochlearimplantationhaswellrecognizedprimarybenefits.Severalfactorsarerecognizedtoinfluencethesuccessofhearingpreservationcochlearimplantationsurgery.Monitoringofresidualhearingmayofferasurrogateforthepreservationofdelicateintracochlearstructureandfunctionduringelectrodeinsertion.Severalelectrophysiologicalmeasuresandelectrocochleographytechniqueshavebeeninvestigatedforthispurpose,eachwiththeirownchallengesinprovidingareliableandreal-timemeasureofresidualcochlearelectrophysiologicalfunction.Wepresentanoveltechniqueusingtheimplantelectrodearraytomonitorintracochlearelectrophysiologicalpotentialsduringcochlearimplantinsertionandcorrelatethiswithpreservationofresidualhearingfunction.Methods:Aprospectivepilotstudybeingcarriedoutatatertiaryreferralcentreenrollingbothadultandpaediatricpatients.Surgeryiscarriedoutbyastandardizedteam,utilizingastandardizedsetupandhearingpreservationtechnique.Intraoperativeelectrophysiologicalmonitoring(intracochlearmicrophonic,ICM)iscarriedoutduringinsertionoftheimplantelectrode,attheculminationoftheprocedureandatspecifiedintervalspostoperatively.Theintraoperativeandpostoperativefindingsarecorrelatedwithpreoperativeandpostoperativeresidualhearingthresholdsanddegreeofhearingpreservation.Results:Intraoperativeelectrophysiologicalresponses(ICM)wereidentifiedin60%ofcasesandthiswaspreservedattheendoftheprocedurein78%ofcases.AbetterpreoperativeaveragehearingthresholdwasassociatedwithagreaterlikelihoodofdetectinganICM,howevertheICMcouldstillbeidentifiedinsomecaseswithminimalpreoperativeresidualhearing.Therelationshipbetweenpreoperativeandpostoperativehearingthresholds,andageandhearingpreservation,wasstatisticallysignificant(p<0.05).Completepreservationofhearing,asdefinedbytheHEARRINGhearingpreservationclassificationsystem,wasachievedin100%ofpatientsthatmetcriteriaforEAScochlearimplantation.Allpatientswhoreceivedpreoperativetranstympanicinjectionofglucocorticoidshadcompletehearingpreservation.Conclusion:Thecochlearimplantelectrodearraycanbeusedtoperformdirectintraoperativemonitoringofintracochlearelectrophysiologicalresponsesthatinturnreflectresidualhearingfunctionduringcochlearimplantsurgeryinadultsandchildren.Furtherexperienceandrefinementofthestimulation/detectionsystemmayprovidemoresensitive,moreaccurateandmorereal-timefeedbacktothesurgeontofacilitateandimprovehearingpreservationincochlearimplantation. SessionID:S1-2SessionTitle:SurgicalTechnologiesAbstractID:121Title:ReducingTraumaandOptimizingIntracochlearPositionwithaShapeMemoryPolymerCochlearImplantArrayAuthors:KennethH.Lee,M.D.,Ph.D1,WalterVoit,Ph.D.2,HansAjieren,B.S.pending3,EricEisner,B.S.3,MarkSonderman,B.S.4,DongmeiShao,M.D.1;1Otolaryngology,UTSouthwesternMed.Ctr.,Dallas,TX,2MechanicalEngineering,MaterialScienceandEngineering,UTDallas,Dallas,TX,3MaterialScienceandEngineering,UTDallas,Dallas,TX,4UTSouthwesternMed.Sch.,Dallas,TX.Abstract:Introduction:Shapememorypolymers(SMP)belongtoaclassofsmartmaterialsthatcanchangeshapeinresponsetoastimulus.Withthesepolymers,wehavedevelopedacochlearimplantelectrodearraythatisstraightatroomtemperature,butchangesitsshapetoselfnavigatetheturnsofthecochleaonceinsertedandwarmedtobodytemperature.UseofanSMPbasedself-coilingcochlearimplantelectrodearraycanreduceinsertiontraumaandoptimizeintracochleararraypositiontoimprovecochlearimplantfunctionandoutcomes.


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Methods:Self-coilingcochlearimplantarraysweregeneratedbylasercuttingprobesfromsheetsofSMP.Self-coilingSMPbasedcochlearimplantelectrodearraysaswellasstandardsiliconarrayswereinsertedintoacochlearmodelandinsertionvideoswerecaptured.SMPandstraightsiliconarrayswerealsoinsertedintoratcochleaeandhistologicalanalysesofparaffinembeddedsectionswereperformedtodeterminedegreeoftraumatothelateralwallofthecochleaandtheintracochlearpositionofthearrays.Results:Reviewofvideosrevealedthattheself-coilingarraysinsertedintocochlearmodelsatbodytemperature(37°C)demonstratedthatfullinsertionwasachievedwithminimalcontactwiththewallsofthecochlea.Incontrast,thestandardstraightarrayshadcontinuouscontactwiththelateralwallfollowinginitialcontactatthebasalturn.Histologicalanalysisshowedlesstissuetraumaresultingwithinsertionoftheself-coilingarrayscomparedtothatofstandardstraightcochlearimplantarrays.Inaddition,reviewofthehistologicalsectionsrevealedthattheself-coilingarraysmaintainedamoremedialpositionwithinthescalaofthemiddleturnofthecochlea.Conclusion:Wehavedemonstratedthatshapememorypolymerscanbeusedtodevelopaself-coilingcochlearimplantarraythatcanbeinsertedwithreducedtissuetraumaandmoreconsistentmid-scalarpositioningwithinthecochleaoncefullyinserted. SessionID:S1-2SessionTitle:SurgicalTechnologiesAbstractID:476Title:CanIntracochlearElectrocochleographybeUsedtoEstimateResidualAcousticHearingFollowingCochlearImplantation?Authors:JourdanT.Holder,AuD1,BrendanP.O'Connell,MD2,RobertT.Dwyer,AuD1,KanthaiahKoka,PhD3,RenéH.Gifford,PhD1,RobertF.Labadie,MD,PhD2;1HearingandSpeechSciences,VanderbiltUniv.Med.Ctr.,Nashville,TN,2Otolaryngology,VanderbiltUniv.Med.Ctr.,Nashville,TN,3AdvancedBionics,Valencia,CA.Abstract:Introduction:Thecochlearimplant(CI)electrodecanbeusedtorecordclose-proximityelectrocochleography(ECochG)responses,whichcanlendinformationaboutphysiologicchangesoccurringinthecochlea.Whenutilizedduringcochlearimplantinsertion,thistechniqueallowsfortherecordingofreal-timechangeswithinthecochleathatmaybecorrelatedwithsurgicaltrauma.TheobjectiveofthecurrentstudywastodetermineifECochGrecordedfromtheCIcompletedeitherintra-operativelyorpost-operativelyatactivationiscorrelatedwithpre-operativeand/orpost-operativeaudiometricthresholds.Methods:Patientswith250-Hzthresholds≤80dBHLundergoingCIwithamid-scaladevicewerestudied.Usinganin-the-canalfoaminsert,tonebursts(500Hz,110dB)werepresentedtotheoperativeearduringelectrodeinsertion.ECochGresponseswererecordedusingtheimplantandacustomsignalrecordingunit.ThisprocesswasrepeatedatCIactivation.ECochGamplitudecollectedintra-operativelyduringCIinsertionandatactivationwerecomparedwithair-conductionaudiometricthresholdsatboththepre-operativeandactivationtimepoints.Results:Sixteenpatients(8female)withresidualhearinghavebeenenrolledtodate.Meanpre-operativelow-frequencyPTA(puretoneaverageof125,250,and500Hz)atthepre-operativeandactivationtimepointswas53dBHLand84dBHL,respectively.Ninepatientsmaintained250Hzthresholds≤80dBHLatactivationwithanaveragethresholdshiftof31dB.Intra-operativeECochGamplitudesweresignificantlycorrelatedwithboththepre-operativelow-frequencyPTA(r=0.61,p<0.001)andtheactivationlow-frequencyPTA(r=0.51,p<0.001).ActivationECochGamplitudeswerealsosignificantlycorrelatedwiththeactivationlow-frequencyPTA(r=0.86,p<0.001).


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Conclusion:ECochGamplitudescollectedintra-operativelyandpost-operativelyfromtheCIelectrodemaybeusedtoestimatepre-operativeandpost-operativebehavioralaudiograms.Assuch,thismeasuremayserveasareal-timemeasureofinsertiontraumaandcochlearstructuralpreservationandcouldpotentiallyhelpguidefuturesurgicalinsertion. SessionID:S1-2SessionTitle:SurgicalTechnologiesAbstractID:466Title:UseofanIntegratedSystemtoMeasureElectricalStapedialReflexesinChildrenwithCochlearImplantsAuthors:LizetteCarrancoHernandez,M.D.1,LisetteCristernaSánchez,M.D.1,MiriamCamachoOlivares,M.D.1,AniketA.Saoji,Ph.D.2,LeonidM.Litvak,Ph.D.2,CarinaRodríguez,M.S.2;1InstitutodeEnfermedadesRespiratorias,MexicoCity,Mexico,2AdvancedBionics,Valencia,CA.Abstract:Introduction:Electricalstapedialreflexthreshold(ESRT)isusedtodeterminetheupperlimitofelectricalstimulationincochlearimplants.WhileperformingroutineESRTmeasurement,thecochlearimplantfittingsoftwareandthemiddleearimpedancemeasurementsystemareindependentlymaneuveredtodeliverelectricalstimulationandmeasurestapedialreflexes,respectively.Inthepresentstudy,anintegratedsystemwasusedtomeasureESRT.Inthissystem,thepuretonefromthecontralateraloutputofthemiddleearanalyzerisroutedtotheauxiliaryportofthecochlearimplantspeechprocessorandthelevelofthepuretoneisusedtosendappropriatecurrentleveltotheimplant.Methods:PriortoESRTmeasurement,theelectricalstimulusiscalibratedtoa2000Hzpuretonepresentedat80dBSPLwhichispresentedthroughthecontralateralportofthemiddleearanalyzer.WhilemeasuringESRTthepuretonelevelisvariedin1dBstepswhichcorrespondstoachangeof10clinicalunitsintheelectricalstimulation.Usingtheintegratedsystem,ESRTsweremeasuredintheipsilateralandcontralateralun-implantedearusingthreeprobefrequenciesof(226,678,and1000Hz)in19children(meanage=8.6years,SD=2.29)withAdvancedBionicsHiRes90kimplants.Results:ESRTmeasuredwiththeintegratedmiddleearanalyzershowedgoodtest/re-testreliability.ESRTscouldbemeasuredin3,4,and7cochlearimplantsubjects(outof19)intheipsilateral(implanted)earusingprobefrequenciesof226,678,and1000Hz,respectively.Inthecontralateralear,ESRTsweremeasuredin11,13,and13outof19subjectsusingprobefrequenciesof226,678,and1000Hz.Conclusion:TheintegratedsystemallowedthecliniciantousethemiddleearsystemtocontrolelectricalstimulationandthereforesimplifiedtheESRTmeasurementincochlearimplants.Ascomparedtotheroutinelyused226Hz,ahigherprobefrequencyof1000HzelicitsmoremeasurableESRTsinchildrenwithcochlearimplants. SessionID:S1-2SessionTitle:SurgicalTechnologiesAbstractID:439Title:Intra-operativeTraumaDetectionwithHelpofElectrocochleographyandFluoroscopyVideoAuthors:RalfGreisiger,PhD1,TorquilSørensen,PhD1,HildeKorslund,Radiograph2,MarieBunne,PhD1,PerKristianHol,PhD2,GregEignerJablonski,PhD1;1DepartmentofOtolaryngology,Univ.Hosp.Oslo,Oslo,Norway,2InterventionCentre,Univ.Hosp.Oslo,Oslo,Norway.Abstract:Intra-operativeTraumaDetectionwithhelpofElectrocochleographyandFluoroscopyvideoRalfGreisiger1,TorquilSørensen1,HildeKorslund2,MarieBunne1,PerKristianHol2,3,GregEignerJablonski1,3


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1DepartmentofOtolaryngology,OsloUniversityHospital,Norway2InterventionCentre,OsloUniversityHospital,Norway3UniversityofOslo,InstituteofClinicalMedicine,NorwayIntroductionThereisrisinginterestinElectrocochleography(ECoG)measurementsduringcochlearimplant(CI)surgery.ThesemeasurementsmightgivethesurgeonfeedbackaboutCIelectrodearrayinsertion.ECoGalonedoesnotallowmovementsoftheelectrodetobeobserved,whilethesemaybecausingtraumatotheinnerearstructures.Thishasbeeninvestigatedinourstudyusingper-operativefluoroscopytomonitortheintra-cochlearelectrodearraymovementswhilesimultaneouslyrecordingECoG.ObjectivesTheaimofthisstudyistoinvestigatewhethersimultaneousECoGandfluoroscopyimagingcanteachustominimizeriskfactorsduringelectrodearrayinsertion,withregardtointra-cochleartrauma.PatientsForthisstudyweinvestigateatleast10patients.Itisanongoingstudy,andallpatientsinvestigateduntiltheconferencewillbeincludedinthepresentation.MethodsDuringinsertionofanAdvancedBionicselectrodearray,per-operativefluoroscopyvideowasconductedtomonitortheinsertiondynamicsvisuallywhileperformingECoG.TheconnectionbetweenelectrodemovementsandECoGresponsewasinvestigated.Thesurgeryitselfwascarriedoutusingastandardprocedure.ResultsPreliminarydatameasuredinourfirstpatientshaveshownthatsimultaneousECoGmeasurementsandfluoroscopyvideocanbeobtained.Togethertheygaveinterestinginsightsaboutintra-cochleartraumawhiletheelectrodewasmovinginsidethecochlea.ConclusionWeconcludefromourpreliminarydatathatECoGisavaluabletooltoinvestigatecochleartraumaduringelectrodeinsertion.Fluoroscopicimaginghelpstoidentifycriticalmomentsduringinsertion,andtointerprettheECoGresultsobtainedduringinsertion.SessionID:S1-3SessionTitle:PredictingandImprovingOutcomesAbstractID:217Title:Long-termResultsofAuditoryAbilitiesafterCochlearImplantationinSubjectswithUnilateralDeafnessAuthors:RolfBattmer,PhD1,IngoTodt,MD1,FrederikeWagner,MD2,ArneErnst,MD1,JuliaWeber,Audiologist2;1Otolaryngology,UnfallkrankenhausBerlin,Berlin,Germany,2HörtherapiezentrumimOberlinhaus,Potsdam,Germany.Abstract:Introduction:Recenttreatmentsforsinglesideddeafsubjects(SSD)areverylimited.Iftreatedatall,acousticsignalsareonlypickedupfromthedeafsideandroutedtothehearingsideeitherasanelectricalsignal(CROS)orthroughboneconduction(BAHA).Bothmethodsuseforthetransmissionofauditorysignalsonlythecontralateralhearingcochleaanddonotutilizetheperipheralauditorypathwaysonbothsides.However,throughelectricalstimulationviaacochlearimplantthedeafsidecanbeactivated.Theaimofourpresentstudywastodemonstratethatinsuchacasespeechreceptioninnoiseandlocalizationcanbeimproved.Methods:Nineadultparticipantswithshort-termunilateraldeafness(<5yr)participated.Allhadsuddenonsetofsevere-to-profoundhearinglossin1ear,whichthenreceivedaCI,andnormalornear


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normalhearingintheotherear.Speechrecognitioninquietandnoisewithanadaptivesentencetestwastestedafter3months,6monthsand12months.Threebinauraleffectswerecalculated:summationeffect(S0N0),squelcheffect(S0NCI)andcombinedheadshadoweffect(SCIN0).Forlocalization,a7loudspeakersetup(±90°,30°distance)wasused.Discriminationwastestedpreoperatively(normalhearing(NH)earalone)andafter12monthsbilaterally(CIandNH).Results:Onesubjectquitthestudyafter3monthsduetosubjectivelylimitedbenefit.Allotherparticipantshadopen-setspeechrecognitionandexcellentaudibilitywiththeCI.Sentencerecognitioninthevariousnoiseconditionsshowsignificantbilateralimprovementovertime,i.e.intheconditionS0N0from-3.1dBpreoperativelyto-5.7dBafter12months.LocalizationimprovedbilaterallycomparedwiththeNHearaloneupto10°RMS.The8participantsworetheCIfulltime,andsubjectivereportswerepositive.Conclusion:Overall,theCIrecipientswithunilateraldeafnessobtainedopen-setspeechrecognitioninquietandinnoiseandimprovedlocalization.However,carefulpatientselectionisadecisivefactorforasuccessfultreatmentofthispatientgroup.Undertheseconditions,CIimplantationisaviabletreatmentofsinglesideddeafsubjects. SessionID:S1-3SessionTitle:PredictingandImprovingOutcomesAbstractID:311Title:PredictingOutcomesofChildrenwithCochlearImplants-FindingsfromtheLOCHIStudyAuthors:TeresaY.C.Ching,PhD,HarveyDillon,PhD,LauraButton,BASpeechpathology,MarkSeeto,MAud,VickyZhang,PhD,PatriciaVanBuynder,MAud,MAudSA(ccp);Natl.AcousticLab,Australia,Sydney,Australia.Abstract:Introduction:Toidentifyfactorsthatinfluence5-yearlanguageandspeechoutcomesofchildrenwithcongenitalhearinglosswhoreceivedcochlearimplantsbetween6and36monthsofage.Methods:ParticipantswereenrolledintheLongitudinalOutcomesofChildrenwithHearingImpairment(LOCHI)study,apopulation-basedstudythatinvestigatedtheoutcomesofchildrenwithcongenitalhearinglossinaprospectivemanner.Onehundredandfourteenchildrenwithcochlearimplantswereevaluatedat5yearsofage,usingabatteryofstandardisedtestsandcustom-designedtests.Abouthalfofthechildrenreceivedacochlearimplantbefore12monthsofage.Parentreportsonfunctionalandpsychosocialoutcomesweresolicited.Usingregressionanalyses,thisstudyexaminedtheinfluenceofarangeofchild-,family-andintervention-relatedfactorsonthelanguageandspeechoutcomesofchildrenat5yearsofage.Results:Ageatimplantationandnonverbalcognitiveabilityaccountedfor58%varianceinlanguageperformance.Inaddition,theabsenceofadditionaldisabilitiesandtheuseoforalcommunicationweresignificantfactorsinfluencingoutcomes.Theeffectofdelaysinageatimplantationonlanguageoutcomeswasalsoquantified.Conclusion:Thefindingshighlighttheeffectivenessofearlytreatmentforimprovingchildoutcomes,andthenecessitytomonitorearlyoutcomestoensurethatchildrenwhorequirecochlearimplantationreceivethetreatmentearly,before12monthsofage. SessionID:S1-3SessionTitle:PredictingandImprovingOutcomesAbstractID:441Title:DevelopmentTrajectoriesofSpeechProductionbetween4and8YearsPost-implantAuthors:AndreaWarner-Czyz,Ph.D.1,AnnGeers,Ph.D.1,Nae-YuhWang,Ph.D.2,ChristineMitchell,ScM3,LaurieEisenberg,Ph.D.4;


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1CommunicationSciencesandDisorders,TheUniv.ofTexasatDallas,Dallas,TX,2Medicine,Biostatistics,andEpidemiology,JohnsHopkinsUniv.Sch.ofMed.,Baltimore,MD,3Epidemiology,JohnsHopkinsBloombergSch.ofPubl.Health,Baltimore,MD,4KeckSchoolofMedicine,Univ.ofSouthernCalifornia,LosAngeles,CA.Abstract:Introduction:Thisstudysoughttodeterminewhetherphonemeproductionskillsinearly-implantedchildrenimprovedsignificantlyasafunctionofdeviceexperienceafter4yearspost-implant.Additionally,weaimedtoevaluatewhichvariablescoincidedwithfewerphonemeproductionerrors.Methods:Participantsinclude160childrenwithcochlearimplantsenrolledinalongitudinal,multi-centerproject,theChildhoodDevelopmentafterCochlearImplantationstudy.Participantshadameanageatimplantationof2.4years.ChildrencompletedtheGoldman-FristoeTestofArticulation(GFTA)between4and8yearspost-implant.Errorscoreswerecomputedforeachchild.Datawereanalyzedusingamixed-effectslinearmodelutilizingallavailableGFTAdatabetween4and8yearspost-implant.Results:Model-basedmeanerrorscoreontheGFTAat4-yearspost-implantwas51.0.Relativetothe4-yearpost-implantevaluation,errorscoresdecreasedby5.1,9.6,10.9,and10.6at5-,6-,7-,and8-yearspost-implant,respectively.OlderageatimplantactivationwassignificantlyassociatedwithhigherGFTAerrorscoresoverfollow-uppostimplant(4.6points/yearolder,p<0.0001).Betterspeechperceptionscoresatbaselineandat3-yearspost-implantwereindependentlyassociatedwithlowerGFTAerrorscoresoverthe4-8yearfollow-upperiod(bothp<0.001).Conclusion:Phonemeproductionaccuracycontinuestoimproveafter4yearsofimplantexperience,withperformanceappearingtoleveloffaround6yearsofuse.Childrenwithayoungerageatimplantactivationandfasterdevelopmentofspeechperceptionskillshaveasignificantadvantageforproductionaccuracy. SessionID:S1-3SessionTitle:PredictingandImprovingOutcomesAbstractID:250Title:FactorsAffectingDevelopmentofBabbleinPrelinguallyDeafChildrenWhoUseCochlearImplantsAuthors:LizHamilton,PrincipalSpeechandLanguageTherapist1,HelenPeebles,PrincipalSpeech&LanguageTherapist1,EdwardC.Killan,PhD2;1YorkshireAuditoryImplantService,Bradford,UnitedKingdom,2SchoolofMedicine,Univ.ofLeeds,Leeds,UnitedKingdom.Abstract:Introduction:Theemergenceofbabbleisconsideredakeylandmarkinvocaldevelopmentandisaprecursortothedevelopmentoffirstwords.Lateonsetofbabbleexhibitedbychildrencanbeastrongpredictorofspeechandlanguagedisorders.Anunderstandingofbabbledevelopment,andpotentialfactorsaffectingit,incochlear-implantedchildren,wouldbeusefulintermsofsettingexpectationsandplanningspeechandlanguagerehabilitativesupport.Tothisend,clinicaldataforcochlear-implantedchildrenwereanalysedtoprovideadescriptiveaccountofbabbledevelopmentatvariousstagespostimplant,aswellastoinvestigatepotentialfactorsthataffectbabbledevelopment.Methods:Alongitudinalstudyof39cochlear-implantedchildrenwascompletedovera4yearperiod.Allchildrenincludedwerepre-verbalwithadiagnosisofcongenitalprofoundsensori-neuralhearingloss.Meanageatimplantationwas26months.Dataregardingvocaldevelopmentwascollectedatthepre-implantassessmentandat6,12and24monthspostimplant.Dataincludedparentalinterviews,observationsandtheProfileofActualSpeechSkills(PASS),whichallowshierarchicalcategorisationofvocalisations.Theinfluenceofhearingaidusepriortoimplant,ageatimplant,timetakenforoptimalprogrammingandhomelanguageonspeechandlanguagedevelopmentwillbeexploredusinglogisticregression.Whilstitishypothesisedthathearingaiduseandhomelanguagewillnotbesignificant


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effects,itispredictedthatthetimetakentoachieveanoptimalmapwillhaveasignificanteffectonbabbledevelopment.Results:Initialdataanalysisindicatesthat100%ofthechildrenwhodevelopedcomplexcanonicalbabbleby6monthspostimplantwerenotfoundtohaveanyadditionalspeech,languageandcommunicationneeds.However,67%ofthechildrenwithcanonicalbabbleand80%ofthosewithnobabbleatthisstagepresentedwithadiagnosedorsuspectedadditionalcommunication,speechorlanguageneed.Thesecategoriesofbabbledevelopmentwillbeusedbyregressionanalysistotesttheabovehypotheses.Conclusion:Theinitialfindingsfromthisstudyindicatethatarangeofbabbledevelopmentstageshasbeenobservedinchildrenat6monthspostimplantconfirmingtheoutcomesofpreviousresearch.Inthisstudythebabblehierarchyappearstobeapredictorofadditionalspeech,languageandcommunicationneeds.Furtherresultswillbegainedfromtheregressionanalysisinrelationtothehypothesisedeffects. SessionID:S1-3SessionTitle:PredictingandImprovingOutcomesAbstractID:327Title:CategoryIndicatorsforMonitoringLong-termCommunicationOutcomesinaLargeCohortofChildrenUsingCochlearImplantsAuthors:ShaniDettman,PhD1,DawnChoo,MasterofSpeechPathology1,JaimeLeigh,PhD2,RichardDowell,PhD1;1AudiologyandSpeechPathology,TheUniv.ofMelbourne,Melbourne,Victoria,Australia,2CochlearImplantClinic,RoyalVictorianEyeandEarHosp.,Melbourne,Victoria,Australia.Abstract:Introduction:Formaltestinghasbeenusedtomonitortherateoflanguagedevelopmentandprogressoflisteningskillsinchildrenusingcochlearimplants(CI).Evaluatingcommunicationoutcomesinlarge,heterogeneouscohortsischallenging,duetothewiderangeoflanguageassessmentsandauditoryperformancemeasuresusedatdifferentages,andthepresenceofindividualdifferences(child,deviceandfamilycharacteristics).Methods:Demographicinformationandoutcomedataforover900childrenwerecollectedatroutineassessmentintervalsaccordingtoaCIclinic’sprotocol.Thechildren'slanguageabilitiesassessedonarangeofcommonlyusedmeasuresanddescribedusingthenewlydevelopedCategoriesofLinguisticPerformance(CLIP).SpeechperceptionresultswereclassifiedandanalysedusingArchboldetal’s(1995)CategoriesofAuditoryPerformance(CAP)andBlacketal’s(2014)’sadaptedscale,CategoriesofAuditoryPerformanceIndex.SpeechproductionskillsandphonologicalprocesseswereexaminedusingComputerAidedSpeechandLanguageAnalysis(CASALA).Communicationgainsanddegreeofprogressovertimeweredocumentedforasubsetofchildren.Multipleregressionanalysiswasconductedtoexplorefactorscontributingtothevariabilityinthechildren’scommunicationoutcomesduringschool-entryandschoolyears.Results:Theinfluenceofvariablesincluding,ageatimplant,ageathearingaidfitting,typeofearlyinterventionprogram,presenceofadditionaldiagnosesandsocio-demographicindicators,arereflectedinthelong-termspeechandlanguageoutcomesforpaediatriccochlearimplantrecipients.Conclusion:Thebenefitsofcochlearimplantationmaybecapturedbymonitoringcommunicationperformanceforchildrenwithsensorineuralhearingloss.Itis,however,alsoobservedthatindividual,educationalandfamilycharacteristicsareassociatedwithpost-implantoutcomes.Inadditiontoprovidingdevicesupport,itisalsoimportantforearlyinterventionprofessionalsandCIclinicianstoprovideevidence-basedguidancetofamiliesforchildrenwithprofoundhearingloss.


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SessionID:S1-3SessionTitle:PredictingandImprovingOutcomesAbstractID:515Title:AttentiontoSpeechinDeafInfantswithCochlearImplantsAuthors:YuanyuanWang,Ph.D.1,CarissaShafto,Ph.D.2,DerekHouston,Ph.D.1;1Otolaryngology,TheOhioStateUniv.,Columbus,OH,2GalenColl.ofNursing,NewYork,NY.Abstract:Introduction:Therehasbeenagrowingbodyofevidencesuggestingthatearlyauditorydeprivationaffectsthedevelopmentoftheauditoryneuralpathwayaswellasotherhigher-levelcorticalareas,whichmayleadtopoorprocessingevenaftercochlearimplantation(CI)(Geersetal.,2011;Holtetal.,2012;Pisonietal.,2000).Forexample,infantswithCIsoftenlagbehindtheirnormalhearing(NH)peersinarangeofspeechandspokenlanguagetests(Fagan,2015;Niparkoetal.,2010).Inthisstudy,wewouldliketoexamineoneofthecognitiveskillsthatiscriticaltotheacquisitionofspokenlanguage,namely,theabilityto“listen”-i.e.,sustainedattentiontospeech(ATS)(Columbo&Bundy,1981;Glennetal.,1981;Houston,2003,2013;Vouloumanos&Werker,2004,2007).Specifically,weexaminedtheeffectsofearlyauditorydeprivationandsubsequentCIonthedevelopmentofATSindeafinfantswithCIs.Inaddition,wealsoinvestigatedtheextenttowhichATSmaypredictlaterlanguageoutcomesinchildrenwithCIs.Methods:Usingthevisualhabituationprocedure,wetesteddeafinfantswhoreceivedCIsbefore2yearsofageandtheirchronologicalage-matchedNHpeersontheirATS.Thereweretotal104CI-NHpairedsessionsgroupedinto3post-CIintervals:<1month(41pairs),3-6months(35pairs),and>8months(28pairs)afterimplantation.Infantsreceivedoneoffourrepeatingspeechsoundspairedwithacheckerboardpatternonhalfofthetrialswhilereceivednosoundwiththecheckerboardpatternontheotherhalfofthetrials.ATSwasmeasuredastheproportionoftimethatinfantslookedatthespeechtrialsrelativetothetotallookingtimeeitheratthespeechorsilenttrials.Receptive,expressivelanguage,andwordrecognitiontestswereadministeredtotheCIinfants2and4yearsafterimplantation.Results:Theresultsdemonstratedthatwith<1month’sCIexperience,deafinfants’meanproportionoffixationtospeechtrialswassignificantlylowerthanthatofNHinfants,p<.001;with3-6monthsCIexperience,CIinfantsshowedatrendinthesamedirectionastheirNHpeers(lookedlongertothespeechthantothesilenttrials)andshowedsimilarmeanproportionofspeechfixationcomparedtotheirNHpeers,p=.91;during>8monthspost-CIinterval,neitherCIorNHinfantsshowedanypreferenceandthefixationbehaviordidnotdifferbetweenthetwogroups,p=.30,seeFigure1.Inaddition,CIinfants’differentlookingtimetospeechvs.silenttrialsduring3-6monthspost-CIintervalwassignificantlypositivelycorrelatedwiththeLexicalNeighborhoodTest(LNT),p=.021,administeredfouryearsafterimplantation.Conclusion:Thesefindingssuggest1)auditorydeprivationpriortoCImayaffectdeafinfants’ATS;2)earlyimplantationmayfacilitatethedevelopmentofATSininfantswithCIs;and3)theabilitytoattendtospeechafterimplantationmayunderliethedevelopmentofspeechperceptionskills.Theseresultsmayinformlanguageacquisitiontheoriesandbringsomeinsightsintoourunderstandingoftheroleofearlyauditoryexperienceoncognitiveprocesses.Inaddition,thesefindingshavesignificantclinicalimplicationsofearlyinterventiononhearinglossandemphasizetheimportanceofdevelopingstronglisteningskills. SessionID:S1-3SessionTitle:PredictingandImprovingOutcomesAbstractID:462Title:ALongtermStudyofCIOperationsinInfants


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Authors:EvaL.Karltorp,MD,PhD,MartinEklöf,PhDstudent;ENT,KarolinskaUniv.Hosp.,Stockholm,Sweden.Abstract:Introduction:Themainobjectiveofthisstudywastoinvestigatewhetherprelinguallydeafchildrenwhoreceivedacochlearimplant(CI)beforeninemonthsofagedevelopedage-equivalentspokenlanguageabilitiestoagreaterextentthanchildrenwhowereoperatedonatalaterstage.ThestudyalsoexaminedthemedicalriskofinterventionwithCIsinveryyoungchildren.Methods:Thespokenlanguageabilitiesof137prelinguallydeafchildren,whoreceivedCI,wereanalysed.Thechildrenweredividedintofivegroupsdependingontheirageatthetimeoftheimplantation.Languageunderstanding,vocabulary,speechproductionandspeechperceptionwereassessedwithlanguageandhearingtests.ThelevelsoftheskillsweretestedatsixmonthintervalsaftertheCIoperation.Thechildrenwerefollowed-upforupto14years.Results:Childrenimplantedbefore9monthsofagehadnolanguagedelayandreachedageequivalenceresultsonalllanguagemeasures.Childrenimplantedat9-11monthsofagehadaninitiallanguagedelayinlanguageunderstandingandinspeechintelligibility,butcaughtupafter2-3years.Thechildrenimplantedbetween12-17monthsdidnotclosethegaponlanguageunderstandingduringpre-schoolage,butcaughtuponvocabularyatearlyschoolage.Childrenoperatedfrom18monthsandonwardsdidnotclosethegapcomparedtochildrenintheyoungestagegroup,inanylanguagemeasuresexceptforspeechintelligibility.Noincreaseincomplicationswasrecordedwhentheyoungestchildrenwhoreceivedimplantswerecomparedwiththosewhowereolderwhentheyreceivedtheirimplants.Conclusion:Cochlearimplantationbeforeninemonthsofagereducethespokenlanguagedelay,comparedtochildrenimplantedathigherages,andgivesthemajorityofprelinguallydeafchildrenspokenlanguageacquisitionsimilartothatoftheirnormalhearingpeers. SessionID:S2-1SessionTitle:MusicPerceptionAbstractID:263Title:MusicProcessingRevealsDoubleDissociationEffectsbetweenDiscrimination,AssociationandAppreciation:EvidencefromAdultPre-andPostlingualCIUsersAuthors:AnjaHahne,Dr.,LisaBruns,Dr.,DirkMürbe,Prof.,NikiVavatzanidis,M.Sc.MedicalNeuroscience;SaxonianCochlearImplantCenter,TechnischeUniv.Dresden,Dresden,Germany.Abstract:Introduction:WhereasmanyadultCIusersarecapableofunderstandingorallanguage,theprocessingofmusicisoftendescribedasbeingproblematic.Hearingandunderstandingmusiccomprisesverydifferentdimensionswhichrelyondifferentmechanisms.WeaimedtorefinetheviewonmusicperceptionwithCIbycomparingthreedimensionsofmusicprocessingwithinandacrosstwoCIgroups:(1)musicaldiscriminationabilities,(2)accesstomeaninginmusic,and(3)subjectiveappreciation.Methods:TwoCIusergroupsparticipatedinthestudy.Allofthemwereimplantedasadults.Participants’hearingimpressioninchildhoodwaseithernormal(N=38,postlingual)orprofoundlyimpaired(N=15,prelingual).Additionally,amatchednormalhearingcontrolgroupwastested.DiscriminationabilitieswerestudiedusingtheMuSICtestdevelopedbyBrockmeyeretal.(2011).Semanticmeaningwasobjectivelymeasuredbyevent-relatedbrainpotentials(ERPs)onvisuallypresentedwords.Thesewerepresentedsubsequenttoamusicalexcerptofabout10seconds.Thewordswereeithersemanticallyrelatedorunrelatedtothemusicasdefinedinpretestswithnormalhearingparticipants.Studiesonnormalhearingparticipantshadshownthatthemusicinfluencesthe


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processingofthevisualwordwithunrelatedwordselicitingalargernegativitythanrelatedwords(N400effect;cf.Koelschetal,2004).Appreciationofmusicwasassessedviaquestionnaires.Results:ThebehaviorallyassesseddiscriminationabilitieswerereducedinbothCIgroupscomparedwiththenormalhearinggroup.TherewerehardlyanysignificantdifferencesacrossthetwoCIgroups.Bycontrast,ERPresultsdifferedclearlyforthetwoCIgroups:thepostlingualgroupshowedasimilarN400effectasthenormalhearinggroupwhereastherewasthenoN400effectobservableintheprelingualgroup.Theevaluationofmusicalappreciationwascomparablebetweentheprelingualgroupandthenormalhearinggroupwhereasitwassignificantlylowerforthepostlingualgroup.Conclusion:Despiteimpaireddiscriminationabilitiesofbothgroups,appreciationwasreducedonlyinpostlingualCIusers.Remarkably,musicalmeaningprocessingwasrestorableinpostlingualCIusersasshownbyaN400effect,buttheabilitytoactivatesemanticassociationsdoesnotimplyanybenefitintheappreciationofmusic.Rather,postlingualCIusersseemtocomparetheirimpressionwiththesituationpriortohearinglossandsufferfromthemodifiedinput.Bycontrast,dataofprelingualCIusersindicatepreviousdysfunctionalconceptbuilding.Takentogether,ourresultsdidnotexhibitasimple,one-dimensionalpictureofunderstandingmusicwithacochlearimplant.Instead,wedemonstratedthatthediscriminationofmusicalstimuli,theprocessingofmusicalmeaningandtheappreciationofmusicaredifferententitiesofanoverallmusicimpression,influencingeachotheronlymarginally.AnyinferencesonmusicprocessinginCIusershavetoincludethemusicaldimensionaswellasthehearinghistoryoftheCIusers. SessionID:S2-1SessionTitle:MusicPerceptionAbstractID:448Title:BeyondTechnology:TheInteractionofPerceptualAccuracyandExperientialFactorsinPediatricMusicEngagementAuthors:KateE.Gfeller,Ph.D.,VirginiaDriscoll,MA,AdamT.Schwalje,MD;Otolaryngology_HeadandNeckSurgery,Univ.ofIowaHosp.andClinics,IowaCity,IA.Abstract:Introduction:PriorstudiesofpediatricCIusers,typicallyenrollingsmalltomoderatesamplesizes,havetendedtofocusoneitherperceptualaccuracyorexperientialfactorsastheyinfluencemusicenjoymentandparticipation.PerceptualstudiesindicatethatpediatricCIusersasagrouparesignificantlylessaccuratethannormalhearingpeersintaskssuchaspitchormelodyperception,thoughthereisconsiderablevariabilityamongusers.DespitethedegradedrepresentationofpitchandtimbreconveyedbytheCI,studiesfocusingonmusicengagementandenjoymentindicatethatmanyCIrecipientsenjoysomeaspectsofmusicandengageinmusicinstruction;patternsofenjoymentandengagementarehighlyvariable.Thispresentationinvestigatestherelationsamongperceptualandexperientialvariables,withtheintenttobetterunderstandtheirimpactonmusicengagement(participation)ofpediatricCIrecipients.Methods:Weexaminedthefollowingvariablesfor77pediatricCIusersofage12orolder:pitchperception,ratingsofpersonalimportanceofmusic,familialinvolvementinmusic,andextentofinvolvementinmusicinstruction.ThedatasetwaslimitedtopediatricCIuserswhohadreachedmiddleschoolorhigher,becauseatthatstageofdevelopment,musicensemblesandlessonsaregenerallyelective(suggestingpersonalchoiceofparticipation)andalsorequirehigherlevelsofmusicalaccuracyandprecision.Regressionanalyseswereconductedtoexaminetherelationsamongthetargetvariables.Thedatasetwasthenbrokenintotertilesofhigh,middle,andlowpitchperceptionbaseduponarangeof1to24semitonesthresholds(lowerscore=higherperformance).Musicalinstrumentsplayedweredocumented.Caseexampleswereidentifiedthatillustrateinterestingprofilesofhightolowperceptualaccuracyinrelationtohightolowmusicinvolvement.


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Results:Analysesrevealedthatofthe77participants,39fitinthehightertile(Mof4.79semitones),16inthemiddletertile(Mof11.83semitones)and22inthelowtertile(Mof23.36semitones)forpitchperceptionaccuracy.Extentofmusicengagementrangedfrom0to25unitsofmusicinstructios,withmeansof6.18,4.31,and2.64unitsofmusicinstructionforthehigh,middle,andlowpitchperceptiontertiles.AlthoughCIusersinthelowpitchperceptiongroupweresignificantlylessaccurate(p>.0001)thanthemiddleandhighperceptiongroups,pitchaccuracydidnotpredictattitudestowardmusicorextentofengagementinmusicinstruction.CIrecipientswithmiddleandhighperceptualaccuracydemonstratedsimilarlevelsofmusicengagementandpositiveattitudestowardmusic.Casestudyanalysesrevealedinterestingprofilesofperceptualaccuracyandmusicengagement.Forexample,someuserswithlowperceptualaccuracyhavehighengagementinmusic,whichmaybedueinparttoplayinginstrumentsrequiringlesserpitchperceptionaccuracy(e.g.,percussion).Insomecases,familialsupportisassociatedwithpersistenceinmusic.Conclusion:PerceptualaccuracydoesnotpredictmusicenjoymentandengagementamongpediatricCIrecipients.Otherfactorssuchasfamilialsupportandjudiciousselectionofmusicexperiencesmaycontributetoactiveengagementovertime.ThesedatasuggestthatmusicengagementcanbeenjoyedbypediatricCIuserswithappropriateparticipationoptionsandsupport,despiteatypicalmusicperception. SessionID:S2-1SessionTitle:MusicPerceptionAbstractID:173Title:AFollow-upStudyonMusicTimbreandLexicalTonePerceptioninAdultMandarin-SpeakingCochlearImplantUsersAuthors:BoLiu,Master1,XinGu,Master1,ZiyeLiu,Master2,BeierQi,Master1,RuijuanDong,Master1;1BeijingTongrenHosp.,Beijing,China,2CivilAviationGen.Hosp.,Beijing,China.Abstract:Introduction:Ascochlearimplant(CI)hasprovedtobeasuccessfulandeffectivetreatmentforseverelyandprofoundlydeafenedindividuals,itenhancesspeechperceptioninadultsandimproveshearinginallrespects.Theoutcomeofcochlearimplantationhasbeenreportedinmanystudiesusingdifferentmeasurementsanddifferentlanguages,howeverfewstudieshavebeenconductedonthelong-termeffectsofcochlearimplantationonmusicperceptionandtoneperception.Basedonthenotionthatmusicappreciationandtonerecognitionbothinvolvepitchcues,thesetwoaspectsofpitchperceptionmaycorrelatewitheachother.Theobjectiveofthisprospectivefollow-upstudywastodeterminemusictimbreandtoneperceptionoutcomesinChineseMandarin-speakingadultswithaCIdeviceoverthecourseof1-yearafterimplantation.WehypothesizedthatthecontinuoususeandacclimatizationofaCIdevicewouldbenefittimbreandtoneperceptionofpostlinguallydeafenedMandarinpatients.Methods:Twenty-fiveadultCIusers,16malesand9females,withagesrangingfrom19to75yearsold,participatedinayear-longfollow-upevaluation.Therewerealso40normal-hearingadultsubjectswhoparticipatedasacontrolgroupinordertoprovidethenormalvaluerange.MusicalSoundsinCochlearImplants(Mu.S.I.C)testbatterywasundertakentoassessmusicperceptionability.Instrumentidentificationsubtestwasintendedtoevaluatetheabilityofsubjectstoperceivetimbrebyidentifyingtheinstrument.MandarinToneIdentificationinNoiseTest(M-TINT)wasusedtoassesslexicaltonerecognition.ThetestsforCIuserswerecompletedat1,3,6,and12monthsaftertheCIswitch-on.Results:Theperformanceofmusictimbreperceptionandtonerecognitionbothdemonstratedanoverallimprovementinoutcomesduringtheentire1-yearfollow-upprocess.Theincreasingtrendswereobviousintheearlyperiodespeciallyinthefirst6monthsafterswitch-onandtheperformanceachievedarelativelystablestateafter6months.Therewasasignificantimprovementduringthe1-year


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periodinthetimbreidentification(P<0.001),tonerecognitioninquiet(P<0.0001)andinnoise(P<0.0001)listeningenvironment.ThetoneperceptionperformanceofCIsubjectswaspositivelycorrelatedwithinstrumentperceptionperformanceinthe1,3,and6monthsafterswitch-on(P<0.05).Conclusion:AdultMandarin-speakingCIusersshowanincreasinglyimprovedperformanceonmusicaltimbreperceptionandtoneidentificationduringthe1-yearfollow-upevaluationafterimplantation.Theimprovementoftheperformancewasthemostprominentinthefirst6monthsofCIuse.Thus,itisessentialtostrengthentherehabilitationtrainingwithinthefirst6monthsafterimplantation.ThepresentstudyobservedasignificantcorrelationbetweentoneperceptionperformanceandtimbrerecognitionatsometimepointsforCIusers,supportingthehypothesisthatmusicperceptionandlexicaltoneforCIusersshouldsharesimilarmechanismsinelectricalhearing. SessionID:S2-1SessionTitle:MusicPerceptionAbstractID:248Title:LinksBetweenAudioFeatures,AspectsofMusic,andHappy/SadEmotionsExpressedbyMusicinCochlearImplantUsersandNormallyHearingAdultsAuthors:GeorgiosPapadelis,AssociateProfessorMUSICSTUDIES,ARISTOTLEUNIV.OFTHESSALONIKI,THESSALONIKI,Greece.Abstract:Introduction:WhilemusiclisteningabilitiesinCochlearImplant(CI)usersandtheirappreciationofmusichavereceivedmuchattentionoverthelastthreedecadesorso,theeffectsofdegradedperipheralencodingofmusicalsoundthroughaCIonrecipients’aesthetic/emotionalreactionstomusicarestillpoorlyunderstood.Themainscopeofthisstudywasthustoseeifperceptionofhappyvs.sademotionsexpressedbymusicissystematicallydifferentbetweenCIusersandNormallyHearing(NH)individuals,andfurther,toexplorepatternsofassociationsbetweenaudiofeatures,aspectsofmusic,andperceivedemotionalcategories,withineachgroupseparately.Methods:Judgementsofhappyvs.sademotionsexpressedbyfifteenshortmusicalpiecesofinstrumentalWesternartmusicwereobtainedbyagroupofCIusers(N=53),andagroupofNHadults(N=44)throughtheuseofa10-pointratingscalerangedfrom1(verysad)to10(veryhappy).Thesepieceswereeithersolo,ormulti-instrumentarrangements,speciallycomposedwiththeintentiontoproducearangeofemotionsalongthehappy/sadcontinuum(Fitzgeraldetal.,2006),asjudgedbynormalhearers.Mappingofthosestimuliintoa“psychologicalspace”ofperceivedhappiness/sadnesswasderivedforeachgroupseparatelythroughtheuseofmultidimensionalscalingmodels(PROXSCAL).AlargesetofaudioandmusicalfeaturesweresubsequentlyextractedforallmusicalpiecesbytheuseoftheMIRToolbox(Lartillotetal.,2008),andbi-variatecorrelationsbetweentheextractedfeaturesandparticipants’judgmentswerecalculated.Results:Themapsresultedfromthetwogroupswerequitecomparable(r=.84,p<.001),butnotexactlythesame,bothdemonstratingasimilarclusteringofthemusicalpiecesintodiscreteemotionalcategoriesof(happy,neutral,andsad)inatwo-dimensionalspace.Besides,analysisofcorrelationsshowedthatthesetsofaudioandmusicalfeatureswhichmostlyinfluencedperceivedhappiness/sadnesswerequitesimilarinbothgroupsincludingfeaturesthatrelatedtodynamics(lowenergyrate),timbre(spectralflux),rhythmandarticulation(attacktime,tempo,rhythmicfluctuation,pulseclarity,eventdensity),andharmony(mode,harmonicchange).Nevertheless,incontrasttoNHlisteners,CIusers’judgementsdisplayedstrongerassociationswithfeaturesrelatedtothedynamicsandtemporalaspectsofmusic(tempo,rhythm,articulation),whilecorrelationswithspectralandtonalfeaturesweremoresuppressedinthisgroup.Conclusion:Although,sub-optimalencodingoftimbralandtonalaspectsofmusicthroughaCImaynegativelyinfluenceperceptionofdiscreteemotionalcategories,ourresultssuggestthateffective


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processingofcuesrelatedtothedynamicsandtemporalaspectsofmusicmayunderlieCIusers’abilitytodistinguishamonglevelsofhappyvs.sademotionsexpressedbymusicinasimilarwaytothatofNHlisteners. SessionID:S2-1SessionTitle:MusicPerceptionAbstractID:298Title:HybridMusicPerceptionOutcomes:ImplicationsforMelodyandTimbreRecognitioninCochlearImplantUsersAuthors:JayT.Rubinstein,MD,PhD,AaronJ.Parkinson,PhD,WardDrennan,PhD,ChristaDodson,AuD,KaibaoNie,PhD;VMBloedelHearingResearchCenter,Univ.ofWashington,Seattle,WA.Abstract:Introduction:Individualsabletouseelectric-acoustic(EA)stimulationmaintainmusicperceptionabilitiessuperiortothoseobservedbytypicalcochlearimplant(CI)recipients,makinguseofelectricstimulationalone(e.g.,Gfelleretal.,2006;Golubetal.,2012).TheassumptionisthatEAstimulationconfersadvantagesrelatedtotheavailabilityoflow-frequency(LF)acoustichearing.TheobjectiveofthisstudywastofurtherexaminewhetherEA-relatedoutcomesformusicperceptionarerelatedtotheavailabilityofacousticcuesnotpresentintheelectricdomain.EAhearingwassimulatedinagroupofnormallyhearingadultsubjectssothattherelativecontributionsofacousticandelectrichearingcouldbemanipulated.ResultswerecomparedwiththeoutcomesfromarecentHybridclinicaltrial.Methods:NinenormallyhearingindividualslistenedtostimulithatsimulatedEAhearing.Tosimulateelectrichearing(E),aneight-bandnoisevocoderwasusedtoprocessthestimulifromthemelodyandtimbresubtestsoftheUniversityofWashington’sClinicalAssessmentofMusicPerception(CAMP).Thevocoderprocessedinputoverthefrequencyrangeof813through7938Hz,typicalforHybridimplantsubjectsintheclinicaltrial.TosimulateresidualLFacoustichearing(A),thestimuliwerefilteredusingasteeplow-passfilterat500Hz.Theshapeofthefilterwasmatchedtosimulateaverageaudiometricthresholdsat125,250,and500HzbasedontheHybridclinicaltrialsubjects.Inputabove500Hzwasfurtherattenuatedbyatleast80dB.ForconditionssimulatingEAhearing,theacousticandelectriccomponentswerecombinedunilaterally.Results:Preoperatively,withjustacousticinformation,themeanmelodyrecognitionscoreforHybridtrialparticipantswas68.8%(SD±26.5%).Postoperatively,themeanscoreintheEAconditionwas65.6%(SD±29.4%).Comparablescoresfortimbrerecognitionwere52.7%(SD±19.2%)and59.4%(SD±22.1%),respectively.Forbothmelodyandtimbre,pre-to-postdifferenceswerenotsignificant.Meanmelodyrecognitionscoreswere73.5%(SD±15.5%)fortheacousticcondition,39.20%(SD±18.1%)forelectric,and67.9%(STD±21.2%)forEA.TheEAandacoustic-onlyconditionsweresignificantlybetter(p<0.01)thantheelectriccondition,whereastheEAandacousticconditionsscoreswerenotsignificantlydifferent(p>0.05).Meantimbrescoreswere38%(SD±20.4%)fortheacoustic,36.1%(SD±17.7%)fortheelectric,and40.7%(SD±19.7%),forEA.Noneofthesewerestatisticallydifferent(p>0.05).Conclusion:DatafromtheHybridclinicaltrialindicatethatthepresenceofLFacoustichearingpermitsEAuserstomaintaingoodmelodyperceptionabilitiesrelativetoCIusers.ResultsofthesimulationstudyareconsistentwiththeclinicaltrialinthatLFacoustichearingappearstobeimportantformelodyperception.MelodyrecognitionwasbetterinconditionsthatincludedacousticLFinformation,butthiswasnotthecasefortimbre. SessionID:S2-1


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SessionTitle:MusicPerceptionAbstractID:340Title:WrapitinRap-MusicMakingwithAdolescentCIUsersAuthors:BjørnPetersen,Ph.D.1,StineDerdauSørensen,MALinguistics1,EllenRabenPedersen,Ph.D.2,ChristineParsons,Ph.D.3,PeterVuust,Ph.D.Professor1;1Ctr.forMusicintheBrain,Aarhus,Denmark/RoyalAcademyofMusic,Aarhus,AarhusC,Denmark,2TheMaerskMc-KinneyMollerInst.,Univ.ofSouthernDenmark,OdenseM,Denmark,Odense,Denmark,3Dept.ofPsychiatry,Univ.ofOxford,Oxford,UnitedKingdom,Oxford,UnitedKingdom.Abstract:Introduction:WhereasimplantoutcomeinadultandpediatricCIusershasbeenstudiedintensely,informationconcerningthenewgenerationofprelinguallyhearingimpairedadolescents,whohavegrownupwiththeassistanceofCIshassofarbeensparse.Recentstudies,however,indicatethattokeeppacewiththeirnormalhearingpeers,supplementarymeasuresofauditoryrehabilitationareindemandthroughoutadolescence.Musictrainingmayprovideastrong,motivationalandbeneficialmethodofstrengtheningnotonlymusicperception,butalsolinguisticskills,particularlytheprosodicpropertiesofspeech.Sinceadolescenceisanagewhenself-identifyisformingandsocialrelations,includingmusiclisteningandpreferences,areparticularlyimportantitisfairtoassumethatalsoyoungCIuserswillengageinmusicalactivities-despitechallengingpreconditions.Thepurposeofthisstudywastoexamine1)thepotentialeffectsofanintensivemusicaleartrainingprogramontheperceptionofmusicandspeechinprelinguallyhearingimpairedadolescentcochlearimplant(CI)usersand2)theseadolescents’musiclisteninghabitsandmusicenjoyment.Methods:ElevenadolescentCIusersparticipatedinashortintensivetrainingprogram(twoweeks)involvinggroup-basedmusicmakingactivities(e.g.rappingandsinging)andself-administeredcomputerbasedlisteningexercises.TestingofmusicandspeechdiscriminationwascarriedoutbeforeandaftertheprogramfortheCIusersandintwosessionsequallyseparatedintimeforagroupofnormal-hearing(NH)controls.Inaddition,theparticipantsreportedontheirmusiclisteninghabitsandenjoyment.Results:Onaverage,theadolescentsCIusersimprovedtheirdiscriminationskillswithinallmusicaldomainsaftertraining,whichwasreflectedinasignificantoverallprogress.Inparticular,theyimprovedtheirdiscriminationofrhythmandmelodiccontour.TheNHparticipantsoutperformedtheCIusersinallmusicandspeechdiscriminationtestsexceptmelodiccontour.Despitepoormusicdiscriminationabilities,theCIusersreportedlevelsofmusicengagementandenjoymentthatwerecomparabletothoseoftheNHgroup.TheCIparticipantsshowedhighlevelsofengagementwiththemusicmakinggroup,asdemonstratedbylackofattrition,andexhibitedamarkedimprovementintheirperformativeskills.Bycontrast,theparticipantsfoundthecomputerbasedtrainingonlymoderatelyusefulandonaveragespentmuchlesstimeontrainingthanrequested.Conclusion:ThefindingsofthisstudyareanindicationofthepotentialusefulnessoftargetedmusictrainingasaneffectiveandmotivatingactivityforyoungCIusers.Inparticular,rappingandcreationofraplyricsmayformanappealingandrelevantelementinfuturetrainingprograms;theCIfacilitatesitwell,ithasastrongandrepetitivefocusonlanguage,articulation,rhythmandrhymeandmightevenrepresentapossibleformofartisticexpressionforsomeoftheyoungCIusers.Maybetheworldwillonedayseeitsfirstprofoundlyhearingimpairedrapper?Indeed,thatwouldmarktheultimatesuccessofthecochlearimplant. SessionID:S2-1SessionTitle:MusicPerceptionAbstractID:454Title:StabilityandPredictorsofMusicPerceptionandEngagementOverTimeinPediatricCochlearImplantees


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Authors:AdamT.Schwalje,MD,DMA1,VirginiaD.Driscoll,MA1,KateE.Gfeller,Ph.D.2;1DepartmentofOtolaryngology,Univ.ofIowaHosp.andClinics,IowaCity,IA,2DepartmentofOtolaryngology,Univ.ofIowa,IowaCity,IA.Abstract:Introduction:Cochlearimplantationhasbeenapprovedforpediatricpatientssince1990.Manypatientsenrolledinourcenterwhowereimplantedinchildhoodhavenowreachedadolescenceoryoungadulthood.Longtermenrollmentprovidestheopportunitytoexaminepatternsofmusicperceptionandengagementasafunctionoflong-termcochlearimplant(CI)use,maturation,andparticipationinmusicactivities.Methods:Thisretrospectivecohortstudytrackedthestabilityofmusicperceptionandengagementoutcomesin36pediatriccochlearimplanteesgatheredlongitudinally,beforeandaftertheageof15.Averageageofimplantationwas8.7years;26wereprelingualatimplantation.Becauseavailabilityformusictestingwasdependentuponcompletionofprotocolsforspeechandlanguagetestingatannualvisits,musictestingwascompletedintermittently.Wethereforereportonavailabledatapointsgatheredbeforeandaftertheageof15.AComplexityPitchTest(CPT),whichdeterminesabilitytodistinguishpitchesbetween1-24semitones,wasadministeredto21subjects.Thefirsttestscore,whichwasadministeredatleastoneyearafterimplantation,andthefinaltestscore,whichwascompletedafterage15,werecomparedforeachsubject.Thestabilityofthisscorefromthefirsttolastadministrationwasanalyzedusingapairedt-test.Musicengagementwasquantifiedastheextentofparticipationinmusicinstructionascollectedfromamusicbackgroundquestionnaireforchildren(CMBQ),whichwasadministeredto27subjectsanaverageof3.5timeseach.TherelationshipbetweencumulativemusicengagementandpitchperceptionwasanalyzedwithaSpearmanrankcorrelation.Repeatedmeasuresanalysiswasusedtoexaminepossiblecovariantsfortheoutcomesofmusicperceptionandengagement.Results:ThefirstandlastresultsofCPTtesting(beforeandaftertheageof15)werenotsignificantlydifferent(pairedt-test=0.70).Repeatedmeasuresanalysisshowedthatsemitonethresholdswerenotpredictedbyamodelofpre-versuspostlingualimplantation,timepostimplantation,timeelapsedbetweentests,oraveragespeech(CNCandHINT)scores.Thecumulativeunitsofmusicalengagement,asquantifiedbytheCMBQ,wereinverselycorrelatedwiththemostrecentmeasurementofCPTthreshold(Spearman’srho-0.50,p=0.0175).Regressionanalysesindicatedthatthemusicengagementmeasurewasnotpredictedbyamodelincludinglanguagestatusatimplantation,timepostimplantation,timeelapsedbetweentests,andaveragespeechscores.Conclusion:TheseoutcomesindicatethatpitchperceptiondidnotimprovesignificantlyasafunctionoftimewiththeCIforpediatricimplanteestestedintoadolescence.Musicengagement,definedasthecumulativenumberofunitsofmusicinstruction,wasinverselycorrelatedwiththerecipients’pitchperceptionafterage15.Demographicmeasuresrelatedtohearinghistory(ageatimplantation,lengthofCIuse),andspeechperceptionscoresdidnotpredictmusicengagementandpitchperception. SessionID:S2-3SessionTitle:LanguageDevelopmentAbstractID:47Title:ExpandingAccessthroughStrengthsBasedCoachingAuthors:HannahE.Eskridge,MSP,LillianHenderson,MSP;Univ.ofNorthCarolina,ChapelHill,NC.Abstract:Introduction:Forthepasttwentyyears,ourcenterhasprovidedatwoweek,on-siteprofessionaldevelopmentopportunitytospeech-languagepathologists,educators,andaudiologistsworkingwithchildreninaListeningandSpokenLanguageapproach.Ourdesireforthisprogramistotrainprofessionalsthroughoutthecountryandaroundtheworldinhabilitationskillsandstrategiesto


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improveoutcomesforchildrenwhoaredeaforhardofhearingreceivingcochlearimplants.Althoughthetwo-weekexperiencehasbeenhighlyeffectiveforthosewhohaveattended,manyprofessionalswholiveoutsideoflourareaareunabletocommitsignificanttimeandresourcestoparticipateinanon-siteexperience.Overtime,itbecameclearadifferentapproachwasneededinordertoextendprofessionallearningtomoreindividualsparticularlythoseservingpatientswholiveinruralareaswhereaccesstoqualityservicesisoftenlimited(O’Callaghan,et.al).Thispresentationwilldemonstratetheneedformoreprofessionalstrainedinworkingwithchildrenreceivingcochlearimplantsaswellastoolsandstrategiestoeffectivelyincreasecapacityofprofessionalsandthereforeoutcomesforchildrenwhoaredeaforhardofhearing.Methods:Withtheuseofweb-based,flippedclassrooms(McLaughlin,et.al),videoconferencing,anddigitalrecordings,wehaveanincreasedcapacitytocoachandinstructprofessionalsservingpatientsthroughouttheworld.Weareusing21stcenturytechnologyalongwithstrengths-basedcoachingpracticesbasedontheprinciplesofadultlearningtheory,positivepsychology,appreciativeinquiry,andNon-ViolentCommunicationtoincreaseaccessibilitytoprofessionallearningleadingtoincreasedaccesstoListeningandSpokenLanguageSpecialists.Results:Inthissession,thepresenterwilldiscusshowtoimprovepatientcareandoutcomesviacoachingusingcurrenttechnologiesandthestrategiesandtechniquesofastrengths-basedcoachingmodeldesignedtoadvanceadultlearninginordertoimproveoutcomesforchildrenwhoaredeaforhardofhearingandtheirfamilies.Learnerswillexploreanon-lineweb-based,flippedclassroom,viewvideosofrecordedcoachingconversationsusingstrengthbasedcoachingstrategiesandbeabletolistnextstepstoincreaseprofessionallearningopportunitiesusingvirtualplatformsattheirowncenters.Theywillexaminetheimpactofourchangesincoachingdeliveryandstrategiesonourpatientpopulation.Conclusion:Strengthsbasedcoachingusingvirtualplatformsischangingourabilitytoimpactoutcomesforchildrenwithcochlearimplantsaroundtheworld. SessionID:S2-3SessionTitle:LanguageDevelopmentAbstractID:51Title:IntroducingtheOpen-andClosed-setTask:ACriterion-referenceToolforAssessingSpokenLanguageDevelopmentinToddlerswhoareDeaforHardofHearingAuthors:DavidJ.Ertmer,Ph.D.SpeechLanguageandHearingSciences,PurdueUniv.,WestLafayette,IN.Abstract:Introduction:Thereisapressingneedforobjectiveandage-appropriatemeasuresofspokenlanguageacquisitioninchildrenwhoreceivecochlearimplants(CI)orhearingaids(HA)asinfantsandtoddlers.Suchassessmenttoolsareneededtodocumentimprovementsduringtheearlyphasesofauditory-guidedspeechandlanguagedevelopment,andtoidentifychildrenwhoareatriskfordelaysintheseareas.Methods:Thispresentationwill(1)examinethespecialchallengesinassessingspokenlanguagedevelopmentintoddlerswhoaredeaforhardofhearing(D/HH),and(2)introduceTheOpen-&Closed-setTask(O&C;Ertmer,2016)asanobjective,research-basedmeansofmeasuringspokenlanguageoutcomesfollowingCIorHAfittingatayoungage.TheO&Cisawithin-child,criterion-referencetaskthatconsistsofthreelistswith10stimuluswordsineachlist.The30O&Cstimuluswordswereselectedbecausetheyaretypicallyproducedbyatleast75%oftwo-year-oldchildrenwhohavenormalhearing(Dale&Fenson,1996).Thethreewordlistsarebalancedsothattheycanbegiveninanyorderduringthefirst2yearsofCIorHAuse.WhenparticipatingintheO&C,childrenfirstlistentoandimitateadultmodelsofstimuluswords.TheirtranscribedproductionsyieldscoresinPhonemeAccuracy(i.e.,


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accuracyofvowelandconsonantproductions)andWordAcceptability(i.e.,anestimateofsinglewordintelligibility).Next,childrenareaskedtoselectaphotographrepresentingthestimuluswordfromasetofthreephotossothataWordComprehensionscorecanbecalculated.Results:TheO&Cwasfoundtobesensitivetochangesinspokenlanguageabilitiesacrossthefirst2yearsofCIuse.BygivingtheO&Cat6-,12-,andthen18-monthspostCIorHAfitting,earlyinterventionistscandeterminewhethertoddlersaremakinggainsinphonologicaldevelopmentandspokenvocabulary,and-byinference—improvementsinauditoryperceptionabilities.ThispresentationwillincludeavideodemonstrationoftheO&C,researchfindingsrelatedtothedevelopmentoftheO&C,anddataregardingreliabilityandvalidity.Conclusion:TheO&Cprovidesearlyinterventionistswithanassessmenttoolformonitoringprogressinauditory-guidedspeechdevelopmentandspokenlanguageinveryyoungchildrenwhoareD/HH—apopulationforwhichobjectivemeasuresarecurrentlyinshortsupply. SessionID:S2-3SessionTitle:LanguageDevelopmentAbstractID:187Title:Parent-ChildInteractionTherapy:OutcomesofaFamily-BasedBehaviorandLanguageInterventionforChildrenwithCochlearImplantsAuthors:ElizabethAdamsCosta,Ph.D.1,LoriDay,Ph.D.2,ColleenCaverly,M.A.1,NancyMellon,M.S.1,MeredithOuellette,M.A.1,SharleneW.Ottley,Ph.D.1;1DepartmentofPsychology,TheRiverSch./RiverREACHClinic,Washington,DC,2DepartmentofPsychology,GallaudetUniv.,Washington,DC.Abstract:Introduction:Primarycaregiversarecriticalinfacilitatingchildren’snormaldevelopmentofearlyinteractionpatterns,language,andsocial-emotionaldevelopment.Onewaytonurtureparent’sskillsisthroughParent-ChildInteractionTherapy(PCIT),anempiricallysupportedtreatmentthatcoachesparentsandchildrentogethertopromotechilddevelopmentandpositiveparent-childrelationships.Parentsserveasprimarylanguagemodelsfortheirchildren;supportingparentsinprovidingenrichinglanguageenvironmentsenhanceschildren’sdevelopment.Whiletherapueticinterventionsoftenstriveforparentparticipation,mostearlyinterventionsettingsusetraditionalchild-centeredservices(Petersonetal.,2007).Quittneretal.(2013)suggestthatcochlearimplantprogramscanlikelyimprovechildoutcomesbyincorporatingmaternalsensitivitytrainingintointerventionprograms.Severalparentinteraction-trainingprogramsincorporatedidacticand/orhands-onexperientialcoachingtoguideparentsineffectiveinteractionwiththeirchildren.OnesuchprogramisPCIT,abehavioraltreatmentinwhichatherapistworkswithparent-childdyadstopromotechilddevelopment.Parentsaretaughtskillstheycanapplyathometopromotechildlanguage,establishanurturingandsecurerelationship,increasetheirchild’sprosocialbehavior,anddecreasenegativebehavior.PCITtreatmentisstructuredintwoparts:ChildDirectedInteraction(CDI),whichissimilartoplaytherapyandengagesparentsandchildreninplaysituations;andParentDirectedInteraction(PDI),whichteachesparentsconsistentandeffectivebehaviormanagementtechniquesastheyplaywiththeirchild.Thetherapistisa“coach”fortheparent,providinglive,real-timefeedbackusinganearpieceasplayisobservedanddirectedthroughaone-waymirror.Thegoalsofthecurrentstudyweretwofold:toevaluatetheeffectivenessofParent-ChildInteractionTherapyasapsychosocialandbehavioralinterventionforfamiliesofchildrenwithhearingloss,andtoexamineitsapplicabilityasalanguageintervention.Methods:TheeffectivenessofPCITwasevaluatedforparentparticipantswhohadchildrenwithhearingloss(N=17),examiningbothparent’sindirectlanguagestimulation,andchangesinchildbehaviorasa


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resultoftreatment.Forasubsetofthetreatmentgroup(N=6),pre-andpost-treatmentchildlanguagesampleswerecomparedtomatchedcontrolsthatdidnotreceivePCIT.Results:Thechangeinparents’languagestimulationskillsfrompre-treatmenttopost-treatmentwasanalyzed.Thefrequencyofoptimalparentallanguageinput(asmeasuredbyparentsuseofspecificverbalizations)wassignificantlyhigherpost-treatment(Mdn=34)thanpre-treatment(Mdn=5),T=171.0,p<.01,r=.62.Parentreportofproblematicbehavioronastandardizedmeasurewassignificantlylowerpost-treatment(Mdn=85)thanpre-treatment(Mdn=121),T=5.00,p=.01,r=-.42.ThechangeinMeanLengthofUtteranceinWords,MLU-Wfrompre-topost-treatmentforthePCITgroup(Mdn=.96)wassignificantlydifferentthanthechangeinMLU-Wforthematchedcontrolgroup(Mdn=.26),U=30.50,p<.05,r=.58.Conclusion:ThisstudysuggeststhatPCITisapromisinginterventionthatempowersparentstoengageinoptimalindirectlanguagestimulation,improvesparent-childinteractions,andultimatelypromotesspokenlanguageskillsforchildren. SessionID:S2-3SessionTitle:LanguageDevelopmentAbstractID:309Title:CochlearImplantCandidacyConsiderationsandOutcomesforChildrenwithAuditoryNeuropathyAuthors:JaimeLeigh,PhD1,EvelynDo,MAud2,RichardDowell,PhD2,DawnChoo,MSpPath2,ShaniDettman,PhD2;1CochlearImplantClinic,RoyalVictorianEyeandEarHosp.,EastMelbourne,Australia,2AudiologyandSpeechPathology,Univ.ofMelbourne,Carlton,Australia.Abstract:Introduction:Cochlearimplantationiscurrentlytheinterventionoptionofchoiceformanychildrenwithauditoryneuropathy(AN)whoareunabletoobtainbenefitfromconventionalamplification.ChildrenwithANfindingsare,however,aheterogeneousgroupwithawidevarietyofimpairments.Theirpotentialtodevelopauditoryskillswithacochlearimplant(CI)canbeaffectedbysiteoflesion,co-morbidityandthestatusoftheauditorynerve.Theaimofthisstudywastoprovideanup-to-datereportofpatientdemographics,audiologicalprofile,surgicaloutcomeandpost-operativeperformanceforchildrenwithANwhohaveundergoneCIatamajortertiarymedicalfacility.Methods:Retrospectivereviewofcasenotesfor76childrenwithANfindingsreferredforCIevaluationatatertiarymedicalfacilitywasundertaken.Forthe43childrenwithANfindingswhoproceededwithCI,speechperceptionandlanguageassessmentswerecompletedpre-operativelyandonmultipleoccasionspost-operatively.Therateofprogressovertimewasevaluatedandcomparedtopeersnormalhearingandthosewithsensorineural(SN)hearinglosswhohavealsoreceivedaCI.Results:Ofthe43childrenwhoreceivedCIs,40%werebornprematurely,33%requiredtreatmentforjaundice,and23%requiredoxygenatbirth.Asignificantco-morbiditywaspresentfor33%ofthegroup.Sixchildrenwereidentifiedpre-operativelywithcochlearnervedeficiency(CND)onmagneticresonanceimaging.AllchildrenreceivedhearingaidspriortoCI.Meanageatimplantationwas3years1month(range6monthsto16years).ECAPand/oreABRwasconductedatthetimeofCIsurgeryinallcases.Post-operativeauditoryskillswereassessedforallchildrenandrangedfromnoawarenessofenvironmentalsoundstoabilitytofollowaconversationauditionalone.Twenty-fourofthechildrenwereatadevelopmentstageand/orageappropriatetoadministeropen-setspeechperceptiontestingandmeanmonosyllabicphonemescore,auditionalone,was84%.Ameasureofpost-operativelanguageskillswasavailablefor27children.Earlypost-operativelanguagemeasuressuggestedallchildrenhaddelayedlanguagedevelopmentcomparedtopeerswithnormalhearing.Somechildren,however,demonstratedarateoflanguagedevelopmentsimilartonormal,albeitatadelayedage.LimitedornobenefitfromtheCIwasassociatedwitholderageatCI,presenceofasignificantco-morbidity,inability


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tomeasureECAPoreABR,and/orCND.ThreeofthesixthechildrenidentifiedwithCNDobtainednousefulauditoryperceptfromtheCIandbecamenon-users.Conclusion:ThemajorityofchildrenwithANfindingsusingCIsdevelopedspeechandlanguageskillscomparabletotheirpeersusingCIswithSN-typehearinglosswhoreceivedaCIatasimilarage.ChildrenwithCNDshouldbegivenconservativeexpectationsforCIoutcomewithahighriskoflimitedoutcomeornon-useofCI.InabilitytorecordECAPand/oreABRmaysuggestthatelectricalstimulationisinsufficientinovercomingheeffectsofANandlimitedbenefitfromtheCIisapossibleoutcome.ThispaperhighlightstheneedforcarefulcounsellingregardingthepotentialforlessthanoptimaloutcomesforsomechildrenwithAN.Closemonitoringofdevelopmentintheearlypost-operativeyearsisrequiredtoensurethechildismeetingexpectationsfororallanguagedevelopmentandanalternatecommunicationmodeshouldbeintroducedwhenindicated. SessionID:S2-3SessionTitle:LanguageDevelopmentAbstractID:329Title:TrajectoriesofPerformanceinChildrenImplantedUnder18MonthsofAge-WhatisNormal?Authors:ColleenPsarros,MastersofAudiology,MandyHill,MastersofAudiology,KylieChisholm,BachelorofAppliedScienceSpeechPathology;SCIC,Gladesville,Australia.Abstract:Introduction:Approximately30%ofchildrenwhohavereceivedtheircochlearimplantsaged18monthsoryoungerhaveneedsinadditiontotheirdeafness.Since2006,simultaneousbilateralcochlearimplantationisroutineforchildrenidentifiedwithabilateralseveretoprofoundsensorineuralhearinglossatSCIC.Thispaperwilldefinethetrajectoryofauditoryfunctionandlanguageperformanceatthe3intervals(1,2and5years)followingCIforchildrenwhohavenoconsiderationsinadditiontotheirdeafness.ChildrenwhohavebeenidentifiedwithCMVandCHARGE,orwhohaveothercomorbidities,andhavereceivedcochlearimplantsundertheageof18monthswillbecomparedaccordingtothistrajectorytoassistinthecounsellingoffamiliesfordevelopingrealisticexpectationsoftheirchild’spotentialpostCIjourneyandoutcomes.Methods:Aretrospectiveanalysiswasperformedonof100childrenwhoreceivedtheirCI’sbetweentheperiodof2006-2016attheageof18monthsoryoungerwasperformed.Variablesreviewedincludedaetiology,presenceofcomorbidities,earsimplanted,electrophysiologicalfindingspreandpostoperatively,functionalquestionnaires(PEACH),deviceprogrammingandusageissuesandlanguageoutcomes(Rossetti/PLS).ThelisteningandspokenlanguageperformanceforthechildrenwithCMVandCHARGEwasplottedonatrajectoryalongwithchildrenwithnoadditionaldisabilitiestocompareoutcomesachievedanddurationofdeafness.Results:TheprofilesofchildrenwithCHARGEandwithCMVdifferedaccordingtothenumberofearsimplantedandtheintervalatwhichtheywereimplanted.Forexample,ahighprevalenceofauditorynerveabnormalitieswiththeCHARGEgroupledtomoreunilateralorsequentialbilateralCI’s.Oftenthesechildrenwereimplantedalittlelaterthanthecohortwithoutcomorbiditiesduetotheneedforothermedicalinterventions.Theimpactontheiroverallauditoryfunctionreflectedthedelayinmanagement.Conclusion:Thetrajectoriesdevelopedcanprovideessentialinformationforcounsellingfamiliesandsettingrealisticexpectationsofwhatcanbeachieved,andprotocolsandproceduresforreachingtheseoutcomes.GiventhevariabilityinthegroupofchildrenwithCHARGEandCMVtheabilitytoprovideapossiblespectrumofoutcomesisvitalformaximisingthesupportsandinterventionthatarerequiredformaximisingthepotentialoftheseinfantswiththeirfamilies.


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SessionID:S2-3SessionTitle:LanguageDevelopmentAbstractID:504Title:TheEffectofMulti-SessionTrainingProtocolsonRecognitionofSentencesinNoiseinPrelingualYoung-ImplantedLong-TermUsersofCochlearImplantsAuthors:LiatKishon-Rabin,PhD,YossiBugannim,BA,DoreenZechoval,BA,DaphneAri-EvenRoth,PhD;CommunicationDisorders,Tel-AvivUniv.,Tel-Aviv,Israel.Abstract:Introduction:Theabilitytoperceivespeechperceptioninnoisehasremainedamajorcomplaintofthehearingimpaired.Despitemajoradvancesintechnology,performanceofcochlearimplant(CI)usersinadverselisteningconditionshasshowntobequitelimitedcomparedtohearing,puttingtheCIusersatasignificantdisadvantageinmanyreal-lifelisteningsituations.Formanyyearsauditorytraininghasbeenincorporatedinclinicalpracticebutwithlimitedempiricalsupport.Toourknowledge,onlyafewstudiesshowedthatspeechperceptioninnoisecanbeimprovedbyauditorytraininginpostlingualdeafenedCIusersandnonehavelookedattheinfluenceoftrainingprotocols.Thepurposeofthisstudywastoinvestigatetheimprovementofspeechperceptioninnoisefollowingmulti-sessiontraininginprelingualhearing-impairedyoung-implantedCIusers.Asecondarypurposewastotesttheinfluenceoftrainingprotocolonlearning.Methods:Participantsincluded12prelingualyoungadultsaged21-29years,implantedbetween2-16yearsofageandwhousedtheirCIdevicebetween12-23years).Allweregoodperformersinquietandhadnootherhealthrelatedproblems.TestingandtrainingmaterialincludedtheHebrewversionofthesentence-in-noiseMatrixtestwhichconsistsof50differentwordswithwhichatotalof100,000different5-wordsentenceswithsimilargrammaticalstructurecanbeconstructed.UsingtheHebrewMatrixtest,thesignal-to-noiseratio(SNR)atwhich50%ofthewordsinsentenceswerecorrectlyidentifiedwasdeterminedinanadaptiveprocedurebeforeandaftertraining.Foreachthresholdassessment,20differentsentenceswereused.Tentrainingsessionswereconducted,2-3daysapart.SixoftheCIusersweretrainedateasierSNR(70%onthepsychometricfunction)andsixoftheCIuserstrainedatmoredifficultSNR(50%onthepsychometricfunction).Sixspeechreceptionthresholds(SRT)innoiseweredeterminedineachtrainingsession,totally60SRTs.Cognitivetests(workingmemory,non-verbalintelligence,andvisualattention)wereconductedaswell.Retentionoflearningwasassessed2-3monthsaftertrainingwascompleted.Generalizationwasassessedusingmonosyllabicwordsin6dBSNR.Results:(1)ForallCIusers,trainingresultedinsignificantimprovementsinSRTinnoise(2.5-10dB);(2)Characteristicsofthelearningfunctionsvariedconsiderablybetweenparticipants;(3)Largebetween-subjectvariabilityinSRTsinnoisewasobservedatthebeginning,butwasreducedsubstantiallyfollowingtraining;(5)Nosignificantdifferenceswerefoundbetweenthetrainingprotocols;(6)Learningwaspartiallyretained;(7)Memoryspanofnonsensesyllablesinlow-intensitynoisebestexplainedperformance.Conclusion:SpeechperceptioninnoisecanbeimprovedsignificantlyinprelingualCIusersfollowingmulti-sessiontraining.Thedatasupporttheimportanceandbenefitfromauditorytrainingindifficultlisteningconditionswitheithertrainingprotocol. SessionID:S2-3SessionTitle:LanguageDevelopmentAbstractID:518Title:SocialDeterminantofVerbalLanguageDevelopmentafterPediatricCochlearImplantation:TheChildhoodDevelopmentafterCochlearImplantationStudy


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Authors:Nae-YuhWang,PhD1,ChristineMitchell,ScM1,LaurieEisenberg,PhD2,AnnGeers,PhD3,JohnNiparko,MD2;1JohnsHopkinsUniv.,Baltimore,MD,2KeckSch.ofMed.,Univ.ofSouthernCalifornia,LosAngeles,CA,3Univ.ofTexasatDallas,Dallas,TX.Abstract:Introduction:thisstudysoughttoevaluateverballanguagedevelopmentassociatedwithsocialeconomicstatusafterpediatriccochlearimplantationintheUSA.Methods:Verballanguageoutcomesfrom188cochlearimplantcandidatesrecruitedbeforeimplantation(meanage2.2years),alongwith97concurrentlyenrolled,agecomparablepeerswithnormalhearing,collectedthroughthemulticenterChildhoodDevelopmentafterCochlearImplantation(CDaCI)studywereanalyzed.CorecompositestandardscoresofReynellDevelopmentalLanguageScaleandComprehensiveAssessmentofSpokenLanguagewereusedtotracklongitudinaltrajectoriesofoveralldevelopmentofverballanguageover8-yearspostimplantation.Mixed-effectsregressionmodelswereusedtoestimategrowthratesofverballanguageskillsbylevelsoffamilyincomeandotherpredictorsoflanguagedevelopment.Results:Higherfamilyincomewasassociatedinadose-responsemannerwithacceleratedverballanguagegrowthinchildrenwithcochlearimplantover8-yearsofimplantexperience,similartothepatternsoflongitudinallanguagetrajectoriesbyfamilyincomelevelsseeninchildrenwithnormalhearing.Speechperception,4-frequencypuretoneaverage,cognitivefunctionscreeningscore,andmaternalsensitivitylevelatbaselinepre-implant,andageatimplantactivationweresignificantpredictorsofverballanguagedevelopmentover8-yearspostCI,andpartiallyattenuatedtheassociationbetweengrowthratesofverballanguagedevelopmentandfamilyincome.Conclusion:Lowerfamilyincomeisassociatedwithpoorerverballanguagedevelopmentinchildrenwithcochlearimplant.Identifyingmodifiableriskfactorsofpooreroutcomesassociatedwithlowersocialeconomicstatusenablesbetterunderstandingofoutcomevariabilities,andprovidespotentialtargetsforinterventioninordertoreduceoutcomedisparitiesafterpediatriccochlearimplantation. SessionID:S3-1SessionTitle:OutcomeAssessmentAbstractID:307Title:Evidence-basedGuidelinesfortheProvisionandTimingofCochlearImplantationforYoungChildrenAuthors:JaimeLeigh,PhD1,ShaniDettman,PhD2,RichardDowell,PhD2;1CochlearImplantClinic,RoyalVictorianEyeandEarHosp.,EastMelbourne,Australia,2AudiologyandSpeechPathology,Univ.ofMelbourne,Carlton,Australia.Abstract:Introduction:Cochlearimplantationhasnowbecomeastandardtreatmentforbilateralsevere-to-profoundhearinglossinchildren.Inthepastdecade,evidencehasemergedtosupporttheprovisionofcochlearimplants(CIs)foryounginfants.Theavailabilityofneonatalhearingscreeningprogramshasfacilitatedearlierreferral,diagnosis,andinterventionforinfantswithhearingloss;thiscanleadtoearliercochlearimplantationandimprovedoutcomes.Itdoes,however,createaproblemforcliniciansinprovidingrecommendationsaboutcochlearimplantationforyoungchildrenwithhearing-impairment.Belowsixmonthsofageitisonlypossibletoestimatetheaudiometricthresholdsusingobjectiveaudiologicaltesttechniques(e.g.ABRandASSR).Beyondthisage,theseestimatescanbecomemorereliablebyusingconditionedresponsetechniques,butthisinformationdoesnotaccuratelypredictthechild’spotentialtodevelopspeechandlanguageusingconventionalhearingdevices.Thus,itcanbedifficulttomakearecommendationforcochlearimplantationuntilthechildisolderandtheirprogresscanbemeasured.DeterminingthelikelihoodthatindividualinfantswillhaveanimprovedspeechandlanguageoutcomeiftheyreceiveaCIisachallenge.Asaresult,evidence-based


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guidelinesfortheprovisionandtimingofimplantationforclinicianstoassistparentaldecision-makingareneeded.Methods:Speechperceptionresultsfor78early-implantedchildrenwerecomparedto62childrenusingtraditionalamplificationwithhearinglossesranging25-120dBHLPTA.Equivalentpure-toneaverage(PTA)hearinglossforCIuserswasestablished.Languageof32childrenwhoreceivedaCIbefore2.5yearsofagewasassessedoversixyearsandcomparedtohearingpeers.Results:SpeechperceptionoutcomessuggestedthatchildrenwithaPTAgreaterthan60dBHLhavea75%chanceofbenefitwithaCIovertraditionalamplification.MoreconservativecriteriaappliedtothedatasuggestedthatchildrenwithPTAgreaterthan82dBHLhavea95%chanceofbenefit.Childrenimplantedunder2.5yearswithnosignificantcognitivedeficitsmadenormallanguageprogressbutretainedadelayapproximatelyequaltotheirageatimplantation.Conclusion:Hearing-impairedchildrenunderthreeyearsofagemaybenefitfromcochlearimplantationiftheirPTAexceeds60dBHLbilaterally.Implantationasyoungaspossibleshouldminimiseanylanguagedelayresultingfromaninitialperiodofauditorydeprivation. SessionID:S3-1SessionTitle:OutcomeAssessmentAbstractID:398Title:IncorporatingCeilingEffectinAnalysesofSpeechPerceptionOutcomesofaPediatricCochlearImplantCohortAuthors:VedatTopsakal,MDPhD1,HannekeBruijnzeel,MD2,GuidoCattani,MsAud2;1UniversitairZiekenhuisAntwerpen,antwerp,Belgium,2UniversitairMedischCentrumUtrecht,Utrecht,Netherlands.Abstract:Introduction:Severalfactorsmayinfluencewhytheoptimalageforcochlearimplantationisnotexplicitlydefined.Theabsenceofobjectivepediatricspeechandlanguageoutcomemeasureswithouttheoccurrenceofceilingeffectsisknowntobeoneoftheseunderlyingfactors.Ourobjectiveistocomparespeechperceptiondatabetweenchildrenwithadifferentageatcochlearimplantationincorporatingceilingeffects.Methods:Design:WeevaluatedspeechperceptionbycomparingConsonant-Vowel-Consonant(CVC(A))scoresat5-yearfollow-upofchildrenimplantedbetween1997and2010.Theproportionofchildrenfromeachagegroupreachingthe95%CIofCVC(A)ceilingscores(>95%)wascalculatedtoidentifyperformancedifferencesbetweengroupsmaskedbyceilingeffects.StudySample:54childrenimplantedbetween8and36months.Results:Althoughceilingeffectsoccurred,aCVC(A)scoredifferencebetweenage-at-implantationgroupswasconfirmed(H(4)=30.36;p<.001).Outperformanceofearly(<18months)comparedtolaterimplantedchildrenwasdemonstrated(p<.001).Alargerproportionofchildrenimplantedbefore12monthscomparedtochildrenimplantedbetween13and18monthsreachedceilingscores.Logisticregressionconfirmedthatageatimplantationwastheonlysignificantvaluetopredictwhetherachildreachedaceilingscore.Conclusion:AlthoughCVC(A)ceilingeffectstendtomaskthoroughdelineationofspeechperception,speechperformancedifferencesexistedbetweenchildrenimplantedbeforeandafter18monthswhenincludingceilingeffectsandalsowhennotaccountingfortheseeffectsduringanalysis.Developmentoflong-termassessmenttoolsnotaffectedbyceilingeffectsisessentialtomaintainadequateassessmentofyoungimplantedinfants. SessionID:S3-1SessionTitle:OutcomeAssessment


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AbstractID:496Title:TheEffectofDevelopmentonCorticalAuditoryEvokedPotentialsinNormalHearingListenersandCochlearImplantUsersAuthors:EunKyungJeon,Ph.D,Au.D.1,CarolynBrown,Ph.D.2,PaulAbbas,Ph.D.2;1CommunicationSciencesandDisorders,Univ.ofUtah,SaltLakeCity,UT,2CommunicationSciencesandDisorders,Univ.ofIowa,IowaCity,IA.Abstract:Introduction:CanaCIfacilitatethedevelopmentoftheauditorybraininchildrenwhowereborndeafbutimplantedatayoungage?WillthedevelopmentofthecentralauditorysystemintheseCIchildrenbelikethatofNHchildren?Thecurrentstudyattemptstoanswerthesequestionsinpartbystudyingdevelopmentaleffectsontwoauditoryevokedpotentialsmeasuredatthecorticallevel:theonsetP1-N1-P2andtheACC.TheP1-N1-P2complexoccurswithin50to250msafterastimulusonset.Itisalsocalledanonsetresponseandisrelatedtosounddetection.Anotheristheacousticchangecomplex(ACC),elicitedbyanyacousticchangeinongoingsounds.Itisalsocalledachangeresponseandisrelatedtosounddiscrimination.Methods:ForNHlisteners,ninety-onechildrenaged3-19yearsandelevenyoungadultsparticipated.Atotaloffifty-nineCIusersparticipated:forty-eightpre-linguallydeafenedchildrenaged3-19yearsandyoungadults,andelevenpost-linguallydeafenedadults.Allpre-linguallydeafenedsubjectswereimplantedwiththeirCI(s)before3.5yearsofage.Speech-likestimuli(/u/-/i/and/i/-/u/)werepresentedviaaspeakeronceinquietandonceinnoise(+10dBSNR)conditionstoelicitboththeonsetandchangeresponses.Results:ResultsshowthatbothonsetandACCresponsesweresuccessfullyobtainedfromNHlistenersandearly-implanted,pre-linguallydeafenedCIusers,from3yearoldstoadults,inbothquietandnoiselisteningconditions.Whilethemorphology,latency,andamplitudeofbothonsetandACCresponsesshowedsimilardevelopmentaleffects,theACCmaturedlaterthantheonsetresponseinbothquietandnoiseconditions.Withbackgroundnoise,theACCwasaffectedbynoisemorethantheonsetresponse,whichledtoalongerdevelopmentaltrajectoryfortheACC.ThesefindingsweresimilarinbothNHandCIgroups,suggestingthataCIfacilitatestypicaldevelopmentofthetwocorticalresponses.However,theeffectofbackgroundnoisewasprominentintheACCofCIusers.Thismayindicatetheperceptualdifficultiesofdiscriminatingsoundsinnoise.Conclusion:TheresultssuggestthattheACCcanbeusedasameasurementforestimatingperceptualperformanceofindividualsinvariousageandlisteninggroups. SessionID:S3-1SessionTitle:OutcomeAssessmentAbstractID:285Title:EEGAlphaRhythmsasaBiomarkerforListeningEffortforSpeechinNoisePerceptioninCochlearImplantUsersAuthors:AndrewDimitrijevic,PhD,JosephM.Chen,MD;Otolaryngology,SunnybrookHlth.Sci.,Toronto,Canada.Abstract:Introduction:Cochlearimplant(CI)usersoftenstrugglewhilelisteningtoaconversationinadverselisteningenvironmentssuchasanoisyroomandoftenreportthattheyfeelexhaustedafteradayoflistening.Inordertofollowconversations,especiallyinthepresenceofnoise,attentionandeffortmustbeexertedandmayberelatedtolisteningeffort(LE).ThephysiologicalmechanismsofLEarenotwellunderstood.ThisstudyrelatesLEratingtophysiologicalprocessesasmeasuredbytheelectroencephalogram(EEG)inCIuserswhileperformingaspeechperceptioninnoisetask.WehavepreviouslyshownthatEEGalphapowerisrelatedtospeechperceptioninnoiseinnormalhearingadults


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andchildren.WethereforehypothesizedthatalphapowerwouldshowasimilarrelationshipinCIusersandwouldadditionallyberelatedtoLE.Methods:TenadultCIusersweretestedinfreefieldusingtheireverydayCIsettingwhileperformingtheDigitTripletTest(DTT).TheDTTpresentstrialsofthreedigitsinspeech-shapednoise.Inaninitialbehavioraltask,thesignaltonoiseratio(SNR)wasvariedadaptivelyuntil50%ofdigitswereidentifiedcorrectly,theSpeechReceptionThreshold(SRT).Afterwards,64channelEEGrecordingsweremadeduringDTTlisteningatindividualizedsuprathresholdlevels.Aftereachrecordingblock,participantswereaskedtorankthedifficultyofperformingtheDTTtask(i.e,LE).Results:Listeningtospeechinnoisewasassociatedwithincreasedalphapower,inbothnormalhearingindividualsandCIusers.CIusershadgreateralphapowercomparedtonormalhearingindividuals.SignificantcorrelationswereobservedbetweenleftfrontalalphapowerandLEinCIusersusingbrainsourceanalysis.Conclusion:CIusersandnormalhearinghavesimilarcorticaloscillationpatternswhilelisteningtospeechinnoise.GiventhatalphapowerwassignificantlycorrelatedtoLEandthatCIusershadgreateralphapowercomparedtonormalhearingindividuals,alphamayrepresentanobjectivemeasureofLEinCIusers. SessionID:S3-1SessionTitle:OutcomeAssessmentAbstractID:299Title:ProgrammingCharacteristicsofCochlearImplantsinYoungChildren-FindingsfromaPopulation-basedProspectiveStudyAuthors:PaolaV.Incerti,MAud,MAudSA(ccp)1,TeresaY.C.Ching,PhD1,RobertCowan,PhD2,SannaHou,MAud,MAudSA(ccp)3,PatriciaVanBuynder,MAud,MAudSA(ccp)1;1MacquarieUniversity,Natl.AcousticLab.,Sydney,Australia,2TheHEARingCooperativeRes.Ctr.(CRC),Melbourne,Australia,3Natl.AcousticLab.,MacquarieUniversity,Australia.Abstract:Introduction:Expansionofcochlearimplant(CI)candidacycriteriatoincludeincreasinglyyoungerchildrenandmorecomplexcases,hasledtonewprogrammingchallengesforclinicians.TheLongitudinalOutcomesofChildrenwithHearingImpairment(LOCHI)isaprospective,populationbasedstudythatpresentsauniqueopportunitytocomprehensivelyexamineclinicalprogrammingparametersusedinayoungpaediatricpopulationovertime.Thispaperaimsto1)describetheCIprogrammingparameterscurrentlyusedofchildrenintheLOCHIstudy;2)examinechangesoverthefirst5yearsoflife;and3)examinehowtheserelatetotheageofimplantationandaetiology.Methods:Thispaperreportson161ofthe450childreninthestudybornbetween2002and2006,inthreestatesofAustralia(NSW,VIC,andQLD),andwhoaccessedAustralianHearingbefore3yearsofage,andwhoreceivedaCIbetween6and36monthsofage.Informationwascollectedat6monthsafterinitialimplantation,andatchronologicalagesof3years-and5yearsofage.Electricalthresholds(T-levels)andComfortlevels(C-levels)wereconvertedfromclinicalmapunitstocharge-per-phaseinnanocoulombs(nC)unitsforcomparison.Results:Childrenwithauditorynervedeficiencyandcochlearlesionweremorelikelytobeusingprogramswithparameterssettingsthatdeviatedfromthedefault.Therewasasignificantdifferenceinminimumthresholds(T-levels)andmaximumcomfortablecurrentlevels(C-levels)andhowtheselevelsvariedacrosstimeforchildrenwiththeseaetiologiesascomparedtothegeneralgroup.Conclusion:ThecharacteristicsofCIasfittedtochildrenreflecttheextenttowhichmanufacturer’srecommendationsondefaultsettingsmaybevariedtomeetclinicalneeds.


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SessionID:S3-2SessionTitle:ExpandedIndicationsAbstractID:80Title:OutcomesofPediatricCochlearImplantationinSingle-SidedDeafnessorveryAsymmetricalHearingLossAuthors:KarynL.Galvin,PhD1,MichelleTodorov,MAud1,RebeccaFarrell,MAud2,RobertBriggs,FRACS2,MarkusDahm,FRACS2,JaimeLeigh,PhD2;1AudiologyandSpeechPathology,Univ.ofMelbourne,Melbourne,Australia,2CochlearImplantClinic,RoyalVictorianEyeandEarHosp.,Melbourne,Australia.Abstract:Introduction:Cochlearimplantationcanprovideaccesstobilateralsoundforchildrenwithsingle-sideddeafness(SSD)orveryAsymmetricalHearingLoss(AHL).Inordertoadequatelyassessthebenefitsofsuchtreatment,itisimportanttoassesschildrenusingabroadassessmentprotocolandalsotodocumentthereal-worldexperiencesofchildrenandtheirfamilies.TheobjectiveofthisstudywastoevaluatebenefitandfunctionaloutcomesforchildrenwithSSD/AHLwhowereimplantedintheprofoundear.Methods:Dependingonthechild’sage,objectivetestsofspatialhearingandspeechperceptioninnoiseandsubjectivequestionnaireswereadministeredpreoperativelyandat6and12monthspostoperatively.Spatialhearingtestinginvolvedlocatingthepresentingloudspeakerina180-degreearrayorlateralizingsoundpresentedfromtheleftorright.Speechperceptioninnoisetestinginvolvedclosed-setspondeerecognitionorsentencerecognitionincoincidentandseparatedspeech/noiseconditions.Subjectivereportsweregatheredregardinguseof,andadaptationto,thenewimplantandanumberofquestionnaireswereadministered,includingtheversionsoftheSpeech,Spatial,andQualitiesofHearingScaleforParents(SSQ-P)andforChildren(SSQ-Ch),andtheHearingEnvironmentsandReflectiononQualityofLife(HEAR-QL)questionnaire.Results:Fourparticipantsarenowmorethan6monthspostoperative.Thefirstchildhadamild-moderatelosscontralaterally,wasaged10yearsandis12monthspost-implantation.Adaptationtothecombinationofimplantandhearingaidwasstraightforward,andclearbenefitwasevidentontestsoflocalizationandspeechinnoise,andontheSSQ-PandSSQ-Ch.Thesecondchildhadamildlosscontralaterally,wasaged6years,andis12monthspost-implantation.Data-loggingandanecdotalreportsindicatelimitedimplantuse,andobjectiveandsubjectiveassessments,includingtheSSQ-P,indicatenobenefitoverthehearingaidalone.Thethirdchildsufferedmeningitis,wasimplantedaged3.5monthsduetoindicationsofcochlearossification,andis6monthspost-implantation.Theimplantiswornconsistentlywithahearingaid,andreportedfunctionaloutcomeshavebeenverypositive.Thefourthchildhadnormalhearingcontralaterally,wasaged10years,andis12monthspost-implantation.Thedeviceisusedfulltime,althoughthereisnoevidenceofbenefitonobjectiveorsubjectiveassessments,includingtheSSQ-P.Morerecently,anadditionalthreechildrenwithSSDaged5,11and15yearshavebeenimplanted.Theirfunctionaloutcomesinthefirstfewmonthspostoperativewillbereported.Conclusion:InfantsandchildrenwithSSD/AHLmayeasilycombinetheelectricsignalwiththegoodacousticsignalandquicklygainsignificantbenefitsfromthecochlearimplant.Otherchildrenstruggletoadapttotheuseoftheimplantand/ordonotshowevidenceofbenefitintheearlypost-operativeperiod;inthesecases,encouragementandmonitoringofimplantusearecrucialaspectsofclinicalmanagement.Predictingoutcomesisverydifficultgiventhelimitedexperienceworldwide.Giventhis,carefulpreoperativecounsellingisrequiredtohelpfamiliesintheirdecisionmakingandtopreparethechildandfamilyforthechallengesofthepostoperativeperiod. SessionID:S3-2


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SessionTitle:ExpandedIndicationsAbstractID:53Title:ExpandingIndicationsforCochlearImplantation:Single-SidedDeafnessAuthors:HaroldPillsbury,MD1,MargaretDillon,AuD1,EmilyBuss,PhD1,MeredithAnderson,AuD1,EnglishKing,AuD2,EllenDeres,AuD2,KevinBrown,MD,PhD1;1Otolaryngology/HeadandNeckSurgery,Univ.ofNorthCarolinaatChapelHill,ChapelHill,NC,2Audiology,UNCHealthCare,ChapelHill,NC.Abstract:Introduction:PatientswithsubstantialunilateralhearinglossorSingle-SidedDeafness(SSD)experiencepoorspeechperceptioninnoiseascomparedtonormal-hearers.ApprovedtreatmentoptionsforSSDdonotofferimprovespeechperceptioninchallenginglisteningenvironments.Thesetreatmentsroutethesignalfromtheaffectedeartothenormalhearingear,whichlimitsaccesstobinauralcues.Itisofinterestwhethercochlearimplantationoftheaffectedearwouldimproverecipients’speechperceptioninnoiseduetostimulationoftheauditorypathwayontheaffectedside.Theobjectiveofthisstudywastoassessthespeechperceptionandqualityoflifeoutcomeswithacochlearimplantplusanormalhearingearduringthefirst12monthsoflisteningexperience.Methods:Twenty(20)subjectswithSSDunderwentcochlearimplantationaspartofaclinicaltrial.Subjectscompletedaspeechperceptioninspatially-separatednoisetaskpreoperatively,andat1,3,6,9and12monthspostoperatively.TestmeasuresincludedAzBiosentencesina10-talkerbabbleandtheBKB-SINtest.Thenoisewaspresentedatthesamelocationasthestimulus,totheaffectedear,andtothenormal-hearingear.Listeningconditionsincludedthenormalhearingearalone(NHalone)andwithabone-conductiondevice(BCHA+NH)preoperatively,andwiththecochlearimplantplusthenormalhearingear(CI+NH)postoperatively.SubjectscompletedtheSpeech,SpatialandQualitiesofhearing(SSQ)scaleandTinnitusHandicapInventory(THI)atallintervals.Results:SpeechperceptionperformancewaseithersimilarorpoorerintheBCHA+CIconditionascomparedtotheNHaloneconditionatthepreoperativeinterval.Postoperatively,subjectsexperiencedasignificantimprovementinspeechperceptionwhenlisteningwiththeCI+NH.Performancecontinuedtoimprovethroughthe12-monthinterval.Similarly,subjectsreportedasignificantimprovementinqualityoflifewiththeCIintheearlyweeksoflisteningexperience.Subjectsalsoreportedareductionintheirtinnituswithdeviceuse.Conclusion:SubjectswithSSDexperiencedasignificantimprovementinspeechperceptioninnoiseandreportedasignificantimprovementinqualityoflifewhenlisteningwiththeCI+NH.Theseresultsarepromisingascandidacycriteriaexpandtoconsiderpediatricrecipients.Patientanddevicevariablesincludingageatimplantation,durationofhearingloss,electrodearrayinsertiondepthanddurationoflisteningexperiencewillbeexplored. SessionID:S3-2SessionTitle:ExpandedIndicationsAbstractID:459Title:IndicationsandOutcomesofCochlearImplantRevisionSurgeryforLegacyInternalDevicesAuthors:MeredithA.Holcomb,AuD,JaneA.Burton,BA,ElizabethL.Camposeo,AuD,TedA.Meyer,MD,PhD,TedR.McRackan,MD;OTO-HNS,Med.Univ.ofSouthCarolina,Charleston,SC.Abstract:Introduction:Devicefailureandsurgicalormedicalcomplicationsaretheprimaryreasonsforcochlearimplantreimplantation(CIR).Historically,well-functioninginternaldeviceshavenotbeenconsideredforrevisionsurgery.Manycochlearimplantusersareunabletoupgradetothemostup-to-dateexternalprocessorsduetoincompatibilitywiththeirlegacyinternaldevice.Subsequently,theycannottakeadvantageofrecenttechnologicaladvancesinsoundprocessingandnoisesuppression,


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whichmayhavetheabilitytoimprovetheircommunicationability.ThecurrentstudyinvestigatestheindicationsforCIRoflegacyinternaldevicesandauditoryoutcomesfollowingcochlearimplantrevisionsurgery,includingthoserevisedasameansoftechnologyupgrade.Methods:Retrospectivereviewwascompletedofpatientswhowereinitiallyimplantedasachildwithalegacyinternaldeviceandunderwentrevisionsurgeryasayoungadult.Datawerecollectedregardingageatthetimeofimplantation,thedurationofimplantusebeforerevision,reasonforrevision,andpre-andpost-CIRspeechperceptionscores.Results:Ofthe7ears(7patients)withlegacyinternaldevicesthatrequiredCIR,technologyupgradewasfoundtobethemostcommonreasonforrevisionsurgery(5/7).“Softfailure”accountedfortheremainder(2/7).Themeanageofinitialimplantationwas3.8years,andthemeandurationofimplantusebeforeCIRwas15years.Allsubjectswereprelinguallydeafenedandallwerereimplantedwiththesamecompanyastheirinitialdevice.AllsubjectswereprogrammedwithanewspeechprocessingstrategyandwerefitwiththemostrecentlyreleasedexternalprocessorfollowingCIR.Atlastfollowup,meanCNCwordincreasedby18%,CNCphonemeincreasedby16%,andAzBioQuietimprovedby37%comparedtopre-CIRscores.Duetothesmallsamplesizenosignificantdifferencewasfound(allp>0.05).Conclusion:Thefindingsofthisstudyrevealpost-CIRaudiologicalbenefitwasunchangedorimprovedcomparedtothepre-CIRresultsinallreimplantedpatients.Givenourresults,patientswhoareunabletousethemostcurrentexternalprocessorsduetoincompatibilitywiththeirlegacyinternaldeviceshouldbeconsideredforrevisionsurgerytooptimizetheiroverallperformancewithacochlearimplant. SessionID:S3-2SessionTitle:ExpandedIndicationsAbstractID:432Title:HearingPreservationandSpeechOutcomesinPediatricRecipientsofCochlearImplantsAuthors:KevinD.Brown,MD,PhD,HollyTeagle,AuD,LisaPark,AuD,JenniferWoodard,AuD,ErikaGagnon,AuD,LaurenKilpatrick,MD;Otolaryngology-HeadandNeckSurgery,Univ.ofNorthCarolinaSch.ofMed.,ChapelHill,NC.Abstract:Introduction:Thebenefitsofelectricandacousticstimulationofthecochleainadultrecipientsofcochlearimplantshavebeenwelldemonstrated.Limiteddataisavailableinpediatricpatients.Wewishedtodeterminetheratesoflowfrequencyhearingpreservationinpediatricpatientsandthebenefitofcombinedelectricandacousticprocessingforspeechoutcomes.WealsowishedtodetermineifdifferencesinintraoperativeECOGtestingcorrelatedwithdifferentelectrodedesignsandratesofpreservation.Methods:Thirty-threeconsecutivepediatricsubjectsunderwentcochlearimplantationwitheithera20mm22-electrodearrayora24mm12-electrodearray.Allpatientshadpreoperativehearingatofatleast80dBat250Hz.AsubsetofpatientsunderwentintraoperativeECOGtestingusingeitheranextra-cochlearpromontoryelectrodeorbyintra-cochleartestingthroughtheimplantelectrodeitself.ChangeinECOGdBsensitivityastheelectrodewasinsertedwasrecorded.Hearingpreservationwasstrictlydefinedpostoperativelyasmaintenanceoflessthan80dBthresholdsat250Hz.Patientswereevaluatedat1month,3months,and6monthsafterimplantationtodetermineratesofpreservationusingpuretoneaudiometry.Patientswerealsotestedforwordrecognitionpost-operativelyinCIandCI+acousticconditionstodeterminethedegreeofacousticbenefit.Results:Lowfrequencyhearingpreservationwasseenin90%ofpatientsat1month,88%at3monthsand80%at6months.HigherratesofpreservationwereseeninpatientswithoutEVAincomparisontothosewithEVA.DifferentelectrodesdemonstrateddifferentpatternsofECOGsensitivityastheywereinsertedandthiscorrelatedwithhearingpreservation.Therewasasubstantialbenefitofhearing


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preservationwithaverageCNCscoresat3monthsinCIaloneof41%vs74%inEAS/Hybridwiththislargedifferencepersistingoutto6months.Conclusion:Lowfrequencyhearingpreservationispossibleinamajorityofpediatricimplantrecipients.Benefitsofelectricandacoustichearingaresimilartobenefitsseeninadultpatientsforspeechunderstanding.IntraoperativeECOGpermitspredictionofhearingpreservationanddemonstratesimportantdifferencesbetweenelectrodedesigns. SessionID:S3-2SessionTitle:ExpandedIndicationsAbstractID:342Title:PartialInsertionofLongFlexibleElectrodesinChildrenwithHighFrequencyHearingLossAuthors:ThomasLenarz,MD,PhD,RolfSalcher,MD,MelanieLeifholz,.,AnkeLesinski-Schiedat,MD,PhD,AndreasBüchner,PhD;DepartmentofOtorhinolaryngology,HannoverMed.Sch.,Hannover,Germany.Abstract:Introduction:High-frequencyhearinglosscanbeobservedinchildrenaswellasinadults.Thesepatientsshowinparticularaninsufficientspeechunderstandinginnoiseandanotsatisfyingbenefitfromhearingaids.Onegroupofthesepatientsshowsastablelow-frequencyhearingovermanyyears.AttheMedicalSchoolHannover,thosepatientsaretypicallytreatedwithshorterFLEXelectrodesof16mmand20mmlengthsandEAS.Anothergroupofpatientsarethosewithprogressiveorfluctuatinghearinglossinlow-frequencies.Thesepatientshaveahigherrisktolosetheirresidualhearingdirectlyafterimplantationorinthenextyearsafterwards.However,theircurrentresidualhearingisoftentoogoodtoalreadyaimforanelectric-onlystimulationwithalongerelectrode.Forthispatientgroupanewapproachwasused.FLEXelectrodesof24mmand28mmlengthswerepartiallyinserted16mmor20mmintothecochleathusgivingtheopportunitytoinserttheelectrodefurtherifhearingislostovertime.Methods:Toanalyzeiflessthan12contactsinsertedaresufficientforspeechunderstandingwithEAS,N=4patientswithafullyinsertedFLEX16electrodewereinvestigated.Inanacutetesting,everysecondcontactwasturned-offresultingin6activechannels,comparedto12contactsinthenormalsetting.PatientsweretestedinspeechunderstandingwithEAS.Bynow,partialinsertionofaFLEX28orFLEX24electrodewasperformedinn=4patientswithahigh-frequencyhearingloss.FLEX28electrodeinserted20mmhasbeenusedinn=1case.N=1childandN=3adultsweretreatedwithFLEX24,partiallyinserted16mm.Inallpatientstreatedatleast8electrodecontactsareactive.Differencesbetweenthepre-andpostoperativeunaidedair-conductedpuretonethresholdsinlowfrequencies(125Hz⋯1.5kHz)wereanalyzed.Freiburgmonosyllables(FBM)at65dBandHSMsentencetestinnoise(10dBSNR)wereperformed.Results:N=4FLEX16patientswithfullyimplantedelectrodesachievedthesameauditoryperformanceinEASwithasmallernumberofelectrodecontactscomparedtoallelectrodesactive.Preliminaryresultsforpartialinsertion(N=2)showanaveragehearinglossof15dBatfirstactivation.ThoseN=2patientscouldusetheirresidualhearingforEASandachieved50%inFBMand58%inHSMatfirstfitting.Conclusion:FirstresultsshowgoodhearingpreservationrateswithpartiallyinsertedFLEX28andFLEX24electrodes.Usingelectric-acousticstimulation,patientsachievedverygoodperformanceresults.ThisisinlinewiththeexperimentsdonewithFLEX16patientsandreducedactiveelectrodecontacts.Especiallyforchildrenwithaprogressivehearingloss,thisnewapproachofferstheadvantagesofanEAStreatment.Ifthehearinglossisprogressivetheelectrodecanbefurtherorfullyinsertedsothatthepatientscanthenbenefitfromlargerelectrodeinsertiondepthswithelectricstimulation.SessionID:PH-1


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SessionTitle:PosterHighlightsAbstractID:426Title:EstimationofResidualHearingUsingElectrocochleographyinChildrenwithCochlearImplantsAuthors:SarahCoulthurst,MS1,AlisonNachman,Aud1,MichaelMurray,MD1,AniketSaoji,PhD2,LeonidM.Litvak,PhD2,KanthaiahKoka,PhD2;1UCSFBenioffChildren'sHosp.Oakland,Oakland,CA,2ResearchandTechnology,AdvancedBionicsLLC,Valencia,CA.Abstract:Introduction:Incochlearimplantpatientswithpreservedresidualhearing,intra-cochlearelectrode/sfromtheimplantarraycanbeusedtomeasureelectro-cochleography(ECoG)thresholdinresponsetoanacousticpuretonestimulus.Thecochlearmicrophonic(CM)portionoftheECoGresponseisknowntocorrelatewithpuretoneaudiometricthresholdsinadultcochlearimplantpatientswithresidualhearing.ThegoalofthepresentstudywastodetermineifthresholdsestimatedbasedonCM(“CMthresholds”)canbeusedtopredictpuretoneaudiometricthresholdsinpediatriccochlearimplantpatientswithpreservedresidualhearing.Methods:Seven(meanage=7.4years,SD=4.7)AdvancedBionicspatientswithHiRes90kcochlearimplantandaHiFocusmid-scalaelectrodearrayparticipatedinthisstudy.Behavioralpure-tonethresholdsforwarbletonesweremeasuredusinginsertearphonesoverthefrequencyrangefrom125to2000Hzinninecochlearimplantearsfromsevensubjects.ECoGwaveformswererecordedonthemostapicalelectrodeoftheimplantarrayinresponsetocalibratedpuretonesandwereusedtoestimatetheCMthresholds.Results:CMthresholdsandbehavioralaudiometricthresholdscouldbemeasuredfor35(6subjectsmissing125Hzbehavioral,4testfrequenciesshownNoResponseathigheststimuluslevel)frequenciesfromtheninecochlearimplantears.Astrongcorrelation(r2=0.72,p<0.01)wasobtainedbetweenCMthresholdsandthebehavioralaudiometricthresholds.ThemeandifferencebetweentheECoGresponsesandaudiometricthresholdswas-2.6(±13.0)dB.Conclusion:CMthresholdscanbeusedtoroutinelymeasureandmonitorresidualhearinginpediatriccochlearimplantpatients. SessionID:PH-1SessionTitle:PosterHighlightsAbstractID:54Title:ImprovingDeviceUseandExposuretoDifferentListeningEnvironments:UseofDatalogginginPediatricAdvancedBionicsRecipientsAuthors:IvetteCejas,PhD,AnnieP.Rodriguez,AuD;Univ.ofMiamiDept.ofOtolaryngologyEarInst.,Miami,FL.Abstract:ImprovingDeviceUseandExposuretoDifferentListeningEnvironments:UseofDatalogginginPediatricAdvancedBionicsRecipientsIvetteCejas,PhD1&AnnieRodrguez,AuD11UniversityOfMiami,Otolaryngology,Miami,FL,USA; Introduction:Dataloggingprovidesusefulinformationregardingthechild’severydayenvironmentandusetime,whichcanimpactoverallspeechandlanguagedevelopment.Itcanbeusedtoobjectivelymeasureandcounselfamiliesregardingtheirchild’shearingaiduse(Munozetal.,2014;Laplante-Levesqueetal.,2014).Sincethisfeatureisrelativelynewincochlearimplants(Cis),littleisknownaboutitsutilityinpediatricCIusers.


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ThepresentstudyinvestigatesthecorrelationbetweenparentreportsandtheinformationobtainedfromthedataloggingfeatureintheNaidaCIQseriessoundprocessors.Thisfeatureprovidesinformationregardingachild’sdailyusage,programusage,batterytypeandlife,lossoflock,timespentindifferentlisteningenvironments,aswellasamountofusageofdifferentfeatures(i.e.,directionalmicrophones,audio-streamingdevices,etc).Thestudywillreportontwophasesofdatacollection.Methods:Deviceusageinchildrenbetween18monthsand6yearsofageisbeingevaluatedovera7weekperiod.Familiesenrolledcompleteadailyonlinesurveytocapturetheirperspectiveoftheirchild’sCIusage,wearingconfiguration,andfrequencyanddurationofdifferentlisteningenvironments(noise,quiet,music).Datalogsaredownloadedeachweekandcomparedtothedataobtainedfromtheonlinesurveyforthatweek.Thisinformationisusedtocounselthefamilyonweartimeoptimizationandlisteningenvironmentexperiencesandtodetermineifanychangesinweartimeand/orlisteningenvironmentschangedfollowingcounselingsessions.Results:Datasofar(Phase1,n=3)showthatchildren(M=3years),onaverage,spentnotimeinquiet,5%innoise,73%speechinquiet,9%speechinnoise,and14%inmusic.Followingcounselingsessions,overallimprovementswerenotedindailyusageandnumberofunlockedevents.Batterytypeandslotusagefeaturescorrelatedwithparentalreportsonthesurvey.Phasetwoofthestudywillreportdataonfiveadditionalparticipants.Datapretopostcounselingwillbecomparedtodeterminewhethercounselingusingdataloginformationchangespatternsindeviceuseandlisteningenvironments.Differencesinlisteningenvironmentsanddeviceusebasedonageand/orschoolsettingswillbereported.Conclusion:Counsellingpositivelyinfluenceddailyusage.Parentsweresurprisedtofindthatchildrenspentthemajorityoftheirtimeinenvironmentswithspeechinquietinsteadofmostlynoiseenvironments.Themostcommontopicsdiscussedduringcounselingsessionsweredailyschedule,commutetime,routinefamilyactivities,andschoolenvironment.PhaseIIwillfollowfamiliesforanadditionalweekwithamoredetailedsurveyregardingtheirlisteningenvironments.Resultswillprovidemoredetailedinformationregardingdataloggingandparentreportsoftheirchild’slisteningenvironmentsanddeviceuse.LearningObjective:•DescribephaseoneandtworesultsofdataloguseinpediatricAdvancedBionicsNaidaCIQseriesrecipients•LearnaboutpotentialchangesindeviceuseandlisteningenvironmentsfollowingcounselingutilizingdatalogginginformationDisclosureofFinancialRequirements:ThisstudywassponsoredbyAdvancedBionics,LLC. SessionID:PH-1SessionTitle:PosterHighlightsAbstractID:114Title:PerceptionofInterauralTimeDifferenceswithCochlearImplantswithaFocusontheOngoingFineStructureAuthors:TobiasRottmann,Dipl.-Ing.,ThomasLenarz,Prof.Prof.Dr.,AndreasBüchner,Prof.Dr.;DepartmentofOtolaryngology,Med.Univ.ofHannover,Hannover,Germany.


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Abstract:Introduction:Codingstrategiesforcochlearimplants(CI)whichtransferinadditiontotheenvelopeoftheincomingsignalalsotheongoingfinestructurewereintroducedintothemarketsometimeago.However,thepossibilityofbilaterallyimplantedCIuserstoperceiveinterauraldifferencesinthesignalfinestructurehasnotbeeninvestigatedindetailsofar.Inprinciple,afinestructurecodingstrategyreproducethefinetemporalinformationoftheacousticinputsignalontheelectricalside,sothatanITD(interauraltimedifference)perceptiononbasisofthefinestructurecouldbepossible.TheaimofthisstudyistoevaluatetheITDcodingeffectivenesswithastandardCIScodingstrategyandafinestructurecodingstrategy,aswellasmakingacomparisonbetweenthetwo.Methods:Forthispurpose,twobinauralstimuliwithinterauraltimedifferenceswerepresentedinalateralizationexperimenttothebilaterallyimplantedsubjects.Bothprocessorsareconnectedviathedirect-intoasoundcardofacomputerwhichgeneratesthesignals.Themethodofconstantstimuliisused,sothatsevenfixedITDsintherangeof50to600µsarerepeatedlypresented.Differentelectrodeconfigurationswithone,fourandtenactiveapicalelectrodepairsweremeasuredtoinvestigatetheeffectcrosstalktheintra-cochlearelectrodecontacts.Results:Elevensubjectswereincludedinthestudy.SevenofthesesubjectsweresensitivetoITDs.Theyshowedgoodresultswiththefinestructurestrategyinthesinusoidscondition.WiththeCISstrategyhowever,theyonlyreachedITDsintherangeofchancelevel.WiththemuchbroaderpinknoisesignalevenwiththeCISstrategyamoderateITDperceptionwasobserved,probablycausedbyITDcuesintheenvelopeoftheprocessedsignal.HowevertheperformancewiththefinestructurestrategywasbetterthanwithCISinmostofthecases.WealsoobservedthatingeneraltheITDsensitivitydecreasedwithanincreasingnumberofactiveelectrodes.Conclusion:Inthosepatients,whowereabletoperceiveITDcues(<600µs)resultswiththefinestructurestrategyweresuperiorcomparedtotheCISstrategy.However,ourpreliminaryresultsalsosuggestthatchannelinteractionbetweenintracochlearelectrodesmighthamperITDperceptioninCIsubjects. SessionID:PH-1SessionTitle:PosterHighlightsAbstractID:252Title:FactorsInfluencingSound-SourceLocalizationinChildrenwithBilateralCochlearImplantsAuthors:CatherineKillan,MSc1,AndrewScally,MSc2,CatherineL.Totten,MSc1,ChristopherH.Raine,Ch.M.1;1YorkshireAuditoryImplantService,BradfordTeachingHosp.Fndn.Trust,Bradford,UnitedKingdom,2SchoolofAlliedHealthProfessionsandSport,Univ.ofBradford,Bradford,UnitedKingdom.Abstract:Introduction:Theabilitytohearwheresoundscomefromisanimportantskillforchildreninsocial,recreationalandeducationalsettingsaswellasfortheirpersonalsafety.Clinicalassessmentsfindthatlocalizationaccuracyforchildrenwithbilateralcochlearimplantsvariesfromnear-normaltoaninabilitytolocalizeabovechancelevel.Thereasonsforthisvariationarenotyetfullyunderstood.Thisstudythereforeaimedtostatisticallymodeltheeffectsofinter-implantintervalandonsetofprofounddeafnessonsoundlocalizationinchildrenwithbilateralcochlearimplants.Methods:Theauthorsconductedaretrospective,observationalcohortstudyusingroutinelycollectedclinicaldata.Participantswere142bilaterallyimplantedchildrenaged4yearsorolderthatcompletedatleastoneofthreetests12monthsormorepost-secondimplant.Stimuliwerepre-recordedvoicesrandomlyrovedfrom65to75dB(A)in1dBsteps.Left/rightlateralizationwasassessedviatwoloudspeakersat±60°azimuth.Percent-correctscoreswerecalculatedandthesimultaneousandsequentialgroupswerecomparedviaFisher’sExactTest.Sound-sourcelocalizationaccuracywasassessedusingtwoforced-choiceprocedures;a3-choicetestwithloudspeakersat-60°,0°and+60°


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azimuthanda5-choicetestwithloudspeakersat-60°,-30°,0°,+30°and+60°azimuth.Root-mean-square(RMS)errorswerecalculated.Childrenwerecategorizedbyinter-implantinterval:Simultaneous(N=75),0to23months(N=12);24to47months(N=18);48to71months(N=16)and≥72months(N=21).Theywereclassifiedas“CongenitallyDeaf”(thresholdsof≥90dB(HL)at2and4kHzinatleastoneearfrombirth)or“Acquired/Progressive”(thresholdsinitially≤90dB(HL)at2or4kHzbilaterally,laterfallingbelowthislevel).Datawereanalyzedviamultiplelinearregressionmodelling,controllingfortimesincesecondimplant,age,manufacturerandconcentration.Results:Lateralizationdatashowedceilingeffectsandnoeffectofsimultaneousorsequentialimplantationwasseen.Sound-sourcelocalizationmodelsforboththe3-choiceand5-choicetestsfoundnosignificantdifferencebetweenthesimultaneousgroupandchildrenwith0to2yearsinter-implantinterval(p=0.323;p=0.819respectively).Inter-implantintervalof>2yearsledtogreaterRMSerror,from6.3degrees(5-choicetest;inter-implantinterval48to71months;p=0.08)to25.1degrees(3-choicetest;inter-implantinterval>72months;p<0.001).Acquired/progressivehearinglossledtobetteraccuracythancongenitaldeafnessby10.4degrees(3-choicetest;p=0.001)and5.7degrees(5-choicetest;p=0.013)RMSerror.Manufacturerwassignificantinbothmodels(p<0.001).Conclusion:Unilateralandbilateralauditorydeprivationshouldbeminimizedforchildrenwithprofoundhearinglosstomaximizetheirfutureabilitytolocalizesoundsviacochlearimplants. SessionID:PH-1SessionTitle:PosterHighlightsAbstractID:349Title:CochlearImplantationinChildrenwithBorderlineHearingLossAuthors:EunjungNa,MSc,PhD(c)1,ElizabethFitzpatrick,PhD1,JoAnneWhittingham,Msc2,JanetOlds,PhD3,RosemarySomerville,BA,LSLSCert.AVT3;1RehabilitationSciences,Univ.ofOttawa,Ottawa,Canada,2Children'sHosp.ofEasternOntarioRes.Inst.,Ottawa,Canada,3Children'sHosp.ofEasternOntario,Ottawa,Canada.Abstract:Introduction:Determiningcochlearimplantcandidacycriteriahasproventobeachallengeduetosignificantimprovementsinmedicalandtechnology.Asresult,childrenwithresidualhearingareincreasinglybeingconsideredforcochlearimplantationhowever,decision-makingcanbedifficultandtendstooccuronacase-by-casebasis.Theaimofthispopulation-basedstudywastoinvestigatecochlearimplantcandidatesinoneregionofCanadawhoseaudiologicalprofilewasbetterthantypicalaudiologiccochlearimplantcandidacycriteria.Weexaminedtheirclinicalprofilesincludingetiology,ageatdiagnosis,timetoimplantation,ageatimplantation,andpre-implantspeechperception/auditoryfunction.Inaddition,thisstudyexaminedwhethercochlearimplantationoccurredlaterforthesechildrenandthereasonsaffectinglateragesatimplantation.Methods:Inthisretrospectivestudy,wereviewedthemedicalchartsforallchildrenwhoreceivedcochlearimplantsineasternOntario,Canadafrom1993to2016.Weextractedmedicalandaudiologicinformationforallchildrenwhosepre-operativePTAthresholdwasbetterthan90dBHL.Inadditiontodegreeofhearingloss,wealsodocumentedotherfactorsrelatedtoageatimplantationfortheseborderlinechildren.Results:Atotalof348childrenunderwentcochlearimplantsurgeryfrom1993to2016intheeasternOntarioregion.Ofthese,39(11.2%)childrenhadresidualhearingwhichwasbetterthantypicalcochlearimplantcandidatecriteria.Since2010thesechildrenrepresent30to40%ofchildrenimplantedeachyear.Themedianageofcochlearimplantationforthesechildrenwas49.3months(interquartilerange:31.2,84.6)months,andthemedianpreoperativePTAwas85.0dBHL(interquartilerange:78.3,88.3).Ofthe39children,11(28.2%)presentedwithauditoryneuropathyand15(38.5%)hadknown


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progressivehearingloss.Theremaining33.3%ofthechildrenpresentedwithotherfactorsthatinfluenceddecisionmakingsuchasspeech-languagedevelopmentconcerns.Conclusions:Inthispopulation-basedstudy,11.2%ofchildrenimplantedpresentedwithhearinglevelsoutsidetypicalaudiologiccriteriaforimplantation.Primaryreasonsforproceedingwithlatercochlearimplantinterventionforthemajorityofthesechildrenwererelatedtothepresenceofauditoryneuropathyandprogressivehearingloss.SessionID:PH-1SessionTitle:PosterHighlightsAbstractID:338Title:CriticalReviewofSuprameatalApproachforCochlearImplantationAuthors:VedatTopsakal,MDPhDUniversitairZiekenhuisAntwerpen,Antwerp,Belgium.Abstract:Introduction:MastoidectomywithFacialRecessApproach(MFRA)isconsideredthereferencestandardforcochlearimplantation.TheSupraMeatalApproach(SMA)wasdevelopedmorerecentlyanddoesnotrequiremastoidectomy.Weaimtoidentifytheoptimaloperativeapproachforcochlearimplantationbasedonpostoperativecomplicationsandhearingpreservationinchildrenandadultswithasystematicliteraturereviewandaretrospectivecohortstudyforpaediatriccochlearimplantation.Methods:StudiescomparingMFRAandSMAinchildrenandadultswereeligibleforinclusionforthereview.Originalreportswithmoderaterelevanceandvaliditywereincluded.Relevanceandvaliditywereassessedusingaself-modifiedCriticalAppraisalTool.ThisreviewconcordswithPRISMAguidelines.Secondlyweassessedcochlearimplantcomplicationsinchildrenimplantedbetween1996and2014beforetheageof5yearsintheUMCUtrecht.Theseverityofcomplications(minorormajor)wasdocumentedusingHoffmanandCohencriteria.Complicationswerereportedtooccurintraoperative,earlypostoperativeorlatepostoperatively.Intraoperativesurgicalchallengeswerecorrelatedtocomplicationoccurrence.Results:Onlyretrospective,non-randomizedstudieswereidentified(Level-IIIevidence)and294citationswereretrieved.Sixarticleswereselectedforfull-textinclusionand4articleswereselectedfordataextraction.NoarticlefoundasignificantdifferencebetweenMFRAandSMAwithrespecttopostoperativecomplicationsinchildrenandadults.Onestudyfoundasignificantly(p<.023)higherpediatricMFRAmastoiditisrate,however,meta-analysisdidnotindicateanoveralleffect.Analysesofourowndatashowedanaverageage-at-implantationof2.13years(SD:1.14).SMApatientsweresignificantly(p<.001)younger(1.04years(0.55-4.2)).Mostcomplicationswereminor(MFRA:64.0%;SMA:73.1%)andoccurredearlypostoperatively(MFRA:61.5%;SMA:76.9%).MorecomplicationsoccurredinSMAcomparedtoMFRApatients(61.5%vs.20.6%;p<.001)andofteninyoungSMAcohorts(6-12and18-24months;p<.008andp=.016).EspeciallymoreinfectiouscomplicationsoccurredinSMApatients(p<.05).Logisticregressionshowedthatthesurgicaltechniqueandnottheage-at-implantationcausedinfectiouscomplicationoccurrence.Conclusion:NoevidencewasidentifiedinexistingliteratureforlowercomplicationratesbetweentheMFRAorSMAforcochleairimplantationinchildrenandadults.Pediatricdatawereonlyavailableforchildrenimplantedabovetheageof24months.ThereisaneedforLevelIevidencetoresolvethearoundpostoperativeoutcomesofSMA.Significantlymore(infectious)complicationsoccurredinyoungcochlearimplantpatientswhenowndatawereanalysed.Becauseyoungchildrenarepronetodevelopacuteandserousotitismediamastoidectomy(MFRA)couldhaveaprotectiveeffectinthispopulation. SessionID:PH-1


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SessionTitle:PosterHighlightsAbstractID:508Title:Electrically-evokedABR(EABR)forPotentialABICandidatesviaEndoscopically-guided,DirectRoundWindowStimulationAuthors:JohnGermiller,M.D.,Ph.D.1,LuvR.Javia,M.D.1,DanielJ.Lee,M.D.2;1Otolaryngology,Children'sHosp.ofPhiladelphia,Philadelphia,PA,2Otolaryngology,MassachusettsEyeandEarInfirmary,Boston,MA.Abstract:Introduction:Electrically-evokedABR(EABR)testingcanevaluatecochlearnerveresponsestoelectricalstimulation,andcanbeusedinchildrenwithcochlearnervedeficiencytoassessnervestatuspriortoCIorABI.Historically,electricalstimulationhasbeendeliveredbyatranstympanicneedleelectrodeplacedonthecochlearpromontory.However,precisepositioningcanbesomewhatuncertain,sinceitisnotdoneunderdirectviewofthemiddleear.Alsoinprinciple,suchstimulationmightbeattenuatedbyvariationsincochlearanatomyandbonethickness.InanefforttomorecloselysimulatethedirectstimulationofcochlearfluidsprovidedbyanactualCI,wehavebegunperformingEABRviadirectstimulationoftheroundwindow(RW)membraneunderendoscopicguidance.Wereportresultsfromourfirst10patients.Methods:EABRwasperformedunilaterallyin4childrenandbilaterallyin6(total16ears;medianage24mo).Allhadapparentcochlearnerveaplasiabasedonparasagittalmagneticresonanceimaging(MRI)viewsoftheinternalauditorycanal.Themiddleearwasaccessedbytranscanaltympanotomy.Underendoscopicvisualization,a1-mmball-tipprobewasplaceddirectlyontheRWmembranetostimulatefluidsofthescalatympani.NerveresponsesweremeasuredbywaveVonEABR.Forcomparison,EABRsweregeneratedundertraditionalstimulationofthebonycochlearpromontory,witheitherneedleorblunttipprobes.Results:StimulationandEABRmeasurementwassuccessfulusingbothmethodsinall16ears,andtherewerenocomplications.In14ears,noresponsesweredetectablebyeithermethod,consistentwithcochlearnerveaplasia.OneofthesepatientssubsequentlyunderwentABI,duringwhichnerveaplasiawasconfirmed.Theremaining2earshadmeasurableresponsesbybothmethods.Inbothcases,responsesweredetectableatlowerthresholdsviaRWstimulationthanviapromontorystimulation(450-700vs.700-900microamperes).Conclusion:Direct,endoscopic-guidedelectricalstimulationviatheRWmembraneissafeandeffectiveforelicitingEABRresponses,andmayresultinimproveddetectionofsmallresponsesinpatientswithseverecochlearnervehypoplasia.AsABIsurgeryisinvasivewithvariableoutcomes,improvingthesensitivityofEABRtestingiscrucialtodeterminethepresenceofafunctionalcochlearnerveinthesettingofequivocalanatomyonMRI. SessionID:PH-1SessionTitle:PosterHighlightsAbstractID:326Title:HearingPerformancewithDifferentGenerationsofFineStructureStrategiesAuthors:TobiasRottmann,Dipl.-Ing.,ManfredSchwebs,B.Sc.,ThomasLenarz,Prof.Prof.Dr.,AndreasBüchner,Prof.Dr.;DepartmentofOtolaryngology,Med.Univ.ofHannover,Hannover,Germany.Abstract:Introduction:Codingstrategiesofcochlearimplantsystemsconcerningtheirperformanceinspeechunderstandingcouldbeconstantlyimprovedoverthelastdecade.TheclassicCIS(ContinuousInterleavedSampler)strategystillformsthebasisformanyCIcodingstrategies.Basedonthisbasicprinciple,MED-ELhasbeendevelopeddifferentgenerationsoffinestructurecodingstrategies.Therewithbetterlow-frequencyiscodedbydynamicallyadaptingthestimulationrateonthemost


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apicalchannelsdependingontheincomingacousticsignal.ThefirstgenerationofthefinestructurestrategiesiscalledFSP(FineStructureProcessing)whichtheoreticallyofferedratepitchinformationonthreebutonaverageonlyontwofinestructurechannels.Tobeabletoguaranteefinestructureprocessingonfourapicalchannelsregardlessofmappingparameters,amoreadvancedversion,FS4,hasbeendeveloped.Furtheroptimizationproceduresleadtothenewestiterationoffinestructureprocessing,theso-calledFS4HRstrategy.HRstandsforHighRateandoffersanincreasedstimulationrateinthenon-finestructureCIS-typechannelsincontrasttoFS4LR(LowRate).Theaimofthetwostudiespresentedherewastocomparespeechperceptionoutcomesofthethreefinestructureimplementationsmentionedabove(FSP,FS4LRandFS4HR).Methods:15subjects(1ststudy)and20subjects(2ndstudy)withaminimumageof18yearsandaminimumhearingexperienceof6monthswiththeFS4LR(1ststudy)andwiththeFSP(2ndstudy)strategyhavebeenrecruited.Allsubjectswererequiredtoyieldaminimumscoreof20%intheHSMsentencetestinnoisetobeabletoparticipateinthestudies.WithinbothstudiesspeechtestswereconductedrightbeforeandafterswitchingthesubjectsfromFS4LRtoFS4HR(1ststudy)andfromFSPtoFS4HR(2ndstudy),respectively.Inthe2ndstudyacontrolgroupwasincludedkeepingtheFSPstrategyforthreemonths.TestingmaterialconsistedoftheOldenburgsentencetestinnoise,theHSMsentencetestinnoiseandtheFreiburgmonosyllabicwordtest.Thecompletetestbatterywasrepeatedthreemonthsaftertheswitch-overagainforbothstrategiesinbothstudies.Results:ThefinaldataoftheFS4LRandFS4HRcomparisonshowssignificantlybetterresultsfortheFS4HRstrategyintheFreiburgmonosyllablesandintheOldenburgsentencetest.PreliminaryresultsoftheFSPandFS4HRcomparisonshownosignificantdifferences.Conclusion:ThefinaldataoftheFS4LRandFS4HRcomparisonshowssignificantlybetterresultsfortheFS4HRstrategyintheFreiburgmonosyllablesandintheOldenburgsentencetest.PreliminaryresultsoftheFSPandFS4HRcomparisonshownosignificantdifferences.Onthebasisofthecurrentstudyresults,itseemsviabletogivearecommendationfortheuseofbothFS4HRandFSPinthedailyclinicalroutine.Furtherstudyresultsmayshowifoneofthesestrategieswouldbegenerallypreferable. SessionID:PH-1SessionTitle:PosterHighlightsAbstractID:199Title:DevelopmentofaParentingStressModuleforCaregiversofSchool-AgeChildrenwithCochlearImplantsAuthors:AlexandraL.Quittner,PhD1,MichaelF.Hoffman,MS2,IvetteCejas,PhD3;1BehavioralHlth.SystemsRes.,MiamiBeach,FL,2Psychology,Univ.ofMiami,CoralGables,FL,3MillerSchoolofMedicine,Univ.ofMiami,Miami,FL.Abstract:Introduction:Severalstudieshaveshownthatparentsraisingchildrenwithseveretoprofoundhearinglossesreporthigherlevelsofstressintheirparentingrolethanparentsofhearingchildren(Quittneretal.,2010).Acondition-specificfamilystressscalewasdevelopedintheearly1990s,priortotheavailabilityofcochlearimplants(CIs)(FamilyStressScale,FSS;Quittneretal.,1990),whichindicatedthatcommunication,discipline,safetyandeducationalplacementwereamongthemoststressfulparentingtasks.Higherparentingstresswasalsosignificantlyrelatedtolanguagedelaysandbehaviorproblems.DuringthedevelopmentofthefirstCI-specific,health-relatedqualityoflifemeasures,focusgroupparticipants(e.g.,teachers,speechpathologists,surgeons)andindividualparentinterviewsindicatedthatparentsexperiencefrequentandchallengingstressorsuniquetotheirchild’shearingloss


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anduseofaCI.Thus,ourobjectivewastodevelopamodulethatreliablymeasuresthistypeofcontextualparentingstress.Methods:Focusgroupsconsistingofhealthcareproviders(e.g.,audiologists,otolaryngologists)attwocochlearimplantcentersandprofessionalsatoneuniversity-basedschoolwereaskedaboutstressorsrelatedtoparentingachildwithaCI.TwentyparentsraisingachildwithaCI,ages6to12years(Mchildage=9.2years,SD=1.87),completedasemi-structuredinterviewlasting45-50minutes,whichwasaudiotapedandtranscribedforcontentanalysisusingNVivo.Nineitemsweregeneratedfromthisfirstqualitativephase,withfollow-upcognitivetesting.Duringthisphase,parentsratedthenineitemsona4-pointLikertratingscale(extentofstressorconcern),withscoresstandardizedona0-100scale;lowerscoresindicatedhigherlevelsofparentingstress.Results:Parentsinthecognitivetestinggroupweremostlymothers(90%),with50%havingcompletedacollegedegree,85%caringforanotherchildinthehome.Werecruitedparticipantswitharangeofracesandethnicities(65%White,non-Hispanic;15%African-American,15%Hispanic,and5%Asian).Importantly,10%offamiliesreportedthatSpanishwastheprimarylanguagespokenathome.StandardizedscoresontheParentingStressModulerangedfrom20.83(highstress)to85.19(lowstress),withanaveragescoreof58.33.Parents’highestratedstessorsincluded:1)CI/sbreaking;2)CI/sgettinglost;3)childhurtduringsports.Discussion:Qualitativedatafromhealthcareprofessionalsworkingwithschool-agechildrenwithCIs,andparentswhowereraisingthem,reportedanumberofspecificstressorsaffectingtheparentingrole.Nineitemsweregeneratedandratedbycaregiversin20familiesattwocochlearimplantcenters,yieldingawiderangeofparentingstressscores.Themesincludeddecisionsabouteducationalplacement,CIsbreakingorgettinglost,andthereactionsofotherstothechild’sCI/s.Nextstepsincludepsychometricevaluationofitsreliabilityandvalidity.Awell-validatedparentingstressmeasure,whichtakeslessthan5-minutestocomplete,couldbebothakeyoutcomemeasuretoassessfamilyadaptationtoschool-agechildren’suseofCIsandaclinicallyusefulmeasuretoguideandevaluateparent-childinterventionsinthispopulation. SessionID:PH-1SessionTitle:PosterHighlightsAbstractID:119Title:AetiologyandOutcomesinPaediatricReimplantationAuthors:ChristopherRaine,MB.BS.,FRCS.,ChM.,JaneMartin,MED,CatherineTotten,MSc.,IqbalKhan,FRCS,DavidStrachan,FRCS;DeptOtolaryngology,YorkshireAuditoryImplantService,Bradford,UnitedKingdom.Abstract:Introduction:Cochlearimplantsareoneofthemostsophisticatedandreliabledevicesinsertedintothehumanbody.Despitebeingconstructedtoveryhighspecificationsthehumanbodyisa‘hostile’environmentforelectroniccomponents.Variousreasonsforimplantfailurehavebeenrecognized.Itisessentialthatsuchfailuresarerigorouslyreportedandthereneedstobecloseco-operationwithmanufacturersinordertocontinuetoimprovedesign.Methods:Allpatients’demographicsandoutcomesareprospectivelyenteredintoourdepartmentaldatabase.Thisallowsforretrospectiveevaluationofoutcomes.Between1991and2016-559childrenhavebeenimplantedwithbilateralimplantationbeingtheroutinesince2009(atotalof747implants).Thedatacollectedincludedageofinitialimplantationandsubsequentfailure,surgicaldetails,preandpostoperativeassessmentsand,whereappropriate,CategoriesofAuditoryPerformance(CAP)&MeaningfulAuditoryIntegrationScale(MAIS),withaminimumof6monthspostoperativefollowupafterre-implantation.Reasonsforimplantfailure,onceofficialreportshadbeenreceivedfromthecompanies,wereclassifiedaccordingtotheEuropeanConsensusStatement


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Results:Of747implants55episodeswereidentified(7.36%)-13withbilateralCI;42unilateral.Datawasavailableforallbilateralandin39oftheunilateralcases.1childwasnotreimplanted;7childrenhadinsufficientdataorhadmovedawayfromourservice.Therewerenosurgicalcomplications.Statisticallythe13bilaterallyimplantedchildrenshowedcontinuedimprovementwithapositivecorrelation(0.89).3patientsregressedonCAPscoreforashortperiodhoweverthemajority(36)remainedstaticorimprovedwithapositive(correlation0.88).MAISschoolscoresshowedpositiveimprovement.Withregardtotheoverallcauseofre-implantation;5.5%relatedtoinfectionand/orextrusion;9%relatedtoimplantperformance;9%withdecrementlossofperformancerelatedtotrauma;76.5%relatedtodevicefailure.Ofthelattergrouptherewasaclearhistoryoftraumain20%;Youngerimplanteeswithahistoryoftraumaweremorepronetofailure(p=0.023),similarlytheageatfailurewasrelatedtotrauma(p=0.035).Conclusion:Whilstsuddenfailureisusuallyquicklydiagnosedagradualdecrementaldeclinecanbeverydifficulttoidentifyinyoungerchildren.Ifimplantedchildrenarefailingtoprogressthenimplantintegrityshouldbetested.Surgicalreimplantationissafeandifperformedassoonaspossibleproduceslittlelossinfunction.Singlesidedimplanteesdoremainstableorcontinuetoprogressandallbilateralimplanteesprogressed(astheyretainedonefunctioningimplant).Traumainyoungchildrenisasignificantcontributoryfactordespitetherobustengineeringofimplants. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:368Title:LanguageSamplingPracticeswithChildrenwhoareDeafandHardofHearingAuthors:MeganShannahan,B.S.,KristinaBlaiser,PhD,CCC-SLP;CommunicationSciences&Disorders,IdahoStateUniv.,Meridian,ID.Abstract:Introduction:Languagesamplingcanbeaninvaluabletoolforspeech-languagepathologiststoassessthecommunicativeoutcomesofchildrenwhoareDeaf/Hard-of-Hearing.Thisisparticularlyimportantas,inisolation,normreferencedassessmentsarenotsensitivetoidentifyerrorpatternsintheuseoromissionofhighfrequencynounandverbmorphology,errorsthatarecommoninchildrenwithhearingaidsandcochlearimplants.However,arecentstudyreportsthatprofessionalswhoworkwithchildrenwithcochlearimplantsdonotfrequentlyuselanguagesamplingandmostoftenusestandardizedassessmentsandcheckliststoevaluateandmonitorprogressofchildrenwithcochlearimplants(Neussetal.,2013).Thepurposesofthisstudyisto1)identifycommonlanguagesamplepracticesofprofessionalswhoworkwithchildrenwhoareDHH,2)identifyhowprofessionalsareusinginformationgainedfromlanguagesamplesand3)outlinecommonpracticesandproposeaclinicalprotocolforlanguagesampleuseMethods:Anelectronicquestionnairewasdisseminatedtoaudiologists,SLPsandEducatorsoftheDeafintheUnitedStates.ParticipantresponseswerecodedinanExcelfileandcheckedforcompleteness.DescriptivestatisticswereusedtoanalyzetrendsResults:Atotalof168participantsparticipatedinthesurvey(16.8%responserate).Approximately77.3%(n=129)ofparticipantsreportedthatover75%oftheircaseloadwaschildrenwhoareDHH.Additionally,75%(n=123)oftheparticipantsreportedthattheyhadworkedwithchildrenwhoareDHHforover10years.Mostparticipants(n=153;91.6%)reportedthattheyuselanguagesamplingasapartoftheirinterventionwhenworkingwithchildrenwhoareDHH.Despitethis,approximatelyhalf(n=63;51.2%)ofparticipantsreportedusingnorm-referencedtestingmostoftenwhenevaluatinglanguageofchildrenwhoareDHH.Whenaskedhowtheyuseinformationobtainedfromlanguagesamples,participantsreportedmostoftentomonitorprogressofclients(n=79;62.7%),andtosetgoalsforclients(n=75;60.0%).Participantsoverwhelminglyagreedthattheyfoundlanguagesamplesusefulwith


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thepopulationstheyserve(n=130;94.9%)andthattheycouldofferinformationthatnorm-referencedassessmentscouldnotprovide(n=133;97.1%),despitethembeingmostpopularlyusedforevaluationofchildrenwhoareDHH.However,despitetheseadvantages,theywereleastlikelytouseinformationobtainfromlanguagesamplestodetermineeligibilityofservices(n=27;23.0%).Conclusion:Resultsfromthecurrentstudyreflectthatmostrespondentsbelievelanguagesamplesofferauniquelookintoachild’slanguagedevelopmentthatnorm-referencedassessmentsarenotsensitiveenoughtodetect.Despiteprofessionals’frequentuseoflanguagesamplestoevaluatelanguageabilitiesandmonitorprogress,thelackofstandardizationmaycontributetotheincreaseduseofnorm-referencedtestingtodetermineeligibilityforchildrenwhoareDHH.ItisproposedthattheresultsofthisstudymayhelpestablishastandardizedlanguagesampleprotocolthatwouldguidepracticesintheuseoflanguagesampleswithchildrenwhoareDHH. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:487Title:IntraoperativeElectrocochleography(ECochG)inResponsetoAcousticStimulusUsingtheCochlearImplantElectrodeArrayandPost-activationSpeechOutcomesAuthors:RobertT.Dwyer,AuD1,JourdanHolder,AuD1,BrendanP.O'Connell,MD2,GeorgeB.Wanna,MD2,MarcL.Bennett,MD2,AlejandroRivas,MD2,DavidS.Haynes,MD1,RenéHGifford,PhD1,RobertF.Labadie,MD2;1HearingandSpeech,Vanderbilt,Nashville,TN,2Vanderbilt,Nashville,TN.Abstract:Introduction:Evenwithimprovementsincochlearimplant(CI)technology,largevariabilityinspeechunderstandingoutcomesexists.DurationofdeafnesshasconsistentlybeenmostshowntobetheprimaryvariableaffectingoutcomesinCIlisteners—primarilydrivenbytheextremeendsofthefunction.Fitzpatricketal.(2014)recentlyshowedhighpredictivevalueofelectrocochleography(ECoG)onCNCwordrecognitioninadultCIusers.TheprimarypurposeofthisstudywastodeterminethefeasibilityofmeasuringintraoperativeECochGinresponsetoacousticstimulususingtheelectrodearrayandsecondly,tocorrelatethiswithpost-activationoutcomes.Methods:28adultpatientswithnormalcochlearanatomyundergoingcochlearimplantationwithanAdvancedBionicsMid-Scaladevicewerestudied.Acoustictonebursts(125Hz,250Hz,500Hz,1000Hz,and2000Hz)werepresentedtotheoperativeearviafoaminsertearphoneafterelectrodeinsertion.ECochGresponseswererecordedusingtheimplantelectrodearray.Results:ECochGresponsesweresuccessfullymeasuredin27/29(93%)earsusingtheelectrodearray.Therangeofthetotalresponse(TR)measuredwas55dB.NosignificantcorrelationbetweenthemagnitudeoftheTRandpost-operativeCNCwasobservedfor11earsreachingthe3-monthtimepointatthetimeofabstractpreparation(p>0.05).FurtherwefoundnocorrelationwithCNCwordscoreanddurationofhearingloss,ageatimplantation,pre-CIsentencerecognition,norcognitivestatus(MMSE).Conclusion:ECochGcanreliablybemeasuredinmostCIpatients.Responsestoacousticstimuliweresuccessfullymeasuredin27/29(93%)ofdeviceinsertions.Lossoflockononedeviceandakinkedstimulusdeliverytuberesultedinlostdatafortheremaining2cases.PreliminaryfindingssuggestthatECoGmagnitudeobtainedintraoperativelyfollowingelectrodeinsertionisnotcorrelatedwithwordrecognition;however,the11patientshadnotyetreachedexpectedperformanceasymptoteatthetimeofabstractpreparation.Wewillcontinuelongitudinalassessmentwithadditionalanalyses. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:102


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Title:AttentiontoInfant-directedSpeechinDeafInfantswithCochlearImplantsAuthors:YuanyuanWang,Ph.D.1,TonyaBergeson,Ph.D.2,ShanaLucius,MA3,DerekHouston,Ph.D.1;1Otolaryngology,TheOhioStateUniv.,Columbus,OH,2TheUrbanChalkboard,Carmel,IN,3NationwideChildren'sHosp.,Columbus,OH.Abstract:Introduction:Veryyoungnormal-hearing(NH)infantspreferandlearnbetterfrominfant-directedspeech(IDS)overadult-directedspeech(ADS)(e.g.,Cooper&Aslin,1990;Fernald,1985;Maetal.,2011;Singhetal.2009),becauseIDStendstoexhibitexaggeratedacoustic-prosodicproperties,suchasslowerspeakingrate,higherpitch,widerpitchrange,andlongerpauses,relativetoADS(FernaldandSimon,1984;Fernaldetal.,1989;Werkeretal.,1994).Infantswhoreceivecochlearimplantations(CIs)mayshowdifferentsensitivitytoIDSversusADSduetoearlyauditorydeprivationanddegradedauditoryinputafterwards(Geersetal.,2011;Holtetal.,2012;Pisonietal.,2000).Forexample,inonestudywefoundthatCIinfants’sustainedattentiontospeechdifferedfromthatofNHinfants(Yangetal.,inpreparation).Therefore,thepurposeofthepresentstudywastodeterminewhetherinfantswithCIs,liketheirNHpeers,preferlisteningtoIDSoverADS.Methods:Usingthecentralfixationprocedure,wetested46infants-12prelinguallydeafinfantswhoreceivedCIsbefore2yearsofage(meanchronologicalage=27.24months;meanhearingage=11.88months;CIgroup),22NHinfantswithmatchedhearingexperience(mean=11.68months;NH-HEMgroup),and12NHinfantswithmatchedchronologicalage(mean=27.55months;NH-CAMgroup)-ontheirlisteningpreferenceinthreeblocks:IDSvs.ADS,IDSvs.Silence,andADSvs.Silenceblock(thelasttwoservedasbaseline).Wecalculatedtheaveragelookingtimestodifferenttypesofstimuli(IDS,ADS,orSilence)withineachblockforeachinfant.ToassessCIinfants’developmentallanguageskills,weadministeredthePreschoolLanguageScale(PLS;Zimmerman,Steiner,&Pond,2002)approximately18monthsafterimplantation.Results:IntheIDSvs.ADSblock,boththeCIandNH-HEMgroupspreferredIDSrelativetoADS,p=.010andp=.003,respectively;however,theNH-CAMgrouplookedequallylongtoIDSandADS;intheIDSvs.Silenceblock,allthethreegroups,ingeneral,lookedsignificantlylongertoIDSthantosilence,p<.001.IntheADSvs.Silenceblock,boththeNH-HEMandNH-CAMgroupslookedsignificantlylongertoADSrelativetosilence,p=.001andp=.019,respectively;however,theCIgroupdidnotshowanypreference,seeFigure1.TheregressionanalysesdemonstratedthatCIinfants’IDSpreferencequotient(calculatedbydividingtheaveragelookingtimedifferencestoIDSandADSbythetotalamountoflookingtimetobothIDSandADSforeachCIinfant)intheIDSvs.ADSconditionwasthesinglebestpredictorofPLSAuditoryComprehension,p<.001,andPLSExpressiveCommunication,p=.052.Conclusion:Theresultsshowedthat1)similartoNH-HEMcontrols,CIinfantspreferIDSoverADS;and2)thedegreeofIDSpreferencepredictslanguagedevelopmentinCIinfants.ThesefindingssuggestthatinfantswithCIsmayhaveaccesstotheinformationprovidebyIDSforthepurposeoflanguageacquisition.Theymayalsoinforminterventionstrategiesbyindicatingwhatkindofinputismosteffectivefordeafinfantstoattainage-appropriatelanguageskills. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:148Title:EvaluationofanAutomaticSystemtoRecordandAnalyzeElectricallyEvokedCompoundActionPotentialsAuthors:LutzGaertner,PhD1,AndreasBuechner,PhD1,ThomasLenarz,MD1,KonradE.Schwarz,PhD2,StefanB.Strahl,PhD2,AngelikaDierker,PhD2,PhilippSpitzer,PhD2;


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1DepartmentOfOtolaryngology,HannoverMed.Sch.,Hannover,Germany,2R&D,MED-ELGmbH,Innsbruck,Austria.Abstract:Introduction:Themeasurementofelectricallyevokedcompoundactionpotentials(ECAP)providesabasisforprogrammingthespeechprocessorofacochlearimplant(CI)especiallyinveryyoungchildrenwhocannotgivesufficientfeedbackabouttheirhearingimpressions.AnovelautomaticECAPrecordingsystemwhichisbasedonacombinationofinformationthatwasunusedsofarinstandardclinicalsoftwarewasevaluatedagainsthumanexperts.Methods:In21cochlearimplants234measurementsoftheamplitudegrowthfunction(AGF)havebeentakenusinganewrecordingparadigmwherethecurrentamplitudewasincreasedinquasi-continuousstepsanddifferentrecordingelectrodeshavebeenused.FiveexperiencedaudiologistsdeterminedtheECAPthresholdinthesemeasurements.TheresultswerecomparedtoanewautomaticanalysismakinguseofaphysiologicalbasedECAPclassifierbasedonfiringprobabilityoftheauditorynerve.PeakpickingoftheN-andP-peaksoftheECAPresponsewereimprovedbysurfaceanalysisoftheAGF.ThresholdestimationwassupportedbyfittingasigmoidalmodeltotheAGF.Results:Pearson’scorrelationcoefficientrbetweenthethresholdsestimatedbythehumanexpertsandtheautomaticsystemwasintherangeof0.78to0.91withamedianof0.83.ThecorrelationcoefficientRbetweenthethresholdsestimatedbydifferenthumanexpertswasintherangeof0.84to0.92withamedianof0.88.Conclusion:ThenovelautomaticECAPrecordingsystemleadstothresholdswithinthoseestimatedbyhumanexperts. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:376Title:InfluencesofWorkingMemoryonHearingAbilitiesinCochlearImplantUsersAuthors:HannaBoenitz,M.Sc.1,BjoernLyxell,Professor2,ThomasLunner,Professor3,AndreasBuechner,Professor1,BrunoKopp,Professor4,MareikeFinke,PhD1;1DepartmentofOtolaryngology,HannoverMed.Sch.,Hannover,Germany,2LinköpingUniv.,Linköping,Sweden,3EriksholmRes.Ctr.,OticonA/S,Snekkersten,Denmark,4DepartmentofNeurology,HannoverMed.Sch.,Hannover,Germany.Abstract:IntroductionWorkingmemoryappearstobeanimportantcontributortospeechunderstanding.The“Easeoflanguageunderstanding”modelbyRönnbergandcolleagues(2013)statesthatindifficultlisteningsituations(e.g.withacochlearimplant(CI))theworkingmemoryisneededtocompensatethemismatchbetweentheheardwordandthestoredwordpattern.Inourstudyweaimedtoinvestigatetheinfluenceofauditorydistractionontheworkingmemorycapacity,whilebeingengagedinavisualworkingmemory/n-backtask.Weinvestigatedadultcochlearimplant(CI)usersbymeansofelectroencephalography(EEG).MethodsThirteenadultCIusersweretestedinthisstudy.TheEEGwasrecordedwhiletheparticipantsperformedavisualn-backtask.Participantswerepresentedwithasequenceofnumbers.Intheeasiestcondition,theparticipantshadtodecideifthenumberwasoddoreven.Inthemorecomplexconditions,participantshadtocomparethepresentnumbereithertothepreviousortheprevioustolastnumber,dependingontheloadconditionofworkingmemory.Bymeansofabuttonpress,theyhadtoindicatewhetherthetwonumberswereidentical.Duringthevisualtask,additionalauditorydistractorstimuliwerepresented.Participantswereinstructedtoignorethosestimuli.Auditorystimuliincludedstandardandnovelsounds(25%).Thenovelsoundsconsistedofdifferentenvironmental


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sounds.Duetotheexperimentalsettingwecouldanalyzeauditoryevent-relatedpotentials(ERPs;N1aud,Novelty-P3),visualERPs(N1vis,Target-P3)andvisualERPsfollowinganovelorastandardtone.TheanalysisofthelatterERPsofferstheopportunitytoinvestigatetheinfluenceofauditorydistractiononthetaskperformance.ResultsBehavioralresultsindicateslowerandlessaccurateresponsesinthehigherloadconditions.Additionally,theresponsesfollowinganoveltoneweresignificantlyfastercomparedtothestandardtones.ThesensoryauditoryERPs(N1aud)suggestreducedamplitudesforthemoredifficultconditionandadditionallyshowedreducedamplitudesinresponseofastandardtonecomparedtoanoveltone.TheearlyvisualERPs(N1vis)alsoshowedarelationtoworkingmemorycapacity:asthetaskdemandsincrease,theamplitudedecreases.Thepost-perceptualvisualERPs(Target-P3)showedau-shapedrelationinregardtolatency.Preliminaryresultsregardingtheeffectsofdistractiondisplayedaninfluenceofworkingmemoryaswellastypeofstimulation.Visualresponsesfollowingthenovelstimuliwereincreasedtostandardtones.ConclusionBehavioralandalsovisualresultsindicatethatCIusersshowaworkingmemorymanipulation.ThereducedamplitudesoftheauditoryERPssuggestaninfluenceofworkingmemoryonhearing-notonlyforspeech,butalsofortonalstimuli.Behavioral,butalsoelectrophysiologicalresultsindicateafacilitationeffectratherthanadistractioneffectofthenovelsounds.ThenoveltonemaycauseanunspecificstateofreadinesswhichmightleadtoamodulatedERPsresponse.AllinalltheseresultsunderlinetheroleofcognitioninhearingwithCIs.FurtherinvestigationswillbeconductedincludingattemptstoalsoexpandtheseresultstoCIimplantedchildren. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:35Title:AuditoryNeuropathySpectrumDisorder:ProposedProfilesforImprovedAudiologicManagementAuthors:AlisonJ.Nachman,AuDAUDIOLOGY,UCSFBENIOFFCHILDREN'SHOSPITALOAKLAND,OAKLAND,CA.Abstract:AlisonNachman,AuDAbstract-TITLEAuditoryNeuropathySpectrumDisorder:ProposedProfilesforImprovedAudiologicManagementOBJECTIVES:Thisproposalcallsforacategorizationofauditoryneuropathyspectrumdisorder(ANSD)intosubtypesorprofilesbasedonetiologyinordertoassistwithaudiologiccareandmanagement.ChildrenwithANSDrepresentnotonetype,butaspectrumofdisordersorprofiles.Researchsupportsthemanagementandaudiologicoutcomesdifferbasedontheproposedsubtypes.WithfurtherclarificationonguidelinesformanagementofchildrenwithANSDwithmorespecificcategories,audiologistscanprovideimprovedcare.WithadeeperunderstandingofANSDsubtypes,improvedcarecanincludefasterreferralstocochlearimplantprogramswhenappropriatetoavoidunnecessarydelaysinspeechandlanguagedevelopment.METHODS:LiteraturereviewofANSDdescriptionandmanagement.Inaddition,currenthospitaldatabaseofchildrenwithANSDwithretrospectiveanalysisofcareandmanagement.RESULTS:


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UtilizingANSDprofiles,coupledwithcurrentGuidelinesforthemanagementofchildrenwithANSD,clinicianscanfollowamoreprecisemethodologytodeterminenextstepsinmanagementandcare.WhenchildrenwithANSDareprofiledbytheirmedicalhistoryorlackthereof,morespecificprotocolscanbeusedinadditiontothecurrentGuidelinesforIdentificationandManagementofInfantsandYoungChildrenwithAuditoryNeuropathySpectrumDisorder(2008).Previoussubtypeshavebeenproposedbasedonauditoryresponses,however,withmorespecificinformationregardingtheANSDprofile,onewouldnothavetowaituntilbehavioraltestingcanbeobtainedtoprovidethefamilywithprojectedpathwayforauditorymanagementandcare.Proposedsubtypesincludea.)Geneticetiology,b.)GeneticSyndromes(CharcotMarieTooth,Friedrich’sAtaxia,etc.)c.)Prematurity,d.)Hyperbilirubinemiae.)Unknownetiology(notpremature,nogeneticcomponentidentified,nootherperipheralneuropathies,nointra-cranialanomalies,andnormalneuralanatomy,)andlastlyf.)Anatomicetiology(cochlearnervehypoplasiaoraplasia).SpecificguidelinesformanagementareprovidedbasedontheANSDprofiles.ByprovidingaGuidelinefortypicaloutcomesbasedonthesuggestedprofiles,audiologistswillinturnbeabletoprovideimprovedmanagementandcareofthesepatientsandtheirfamilies.CONCLUSIONS:BydescribingchildrenwithANSDintosubtypesorcategories,audiologistscanprovidefamiliesandtherestofthemedicalteamwithamoreconfidentpathwayforthecareandmanagementoftheseoftencomplicatedcases.Withcompoundingyearsofexperienceofworkingwiththispopulation,professionalscanbetterhelptoserveandguidefamiliesalongthisjourney.ByofferingfamilieswithaprojectedpathwayofcarebasedonANSDprofilesthatismoredefinitivethanwhatisusuallyofferedtofamilies,delaysmaybeavoided. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:328Title:FirstExperienceWithANewThinLateralElectrodeArrayAuthors:ThomasLenarz,M.D.Ph.D.,NilsPrenzler,M.D.,RolfSalcher,M.D.,AndreasBuechner,Ph.D.;DepartmentofOtorhinolaryngology,HannoverMed.Sch.,Hannover,Germany.Abstract:Introduction:Tobeviable,anewcochlearimplant(CI)electrodearraydesignmustcombine:improvedsurgicaleaseofuse,structurepreservation,particularlyimportantforpaediatricapplication,resistbackingoutofthecochleaandbalancehearingpreservationagainstaddressingsufficientcochleartissuetosupportelectrical-onlyhearing.Methods:Thenewelectrodearraywasdesignedtakingaccountofthedetailed3-dimensionalvariabilityanalysedfrom20microCTscansofhumancochleae.Itbuildsonpositiveexperiencewithamid-scalaarraybuthasonlyaslightcurvature,beingdesignedtotakealateralscalatympaniposition.Throughfourmajordesigniterations,manualandautomatedinsertionexperimentsona3-dimentionalforcemeasurementsystemalloweddifferentialstiffnesstobetunedsuchthatinsertionforcesofunder60mNwereachieved.Thefinaldesigntestedhereis23mmlong,varyingfrom0.25x0.55mmatthemostapicalcontactto0.6x0.8mmattheproximalmarkercontact.Toconfirmtheabovedesignobjectives,10arrayswereimplantedinfreshlyfrozenhumantemporalbones.Theinsertionsweremadeusingacombinationofpureandextendedroundwindowapproaches.Surgicalaccesswasrealistic,includingthefacialrecess.Tostabilizethearray,achannelwascarefullydrilledinthefacialrecesstoaccommodatetheelectrodelead.Eachimplantedbonewasvibratedtoassessresistanceagainstextrusion.BothmicroCTandhistologicalanalysiswereconducted.Results:Foreachboneitwaspossibletoinsertall16stimulatingelectrodecontacts,withinsertionbeingstraightforwardinallcases.Intwocasestheroundwindowwasdeliberatelyextendedtoimprove


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access.Notranslocationswerefound.Ameaninsertiondepthof405degreeswasachieved.Therewasnodifferenceineither,easeofinsertion,orinsertiondepth,forextendedorpureroundwindowapproaches.Nobackingoutwasobservedduringthebriefagitationandvibrationofeachimplantedbone.Conclusion:Thenewarrayappearswellsuitedtoclinicalapplication,particularlywhereasimpleone-handedinsertiontechniqueisdesired.Itssmalldimensionsallowflexibilityforcochleostomy,aswellasextendedorpureroundwindowapproaches.Theinsertiondepthachievedissufficienttosupportelectricalonlyhearing,withaslightlydeeperinsertionlikelyinclinicalpractice.Withminimaltraumaobservedinthisseries,ourintentionisnexttostudyhearingpreservationwiththisarray. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:52Title:OptimizingCIProgrammingusingClinicalMethodsofElectrodeDeactivationAuthors:SarahW.Kennett,Au.D.,Ph.D.Candidate1,SamuelR.Atcherson,Ph.D.1,CharlesFinley,Ph.D.2;1Univ.ofArkansasforMed.Sci.,LittleRock,AR,2AdvancedBionics,LLC,Valencia,CA.Abstract:Introduction:Whilecochlearimplants(CIs)areconsideredahighlysuccessfulmedicaldeviceforrestoringspeechunderstandingtohard-of-hearingindividuals,highindividualvariabilityofoutcomesremainsasignificantconcerninthefield.AnimportantfactorinCIperformancevariabilityistheeffectoftheelectrode-neuralinterface.Significantwithin-userandbetween-uservariabilityexistsinbothneuralsurvivalandphysicallocationoftheelectrodeinthecochlea.Becausetheelectrode-neuralinterfaceisnotwellunderstoodintheclinicaldomain,itisnotuncommonforclinicianstoassumehomogeneityandprogramdeviceswithoutconsiderationforindividualvariation.Severalmethodsexistforidentifyingelectrodeswithpoorneuralinterface,anddeactivatingthoseelectrodesresultinimprovedoutcomes.Whilethesemethodsareeffective,theyarenotfeasiblefordirectimplementationintheclinic.Despitepositivetrendsinoutcomeswhendeactivatingpitch-confusedpairsusingavarietyofmethods,thisrecommendationisnotapartofcommonclinicalpractice.Methods:ThisprojectisdesignedtocompareclinicaloutcomesofconventionalCIprogrammingtoaresearchprogramwhereelectrodeshavebeendeactivatedidentifiedbyinabilitytodiscriminateadjacentelectrodes.Allmeasuresusedinthisstudyarestandardproceduresusingcommonclinicalequipmentandassessmentsastoeliminatethebarriertoclinicalpractice.Atotalof28adultswithcochlearimplantsfromCochlearCorporation,AdvancedBionics,andMed-Elwillbeincludedinthefullprotocol.Priortoanyprogramming,theMinimumSpeechTestBatteryandsubjectivequestionnaireswillbepresentedtoeachparticipant.Afterbaselinemeasuresarecollected,apsychometrictaskwillbepresentedtodetermineelectrodepairswithpitchconfusion.Thosewhodonotindicateanypitchconfusedelectrodeswillconcludetheirparticipationinthestudy.Thoseinthefullprotocolwillhaveimmediateretesting,exclusivelyusethenewprogramforanacclimationperiod,andreturnforrepeattestingofbaselinemeasures.Attheendofthestudy,participantsindicatetheirpreferredprogram.Results:Todate,wehavecollecteddataon15participantsand8hadpitchconfusedpairswhichresultedininclusioninourfullcriteria.Priortodatacollectionitwashypothesizedthatamajorityofparticipantswillhaveatleastonepitch-confusedelectrodepair,andthusfar8/15participantsfitthiscriterion.Wealsohypothesizedthatindividualswillperformbetterwiththeresearchprogramthanwiththebaselineprogram.Thishasalsobeenthecase,howeverwedonothaveenoughparticipantstoindicatestatisticalsignificanceatthispoint.Inaddition,itishypothesizedthatparticipantswillprefertheresearchprogramtothebaselineprogram.Thishasbeentrueof6/8participantswhohavecompletedtheentireprotocolatthetimeofthisabstractsubmission.


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Conclusion:Wedonothaveenoughdatatostatestatisticalconclusionsonanyofourresearchquestionsatthispoint,howeverpreliminarydatasupportacceptanceofallourresearchhypotheses.WeanticipateconclusionsbytheconferenceinJuly2017. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:92Title:EvolutionofMappingandVestibularFunctionDuringAcuteLabyrinthitisinaPediatricPatientwithBilateralCochlearImplantsAuthors:SusanGibbons,Au.D.,MargaretKenna,MD,MPH,DennisPoe,MD,Ph.D.,GuangWeiZhou,Sc.D.,AmandaGriffin,Au.D.,Ph.D.,JacobBrodsky,MD;BostonChildren'sHosp.,Waltham,MA.Abstract:Introduction:Vestibulardysfunctioncanaffectpediatriccochlearimplant(CI)patients.VestibularsymptomssuchasvertigoandimbalanceareknowntooccurinsomeCIpatientsduringtheimmediatepost-operativeperiod.However,acutevertigoattackinimplantedchildrenoccurringremotelyfromthepostoperativeperiodhasnotbeenpreviouslywelldescribed.Methods:Casereportofa3-year-oldpatient.Retrospectivereviewofaudiological,vestibularandmedicalchartnotes.Results:Athree-year-oldgirlwithbilateralCIsexperiencedasuddenonsetofvertigoandimbalance,accompaniedbyachangeinhearingperformance.Shehadpreviouslyundergonerightcochlearimplantationat12monthsofageandleftcochlearimplantationat16monthsofage.Causeofthepatient’shearinglossisunknown,withnormalpre-operativeMRIresults.Cochlearimplantprogrammingfourdaysaftertheonsetindicatedasignificantincreaseinright-sidedelectrodeimpedances,resultinginnon-complianceacrossfouroutof22electrodechannels.Left-sidedimpedancesandstimulationlevelswerestable.Tympanometricmeasurementswerewithinnormallimitsbilaterally.Vestibulartestingeightdaysaftertheonsetshowedevidenceofasevereperipheralvestibularlossontherightside.Aprednisonetaperwasprescribed.Hersymptomsresolvedentirely10dayslater.Cochlearimplanttestingfollowingsteroidtreatmentindicatedrightelectrodeimpedancesandstimulationlevelshadreturnedtobaselinelevels.AudiologicalperformancetestingatthistimealsoindicatedstablerightCIdetectionthresholdsandwordrecognitionscores,incomparisontomeasurementsobtainedpriortotheepisode.Noresidualbalancedeficitswereevidentatthefour-weekfollow-upvisit.Conclusion:Wepresentapreviouslyimplantedchildwithsymptomsandevidencesofunilateralacutelabyrinthitisthatoccurredremotelyfromtheperioperativeperiod,resultinginbothdeteriorationinimplantfunctionandipsilateralperipheralvestibularloss.ChildrenwithCIsmaybeatanincreasedriskfordevelopinglabyrinthitisduetotheelectrodecreatingasustainedconduitbetweenthemiddleandtheinnerears.ImplantprogrammingstatusshouldbeassessedinatimelyfashionforpediatricCIrecipientswhoexperienceacuteonsetofvestibularsymptoms. SessionID:PH-2SessionTitle:PosterHighlightsAbstractID:115Title:RemoteSupportforFirst-&Follow-Up-FittingsofCochlearImplantsinChildrenAuthors:KellySchepers,BH1,KarinBauer,BSc1,StefanoMorettini,PhD2,AlexanderMöltner,Dip.Ing.(FH)3,RudolfHagen,Prof.Dr.med.Dr.h.c.4;1StiftungHör-Sprachförderung,CICSüd,Würzburg,Germany,2MED-ELElektromedizinischeGeräteGmbH,Innsbruck,Austria,3MED-ELElektromedizinischeGeräteDeutschlandGmbH,Starnberg,


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Germany,4KlinikundPoliklinikfürHals-,Nasen-undOhrenkrankheitenderJulius-Maximilians-Univ.,Würzburg,Germany.Abstract:Introduction:Tele-healthisabroadtermfortheapplicationofinformationandtelecommunicationtechnologiesinthedeliveryofhealthservicesincaseswhereusersareseparatedfromhealthcareprovidersbysomedistance.Cochlearimplantaudiologyisfairlyspecialized,andisthereforeoftenonlyavailableinlargercitiesorvia‘outreach’services,whichinvolveaspecialistaudiologisttravellingtodifferentsites.Thiscanplacearealburden(intermsoftimeandexpense)onsubjectswholiveinremoteorrurallocations,andtheirfamilies.Hughesetal.(2012)notedthatmostclinicalCIprogramsrequire8-10visitstotheCIcenterwithinthefirstyearofdeviceuse,andannualorsemi-annualvisitsthereafter.Often,asubject’svisitsinvolvetravellingconsiderabledistance,withtheresultthattheyoftenarrivetiredattheCIclinic.RemotedeliveryofCIfittingservicesviatele-healthisthereforeanattractiveoptionandhasthepotentialtoimproveaccesstoservicesandtoreducetheburdenonfamilies.Methods:Whilepriorstudiesonsubjectivepreferenceforremoteorface-to-facefittingsessionshavebeenperformed,thisstudyisthefirstofitskindtoprovideaprospectiveandcontrolledassessmentofthesafetyandperformanceofaremoteprogrammingoptionforCIfittinginchildren.Accordingly,inthisstudyChildrenwhoarebilaterallydeaforborderingondeafness,receivingorusingacochlearimplantwererecruited.Thisstudyaimedtocomparetheoutcomesofelectrophysiologicaltesting,fittingparameters,puretoneaudiometryandspeechintelligibilitymeasureswithinsubjectswhoreceivedacochlearimplantandunderwenttheimplantfittingprocedures.Specifically,subjectswerefitvia2procedures(remoteandface-to-face)andelectrophysiologicalparameters,puretoneaudiometryandspeechintelligibilityoutcomeswereassessedacutelyaftereachsessioninastandardaudiologicaltestsetupatthestudycenters.Inadditioneachfittingsessionwasappraisedbytheremoteexpert,localhost,andthesubjectviaanadhocdesignedquestionnaireandthetotaltimeinminutesneededtoperformeachtypeofsessionwasrecorded.Results:Initialdatagatheredonsubjectsreceivingafollow-upfitting,showageneralgoodacceptanceandapositiveappraisaloftheremotesettingbythesubjectsthemselvesandtheprofessionalsinvolved.Likewise,fittingmapsgeneratedwitheithersettingdidnotdiffersignificantlyandinitialdataontheoutcomesofthetwoset-upsonspeechintelligibilityshowsimilarperformancesforwhatconcernsubjectsreceivingfollow-upfittings.Inaddition,boththeremoteandthelocalfittingcouldbeperformedinasimilaramountoftimewithoutexperiencingmajordelaysorinterruptions.Conclusion:RemoteCIfittingwasgenerallywell-receivedbyCI-usersandmedicalprofessionals.Subjects’performanceonaudiologicaltestsafterremotefittingwasnotsignificantlydifferentthanafterstandardface-to-facefitting.Additionally,remotefittingdidnottakelongertoperformthatface-to-facefitting. SessionID:PH-3SessionTitle:PosterHighlightsAbstractID:513Title:BimodalEartoEarAudioStreaming:SpeechUnderstandingAdvantagesinComplexListeningSituationsAuthors:SarahDowning,M.S.,CCC-A,EmilyCardenas,Au.D.,CCC-A,SmitaAgrawal,Ph.D.;AdvancedBionics,LLC,Valencia,CA.Abstract:Introduction:Theabilitytostreamfull-bandaudiosignalsbetweentwoearleveldevices(e.g.,betweentwoHearingAids(HA)ortwoCochlearImplant(CI)soundprocessorsorbetweenaCIsoundprocessorandanHA)inrealtimeoffersopportunitiesforsignalenhancementinseveralinterestingways.Oneapplication(StereoZoom)allowscreationofafour-microphonearrayviatwo-way


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communicationbetweenthedual-microphonesystemsoneachofthetwohearingdevices.Theresultingthird-orderdirectionalsystemcreatesanarrowerfixedtargetbeamascomparedtodual-microphonesystems.Thiscouldallowuserstofocusonasinglespeakerdirectlyinfrontoftheminverynoisyenvironments.Inasecondapplication(ZoomControl),audioinputatoneearisstreamedsimultaneouslytobothears,thusreducingthesignaldeficitatthecontralateralearduetoheadshadow.ThedirectmicrophoneinputatthecontralateralearisattenuatedtofurtherenhancetheSNR.Thiscouldimprovespeechunderstandinginnoiseinsituationswherethespeakerisnotinfrontofthelistener,suchaswhentalkingonthephoneordrivingacar.Theobjectiveofthisstudywastoassessthebenefitoftheabovetwoapplicationsofear-to-earaudiostreaming(StereoZoomandZoomControl)inadultbimodallisteners(cochlearimplantinoneearandahearingaidinthecontralateralear).Atthetimeofthestudy,thesewereexperimentalapplications.Theyarenowavailableforclinicaluse.Methods:19adultbimodalparticipants(13males,6females,meanage61years)withaNaidaCIQ90processorinoneearandaNaidaLinkhearingaidinthecontralateralearparticipatedinthestudy.SpeechunderstandingwasevaluatedusingAzBiosentences(60dBC)incafeterianoise.SNRwasbasedonthenoiselevelforeachparticipantwheretheirbimodalscoreinnoisewasapproximatelyhalftheirscoreinquiet.AnS0N±60,±90,180speakerconfigurationwasusedforassessingtheeffectivenessofStereoZoom.ZoomControlwasassessedwithspeechontheHAsideandnoisefromtheCIside(SHANCI).Bimodalbenefitwasalsomeasuredinbothstudyset-upsbyswitchingofftheHA.Easeoflisteningratingswereobtainedineachconditionona5-pointscalerangingfromverydifficulttoveryeasy.Results:ActivationofStereoZoomledtoamean21%improvementinspeechscoresinnoise(p<0.0001).ZoomControluseimprovedspeechscoresby28%(p<0.0001).Additionally,significantbimodalbenefitwasmeasuredinbothtestset-ups(21%and33%respectively,p<0.0001).Easeoflisteningratingswerecommensuratewiththesentencescores.Conclusion:Ear-to-earaudiostreamingcanallowbimodallistenerstotakeadvantageofenhanceddirectionalcapabilityandfocusedlistening,therebyimprovingspeechunderstandingandeaseoflisteninginchallenginglisteningsituations. SessionID:PH-3SessionTitle:PosterHighlightsAbstractID:112Title:TheNaturalHistoryandRehabilitativeOutcomesofHearingLossinCongenitalCytomegalovirus:ASystematicReviewAuthors:KyleT.Fletcher,MD1,TianshiLiu,BS2,ErinM.Wolf,PhD2,MariaMuthoka,MBChB3,MatthewL.Bush,MD1;1Otolaryngology-Head&NeckSurgery,Univ.ofKentucky,Lexington,KY,2CollegeofMedicine,Univ.ofKentucky,Lexington,KY,3DivisionofOtolaryngology–HeadandNeckSurgery,DepartmentofSurgery,Univ.ofNairobiColl.ofHlth.Sci.,Nairobi,Kenya.Abstract:Introduction:CongenitalCytomegalovirus(cCMV)infectionisacommoncauseofpediatrichearinglossyetthenatureofthehearingloss(onset,progression,andfluctuation)ispoorlyunderstood.Furthermore,thefactorsaffectingsuccessfulauditoryrehabilitationoutcomesofchildrenwithcCMVareunknown.ThepurposeofthisstudywastosystematicallyreviewtheliteratureregardingthenaturalhistoryandrehabilitativeoutcomesofsensorineuralhearinglossfromcCMVinfections.Methods:AsystematicsearchwasperformedinPubMed,PsychINFO,CINAHL,andWebofSciencetoidentifypeer-reviewedresearch.Inclusioncriteriawere:1)studiesaddressingtimingofonset,progression,and/orfluctuationofhearingincCMV2)resultsofcochlearimplantationinthecCMVpopulation3)documentationofcCMV(asopposedtopost-natalCMV)viaappropriatetesting(dried


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bloodspot,cordblood,urineorsalivacultureorpolymerasechainreaction)4)hearinglossdocumentedby2separateaudiologicalassessments.Exclusioncriteriawere:1)casereportsornon-originalresearch,2)languageotherthanEnglish.Results:Thirty-sixarticleswerereviewed.StudiesthatreportedonuniversalscreeningidentifiedcCMVin0.2–1%ofnewbornsandofthosenewborns8-22%hadhearingloss.SensorineuralhearinglosswasmoreprevalentinchildrenwithsymptomaticcCMV(growthretardation,prematurity,microcephaly,chorioretinitis,seizures,and/orotherneurologicalabnormalities)comparedtoasymptomaticcases.Post-nataldevelopmentofhearinglosswas9–68%ofcasesofcCMVandageofonsetrangedfrom3monthsto16years.CochlearimplantationinchildrenwithcCMVsignificantlyimprovesexpressiveandreceptiveoutcomes;however,symptomaticchildrenandthosewithcognitiveimpairmentshavepooreroutcomesthannon-cCMVCIrecipients.ThisislimitedliteraturecomparingrehabilitationoutcomesincCMVandnon-cCMVCIrecipients.Conclusion:LateonsetandprogressivehearinglossisseeninchildrenwhodevelophearinglossfromcCMV.Frequentaudiologicfollow-upisnecessaryconsideringthenaturalhistoryofcCMVhearingloss.Universalscreeningshouldbepursuedduetothenumberofasymptomaticchildren,atbirth,whodeveloplateonset/delayedhearingloss.Cochlearimplantationisaneffectivemeansofimprovingspeechandlanguageskillsinthispopulation. SessionID:PH-3SessionTitle:PosterHighlightsAbstractID:163Title:HearingPreservationinChildrenFollowingCochlearImplantationAuthors:NeilS.Patel,MD,NicoleM.Tombers,RN,MelissaD.DeJong,AuD,AlyceI.Breneman,AuD,BrianA.Neff,MD,ColinL.W.Driscoll,MD,MatthewL.Carlson,MD;Otorhinolaryngology,MayoClinic,Rochester,MN.Abstract:Introduction:Presently,therearefewstudiesevaluatingtherateofhearingpreservationaftercochlearimplantationinchildren,asonlyrecentlyhasimplantationofchildrenwithgreaterdegreesofresidualhearingbecomemorewidelyaccepted.Asaresultofimprovementsintechnology,programmingstrategies,andsurgicaltechnique,thenumberofchildrenwithlowfrequencyresidualhearingwhoundergocochlearimplantationhassteadilyincreased.Atthesametime,thevalueofelectroacousticstimulationhasbeendemonstrated,reinforcingthevalueofatraumaticsurgicaltechniquestopreservecochlearfunction.Theobjectiveofthecurrentstudyistoreportpediatrichearingpreservationresultsfollowingcochlearimplantationwithconventionalfull-lengthelectrodes.Methods:Aretrospectivereview(2000-2016)atatertiaryreferralcenterwasperformedofallpediatricpatientswitha≤75dBpreoperativelow-frequencypuretoneaverage(LFPTA;250-500Hzaverage),whounderwentcochlearimplantationwithaconventionallengthelectrode.Thedegreeofhearingpreservationwasdeterminedaccordingtothe2013HEARRINGgroupguidelines.Results:Atotalof43ears,in35pediatricpatients,metinclusioncriteria.Themeanageattimeofimplantationwas8.6years(range1.4-17.8yrs),20(57.1%)patientswerefemale,and25(58.1%)caseswereleft-sided.ThemeanpreoperativeipsilaterallowfrequencyPTAandstandardPTA(500,1000,2000,3000Hzaverage)were54.2dB(range15-75dB)and82.2dB(range25-102.5dB),respectively.ThemeanlowfrequencyPTAandstandardPTAshiftscomparingthepre-andfirstpostoperativeaudiogramwere∆25.2dB(range-5–92.5dB)and∆18.3dB(range-8.8–100dB),respectively.Overall,17(39.5%)earsdemonstratedcompletehearingpreservation,19(44.2%)earspartialhearingpreservation,and7


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(16.3%)exhibitednomeasurableacoustichearingaftersurgery.Intotal,26(60.4%)earsmaintainedfunctionallow-frequencyhearing(i.e.,≤80dBLFPTA)basedontheinitialpostoperativeaudiogram.TherewasnostatisticallysignificantdifferenceintheinitiallowfrequencyPTAshiftcomparinglateralwallandperimodiolarelectrodes(∆22.2vs∆28.1;p=0.44),cochleostomyandroundwindowinsertions(∆25.2vs.∆24.7;p=0.95),orstatisticallysignificantassociationbetweenageatimplantationandlowfrequencyPTAshift(r=0.174;p=0.26).Conclusion:Varyinglevelsofhearingpreservationwithconventionallengthelectrodescanbeachievedinover80%ofpediatricsubjects.Thesedatamaybeusedtoguidepreoperativecounselinginpediatricpatientswithresidualacoustichearing.Additionally,thefavorableratesofhearingpreservationachievedinchildrenprovidefurtherevidencefortheexpansionofpediatriccochlearimplantcandidacytoincludepatientswithgreaterdegreesofresidualhearing. SessionID:PH-3SessionTitle:PosterHighlightsAbstractID:484Title:EffectofPhonologicalErrorsonSpeechIntelligibilityinEarlyandLaterImplantedPediatricCochlearImplantUsersAuthors:OlgaPeskova,MS1,NirmalSrinivasan,PhD2,AnnGeers,PhD3,EmilyTobey,PhD3,PeterAssmann,PhD1;1BehavioralandBrainSciences,UTDallas,Richardson,TX,2Audiology,Speech-LanguagePathology,andDeafStudies,TowsonUniv.,Towson,MD,3BehavioralandBrainSciences,TheUniv.ofTexasatDallas,Richardson,TX.Abstract:Introduction:Cochlearimplants(CI)allowchildrenwithhearingloss(HL)toachievespeechperceptionandproductionoutcomestomaketheirspeechunderstandabletonormalhearing(NH)adultlisteners.Thiscapabilityisaccompaniedbyawidevariabilityofscores.Inordertounderstandthefactorsthatcontributetothisvariability,weinvestigatedtheeffectsofphonologicalerrors,ageofimplantationanddurationofCIuseonspeechintelligibilityofearlierandlaterimplantedCIusers.Methods:Laterimplantedparticipantsincludedthegroupof107childrenimplantedbetweentheagesof2and4testedat8yearsofage.Earlyimplantedparticipantsincludedthegroupof60childrenimplantedbetweentheages1and3(±2months)testedat8yearsofage.SpeechintelligibilityperformanceandnumberofphonologicalerrorswereevaluatedusingMcGarrsentences(McGarr,1983),whichvariedinlengthfrom3to5to7syllablesandweredefinedaslowandhighcontextsentences.ThreeNHlistenersindependentlyheardonesentencefromonechildandwrotedownthewordstheyunderstood.Theaveragescorewascalculatedforintelligibility.SentencesproducedbyCIusersweretranscribedbyfourspeechlanguagepathologists.BroadtranscriptionswereanalyzedusingtheComputerAidedSpeechandLanguageAnalyses(CASALA)software(Serryetal.,1997)todeterminethepercentcorrectforeachconsonantandcalculatepercentofomissionsandsubstitutions.Results:Significantnegativecorrelationsbetweenspeechintelligibilityscoresandphonologicalerrorsforbothgroupswereevident.Theearlierimplantedgrouphadsignificantlyfeweromissionandsubstitutionerrorscomparedtothelaterimplantedgroup.Conclusion:Thesignificantreductioninthenumberoferrorsfortheearlierimplantedgroupindicateadvantagesofearlyimplantation,longerdurationofCIuseandnewerspeechprocessingstrategiesrelativetolaterimplantedgroup. SessionID:PH-3SessionTitle:PosterHighlights


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AbstractID:147Title:CochlearImplantation:OutcomesinChildrenwithCochlearNerveDeficiencyAuthors:AnnieRodriguez,Au.D.,MelissaAuchter,Au.D.;Univ.ofMiamiEarInst.,Miami,FL.Abstract:Introduction:Cochlearimplantationinchildrenwithcochlearnervedeficiency(CND)isanareathathasnotbeenfullyexploredandremainsindebate.CND,whichincludesbothcochlearnervehypoplasiaandaplasia,occursinapproximately12-18%ofearsaffectedwithsensorineuralhearingloss(Huanget.al,2011).Inthepast,CNDhasbeenacontraindicationforcochlearimplantation;howeverrecentstudieshaveshownsomepatientswithCNDachieveopen-setwordunderstandingandshouldbeconsideredpriortopursuinganauditorybrainstemimplant(ABI)(Buchmanet.al2011).Todate,littleisknownabouttheoutcomesandbenefitsofpediatriccochlearimplantpatientswithCND.Methods:Pre-operativeimaging(MRI/CTScan)aswellaspre-operativeaudiometricthresholdsandspeechperceptionscoreswerereviewedandcomparedtopost-operativeneuralresponsetelemetrydata(NRT)andpost-operativeaudiometricthresholdsandspeechperceptionscores.Results:Despitelackofvisiblenervetracingonimaging,allthreecasespresentedwithNRTmeasurements,thoughmeasurementswerefoundtofluctuatebetweenvisits.Post-operativeaidedthresholdswereobservedtoimproveinallpatients.Speechperceptionscoreswerealsofoundtoimprovewhentestingcouldbecompleted.Variabilityinimprovementwasnotedbetweenpatients.Conclusion:Basedonthepreliminarydatafoundinthesecasereports,cochlearimplantationshouldnotbeeliminatedasapotentialoptionforpatientsdiagnosedwithCND.ResultsfoundinthesethreecasessuggestthatcochlearimplantationmaybeaviableoptionforchildrenwithCND.Auditoryprogresswasnotedinallthreecasesanddespiteimagingdata,nerveresponseswereseenthroughNRTmeasurements. SessionID:PH-3SessionTitle:PosterHighlightsAbstractID:305Title:PediatricCaseReportofPerformancewithThreeDifferentRemoteMicrophoneSystems:ReceiversVersusStreamersAuthors:BethA.Holstad,Au.D.Audiology,TheMoogCtr.forDeafEd.,St.Louis,MO.Abstract:Introduction:Parentsfrequentlyreportthattheirchildhasdifficultyhearinginnoise,despiteuseofnewspeechcodingstrategiesaimedatconqueringthisproblem.Subjectiveandobjectivebenefitofnoiseprogramscontinuestolagbehindthatrealizedwithremotemicrophonesystems.SchoolsstrugglewiththecostsassociatedwithprovidingIEPmandateddigitalremotemicrophonesystems,andgravitatetowardcost-savingsingle-receiveroptionscoupledtoneckloopsystems,streamers;or,microphonestreamersalone.Historically,signaldeliverythroughnondirectconnectsystemshasresultedinpoorerperformance.Currentsystemsthatstreamremotemicrophonesignalswithorwithoutasinglereceivermaylikewiseresultinpoorerperformancecomparedtodirectconnect,bilaterallyfitteddigitalreceivers.Conversely,wirelessstreamingofremotemicrophonesignals,withorwithoutareceiver,maybemorecosmeticallydesirabletochildren,andreduceprocessorbatterydrainandpowerlimitations.Methods:Completedfittingandfunctionalevaluationofthreesystems:1)adigital,dynamicremotemicrophone/2-receiversystem,2)adigital,dynamicremotemicrophone/1-receiver/streamersystem,and3)astreameraloneusing60dBArecordedpresentationoftheW-22wordlists(binaurally)andAZBiosentencelists(monaurally)presentedat0°azimuthinquiet,innoise,andinnoisewithHATsystem.Recordedmultitalkerbabblewaspresentedat-180°azimuthforbinauraltesting,andatthetest


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earformonauraltestinginnoiseconditions,ataSNRneededtoreduceperformanceinquiteby~50%.Optimalreceivergainorstreamervolumewasidentifiedasthatwhichallowedperformanceinnoisetoequalorapproximatethatinquiet.Results:Inquiet,listeningwithbothimplantsonly,RSrepeatedwordswith84%accuracy.Inthemonaurallyaidedcondition,AZBiosentenceswererepeatedwith95%and92%accuracyattherightandleftearrespectively.Innoise(0SNR),RS’saccuracydeclinedto40%forwords,and57%(right),38%(left)forsentences.Withtheadditionofadigital,dynamicremotemicrophone/2-receiversystem,RSrepeatedwordswith92%accuracyandsentenceswith89%(right)and93%(left)accuracy.Withadigital,dynamicremotemicrophone/1-receiver/streamersystemwordswererepeatedwith92%accuracy,andwithastreameralone,wordswererepeatedwith88%accuracy.Conclusion:Forthischild,essentiallyequalperformancewaspossibleusinga0SNRin60dBAofnoisewiththesethreesystems.Thisunexpectedfindingsuggestsfuturehypothesis-basedevaluationofthesesystemsiswarrantedinlargergroupsofchildren,andathigherlevelsofnoise. SessionID:PH-3SessionTitle:PosterHighlightsAbstractID:271Title:TheImmersion360System:BringingtheOutsideWorldintotheClinicAuthors:FrancoisBergeron,Ph.D.1,KevinLeungKam,M.Sc2,WalidChafiq,M.Sc2,BastienBouchard,M.Sc3,DominiqueDemers,M,Sc.4;1Speech&languagepathology,UniversitéLaval,Québec,Canada,2Neuroprothèses,UniversitédeMontpellier,Montpellier,France,3TechnologiesImmersion,Québec,Canada,4Clinicalandbiomedicalsciences,UniversitéLaval,Québec,Canada.Abstract:Introduction:Improvementinauditoryperceptionisamajorobjectiveoftherapeuticinterventionsforthehearingimpairedchild.Numeroustestsareproposedtoguidetheseinterventionsandassesstheirbenefits.Optimally,thesetestsshouldexplorecomplexabilitiessuchasthoseencounteredbyhearingimpairedchildrenindailylife.Thus,manycontemporarytestsweredesignedonsentencerecognitionagainstaspeechspectrumnoisecomingfromfixedsources.Whilesentencesappearasarealisticdailystimulus,onecanarguethataspeechspectrumnoiseissuedfromfixedpositionswithvariableorarbitrarilypredeterminedsignaltonoiseratioscanbefarfromwhatchildrenexperienceinreallife.Yet,itispossibletocreatemorerealistictestenvironments.TheImmersion360systemproposesavirtualenvironmentthatcanreproduceanyeverydaysoundexperienceandthus,supportamorerealistictestingconditiontoassessauditoryperception.ThisprojectaimedtospecifythepsychometricsofthissystemanddefinenormsforspeechperceptionforFrenchspeakingnormal-hearingpeople.Methods:ThirtyyoungadultswithnormalhearingwereassessedinCanadaandinFrancewiththeFrenchadaptationofAzBioin9virtualenvironments(car,garage,cafeteria,restaurant,ballgameinagymnasium,racetraininginagymnasium,kindergarten,roadtraffic,streettraffic).Presentationandsignaltonoiselevelsweresetatthelevelsmeasuredontherecordingsites.Results:Descriptiveanalysisspecifytheaverage,varianceandconfidenceintervalsat95%foreachtestconditionoftheImmersion360system.Normativedataarederivedfromthesemetrics.Conclusion:Anewtestbasedonvirtualenvironmentsisnowavailabletoassessspeechperceptioninarealistictestingcondition.FutureworkwillfocusondefiningnormswiththeFrenchpediatricversionofAzBiopresentlyindevelopment. SessionID:PH-3SessionTitle:PosterHighlights


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AbstractID:583Title:LearningMolecularImaging-basedNeurologicPredictorsofCochlearImplantOutcomeinPrelinguallyDeafChildrenAuthors:Jae-JinSong,MD,PhDDepartmentofOtorhinolaryngology,SeoulNatl.Univ.BundangHosp.,Korea,DemocraticPeople'sRepublicof.Abstract:Introduction:Therearenumerouspatientfactorsaffectingtheoutcomeofcochlearimplantation(CI).However,preoperativefunctionalstatusofthecerebralcortexhasonlybeeninvestigatedinsmallnumbersofpatients.Hence,thecurrentstudywasperformedtorevealfunctionalneuroimagingsignaturesofspeechoutcomeafterCIinprelinguallydeafpatientsusingresting-stateFDG-PETbig-databasedmachinelearningapproachandtosuggestaoutcomepredictionmodelbasedoncorticalpredictorsofCIoutcome.Atotalof111prelinguallydeafchildrenunderwentpre-CIresting-stateFDG-PET.ThisFDG-PETwasusedtopredictpost-CI3yearspeechoutcomewithregardtoopensetwordandsentencetestunderauditory-only(A-only)andaudiovisual(AV)conditions.FDG-PETdatawaspreprocessedwithMarsBaRtoolboxforregionofinterest(ROI)analysis,and90cerebralcorticalROIswereusedfortheanalysis.Forstatisticalanalysis,LASSO(LeastAbsoluteShrinkageandSelectionOperator)regressionanalysisusingaverageglucosemetabolismof90ROIswithregardtopost-CI3yearopensetwordandsentencescores.InprelinguallydeafCIusers,activationsofthesupreriortemporalgyrus,supramarginalgyrus,andinferiorfrontalgyruswerepredictorsofhigherpost-CI3yearspeechoutcomeundertheA-onlycondition.Meanwhile,underA-Vcondition,anadditionalactivationoftheanteriorcingulategyruswasnecessarytoshowbetterspeechoutcome.InprelinguallydeafCIusers,activationsoftheventralattentionnetworkandprefrontaltop-downmodulatorareimportanttobetterprocesslanguageundertheA-onlycondition.UnderA-Vcondition,anadditionalactivationofthesaliencenetworkisnecessarytobetterunderstandmultimodalinformation.Takentogether,FDG-PET-basedmachinelearningusingLASSOcouldpredictCIoutcomeinprelinguallydeafsubjects,functionalneuroimaging-basedoutcomepredictionmaybeofhelpforprecisionmedicineinCIsubjects. SessionID:PH-3SessionTitle:PosterHighlightsAbstractID:582Title:MusicEnjoymentinSSDPatients:TheSynergisticEffectofElectricandAcousticStimulationAuthors:DavidLandsbergerOtolaryngology,NewYorkUniv.Sch.ofMed.,NewYork,NY.Abstract:Introduction:Althoughtherehavebeenmanystudiesofmusicperceptionwithacochlearimplant(CI),musicalsoundqualityhasbeendifficulttoquantify.Forexample,ratingsofmusicenjoymentonascaleof1-100bydeafCIusersaredifficulttointerpret.TheemergenceofCIuserswithnormalcontralateralhearingpresentsauniqueopportunitytoassessmusicenjoymentquantitativelyinCIusersbyreferencingittothatobtainedinanormalear,whichprovidesaknownandreadilyinterpretablebaseline.Methods:Inthepresentstudy,weinvestigatedsoundqualityofmusicinSingle-SidedDeafened(SSD)subjectswithaCIusingamodifiedversionoftheMUSHRA(MUltipleStimuliwithHiddenReferenceandAnchor)method.Listenersratedtheirenjoymentofbriefmusicalsegmentsofthesongs“RingofFire”and“RhapsodyinBlue”onascaleof0-200relativetoareferencestimulus,definedas100.Thereferencewastheunmodifiedmusicalsegmentpresentedtothenormalhearingearonly.An“anchor”stimulus(definedas0)wasalsoprovidedonlytothenormalhearingear.Theanchorwasthesamemusicalsegmentprocessedwitha6-channelnoisevocodersimulatinga6.5mmshift.Stimuliconsistedofacousticonly,electriconly,acousticandelectric,aswellasanumberofconditionswithlowpass


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filteredacousticstimulitosimulatevaryingdegreesofhearinglossandbimodalstimulation.Acousticstimulationwasprovidedbyheadphonetothenormalearandelectricstimulationwasprovidedbyadirectconnectcabletothesubject’sclinicalspeechprocessor.Results:Tenoutof11subjectsratedcombinedelectricandacousticstimulationthebest,withatrimmedmeanrating“RingofFire”as133and“RhapsodyinBlue”as120.Thecombinationofacousticandelectricstimulationwassignificantlybetterthanunilateralacousticprocessingalone.Thesoundqualityofelectricstimulationalonewasmuchworsethanacousticstimulationalone.Inalltestedconditions,addingelectrichearingtoacoustichearingprovidedimprovementinsoundquality.Conclusion:Insummary,musicenjoymentfromelectricstimulationwasextremelypoorrelativetoaninterpretablenormal-hearingbaseline.Interestingly,addingtheelectricstimulationactuallyenhancedthesoundqualityofunilateralacousticstimulation.Thiseffectalsohappenedwithlowpassfiltered,acousticallypresentedmusicalsegments,suggestingthatsimilarresultsmaybefoundforbimodalCIusers. SessionID:PH-3SessionTitle:PosterHighlightsAbstractID:405Title:TurkishAdaptation,ValidityandReliabilityofMusicalPerceptionTest(MPT):T-MPTAuthors:AyseSanemSahli,PhD1,ErolBelgin,PhD2;1VOCATIONALSCHOOLOFHEALTHSERVICES,HEARINGANDSPEECHTRAININGCENTER,HACETTEPEUNIVERSITY,TURKEY-ANKARA,Turkey,2FACULTYOFHEALTHSCIENCES,AUDIOLOGYDEPARTMENT,MEDIPOLUNIVERSITY,TURKEY-ISTANBUL,Turkey.Abstract:Introduction:Thehearingaidtechnologies(CI,HA)atpresentdayperformwellontheskillsofpatientswithhearinglosstohearingandunderstandingofspeechsounds,butnotontheskillsofmusicalperceptionasmuchasexpected.Musicalperceptionisstilloneofthemostimportantproblemsufferedbypatientswithhearingloss.However,thereisnovalidandreliablemusicalperceptiontestinourcountrytoassesstheskillsofmusicalperceptionofbothpatientswithnormalhearingandthosewithhearingloss.ThepurposeofthisstudyistotranslateandadapttoTurkishthe“MusicalPerceptionTest”widelyusedforinternationalscientificresearch,determinethevalidityandreliabilitythereofand,bringtoourcountryatestthatobjectivelyassessestheskillsofmusicalperception.Methods:100individualsattheageof18-40withnormalhearingandwithoutanyprofessionalmusiceducationhaveparticipatedinthestudy.AfterthetranslationandadaptationtoTurkishtheMusicalPerceptionTest(MPT)consistingof4fieldsincludingRhythm,Pitch,TimbreandMelodyand,11subteststeps,soundrecordshavebeencompletedinaprofessionalstudioand,thevolunteerstookpartinthetest.A“ParticipantGeneralInformationForm”wasprovidedtocollectinformationonthesociodemographicattributesofthesubjectsand,theirinterestandexperienceinmusic.Thedataobtainedinthismannerhavebeenstatisticallyassessedand,thefindingsonthevalidityandreliabilityofthetesthavebeenanalyzed.Results:Asaresultofthisstudy,itisfoundoutthatthetotalpointaverageofthesubjectsfortheMusicalPerceptionTestis97,5±12,2(Min:69,Max:120),theInternalConsistencyValueis0,898,andthetest-re-testcorrelationis0,997.ThisresultshowsthattheMusicalPerceptionTestisaveryreliabletest.Inthestudy,thehighestpointreceivedbythesubjectswasforRhythmIdentification(9,2±1,2),whilethelowestpointwasfortheIdentificationofNumberofInstruments(4,2±1,3).Inaddition,althoughthereisnorelationshipbetweenthetotalpointfromtheMusicalPerceptionTestand,theageofthesubjects,thegenderandeducationalbackgroundisastatisticallysignificantdeterminantonthetotalpointoftheMusicalPerceptionTest.Nonetheless,ithasconcludedthatthereisastatistically


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significantrelationshipbetweenthelevelofinterestinmusic,frequencyoflisteningtomusicandmusicgenre,andthemusicalperceptiontotalpoint.Conclusion:Music,oneoftheindispensablefactorsinourlives,isalsoveryimportanttothosewithhearingloss.Asavalidandreliabletestthatobjectivelyassessallthefieldsofmusicinourcountry,theTurkishMusicalPerceptionTest(T-MPT)isthefirstandonlytestbothforpeoplewithnormalhearingandthosewithhearingloss.Anobjectiveassessmentofmusicalperceptionskillsofpeoplewillprovidebenefitinthedeterminationofmusicalperformanceforthosewithnormalhearingand,inthedevelopmentofdiagnosis,re/habilitationandamplificationsystemsforthosewithhearingloss. SessionID:S4-2SessionTitle:ResidualHearingAbstractID:64Title:EvaluationofLongTermCochlearImplantUseinPatientswithAcquiredUnilateralProfoundHearingLoss:FocusonBinauralAuditoryOutcomesAuthors:GrietMertens,PhD,PaulVandeHeyning,MD,PhD;Univ.Dept.OtorhinolaryngologyandHeadandNeckSurgery,AntwerpUniv.Hosp.,Edegem,Belgium.Abstract:BackgroundCochlearimplantationistheonlytreatmenttorestoreusefulhearingtoaprofoundlydeafearand,therefore,theonlychoiceinindividualswithprofoundunilateralhearingloss(UHL)thatmightrestorebinauralhearing.Thestudyaimedtoevaluatethelong-term(LT)binauralauditoryoutcomesinUHLCI,rangingfrom3-10yearsafterCIprovision.MethodsLTevaluationwasderivedfrom12single-sideddeaf(SSD)CIrecipientsandfrom11CIrecipientswithasymmetrichearingloss(AHL).Astructuredinterviewwasconductedwitheachsubject.SpeechperceptioninnoiseandsoundlocalizationwereassessedinaCIOFFandinaCIONcondition.Fourbinauraleffectswerecalculated:summationeffect(S0N0),squelcheffect(S0NCI),combinedheadshadoweffect(SCIN0),andspatialreleasefrommasking.AttheLTevaluation,thecontributionofaCIandabone-conductiondevice(BCD)onspeechperceptioninnoisewasinvestigatedintwochallengingspatialconfigurationsinthesameSSDgroup.ResultsAll(23/23)subjectsworetheirCI7daysaweekatLTfollow-upevaluation,whichrangedfrom3-10yearsfollowingimplantation.IntheSSDgroupasignificantcombinedheadshadoweffectof3.17dBandaspatialreleasefrommaskingbenefitof4.33dBwerefound.IntheAHLgroup,ontheotherhand,thesummationeffect(2.00dB),thesquelcheffect(2.67dB),thecombinedheadshadoweffect(3.67dB),andspatialreleasefrommaskingbenefit(2.00dB)weresignificantatlong-termtesting.Inboththespatialchallengingconfigurations,thespeechinnoiseresultsweresignificantlyworseintheconditionwiththeBCDcomparedtotheunaidedcondition.NonegativeeffectwasfoundfortheCIONcondition.AsignificantbenefitintheCIONconditionwasfoundforsoundlocalizationcomparedtotheCIOFFconditionintheSSDgroupandintheAHLgroup.ConclusionAllsubjectsworetheirCI7daysaweekatlong-termfollow-upevaluation.Thepresenceofbinauraleffectshasbeendemonstratedwithspeechinnoisetesting,soundlocalization,andsubjectiveevaluation. SessionID:S4-2SessionTitle:ResidualHearingAbstractID:86


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Title:ChineseMandarinToneRecognitioninPatientswithBimodalCochlearImplantsAuthors:YongxinLi,Professor,XingmeiWei,Master,YueGong,Master,BiaoChen,Master,JingyuanChen,Master;Otolaryngology,BeijingTongrenHosp.,Beijing,China.Abstract:Introduction:Fordeafindividualswithresiduallow-frequencyacoustichearing,combineduseofacochlearimplant(CI)andhearingaid(HA)typicallyprovidesbetterspeechunderstandingthanwitheitherdevicealone.WecalleditbimodalwhenalistenerhasaCIinoneearandaHAintheoppositeear.Becauseofcoarsespectralresolution,CIsdonotprovidefundamentalfrequency(F0)informationthatcontributestounderstandingoftonallanguagessuchasMandarinChinese.ChineseMandarinisatonallanguagewithoneoffourbasictonesallottedpersyllable.ThevariationinF0ofthetargettalker,andtheamplitudeenvelopeofthelow-passtargetspeech,areimportantcuesinbackgroundnoise.TheHAcanprovidegoodrepresentationofF0and,dependingontherangeofaidedacoustichearing,firstandsecondformant(F1andF2)information.Howeverinmanycasescochlearandhearingaidarenotinagoodfit.ManyCIusersdonotpossessenoughresidualhearingtoshowabimodalbenefit.SowewanttofindouthowtoshowmaximumbenefitwithCIandHAtogether.Methods:TwelveMandarin-speakingbimodalpatients(8maleand6female)participatedinthisstudy.SubjectswerenativespeakersofMandarinChineseandwerebetweentheagesof8to33yearsold.Allsubjectshadmorethansixmonthsofexperiencewiththeirdeviceatthetimeoftesting.SubjectswererecruitedfromtheDepartmentofOtolaryngology,HeadandNeckSurgeryofBeijingTongRenHospital(whichspecificallyapprovedthisstudy).ThetestmaterialwasprovidedbyMandarini-CASTsoftwaredevelopedbyQian-jieFuprofessor.ClosedsetidentificationtaskswereusedtomeasureChinesetonerecognition(16-alternative,forced-choice).The16choiceswereBa1,Ba2,Ba3,Ba4,Bi1,Bi2,Bi3,Bi4,Bo1,Bo2,Bo3,Bo4,Bu1,Bu2,Bo3,Bo4.1,2,3,4standfortone1,2,3,4,respectively.ThesubjectsweretestedwithCI+HA,withCI-onlyandwithHA.Amanspokethetoneinquiet,awomanspeakingBa1asabackgroundnoisewithSNR10dB,5dBand0dB,andamanspeakingBa1asabackgroundnoiseasthesamebefore.Inall,thenumberoftestsis21[=3listening(CI,CI+HA,HA)*[quiet+2backgroundmaskers*3SNR(10dB,5dB,0dB)]].FortheCIalonecondition,theHAwasremovedandtheHAearwaspluggedtopreventeavesdropping.Subjectswereseateddirectlyfacingasingleloudspeaker1maway.Theirbasicdemographicandaudiologyinformationwererecorded.Thesubjects’pure-tonethresholdsat0.25,0.5,1,2,4,and8kHzweretestedwithCI+HA,CIalone,HAaloneandnakedearoftheHAside,respectively.AudiometrywasconductedinsoundfieldusingwarbletonesinthefirstthreemodeswhileforthenakedearoftheHAsideitwasconductedusingheadphone.Results:Nosignificantbimodalbenefitswerefoundinquietconditions.ButSignificantbimodalbenefitswereobservedwhenmaskersandtargetshavedifferentF0inallSNRconditions.Intonerecognition,tone3islessaffectedbythebackgroundmasker.Invowelrecognition,Boislessaffectedbybackgroundmasker,howeverBaisrelativelymoreaffectedbymasker.Conclusion:BimodalisgreatlybenefitforrecognitionofinformationwithdifferentF0.Mandarintone3andvoweloaremorestablethantheothertonesandvowelsforbimodalusers. SessionID:S4-2SessionTitle:ResidualHearingAbstractID:155Title:CochlearImplantationforRehabilitationofSingleSidedDeafnessinChildrenandAdolescentsAuthors:DanielM.Zeitler,MD,FACS1,MichaelF.Dorman,PhD2,DouglasP.Sladen,PhD3,MelissaD.DeJong,AuD4,JenniferH.Torres,MA5,MatthewL.Carlson,MD3;


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1Otolaryngology,VirginiaMasonMed.Ctr.,Seattle,WA,2ArizonaStateUniv.,Tempe,AZ,3Otolaryngology,MayoClinic,Rochester,MN,4MayoClinic,Rochester,MN,5DenverEarAssociates,Englewood,CO.Abstract:Introduction:Introduction:Theuseofcochlearimplantsfortherehabilitationofsingle-sideddeafness(SSD)isanemergingstrategy.Todate,themajorityoftheworld-literaturehasfocusedontheadultpopulation,whileoutcomesinthepediatricpopulationaresparse.Furthermore,currentdatahasproposeda‘sensitiveperiod’duringwhichobjectiveoutcomesfollowingcochlearimplantationinbilaterallydeafenedchildrenappeartobeoptimized,butthisquestionhasnotbeenaddressedforchildrenandadolescentswithSSD.Methods:Methods:Thecurrentstudyisaretrospectivereviewperformedattwotertiaryacademicreferralcenters.Subjectsincludedallpediatricpatients(<18yearsofage)whounderwentcochlearimplantationforrehabilitationofSSD.Demographicdataincludinglengthofdeafness,etiologyofdeafness,andageatimplantationwerecollected.Outcomemeasuresincludedspeechperformanceinquietandnoise,subjectivereportedbenefit,andfrequencyanddurationofdeviceusage.Results:Results:Eightpatients(4females,4leftears)wereimplantedbetweenNovember2011andAugust2016.Themedianageattimeofimplantationwas9.2years(range5-15years)andthemediandurationofdeafnesswas41.5months(range10-113months).Allpatientshadnormalhearinginthecontralateralear.Onlytwopatientshadresidualhearing(45and72.5dBPTA)withpoorspeechperception(17%and8%wordsMLNT).Threepatientshadcongenitalunilateraldeafness,twohadsuddenidiopathicsensorineuralhearingloss,twohadprogressivedeafnesssecondarytoConnexin26mutations,andoneduetocholesteatoma.Medianpreoperativewordandsentencerecognitionscoreswere27.5%and40%,respectively.Afteramedianpost-implantationintervalof7months(range3-27months),postoperativewordandsentencescoreswere74%and73%,respectively.OnlyonechilddidnotshowimprovementinspeechperceptionfollowingCI,andnotablyshewascongenitallydeafenedandimplantedat9.5yearsold.Allpatientscontinuetobefulltimeusersoftheirdeviceandreportsubjectivebenefit.Otherdataregardingsoundquality,soundlocalization,tinnitussuppressionandperformanceinnoisearevariablyreported.Conclusion:Conclusion:Motivatedpediatricandadolescentsubjectswithsingle-sideddeafnesscanbenefitsignificantlyfromcochlearimplantation.Objectivespeechoutcomemeasuresareimprovedinbothquietandnoise,andthechildrenconsistentlyusetheirdevice.Parallelingpreviouslypublisheddataforpediatricpatientswithbilateraldeafness,thesedatasuggestthatthereismostlikelyasensitiveperiodafterwhichtheefficacyofcochlearimplantationforcongenitalsingle-sideddeafnessmaybemitigated. SessionID:S4-2SessionTitle:ResidualHearingAbstractID:420Title:HearingBenefitFollowingExtendedContralateralRoutingofSignalUseinUnilateralCochlearImplantUsersAuthors:HillarySnapp,AuD,SuhrudRajguru,PhD;Univ.ofMiami,miami,FL.Abstract:Introduction:Monauralcochlearimplant(CI)recipientssufferfromthelossofcriticaltimingandlevelcuesprovidedthroughbinauralhearingthatdirectlycontributetoimprovedabilitytoprocesscomplexauditorystimulisuchasspeechperceptioninnoise.Wepreviouslyinvestigatedthelimitationsofunilateralhearinglossanddemonstratedthepotentialbenefitofcontralateralroutingofsignaltechnology(CROS)intraditionalmonaurallistenersandinunilateralcochlearimplantrecipients.Whatisunknowniswhetherthesebenefitstranslatetoreal-worldlistening,iftheyaresustainable,andifCROS


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inputisanacceptablesolutiontothelisteningneedsofunilateralCIrecipients.QuestionsremainregardingthehearinghandicapinunilateralCIusersandhowCROStechnologymayaffectreportsofhandicap.ThepurposeofthisstudywastodetermineifCROStechnologyprovidessustainablebenefitinunilateralCIrecipientsasmeasuredbybehavioralstudiesofhearingperformanceandsubjectivereportofbenefit.Methods:AdultswithbilateralprofoundsensorineuralhearinglossusingaCIinatleastoneearwereprospectivelyenrolledforstudy.SubjectswerefitwithanearlevelwirelessCROSprototype(AdvancedBionic,LLC)designedtowirelesslyroutetheacousticsignalfromthenon-implantedeartoaNaidaCIprocessor.SubjectsworetheCI+CROSconfigurationexclusivelyforaminimumof4weeks.Speechinnoiseperformancewasassessedinthemonaural(unilateralCI)andcomparedtotheCI+CROSfollowinga4weekacclimatizationperiod.RecordedBKBSINTMsentenceswereusedforassessmentofspeechinnoiseperception.Subjectswereevaluatedinthespeechfront,noisefront(0º/0º),speechnon-implantedear,noiseimplantedear(90º/270º),speechimplantedear,noisenon-implantedear(90º/270º),andspeechfront,noiserear(0º/180º)configurations.BenefitandacceptanceoftheCI+CROSconfigurationwasassessedusingsubjectivequestionnaires.Results:OurpreliminarydataprovidestrongevidencethatbenefitsgainedintraditionalmonaurallistenersthroughCROStechnologyareachievableinunilateralcochlearimplant(CI)recipients.TheadditionoftheCROSinunilateralCIreducesthevariabilityinperformance,allowingforequalperformanceacrossalllisteningconditionsregardlessofthelocationofthespeakerornoise.GreatestdegreeofbenefitisobservedinthemonauraltotheCI+CROSconditionwhennoiseismaskingtheCIandspeechisdirectedatthenon-implantedear.SubjectivereportsindicatethatunilateralCIrecipientsperceivebenefitfromtheCI+CROSconfiguration.Conclusion:ApplyingCROStechnologytounilateralCIrecipientsprovidesanovelsolutiontoimprovingthespeechperceptioninnoisedeficitsassociatedwithmonaurallistening.AlthoughbinauralfunctioncannotberestoredwithCI+CROS,itmayprovideaneconomicallyfavorablesolutionforthosewhodonothaveaccesstoasecondCI. SessionID:S4-2SessionTitle:ResidualHearingAbstractID:75Title:HearingatBirthtoCochlearImplantation-ProgressiveHearingLossAuthors:KatieSawaya,AuD,StacyPayne,AuD,StevenAndreoli,MD,DrewHorlbeck,MD;Audiology,NemoursChildren'sSpecialtyCare,Jacksonville,FL.Abstract:HearingatbirthtocochlearimplantationIntroductionTheincidenceofprogressivehearingloss(HL)inchildrenvariesfrom4-30%1,2.Riskfactorsattributedinclude:familyhistory,syndromichearingloss,in-uteroinfections,NICUstayover5days,andpostnatalinfections2.Childrenwhoaredelayedinreceivingacochlearimplantare52%morelikelytohaveaprogressiveHL3.Thisdelayisinpartrelatedtopassingthenewbornhearingscreen.Thepurposeofthisstudyistoreviewchildrenwhopassednewbornhearingscreeningandultimatelyrequiredcochlearimplantation.MethodsAretrospectivereviewofchildrenundergoingcochlearimplantationatatertiarylevelchildren’shospitalsinceOctober2000wasperformed.Childrenwhomweredocumentedtohavepassedtheirnewbornhearingscreeningandlaterrequiredacochlearimplantwereincluded.Newbornhearingscreeningresults,diagnosisagerange,etiologyofHL,lagtoimplantationandspeechreceptionanddiscriminationwereexamined.


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Results30childrenwithprogressiveHLwereincluded.ThemostcommonetiologieswererelatedtoextendedNICUstay,enlargedvestibularaqueduct,familyhistoryofHL,andauditoryneuropathy.TheaveragediagnosisageforHLwas2.35±1.5years.13(43.3%)childrenreceivedtheirimplantwithin12monthsofHLdiagnosis,while17(56.7%)childrenwereimplantedmorethan12monthafterdiagnosiswithameanlagtimeof3.11±1.87years.92%ofchildrenimplantedearlyafterdiagnosiswereidentifiedwithsevere-profoundHLatthetimeofdiagnosis.Incontrast,only25%implantedmorethan12monthsafterdiagnosiswerefoundtohaveseveretoprofoundHLattimeofdiagnosis.Thespeechreceptionthresholdsintheearlyandlateimplantedgroupswerecomparableat16.9±2.5dBand17.9±3.6dBrespectively(p>0.05).Speechdiscriminationresultsfromtheearlyandlateimplantationshowatrendtowardsimprovedresultswithearlyimplantation.Discriminationfortheearlyandlaterimplantedgroupswere87.2±13.%and77.4±14.0%(p=0.06).ConclusionChildrenwhoareidentifiedwithprogressivehearinglossappeartoperformbetterwiththeircochlearimplantsifimplantedwithin12monthsofdiagnosiscomparedtotheirlaterimplantedcounterparts.Speechprogressandhearingprogressionneedtobecloselymonitoredtoensureappropriatemanagement.1.Berrettini,S.,Ravecca,F.,Sellari-Franceschini,S.,Matteucci,F.,Siciliano,G.,&Ursino,F.(1999).Progressivesensorineuralhearinglossinchildhood.PediatricNeurology,20(2),130-136.2.Barreira-Nielsen,C.,Fitzpatrick,E.,Hashem,S.,Whittingham,J.,Barrowman,N.,&Aglipay,M.(2016).ProgressiveHearingLossinEarlyChildhood.EarandHearing,37(5),e311-e321.3.Fitzpatrick,E.M.,Ham,J.,&Whittingham,J.(2015).Pediatriccochlearimplantation:whydochildrenreceiveimplantslate?.Earandhearing,36(6),688. SessionID:S4-2SessionTitle:ResidualHearingAbstractID:108Title:LocalizationandQualityofLifeafterCochlearImplantationinCasesofUnilateralHearingLossAuthors:MargaretDillon,AuD1,EmilyBuss,PhD1,MeredithAnderson,AuD1,EnglishKing,AuD2,EllenDeres,AuD2,KevinBrown,MD,PhD1,HaroldPillsbury,MD1;1Otolaryngology/HeadandNeckSurgery,Univ.ofNorthCarolinaatChapelHill,ChapelHill,NC,2Audiology,UNCHlth.Care,ChapelHill,NC.Abstract:Introduction:Patientswithmoderate-to-profoundunilateralhearinglossexperiencepoorerlocalizationabilities,speechperceptioninnoise,andqualityoflifeascomparedtonormalhearers.Currenttreatmentoptions,includingbone-conductiondevicesandCROShearingaids,routethesignalfromtheaffectedsidetothenormalhearingear.Thislisteningconditionlimitstheabilitytousebinauralcuesforimprovedspatialhearing.Itisofinterestwhethercochlearimplantationoftheaffectedearwouldimprovespatialhearingabilitiesduetobinauralinput,andwhethertheCIrecipientwouldexperienceanimprovedqualityoflife.Methods:Twentysubjectswithmoderate-to-profoundunilateralhearinglossunderwentcochlearimplantationoftheaffectedearaspartofaclinicaltrialinvestigatingoutcomesofthisnewindicationoverthefirstyearofdeviceuse.Thepresentreportreviewedspatialhearingabilitiesthatwereassessedonalocalizationmeasureandwithsubjectivequestionnaires(APHABandSSQ).Subjectswereevaluatedpreoperativelywiththenormal-hearingearalone(NH-alone)andpostoperativelywiththeCIplusthe


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contralateralear(CI+NH).Subjectswerefollowed1,3,6,9and12monthspost-initialCIactivation.Datawereanalyzedtodeterminethetime-courseofimprovedlocalizationabilitiesintheCI+NHconditionandwhetherqualityoflifemeasuresreflectedsoundfieldfindings.Results:SubjectsexperiencedasignificantimprovementinlocalizationabilitiesintheCI+NHconditionasearlyasthe1-monthinterval.Localizationabilitiescontinuedtoimprovethroughthe12-monthinterval.SubjectivequestionnairesrevealedanearlyimprovementinqualityoflifeintheCI+NHconditionascomparedtotheNH-alone.InitialdatafrompediatricsubjectslisteninginaCI+NHconditionarecomparabletoresultsinadults.Conclusion:SubjectsexperiencedasignificantbenefitinspatialhearingabilitiesafterafewweeksofCIuse.Achievingagreaterunderstandingofthetime-courseofimprovementandthepotentialrelationshipwithqualityoflifeisimportantwhencounselingpatientsandtheirfamiliesontreatmentoptions. SessionID:S4-2SessionTitle:ResidualHearingAbstractID:213Title:MaskingReleasewithChangingFundamentalFrequency:ElectricAcousticStimulationResemblesNormalHearingSubjectsAuthors:AliceB.Auinger,MD,DominikRiss,MD,RudolfsLiepins,DI,Wolf-DieterBaumgartner,MD,ChristophArnoldner,MD;DepartmentofOtorhinolaryngology,Med.Univ.ofVienna,Vienna,Austria.Abstract:Introduction:Usersofelectricacousticstimulation(EAS)showsuperiorityovercochlearimplantusers(CI)inchallenginglisteningsituationsasitcanbefoundinmultipletalkerenvironments.Thepreservedlow-frequencyregioninEASpatientsmightbeonereasonforthisbenefit.WethereforeinvestigatedwhetherusersofEASbenefitfromincreasingthefundamentalfrequency(F0)differencebetweenatargettalkerandamaskingtalker.Methods:Weincluded29patientsrepresentingthreegroups:EASandCIusersandnormalhearinglisteners(NH).AllCIandEASuserswereimplantedwithaMED-ELcochlearimplantandhadatleast12monthsofexperiencewiththeimplant.TheOldenburgersentencetest(OlSa)corpusservedastestmaterial,onespecificsentencewasusedasamasker.Inthismaskersentencethefundamentalfrequency(F0)wasincreasedby4,8and12semitones.AllothersentencesfromtheOlSacorpuswerepresentedunchangedatafixedlevel.Thespeechreceptionthreshold(SRT)forallF0conditionswasassessedbyadaptivelyvaryingthemaskerlevel.Results:EASusersandNHlistenersshowedastatisticallysignificantimprovementinspeechperceptionwithincreasingthedifferenceinF0betweentargetandmaskersentence.InclassicCIorEASwithelectricalstimulationonly,speechperceptionwasindependentfromdifferencesinF0.WithincreasingthedifferenceofF0betweentargetandmaskingsignalareleasefrommaskingwasobservedonlyinconfigurationswherethelow-frequencyregionwaspresentedacoustically.Conclusion:Thelow-frequencycontentofaspeechsignalseemstoincludeimportantcuesforseparatingmultiplesourcesofspeech.Bycombiningacousticandelectricinformation,EASlistenerscanbenefitfromfine-structurecuesinthelow-frequencyregionandsegregateaudiostreamsfrommultipletalkersmoreeffectively.Preservingthelow-frequencyacousticregionseemstobecrucialtoprovideCIuserswiththebestbenefit. SessionID:S4-3SessionTitle:BasicResearchAbstractID:180


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Title:WhiteMatterAnisotropyintheLeftAnteriorSuperiorTemporalRegionPredictsSpeechPerceptionImprovementinYoungCochlearImplantRecipientsAuthors:ZhizhouDeng,PhD1,PatrickC.M.Wong,PhD2,ErinM.Ingvalson,PhD3,NancyYoung,MD4;1theChineseUniv.ofHongKong,HongKong,HongKong,2TheChineseUniv.ofHongKong,HongKong,HongKong,3FloridaStateUniv.,Tallahassee,FL,4Ann&RobertH.LurieChildren’sHosp.ofChicago,Chicago,IL.Abstract:Introduction:Previousresearchhasshownthattheventralauditorypathwayisassociatedwithsound-to-meaningprocessinginspokenlanguagelearninginadulthood.Thegoalofthepresentstudyistoexaminewhetherthispathwaycanpredictspeechperceptionoutcomesinyoungcochlearimplantrecipients,asassociatingthespeechsignalwithwordmeaningisanimportantpartofearlylanguagedevelopment.Diffusiontensorimaging(DTI)providesinformationaboutwhitematterneuralfibertractsthatinterconnectdifferentareasofthebrainincludingthoseinvolvedinlanguage.WehypothesizethattheabilitytoaccuratelypredictindividualoutcomesbasedonpreoperativeimagingwillbeenhancedbydatafromDTI,andthattheleftventralauditorypathwaywouldbemostpredictiveofoutcomes.Methods:Thisisaprospectivestudyof13CIrecipientsimplantedbeforeage4years(M19.34±9.42months)whounderwentneuroanatomicalMRIandDTIsequencespriortoimplantation.Standardclinicalmeasuresofspeechperception(e.g.,MAIS,ESP)wereobtainedpre-andsixmonthspost-activation.Adiffusiontensormodelwasusedtoobtainvoxel-wisefractionalanisotropy(FA)values.TheobtainedFAmapswerethenprocessedusingamodifiedtract-basedspatialstatistics(TBSS)analysis.Toexaminetheuniquecontributionofwhitematteranisotropytospeechperceptionimprovementafterimplantation,weconductedpartialcorrelationsbetweenthespeechperceptionimprovementandFAvalueswhilecontrollingforage.Significantclusterswereidentifiedwithathresholdofsinglevoxelp<.01andaclustersizelargerthan54mm3,asdeterminedbyaMonteCarlosimulation.Toidentifywhichlanguagepathwaymediatesspeechperceptionimprovement,weusedtheclusterofwhitemattershowingsignificantcorrelationwithspeechperceptionimprovementastheseedvoxelsinprobabilistictractography.Results:WefoundthatFAvaluesinoneclusterintheleftanteriorsuperiortemporalregionwerepositivelycorrelatedwithspeechperceptionimprovementaftercontrollingforage.Fibertrackingresultsshowedseveraltractstoconnecttotheanteriorpartoftheleftsuperiortemporalregion.Themainwhitematterpathwaystartedfromtheleftanteriortemporalpole(seedregion)andwentalongtheinferiortemporalareabeforereachingtheleftposteriortemporal-parietalregion.Conclusion:Priorstudieshavedemonstratedthattheventralauditorycortexispartoftheventralauditorypathwaythatisimportantinearlylanguagelearning.OurDTIstudyprovidespreliminarydatathatmayproveusefultoenhancingourabilitytopredictCIoutcomespreoperativelybaseduponbrainanatomyandfunction.Atpresentthereisnotanaccuratewaytopredictspeechperceptionoutcomes,eveninearlyimplantedchildren.Apredictivemodelbaseduponcomprehensivenoninvasiveneuralmeasureswouldprovideanimportantmeanstoplanindividualizedpost-implanttherapy. SessionID:S4-3SessionTitle:BasicResearchAbstractID:182Title:MorphologicalNeuralPreservationUnderliesSpeechPerceptionImprovementinYoungCochlearImplantRecipientsAuthors:GangyiFeng,PhD1,NancyYoung,MD2,ErinM.Ingvalson,PhD3,TinaM.Grieco-Calub,PhD4,MeganRoberts,PhD4,PatrickC.M.Wong,PhD5;


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1TheUniv.ofTexasatAustin,Austin,TX,2Ann&RobertH.LurieChildren’sHosp.ofChicago,Chicago,IL,3FloridaStateUniv.,Tallahassee,FL,4NorthwesternUniv.,Chicago,IL,5TheChineseUniv.ofHongKong,HongKong,HongKong.Abstract:Introduction:Thoughcochlearimplants(CIs)promotethedevelopmentofchildren’sspeechandlanguagesystems,individualoutcomesarehighlyvariable.Themostconsistentlyreportedpredictorsofoutcomes,suchasageofimplantationandresidualhearing,explainasmallportionofthevariance.Thisstudyusesnewtechniquestodevelopanobjectivepre-surgicalneuralmeasuretopredictCIoutcomesinearlydeafenedchildren.Theabilitytoaccuratelypredictindividualoutcomesisacriticalfirststeptowardsdevelopmentofprecisionrehabilitativetherapytomaximizelanguageacquisitioninchildrenwhoareatriskforlanguagedelayfollowingcochlearimplantation.Methods:Prospectivestudyof36CIrecipientsimplantedbelowage4yearswhounderwentpre-surgicalneuroanatomicalMRI.Standardclinicalmeasuresofspeechperceptionweredonebeforesurgeryandsixmonthspost-activation.NeuroanatomicalcomparisonsbetweenchildrenreceivingCIsandage-matchedchildrenwithnormalhearing(NH)wereusedtodeterminewhichneuralnetworkswereeitheraffectedorunaffectedbyauditorydeprivation.ThesedatawereusedtocreatehypothesisdrivenmachinelearningmodelstoclassifyCIrecipientsintohighversuslowimprovementgroupsbaseduponneuroanatomyalone.Thefirsthypothesis,theneuralrecyclinghypothesis,predictsthatbrainregionssignificantlyaffectedbyauditorydeprivationwouldbemostpredictiveofpost-surgicaloutcomes.Thesecondhypothesis,theneuralpreservationhypothesis,postulatesthatbrainareasunaffectedbyauditorydeprivationwouldmostlikelycontributetopost-implantationlanguagedevelopment.Theabilityofthesemodelstopredictimprovementinspeechperceptionoutcomeswascompared.Results:ThemostobviousmorphologicaldifferencesbetweenthechildrenintheCIandNHgroupswereintheleftauditorycortex,inwhiteandgraymatter,andinlocaldensityandmorphologicalpatterns.Consistentwiththeneuralpreservationhypothesis,themachinelearningmodelsbaseduponbrainregionsunaffectedbyauditorydeprivationhadthehighestaccuracy,sensitivityandspecificityinclassifyingchildrenintheCIgroupintohighversuslowimprovement.Aconvergenceofdatafrommodelsthatwerebuiltusingdifferentmodelparametersfurthersupportedthishypothesis.Importantly,thesemodelsweremoreaccuratethantheuseofpreoperativebehavioralmeasuressuchasresidualhearing.Conclusion:Machinelearningmodelsthatrelieduponbrainregionsunaffectedbyauditorydeprivation,mostlyinauditoryassociationandcognitivebrainregions,producedthehighestaccuracy,specificityandsensitivityinpatientoutcomeclassification.Theuseofneuroanatomicaldataallowedustomostobjectivelypredictoutcomeswithoutrelyingonthepatientstoperformanyauditorytasks. SessionID:S4-3SessionTitle:BasicResearchAbstractID:159Title:Spectral-TemporalModulatedRippleDiscriminationbyChildrenwithCochlearImplantsAuthors:DavidLandsberger,Ph.D.1,MonicaPadilla,Ph.D.2,AmyS.Martinez,MA1,LaurieS.Eisenberg,Ph.D.3;1Otolaryngology,NewYorkUniv.Sch.ofMed.,NewYork,NY,2Otolaryngology,NewYorkUniv.,NewYork,NY,3Otolaryngology,Univ.ofSouthernCalifornia,LosAngeles,CA.Abstract:Introduction:Apost-linguallyimplantedadulttypicallydevelopshearingwithanintactauditorysystem,followedbyperiodsofdeafness(orneardeafness)andadaptationtotheimplant.Foranearlyimplantedchildwhosebrainishighlyplastic,theauditorysystemmatureswithconsistentinputfromacochlearimplant.Itislikelythattheauditorysystemofearlyimplantedcochlearimplantusersis


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fundamentallydifferent(withdifferentlimitationsandbottlenecks)thanpost-linguallyimplantedadults.Thepurposeofthisstudyistocomparethebasicpsychophysicalcapabilitiesandlimitationsofthesetwopopulationsonaspectralresolutiontasktodeterminepotentialeffectsofearlydeprivationandplasticity.Methods:Performanceonaspectralresolutiontask(SMRT)wasmeasuredfortwentybilaterallycochlearimplantedchildren(agedbetween5and13years)andtwentyhearingchildrenwithinthesameagerange.Additionally,10bilaterallyimplantedpost-linguallydeafenedcochlearimplantedadultsand10hearingadultsweretestedonthesametask.Cochlearimplantusers(adultandchildren)weretestedbilaterally,andwitheachearalone.Hearinglisteners(adultandchildren)weretestedwiththeunprocessedSMRTandavocodedversion.Results:Forchildrenwithnormalhearing,apositivecorrelationwasfoundbetweentheirageandtheirSMRTscoreforboththeunprocessedandvocodedversions.Olderhearingchildrenperformedsimilarlytohearingadultsinboththeunprocessedandvocodedtestconditions.However,forchildrenwithcochlearimplants,norelationshipwasfoundbetweenSMRTscoreandchronologicalage,ageatimplantation,oryearsofexperiencewithacochlearimplant.Pediatricperformancewithacochlearimplantwaspoorerthantheadultperformancewithacochlearimplant.Additionally,SMRTscorewassignificantlybetterforthefirstimplantachildreceivedalonethanwiththesecondimplantalone.However,asignificantdifferencewasnotobservedforthefirstandsecondimplantsforadults.Conclusion:Resultssuggestthatbasicpsychophysicalcapabilitiesofearlyimplantedchildrenandpost-linguallyimplantedadultsdifferwhenassessedinthesoundfieldthroughtheirimplantprocessors.Becausespectralresolutiondoesnotimprovewithageforearlyimplantedcochlearimplantusers,itseemslikelythatthesparserepresentationofthesignalprovidedbyacochlearimplantlimitsspectralresolutiondevelopment.Theseresultsareconsistentwiththefindingthatpost-linguallyimplantedadults,whodevelopedtheirauditorysystemfromnormalauditoryinputsbutnowreceivethesamesparsesignalastheimplantedchildren,performsignificantlybetterthanchildrenonthespectralresolutiontest.SupportprovidedbytheNIH/NIDCD(R01DC012152,PI:Landsberger),aswellasgrantsbythreecochlearimplantmanufacturers(PI:LandsbergerandPI:Roland). SessionID:S4-3SessionTitle:BasicResearchAbstractID:378Title:MagneticTargetingofStemCellandGeneTherapytotheInnerEarAuthors:TrungN.Le,MDPhDFRCSC,LolaAwofala,MSc,VincentLin,MDFRCSC,JosephChen,MDFRCSC,AlainDabdoub,PhD;OtolaryngologyHead&NeckSurgery,Univ.ofToronto,Toronto,Canada.Abstract:Introduction:Hearingimpairmenthasasignificantnegativeimpactonthequalityoflifeinasocietythatmainlyreliesonfast,complexcommunication.Wehavepreviouslydemonstratedthatmagnetictargetingdeliveryofstemcelltocochleawithamagnetizedcochlearimplantcouldpromotesurvivalbenefitandhearingrecovery.Theobjectiveofthisstudyistofurthercharacterizeandoptimizemagnetictargetingasaneffectivedeliverymethodofstemcellandgenetherapiestotreathearinglossandpotentiallyimprovecochlearimplantfunction.Methods:Mesenchymalstemcells(MSCs)areequippedwithAdeno-associatedvirus(AAV)containingbrain-derivedneurotrophicfactorandgreenfluorescentproteinmarker.Theexpressionofthesetransgenesisdrivenforanearlyonsetandrobustexpression.TheenhancedMSCs-AAVaremagneticallytargetedtothecochleausingsuperparamagneticnanoparticlesandamagnetizedcochlearimplant.Long-termsupplyofMSCs-AAVcanbeachievedthroughmultiplesystemicinjections.Histological


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qualitativechangesaremonitoredbyexaminationofMSClocalization,numberofhaircells,supportingcells,andspiralganglionneurons.Functionalquantitativechangesareexaminedthroughinvivoneurotrophicfactorlevelandhearingrecovery.Results:Expressionoftransgenesisstablethroughseveralpassagesanddoesnotaffecttheself-renewalcapabilityandmultipotencyofMSCs.TheenhancedMSCsarefoundtobemagneticallytargetedtothecochleainhighnumber.Wearelookingtocorrelateourcurrentfindingswithelevatedneurotrophicfactorlevel,improvedsurvivalofhaircellandspiralganglionneurons,aswellashearingrecovery.Conclusion:Ourstudyproposestousenovelandrecentlyprovenmagnetictargetingdeliverymethodstoconcentratestem-cellsandgenetherapyfactorsintotheinnerear.Ourinitialapproachistoexploreeffectivewaystoprovidelocalizedtreatmenttothedamagedcochleainconjunctionwithcochlearimplantsurgery.Ourstudieswillenablethedevelopmentandtestingofnewbiologicaldeliverystrategiestotheinnerearthatcanleadtopotentialrecoveryfromhearingloss. SessionID:S4-3SessionTitle:BasicResearchAbstractID:411Title:NovelApproachestoMicrobialOpsinDeliveryforanOptogeneticbasedCochlearImplantAuthors:VivekKanumuri,M.D.1,MariaDuarte,B.S.2,LukasD.Landegger,M.D.2,OsamaTarabichi,M.D.2,XiankaiMeng,Ph.D.1,ArielHight,Ph.D.1,ElliottKozin,M.D.1,KonstantinaM.Stankovic,M.D.,Ph.D.2,M.ChristianBrown,Ph.D.1,DanielLee,M.D.1;1HarvardMed.Sch./MEEI,Boson,MA,2HarvardMed.Sch./MEEI,Boston,MA.Abstract:Introduction:Thecochlearimplant(CI)providesmeaningfulsoundandspeechperceptionbutoutcomesarehighlyvariableacrosssimilarcohortsofpatients.Inaddition,CIusersexperiencedegradedperformanceinnoisyenvironmentsandwithmusicappreciationandthismaybeduetolimitedspatialspecificityfromelectricalcurrentspread.Optogeneticsisapowerfultechnologythatharnesseslight-sensitiveproteinscalledopsinstomodulateresponsesofphotosensitizedneuronswithmillisecondprecisioninvitroandinvivo.Unlikeelectricity,lightcanbefocusedtocreateagreaternumberofindependentchannelsofauditoryinformationcomparedtoelectricity.Afundamentalsteptowardslight-basedstimulationofthecochleaisrobustgenedeliveryandexpressionofopsinsinspiralganglioncells(SGCs).Herein,wedescribeseveralminimallyinvasivemethodstophotosensitizeSGCsvialocalandsystemicinjectioninamurinemodel.Methods:LocalopsindeliveryintothecochleawasachievedbydirectinjectionthroughtheroundwindowofP3miceusingadeno-associatedvirus(AAV)withChronosopsinandGFPreporter.SystemicdeliveryofopsinswasachievedusinginjectionintosuperficialtemporalveinofP1micewithAAV-Chronos-GFP.Transgenicmiceexpressingopsinswereusedaspositivecontrolsandgeneratedusingknock-inmousemodelsincombinationwithCremouselinestoselectivelyexpressChannelrhodopsin2(ChR2).SubjectsweresacrificedandimmunohistochemistryofthecochlearsectionsperformedfollowedbyconfocalmicroscopyafterafiveweekincubationperiodResults:OpsinexpressioninSGCswasachievedusinglocalinjection,systemicinjection,andtransgenicapproaches.Localviral-mediatedtransductionachievedhigherratesofexpressioninSGCscomparedwithsystemicviral-mediatedtransduction.TransgeniclinesdemonstratedthemostrobustexpressionofopsinsandthiswasobservedinbothtypeIandtypeIISGCsConclusion:Deliveryoflight-sensitiveopsinstoSGCsisachievablethroughmultipleminimallyinvasiveapproaches.Thesefindingsrepresentanimportantsteptowardthedevelopmentofalight-basedcochlearimplant


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SessionID:S4-3SessionTitle:BasicResearchAbstractID:499Title:VowelRecognitionScoresofChildrenwithCochlearImplantsareRelatedtoSpeech-basedSpectralResolutionandTimewiththeImplantAuthors:MishaelaDiNino,M.A.,MatthewB.Winn,Ph.D.,JulieG.Arenberg,Ph.D.;DepartmentofSpeechandHearingSciences,Univ.ofWashington,Seattle,WA.Abstract:Introduction:Whilecochlearimplantationatayoungagecanresultinfavorableauditoryperceptionoutcomes,considerablevariabilitypersistsamongspeechrecognitionscoresofearly-implantedchildren.Spectralresolution,theabilitytoresolvethefrequencycomponentsofanauditorysignal,isessentialforaccuratespeechidentificationbutislimitedincochlearimplant(CI)usersofallages.ChildrenwithCIshavebeenfoundtovaryintheirindividualspectralresolvingcapabilities;theseindividualdifferencesmaycontributetothewiderangeofpediatricCIusers’speechidentificationscores.Further,normalhearingchildren’sperformanceontestsofspectralresolutionandidentificationofspectrally-degradedspeechhavebeenfoundtoimprovewithage,reflectingauditorysystemdevelopment.Thus,maturityoftheauditorysystemmayalsoplayaroleinpediatricCIusers’speechrecognitionabilities.Thepresentstudyexaminedtherelationshipbetweenspeech-basedspectralresolution,auditorysystemdevelopment,andvowelidentificationscoresofchildrenwithCIs.Methods:ThirteenchildrenwithCIsbetweentheagesof11to17years(m=14.2years)performedavowelidentificationtaskandatestofspeech-based,functionalspectralresolution.AllbutoneparticipantreceivedtheirfirstCIpriorto5yearsofage(m=2.85years).ElevenparticipantswerebilaterallyimplantedandperformedthetaskswitheachCIseparately,foratotalof24CIstested.Stimuliwerepresentedinthesoundfield.Participantsidentifiedvowelsin/hVd/context(naturally-spokenbyafemaletalker)fromaclosedsetof10stimuli.Forthespeech-basedspectralperceptiontest,childrencategorizedthespeechsounds/ba/and/da/,whichweremanipulatedonacontinuumofformanttransitions.Analysisofresultsfromthistestyieldedalogisticregressioncoefficientthatindicatedthelistener’sabilitytouseformantcues.Alargerformantcuecoefficientindicatesgreaterabilitytoutilizethespectralcue.Chronologicalageand“CIage,”ortimewiththeimplant,werealsoanalyzedtodeterminetheinfluenceofauditorysystemdevelopmentonthesetwotasks.Results:Greaterabilitytousetheformantcueincategorizationwassignificantlycorrelatedwithhighervowelrecognitionscores.Greater“CIage,”orlongertimewiththeimplant,wassignificantlycorrelatedwithhighervowelrecognitionscoresandbetteruseoftheformantcueforspeechcategorization.Norelationshipwasfoundbetweenchronologicalageandeithervowelidentificationperformanceoruseoftheformantcue.Conclusion:TheseresultsindicatethatpediatricCIusers’vowelidentificationperformancecanbeexplainedpartlybytheirabilitytomakecategoricaljudgmentsaboutspectralcuesinspeechsounds.Inaddition,“CIage,”ratherthanchronologicalage,isassociatedwithbothspectralresolvingcapabilitiesandvowelrecognitionscores.Thesefindingssuggestthatcochlearimplantationenhancesauditorysystemdevelopmentandcouldleadtomorerapidmaturationofauditoryperception.Futurestudiescoulddeterminethetimelineofauditorysystemdevelopmentinthispopulationbyemployingalongitudinalstudydesign.SessionID:S4-3SessionTitle:BasicResearchAbstractID:150Title:AutomaticCochleaSegmentationUsingDiffusionSnakes


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Authors:IbraheemAl-Dhamari,MScComputerScience1,SabineBauer,PhD2,DietrichPaulus,Prof.ComputerVision3,RolandJacob,PDDr.med.4;1ComputerScience,KoblenzLandauUniv.,Koblenz,Germany,2MTI,KoblenzLandauUniv.,Koblenz,Germany,3AGAS,KoblenzLandauUniv.,Koblenz,Germany,4Ear,NoseandThroat,Militaryhospital,Koblenz,Germany.Abstract:Introduction:Apriorknowledgeofcochleasizeisanimportantfactorforane*cientcochleaimplantsurgery.Medicalimagesegmentationtechniquescanhelptogetsuchmeasurementbyaccurateextractionofthecochlea.WeproposeafullyautomaticsegmentationmethodforhumancochleathreedimensionalimagesusingaLevelSetmodel-basedapproach.Ourdatasetandsourcecodewillbeavailableforfreeandcanbedownloadedfromourpublicserver.Methods:Multi-modalcochleaimagesofpatientsfromdi*erentgendersandagesarecol-lected.TheseimagescontainCBCT,CTandMRImodalities.Theywereautomaticallypre-processed(normalizationandhistogramequalization)andregistered,manuallysegmentedandtheshapesaremanuallyextracted.Theseshapesareusedinthetrainingphaseandasaback-groundtruthforthetestphase(evaluation).WeaddedashapepriorenergytoChan-vesetermsasdescribedin*gure1.Figure1:FlowchartoftheproposedmethodResults:WeusedthestandardDiceCoe*cient(DC)andtheHaussdorfDistance(HD)fortheevaluationpurpose.Otherstandardmodel-basedapproachessuchasGeodesicActiveContours(GAC)andDi*usionSnakeswillbecomparedtotheproposedmethod.Usingtheshapepriorenhancesthequalityoftheresultsandproducesbettersegmentedcochleaimagesas*gure2shows.Figure2:Asampleoftheresults,a:aregionofcoronalviewofaCBCTcochleaimage,b:segmentationresultwithoutusingtheshapeprior(DC=0.91),c=segmentationresultwithusingtheshapeprior(DC=0.95)Conclusion:Wehavedescribedanautomaticsegmentationmethodforhumancochleaimages.Theresultswillbecomparedtostandardmodel-basedmethodssuchasGACusingstandardevaluationmetricssuchasDCandHD.ResultscanbeenhancedbyusingahighresolutionmCTmodelwhichwillbeafocusinfuturework. SessionID:S5-1SessionTitle:Imaging/RevisionsAbstractID:220Title:PredictorsofRoundWindowVisibilityInCochlearImplantationwithTemporalBoneHighResolutionComputedTomographyAuthors:ShupingSun,MD,PhD,WeiLu,MD,PhD;TheFirstAffiliatedHosp.ofZhengzhouUniv.,Zhengzhou,China.Abstract:Introduction:Todiscussthepredictorsofroundwindow(RW)visibilityincochlearimplantation(CI)withtemporalbonehighresolutioncomputedtomography(HRCT).Methods:FromJanuary2013toJanuary2017,130casesunderwentbothHRCTandCIinourhospitalwereanalyzed.Thedistancefromfacialnervetoposteriorcanalwall(FWD),theanglebetweenfacialnerveandinnermarginofroundwindow(FRA),theanglebetweenfacialnerveandtympanicanulustoinnermarginofroundwindow(FRAA)weredetectedatthelevelofroundwindowonaxialtemporalboneHRCT.AlineparalleltotheposteriorwallofearcanalwasdrewfromtheanteriorwalloffacialnerveatthelevelofroundwindowonaxialtemporalboneHRCTanditsrelationshipwithroundwindowwasdetected(facial-roundwindowline,FRL):type0-posteriortotheroundwindow,type1-betweenthe


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roundwindow,type2-anteriortotheroundwindow.Their(FWD,FRA,FRAA,FRL)relationshipswithintra-operativeroundwindowvisibilitywereanalyzed.Results:FWD(F=18.76,P=0.00),FRA(F=34.57,P=0.00),FRAA(F=14.24,P=0.00)canaffecttheintra-operativeRWvisibilitysignificantly.RWcanbeexposedcompletelyduringCIwhenpreoperativeHRCTshowingtype0FRL.RWmaybepartlyexposedandnotexposedwhenpreoperativeHRCTshowingtype1andtype2FRLrespectively.Conclusion:FWD,FRA,FRAAandFRLoftemporalboneHRCTcanpredictintra-operativeroundwindowvisibilityeffectivelyinCI. SessionID:S5-1SessionTitle:Imaging/RevisionsAbstractID:68Title:OutcomesofRevisionCochlearImplantationforSoftFailureAuthors:KyleS.Kimura,MD1,BrendanO'Connell,MD2,MarcBennett,MD2,DavidHaynes,MD,FACS2;1VanderbiltUniv.Med.Ctr.,Nashville,TN,2DepartmentofOtolaryngology,VanderbiltUniv.Med.Ctr.,Nashville,TN.Abstract:Introduction:Itisestimatedthatroughly3-8%ofcochlearimplantsfailinsomecapacity.Incasesinwhichinsitudevicetestingsuggestsnormalfunction,butpatientsexperienceeithersubjectiveorobjectivedeclineinperformance,counselingregardingexpectedoutcomescanbechallenging.Theobjectivesofthisstudyarethereforeasfollows:1)examinetheincidenceofcochlearimplantsoftfailuresatahighvolumeimplantcenter,and2)reportoutcomesofrevisioncochlearimplantationinthesecases.Methods:Medicalrecordsofpatientsundergoingcochlearimplantationatasingleinstitutionfrom2006-2016werereviewed.Casesinwhichinsituintegritytestingsuggestednormaldevicefunctionyetpatientsexperiencedoneofthefollowing:1)decrementinperformance,2)non-auditorysensations,or3)intermittentsoundqualityissues.Softfailurewasconfirmedwitheitherabnormaldevicetestingafterrevisionorimprovementinsymptoms/performance.Speechperformancewasassessedpre-andpost-operativelyusingCNCwordscorestestedinaquietenvironmentintheCI-onlycondition.Results:Duringtheten-yearstudyperiod,1,082patientsunderwent1,469cochlearimplantations.Overall,11revisioncochlearimplantations(0.7%)wereperformedforpresumedsoftfailure.Deviceanalysisafterre-implantationrevealeddevicefailureinonepatient.Fourpatientswerere-implantedduetosignificantobjectiveperformancedecrement(meandecreaseinCNCscoreof24%).Afterrevisionimplantation,meanCNCscoreincreased28%inthesepatientstoalevelcomparabletotheirbestperformancepre-operatively,andsoundqualitywasrestored.Theremainingsixpatientswerere-implantedforsubjectivesymptomswithoutperformancedecrement.Ofthese,onepatientendorsedsoundqualityissuesthatimprovedwithre-implantation.Sixcaseswererevisedduetonon-auditorysensations,withsymptomsdescribedasashock(n=5)orlocalizedpain(n=1).Allpatientsnotedcompleteresolutionoftheirsymptomspost-operatively.Conclusion:Theincidenceofrevisioncochlearimplantationforsoftfailureatourinstitutionislow(0.7%).Ourdatasuggestthatpatientsre-implantedforlocalizingnon-auditorysensationsoranobjectivedecreaseinspeechperformanceexperiencesignificantimprovement,despitetestingthatmaysuggestnormaldevicefunction. SessionID:S5-1SessionTitle:Imaging/RevisionsAbstractID:165


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Title:ComparisonofSkullRadiographandComputedTomographyMeasurementsofCochlearImplantInsertionAngles:ATemporalBoneStudyAuthors:DanielJethanamest,MD1,DavidR.Friedmann,MD1,MariHagiwara,MD2,J.T.Roland,Jr,MD1,MarioA.Svirsky,PhD1;1Otolaryngology-HeadandNeckSurgery,NewYorkUniv.Sch.ofMed.,NewYork,NY,2Radiology,NewYorkUniv.Sch.ofMed.,NewYork,NY.Abstract:Introduction:Accurateestimatesofcochlearimplant(CI)electrodepositionaredesirabletofacilitateinvestigationsoftheassociationbetweenpositionandclinicaloutcomes.Electrodelocationmeasurementisfrequentlydoneusingradiographsbuttheaccuracyofthesemeasurementshasnotbeencarefullyvalidatedagainstcomputedtomography(CT)-baseddata,whicharemoreprecisebutrequireahigherradiationdose.FormanyCIpatients,particularlypediatricusers,accurateestimatesofelectrodepositionwithoutadditionalradiationexposurecanbeuseful.ThisstudyaimstoinvestigatethefeasibilityofmeasuringCIelectrodearrayangulardepthofinsertion(aDOI)onpost-insertionskullradiographsforbothlateralwallandperimodiolararrays,incomparisontoCTinaseriesofcadaverictemporalbones.Methods:Twodifferentelectrodearraydesigns,onelateralwallandtheotherperimodiolar,wereimplantedinfivecadaverictemporalboneseach,foratotalof10specimens.High-resolutionCTofeachspecimenaswellasaskullradiographwereacquired.TheaDOIofthearrayswasmeasuredindependentlyfromCTandfromtheradiographs.Results:Post-insertionskullradiographsallowedforreliableaDOImeasurementsforbothlateralwallandperimodiolararrays.Theimagingmodalitiesprovidedcomparablemeasures,withameandifferencebetweenaDOImeasurementsbetweenthetwomodalitiesof8.4degrees(range1.8to16.0degrees).Conclusion:Post-insertionradiographsprovidereliablemeasuresofangularinsertiondepthforCIelectrodearraysincomparisontoCT.ThismethodissuitableforbothlateralwallandperimodiolararraysandcanprovidemeaningfulinformationaboutelectrodepositionforpatientswithoutapostoperativeCT. SessionID:S5-1SessionTitle:Imaging/RevisionsAbstractID:377Title:RevisionCochlearImplantationAuthors:NoamYehudai,MD,MHA,TalmaShpak,PhD,CarolinePeleg,MA,OsnatRot,MA,DanaEgra-Dagan,MA,ChananMazzawi,MA,RiadKhnifes,MD,MHA,MichalLuntz,MD;DepartmentofOtolaryngology—Head&NeckSurgery,BnaiZionMed.Ctr.,Haifa,Israel.Abstract:Introduction:Improveddocumentationofcochlearimplantation(CI)outcomes,togetherwiththeincreaseinthenumberofimplanteesandthestraightforwardinvolvementofmanyoftheminthehearingsociety,haveledtowideningcandidacycriteria.Yet,aCImaysometimesrequirereplacement,duetodevicefailureormedicalreasons.TheaimsofthestudyaretodefinetheratesofrevisionCIandinfluencingfactors.Methods:Aretrospectivechartreviewincluding79CIreplacementsperformedbetween1998and2016.ParametersevaluatedincludedageatCI,dateofCI,typeofdevice,dateandindicationforrevision.Kaplan-MeiersurvivalestimateswerecalculatedforcumulativerevisionrateversusthenumberofyearspostCIforseveralsubgroups.Survivaldistributionsbetweenthesesubgroupswereanalyzedandcomparedandtherelativehazardratioswerecalculated.Results:75patients(19adultsand56children)underwent79CIreplacementssurgeries.Themostcommonindicationswere'soft'and'hard'devicefailure(36.7%and45.6%ofindicationsfor


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replacements,respectively)followedbymedicalindications(17.7%)whichincludeinfectionandchronicpainatthereceiverstimulatorsite,andlatedevelopmentofretractionpocketcholesteatomainchildrenwhowereimplantedasyoungbabies.Overallrevisionanddevicefailurerateswere7.1%and5.8%,respectively.Replacementratesbetween2003and2016weresignificantlylowerthanthosebetween1998and2002(4.5%vs.28.8%,OR=3.37,p<0.001).Replacementratesweresignificantlyhigherinchildrencomparedtoadults(8.6%vs.4.6%,OR=1.86,p<0.04).Conclusion:Harddevicefailureisthemainindicationforrevisioncochlearimplantationfollowedbysoftdevicefailure.Revisionrateshavesignificantlydecreasedovertheyears,probablyduetoimprovedtechnologicreliability,butarestillsignificantlyhigherinchildrencomparedtoadults. SessionID:S5-1SessionTitle:Imaging/RevisionsAbstractID:228Title:InsertionDepthAnglePredictionAccuracyforCochlearImplantElectrodeArraySelectionAuthors:LukasAnschütz,MD1,StefanWeder,MD1,GeorgiosMantokoudis,MD1,MartinKompis,Prof.MD,PhD1,MarcoCaversaccio,Prof.MD1,WilhelmWimmer,PhD2;1DepartmentofOtolaryngology,HeadandNeckSurgery,Univ.Hosp.Bern,Inselspital,Bern,Switzerland,2ARTORGCenterforBiomedicalEngineering,Univ.ofBern,Bern,Switzerland.Abstract:Introduction:ItishypothesizedthatpreoperativeplanningofaspecificangularinsertiondepthforCIelectrodearrayscanbeachievedbyutilizingthecorrelationbetweenthecochleardiameterandthecochlearductlength.Inpractice,however,theresultcanbedistortedmainlyfortworeasons:wronglymeasuredcochleardiameters(i.e.,incorrectlyalignedimageslicestovisualizethecochlea)andanuncontrolledinsertiondepthofelectrodearrays(i.e.,difficultytoreproducetheinsertionpointanddepth).Theaimofthisexvivostudywastoevaluatetheaccuracyofinsertionanglepredictionwithalogarithmicequationunderoptimalconditions,i.e.optimallyalignedimagingslicestomeasurethecochleardiameterandacontrolledinsertionofelectrodearraysinhumanspecimen.Methods:Eighthumantemporalbones(Thielconservation)wereimagedwithacone-beamcomputed-tomographyscanner(0.33mm3voxelsize).Anobliqueslicewasplacedaccordingtoanatomicallandmarkstoensureareproduciblevisualizationofthebasalturn.Inthebasalturnplane,themaximumdiameterofthecochleathroughtheroundwindowwasmeasured.Usingalogarithmicequationthelinearinsertiondepthrequiredforaninsertionangleof540°degreeswascomputed.Lateralwallelectrodearrays(28mmlength)weremarkedatthespecificinsertiondepthandinsertedthroughtheroundwindow.Theinsertionwasstoppedwhenthemarksreachedtheroundwindowmembrane.Theelectrodearrayswerefixedusingbonewaxtoavoidarraymigration.Aftertheinsertion,CBCTimagesweretakentoassesstheinsertionoutcome,i.e.,theangularinsertiondepth,theimplantedscala,andthearraycourse.Results:Themeancochleardiameterwas8.9mm(range,8.3mmto9.4mm).Onaverage,theestimatedlinearinsertiondepthfora540°insertionwas24.9mm(range,23.2mmto26.3mm).Anaverageangularinsertiondepthof529°(range,510°to555°)wasachieved.Thiscorrespondstoameanpositioningerrorof11°(standarddeviation,±15°).Thedifferenceswerenotstatisticallysignificant(p=0.11,two-tailedWilcoxonsignedranktest).Allelectrodearrayshadasmoothcoursealongthelateralwallandwerefullyimplantedintothescalatympani.Conclusion:Thepresentedresultsdemonstratethepossibilitiesandlimitationsofinsertionanglepredictionusingalogarithmicequation.Itwaspossibletoplacetheelectrodearrayscloselytotheaimedtarget,however,clinicalsettingswillintroduceadditionalerrorsourcessuchasbendingofthearraywithinthecochleaandthedifficultytoreproduciblystopattheplannedposition.Regardingthe


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latter,computer-assistedplanningandcontrolledinsertiondevicescouldhelptoincreasethepositioningaccuracyofCIelectrodearrays. SessionID:S5-1SessionTitle:Imaging/RevisionsAbstractID:359Title:CochlearImplantDeviceFailures-IndicationsforRevisionandOutcomesAuthors:NoamYehudai,MD,MHA,TalmaTalma,PhD,CarolinePeleg,MA,OsnatRot,MA,DanaEgra-Dagan,MA,ChananMazzawi,MA,RiadKhnifes,MD,MHA,MichalLuntz,MD;DepartmentofOtolaryngology—Head&NeckSurgery,BnaiZionMed.Ctr.,Haifa,Israel.Abstract:Introduction:Devicefailureisthemostcommoncauseforrevisioncochlearimplantation(CI).Devicefailurecanbeabruptwithimmediatedeprivationofauditoryperception(hardfailure),orgradual,withprogressivedeclineinhearingfunctionornon-auditorysymptoms,whileauditoryperceptioncontinues(softfailure).TheaimofthestudyistodefinecharacteristicsofpatientswithdevicefailureanddescribepostrevisionCIoutcomesinthesecases.Methods:Aretrospectivechartreviewincluding65cochlearimplantdevicefailures(13inadultsand52inchildren),diagnosedandre-operatedbetween1998and2016.Dataregardingpatientdemographics,pre-CIsymptoms,findingsinthereturneddeviceanalysiscompanyreportsandpostrevisionmedicalandauditoryoutcomeswereretrospectivelyanalyzed.Results:Therewere29'soft'devicefailureand36'hard'devicefailure.Inadults,mostfailuresweresoftfailures(10/13),andinchildrenmostfailureswerehard(31/52).MeanintervalsbetweenCIandre-implantationforsoftandhardfailurewere5.38±3.82years(range,0.6-13.2)and4.51±3.35years(range,0.7-14.9),respectively.Medianintervalsbetweensymptomsandre-implantationforsoftandhardfailurewere13.2months(range,0.1-6.3)and3.6months(Range,0.1-8.5),respectively.Hearingoutcomesinallre-implantedpatientsimprovedafterre-implantationcomparedtotheirperformancepriortorevisionCI.Conclusion:Thediagnosisofsoftdevicefailureishardtomakeandconfirmedonlybyimprovementofsymptomsafterre-implantation.Therefore,re-implantationintheseindividualsisoftenpostponed.Thepresentstudyfindingshowingthatpatientsimprovefollowingre-implantationsupportsafastersoftdevicefailuredecisionmakingalgorithm. SessionID:S5-1SessionTitle:Imaging/RevisionsAbstractID:91Title:Three-dimensionalVisualizationofMicro-anatomicalStructuresoftheHumanInnerEarAuthors:R.vandeBerg,MD1,T.vandenBoogert,MD1,N.Guinand,MD2,Jp.Guyot,Prof.2,H.Kingma,Prof.1,A.Perez-Fornos,PhD2,S.Handschuh,PhD3,L.j.Chacko,MSc4,R.Glueckert,Dr.rer.nat.4,M.vanHoof,MD1,A.Schrott-Fischer,Prof.4;1Div.ofBalanceDisorders,Dept.ofOtorhinolaryngologyandHeadandNeckSurgery,FacultyofHlth.Med.andLifeSci.,Sch.forMentalHlth.andNeuroscience,MaastrichtUniv.Med.Ctr.,Maastricht,Netherlands,2ServiceofOtorhinolaryngologyandHeadandNeckSurgery,Dept.ofClinicalNeurosciences,GenevaUniv.Hosp.,Geneva,Switzerland,3VetCoreFacilityforRes.,Vet.Univ.Vienna,Vienna,Austria,4Dept.ofOtorhinolaryngology,Med.Univ.Innsbruck,Innsbruck,Austria.Abstract:Introduction:Knowledgeoftheneuro-anatomicalarchitectureoftheinnerearcontributestotheimprovementanddevelopmentofcochlearandvestibularimplants.Thepresentknowledgeismainlybasedontwo-dimensionalimages(histology)orderivedmodelsthatsimplifythecomplexityofthisarchitecture.Thisstudyinvestigatedthefeasibilityofvisualizingrelevantneuro-anatomical


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structuresoftheinnerearinadynamicthree-dimensionalreproduction,usingacombinationofstaining,micro-CTandanewlydevelopedimageprocessingalgorithm.Methods:Fourfreshcadaverictemporalboneswerepostfixedwithosmiumtetraoxide(OsO4)tovisualizemembranesandmyelinatednervefibersanddecalcifiedwithEDTA.Amicro-CTwasusedforscanningataresolutionof10micrometers(4scans)and5micrometers(1scan).AnewimageprocessingalgorithmwasdevelopedandappliedinMathematica(version10.4).Thescanswerevisualizedin3Dslicer.Results:OsO4enhancedthecontrastinallscansandthesignal-to-noiseratiowassubstantiallyimprovedbytheimageprocessingalgorithm.Thethree-dimensionalmodelsprovideddetailedvisualizationofthewholeinnerear.Detailswerevisibleuptoneurons,nervecrossingsandthespecificneurosensorystructureslikethetunnelofCortiandtheotolithorgans.Conclusion:ThecombinationofOsO4withmicro-CTandthenewlydevelopedimageprocessingalgorithmprovidesanaccurateanddetailedvisualizationofthethree-dimensionalmicro-anatomyofthehumaninnerear. SessionID:S5-3SessionTitle:Quality,AccessandPolicyAbstractID:375Title:ANewU.S.Standard-AAMICI86CochlearImplantSystems:RequirementsforSafety,FunctionalVerification,LabelingandReliabilityReportingAuthors:WilliamRegnault,PhD1,VasantDasika,PhD1,AamiCiCommittee,-2;1USFDA,SilverSpring,MD,2AAMI,Arlington,VA.Abstract:Introduction:AU.S.standardforcochlearimplantsystems,AAMI/CI86CochlearImplantSystems:RequirementsforSafety,FunctionalVerification,LabelingandReliabilityReportinghasbeendevelopedbytheAmericanAssociationforMedicalInstrumentation(AAMI).Thestandardestablishesacceptabledesignandtestingrequirementsaswellasstatisticalandanalyticalreliabilitymethodsforcochlearimplantsystems.Bothimplantableandexternalcomponentsarecoveredincludingelectrodes,stimulators,soundprocessors,batteries,systemaccessoriesandsupportingsoftware.Methods:TheAAMICochlearImplantCommitteewasformedin2010.Developmentwasacollaborative6-yeareffortbetweencochlearimplantmanufacturers,FDArepresentatives,surgeons,audiologists,academicians,andmembersfrompublic/professionalorganizations.Results:AAMI/CI86uniquelycombinesrequirementsrelatingtouniformreliabilityreporting,appropriatebenchtesting,andregulatorysubmissioncontent.Toourknowledge,theseareashavebeenunaddressed,addressedinlessdetail,oraddressedseparatelybyexistingnational/internationalstandardsformedicaldevices.PublicationofAAMI/CI86,expectedbyearly2017,willcombineallthreeelementsinasingledocumentspecificallyforcochlearimplants.Followingpublication,cochlearimplantmanufacturersmayvoluntarilychoosetocomplywithAAMI/CI86bysubmittinghigh-quality,scientifically-supportedregulatorymarketingapplicationstoregulatorybodies.Also,moreuniformandtransparentreportingofdevicereliabilityinformationwillbeprovidedtothepublicbymanufactureradherencetotherequirementsofthestandard.Conclusion:Compliancetotheclear,uniform,minimumrequirementsforcochlearimplantsystemsestablishedbyAAMI/CI86shouldspurmanufacturerstoinnovatedevicedesignswithimprovedreliabilityandsafetythatwillreachmarketsooner. SessionID:S5-3SessionTitle:Quality,AccessandPolicyAbstractID:497


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Title:DelayinDiagnosisandCompliancewith1,3,6:AnAnalysisofNationalEDHIdataAuthors:MauraCosetti,MD1,AnitaJeyakumar,MD2;1Otolaryngology,NewYorkEyeandEarInfirmaryofMountSinai,NewYork,NY,2PediatricOtolaryngology,VirginiaTechCarilionSch.ofMed.,Roanoke,VA.Abstract:Introduction:NationalEarlyHearingDetectionandIntervention(EDHI)programsstresscompliancewith“1-3-6”inwhichnewbornsarescreenedwithin1monthofage,diagnosedwithin3monthsandreferredforearlyinterventionby6months.Theadventofuniversalnewbornhearingscreening(NBS)hasledtoimpressiveprogresswith>96%ofnewbornsnationwidescreenedwithin1monthofbirth.However,significantchallengesremainintimelyconfirmatorytestingandreferralforearlyinterventionforthosebabieswhoreferontheirinitialscreening.Methods:AvailablenationalEDHIdata(2014)wasanalyzedforcompliancewith1-3-6.Trendsinregionalandstate-specificratesofnon-compliancewereinvestigated.Results:In2014,3,877,851babieswerescreenedforhearinglossin56states(including5territoriesandtheDistrictofColumbia.)Atotalof63,341babiesfailedtheirNBSandofthese,34.4%(n=21,819)werelosttofollow-up(LTFU).RangeofLTFUwaswidelyvariable,rangingfrom0%inVermontto85.7%intheDistrictofColumbia.Whiletherewasavarietyofreasonsforlosttofollowupincludingthefamilydecliningthetesting,over50%(n=12,402)ofthelosttofollowupbabieswereforunknownreasons.Conclusion:SubstantialgainsinNBShaveledtoupwardsof96%ofnewbornsbeingscreenedwithin1monthoflife.NewfocusonconfirmatorytestingisnecessarytoreducethoseLTFUandreducedelaysintimelydiagnosisandappropriateinterventions. SessionID:S5-3SessionTitle:Quality,AccessandPolicyAbstractID:249Title:ApplicationofKaizenPrinciples,Methods,andToodstoaLargeCochlearImplantProgram;AQualityImprovementStudyAuthors:DouglasSladen,Ph.D.,MatthewSchmitt,B.S.,AmyOlund,Au.D.,BarbBenson,AS,AlyceBreneman,Au.D.,BrittanyDowling,Au.D.,NatashaBertsch,Au.D.,MelissaDeJong,Au.D.,MatthewCarlson,MD,ColinDriscoll,MD;Otolaryngology,MayoClinic,Rochester,MN.Abstract:Introduction:The2010HealthyPeoplegoalofincreasing“thenumberofpeoplewhoaredeaforveryhard-of-hearingwhousecochlearimplants”wasreiteratedinthe2020goals.USbasedCIprogramsstruggletoprovideadequateaccessforthegrowingnumberofpatientswhocouldpotentiallybenefit.SeveralstudieshavedemonstratedthatoneofthemajorfactorslimitingaccesstoCIsisinadequatereimbursementaswellasthelong-termrequirementforaudiologyresources.Kaizen(sometimesalsoreferredtoas“Lean”)seekstoimprovebothqualityandoperationalefficiency.Kaizenhasbeenadaptedtohealthcareandusingit,hospitalshaveforexample,reducedinventory,shortenedwaitingtimes,increasedproductivityandimprovedpatientsafetyandqualityofcare.Methods:ApplyKaizenprinciples,methodsandtoolstoimprovemetricsofquality,costandaccessibilitywhenappliedtoalargeCIprogram.Datawascollectedatseveraltimeintervalsandwillbepresented.Results:Preliminarydatashowasignificantimprovementinaccessibilityforpatientsseekingimplantation,alongwithdecreasedpatientcontacthourswithoutsacrificingquality.Conclusions:ApplyingKaizenprinciplestothisCIpracticewassuccessfulinstreamliningthepatientexperience. SessionID:S5-3


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SessionTitle:Quality,AccessandPolicyAbstractID:145Title:TheFundamentalsforDevelopingaNationalRegistryofAuditoryImplantsAuthors:RishiMandavia,MRCSENT1,AlecKnight,PhD2,JohnPhillips,FRCS3,AndyHall,MRCSENT1,EliasMossialos,PhD4,PeterLittlejohns,MD2,AnneSchilder,PhD1;1EarInst.,Univ.Coll.London,London,UnitedKingdom,2DepartmentofPrimaryCareandPublicHealthSciences,King'sColl.London,London,UnitedKingdom,3NorfolkandNorwichUniv.Hosp.,Norwich,UnitedKingdom,4CentreforHealthPolicy,ImperialColl.London,London,UnitedKingdom.Abstract:Introduction:Theregulationofsurgicalimplantsisvitaltopatientsafetyandthereisaninternationaldrivetoestablishregistriesforallimplants.Hearinglosshasamajorhealth,social,andfinancialimpactworldwide.Recognisingthehighunmetneedofhearingcare,industryistargetingthisfieldwithagrowingrangeofsurgically-implantedhearingdevicesincludingCochlearImplantsandBoneConductionHearingDevices.Currently,thereisnocomprehensiveUKregistrycapturingdataonthesedevicesinneitherchildrennoradults;initsabsence,itisdifficulttoreflectonpractices,monitorclinicalandcost-effectivenessanddevelopnationalpolicy.Recognisingthatdevelopingandmaintaininganationalregistryofauditoryimplantsfaceschallenges,wesetouttoidentifythefundamentalsforthisprocessfrompreviousandexistingUKsurgicalregistries.Methods:SystematicliteraturereviewandnarrativesynthesisadheringtoPRISMArecommendations(PROSPEROdatabaseregistrationnumber:CRD42016039793).Inclusioncriteriawere:publicationsdescribingthedesign,development,criticalanalysisorcurrentstatusofanationalsurgicalregistry.Weusedadataextractiontabledevelopedbythematicanalysisandsynthesisedextracteddataintoastructurednarrative.Results:Sixty-sevenpublicationswereincluded.Thefundamentalstosuccessfulregistrydevelopmentinclude:steeringcommitteetoleadandoverseetheregistry;clearregistryobjectives;planningforinitialandlong-termfunding;strategicnationalcollaborationsamongstkeystakeholders;dedicatedregistrymanagementteam;consensusmeetingstoagreeregistrydataset;establisheddataprocessingsystems;anticipatingchallenges;implementingstrategiestoincreasedatacompletion.Patientinvolvementandawarenessoflegalfactorsshouldoccurthroughoutthedevelopmentprocess.Conclusion:Thisreviewidentifiesthefundamentalsfordevelopingasuccessfulnationalregistryofauditoryimplantsincludingstrategiestoincreasethechanceofsuccess.Thekeystrengthofourapproachisthatitprovidesrobustknowledgethatcanbeusedtoinformthedevelopmentofanysurgicalregistry.Italsoprovidesamethodologicalframeworkforinternationalsurgicalregistrydevelopment. SessionID:S5-3SessionTitle:Quality,AccessandPolicyAbstractID:355Title:UnilateralCochlearImplant:ImpactonQualityofLifeMeasuredWiththeGlasgowBenefitInventoryAuthors:DavidLow,MBBS,HosamA.Amoodi,MDFRCSC,DavidShipp,MAFAAA,GeorgeKurien,MDFRCSC,TrungLe,MDFRCSC,JosephChen,MDFRCSC,VincentLin,MDFRCSC;Otolaryngology-HeadandNeckSurgery,SunnybrookHlth.Sci.Ctr.,Toronto,Canada.Abstract:Title:TheUtilityoftheGlasgowBenefitInventoryinUnilateralAdultCochlearImplantRecipientsIntroduction


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Unilateralcochlearimplantationinadultpatientswithbilateralseveretoprofoundhearinglossisnowconsideredthestandardofcare.OurobjectivewastousetheGlasgowBenefitInventory(GBI)toquantifytheimprovementinqualityoflifeinourpatients.MethodsThiswasaprospectivestudyinatertiarycarecenter.Atotalof500post-linguallydeafenedadultswereenrolledinthestudy.Theirpre-andpost-operativeGBIandHINTscoreswerecollectedandanalysed.ResultsInterimanalysisofthefirst224patientsshowsasignificantimprovementinthetotal(+39.77),generalhealth(+53.53)andsocial(+23.36)scoresoftheGBI.Theimprovementinphysicalscoreswerenotsignificant.ThetotalandgeneralhealthscoresoftheGBIcorrelatedsignificantlywiththepostoperativeHINTscoreandthechangeinHINTscore.ConclusionTheGBIreflectstheimprovementinquality-of-life(QOL)afterunilateralcochlearimplantationinadultpatients.ThisfindingconcurswithotherQOLinstrumentsandprovidesyetanotherQOLmeasureincochlearimplantrecipients. SessionID:S5-3SessionTitle:Quality,AccessandPolicyAbstractID:269Title:CochlearImplantAccessandMedicaidAuthors:DonnaSorkin,22101,MAAmericanCochlearImplantAlliance,AmericanCochlearImplantAlliance,McLean,VA.Abstract:Introduction:Medicaidprovideshealthcareforpersonsofallageswhoseincomeandresourcesareinsufficienttopayforsuchservices.Theprogramwascreatedin1965andhasgrowntobecomethethirdlargestdomesticprogramintheFederalbudget.Medicaidisajointprogram,fundedprimarilybytheFederalgovernmentandrunatthestatelevelaccordingtostatespecifiedcriteria.Cochlearimplantcoverageisdeterminedbyeachstate.ChildrenarecoveredforCIinall50statesbecauseofFederalEPSDTrulesthoughthenatureofthecoverage,candidacycriteria,andreimbursementcharacteristicsaredeterminedstatebystate.ItisestimatedthatMedicaidcovers15%ofallCIsurgeries(adultsandchildren)andupto50%ofpediatricsurgeriesinsomestates.Thoughtheadultcoveragenumbersarerelativelylow,Medicaidisasignificantcontributortoaccesstocareforchildren.ItisunclearwhatspecificalterationswillbemadeinMedicaidinthefuturethoughgiventhemomentouschangesthathavebeendiscussedforhealthcare,theremaywellbealterationsinCIcoverage.Havingathoroughunderstandingofpoliciesinanindividualstatemayhelpclinicians,parentsandpolicy-makersproductivelydiscussandaddressproposedchangesorproactivelyseekchangestobetterservicechildrenandtheirfamilies.Methods:CIprogramsin35stateswithrobustcochlearimplantprogramsweresurveyedusingamailsurveyinstrumentregardingMedicaidCIcoveragecharacteristicsforchildrenintheirstate.Programswerealsoqueriedaboutthemajorchallengestheyfacedinprovidingappropriatesupportforlow-andmoderate-incomefamiliesandspecificallythosewhosechildrenarecoveredbyMedicaid.Theinformationwassummarized.Results:ArangeofpatternsexistrelatingtoMedicaidcoverageforchildrenacrossthestatesreviewed.Themajorareasofdifferenceincludepoliciesonbilateralcochlearimplantation,processorreplacementand/orupgrades,coverageofhabilitationservices,andcandidacycriteria.ReimbursementofservicesbyMedicaidvariesquitesignificantlyandcanimpactonaccess.


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Conclusion:Althoughtherearedifferencesbystate,ingeneralMedicaidprovidesavehicleforprovidingchildrenfromlow-andmoderate-incomefamiliesaccesstoCIcare.TherearestrategiesthathavebeenutilizedtoimprovecoverageandreimbursementunderMedicaidandthesecanbeemployedbyclinicians,parentsandadvocatestoexpandaccesstocareforchildren. SessionID:S5-3SessionTitle:Quality,AccessandPolicyAbstractID:39Title:AAMICI86,ANewStandardforCochlearImplants.WhatDoesitMeanforCIProfessionals?Authors:TeresaZwolan,PhD1,JulieVerhoff,PhD2;1Otolaryngology,Univ.ofMichigan,AnnArbor,MI,2Audiology,JoeDiMaggioChildren’sHosp.,Hollywood,FL.Abstract:Introduction:AnewU.S.standard,AAMICI86CochlearImplantSystems-RequirementsforSafety,FunctionalVerification,Labeling,andReliabilityReportinghasbeendevelopedbyastandardscommitteeoftheAssociationfortheAdvancementofMedicalInstrumentation(AAMI).Methods:AcommitteecomprisedofCIsurgeons,audiologists,andrepresentativesfromdevicemanufacturersandtheFDAmetregularlytodevelopanewstandardthatincludesspecificationofhowdevicereliabilityinformationforbothinternalandexternalcomponentsofcochlearimplantsystemswillbedetermined.Itadditionallyincludesinformationregardinghowsuchinformationwillbereportedtoregulatoryauthorities,tothepublic,andtotheclinicalcommunity.Results:ThestandardisexpectedtobeapprovedinJanuary2017andtobepublishedbyMarch2017.Conclusion:Thispresentationwilldescribevariouscomponentsofthestandard,withdirectdiscussionofhowthestandardwillimpactclinicalcare. SessionID:S6-1SessionTitle:ElectrodeArrayAbstractID:510Title:NewLateralWallElectrode:EvaluationofSurgicalHandling,RadiologicalPlacement,andHistologicalAppraisalofInsertionTraumaAuthors:AlejandroRivas,MD1,ColinL.W.Driscoll,MD2,RobertD.Cullen,MD3,StephenJ.Rebscher,M.A.4,AnaH.Kim,MD5,BrandonIsaacson,MD6;1DepartmentofOtolaryngology–HeadandNeckSurgery,VanderbiltUniv.Med.Ctr.,Nashville,TN,2DepartmentofOtolaryngology–HeadandNeckSurgery,MayoClinic,Rochester,MN,3TheOtologicCtr.,Kansas,MO,4DepartmentofOtolaryngology–HeadandNeckSurgery,Univ.ofCalifornia,SanFrancisco,SanFrancisco,CA,5DepartmentofOtolaryngology–HeadandNeckSurgery,ColumbiaUniv.Med.Ctr.,NewYork,NY,6DepartmentofOtolaryngology–HeadandNeckSurgery,UTSouthwesternMed.Ctr.,Dallas,TX.Abstract:Introduction:Lateralwallelectrodesaregenerallyconsideredeasiertoinsertandmoreamenabletoaroundwindowapproachforcochlearimplantation.Theyarealsofavoredforpreservationofresidualhearing.Thedesignintentofthenewlateralwallelectrodeistofacilitateaneasyroundwindowinsertionapproach,tocoverthemainbodyofspiralganglioncellsandtoofferanatraumaticinsertiontohelppreserveresidualhearing.Methods:Agroupof5surgeonsparticipatedinthetemporalbonestudy,eachusing8electrodesand8freshtemporalboneswithintactfacialrecesses.Thechoiceofsurgicalapproachandinsertionmethodwastakenbythesurgeonwithconsiderationoftheindividualbones.Questionnaireswereconductedtoassessthehandlingcharacteristicsandinsertionpropertiesoftheelectrodes.Planefilmx-raysandmicro-CTweretakentodeterminetheangularinsertiondepthoftheelectrodeanditsplacementwithin


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thescalatympani.HistologywasthenconductedtoconfirmelectrodeplacementandtoassignatraumarankingbasedontheEshraghiTraumaScaleforeachelectrode.Results:Questionnairedataindicatesthattheelectrodewaseasytohandleinthesurgicalspaceandsuitableforroundwindowinsertion.Theshapeoftheelectrodeallowedeasyvisualizationofthecochlearopening.X-raysconfirmedthatitachievedthedesiredangularinsertiondepth.Histologyshowedanextremelylowrateofintracochleardamage.Conclusion:Thetemporalbonestudyconfirmsthatthedesignintentsofthenewlateralwallelectrodeweremet.Itpromisesanelectrodethatiseasytoinsert,thatoffersastandardlengthelectrodetocoverelectricalhearingandtherealpotentialtopreserveresidualhearingtoallowaccesstoelectro-acousticstimulation. SessionID:S6-1SessionTitle:ElectrodeArrayAbstractID:495Title:Perimodiolar,SlimStraightandThinPerimodiolarElectrodeArrays:ComparisonofPerformanceOutcomesAuthors:J.EricLupo,MD,MS,AllisonBiever,PhD,DavidKelsall,MD;RockyMountainEarCtr.,Englewood,CO.Abstract:Introduction:Recentstudiesofhearingpreservationincochlearimplantation(CI)havesuggestedthatroundwindowinsertionwithalateralwallelectrodeislesstraumaticthanacochleostomyapproach.Thelateralwallorthinstraightelectrodedoesnotapproximatethemodiolusofthecochleaasdoesaperimodiolarelectrodetherebyminimizingtraumatothedelicateinnerearstructuresandmayleadtoimprovedperformance.Otherstudieshaveshownthatperimodiolar(curved)electrodearrayslowertheneuralresponsetelemetry(NRT)thresholdandconsumelesspowerlikelybecauseofthecloserproximitytothespiralganglioncellsinthemodiolus.Researchhasdemonstratedthatperimodiolarelectrodesprovideexcellenthearingperformance,amorefocusedstimulationandgreaterpowerefficiency.Despitethedifferenceinthegoaltobeachievedbytheelectrode(peri-modiolarvslateralwall),thereislittleknownoftheultimateeffectsoftheselectedelectrodeonpatientperformance.Methods:Inthisretrospectivestudy,weexaminedtheprogrammingparameters,hearingpreservationandoutcomedataforthreegroupsofsubjectswhoreceivedtheslimstraightelectrodearray(CI422orCI522),thosewhoreceivedaperimodiolarelectrodearray(CI24REorCI512)andthosewhoreceivedathinperimodiolar(CI532)device.AllcochlearimplantationproceduresfromJuly2012toDecember2016performedatasingleCIcenterwerereviewedforstudyinclusioncriteria.Thereviewexamineddatafrom93slimstraight,78perimodiolarand38thinperimodiolaradultrecipients.TheprogrammingparameterscomparedforeachrecipientgroupincludedNRTthresholdsaswellTandCLevels.CIperformanceasrepresentedbysentenceandwordperformanceat3,6,and12monthspost-activationandhearingpreservationwascomparedforthethreegroups.Thepairedt-testwasutilizedtotestforstatisticalsignificance.Results:PreliminarydatafromthesegroupsdemonstrateasignificantdifferencebetweenNRTthresholds,andTandCLevelsexistsbetweenthethreegroups,withtheperimodiolarandthinperimodiolarelectrodegroupshavingamuchlowervalue.Asignificantlybetterpreoperativewordandsentencescorewasobservedfromtheslimstraightcohortcomparedtotheperimodiolarcohort.Nosignificantdifferencewasseenbetweentheperimodiolar,slimstraightandthinperimodiolarelectrodesintermsofCIperformanceforsentencesinquietandwordsmeasuredat3,6and12monthspost-activation.


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Conclusion:TheresultsofthestudysupportthepremisethatcloserproximitytothemodiolusaffordedbyperimodiolarelectrodesresultsinlowerNRTandTandClevelsascomparedtoalateralwallelectrodesuchastheslimstraightelectrode.Theslimstraightelectrodecohortandthinperimodiolarelectrodecohortdemonstratedbetterhearingpreservationoutcomescomparedtotheperimodiolarelectrodecohort.DespitethedifferencesseeninNRTandTandClevelsandhearingpreservation,atalltimepointspost-activation,nosignificantdifferencewasobservedinsentenceandwordscoresbetweentheslimstraight,perimodiolarandthinperimodiolarelectrodes. SessionID:S6-1SessionTitle:ElectrodeArrayAbstractID:239Title:EffectofElectrodePositiononElectrophysiologicalandPsychoacousticParametersinCochlearImplantPatientswithLateralandPerimodiolarElectrodeArraysAuthors:ChantalDegen,MD,AndreasBüchner,PhD,ThomasLenarz,MDPhD;Otorhinolaryngology,HannoverMed.Sch.,Hannover,Germany.Abstract:Introduction:Theelectrodepositionwithinthecochleaplaysanimportantrolefortheinteractionbetweenelectrodecontactsandspiralganglioncells.Itisdeterminedbytheformoftheelectrodecarrier.Straightelectrodearrays(Nucleus™522“SRA”)arepressedagainstthelateralwallofthecochlea,whileprecurvedarrays(Nucleus™532“SMA”and512“Contour”)curlaroundthemodiolusandideallyhavenocontacttothelateralwall.RecentimprovementsinpostoperativeDVT(digitalvolumetomography)imagingresolutionnowallowdeterminationofthedistancebetweeneachelectrodecontactandthemedialwallofthecochleaandtoobservecorrelationswithelectrophysiologicalandpsychophysicalmeasurementvaluesinindividualpatients.Methods:PostoperativehighresolutionDVT-imagesof30patientswithCochlear®Nucleus™532,522and512implantswereevaluatedusingtheComet(CochleaMeasurementTool)programtodeterminethedistancebetweenthe22electrodecontactsandthemedialwallaswellastothecentralaxisofthecochlea(modiolus).DuringthefittingweekaftertheinitialactivationECAPs,T-andC-levelsandspreadofexcitationweremeasured.Results:Patientswithperimodiolarelectrodearrays(Nucleus™532and512)overallhavesignificantlylowerECAPthresholds,T-andC-levelsthanpatientswiththestraightdesNucleus™522implant.Thedistanceofindividualelectrodecontactstothemedialwallvariesamongcontactsofthesamearray.Conclusion:Ourresultsshowthattheelectrodepositionhasasignificanteffectonbothelectrophysiologicalandpsychophysicalparameters.Lowpsychophysicalthresholdsareamongotheraspectsrelevantforprolongingbatterylife.Wearecurrentlyevaluatingtherelationshipbetweenthespreadofexcitationandtheintracochlearpositionofelectrodecontactsaswellastheeffectsonspeechperceptionandwillreportonthoseoutcomes. SessionID:S6-1SessionTitle:ElectrodeArrayAbstractID:472Title:ShortandStandardElectrodesinInfantswithProfoundDeafnessAuthors:CamilleC.Dunn,PhD1,ElizabethWalker,PhD2,TanyaVanVoorst,AuD1,StephanieGogel,AuD1,MarlanHansen,MD1,BruceGantz,MD1;1Otolaryngology,Univ.ofIowa,IowaCity,IA,2CommunicationDisorders,Univ.ofIowa,IowaCity,IA.Abstract:Introduction:Bilateralcochlearimplantationinchildrenwithprofoundsensorineuralhearinglosshasbecomeawell-acceptedapproachtoauralhabilitation.Althoughthebenefitsofbinaurallisteningusingtwocochlearimplantsarecompelling,thereissomeconcernthatbilateralimplantation


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mightlimitchildrenfromtakingadvantageoffutureadvancesinmolecularand/orgenetictreatmentsoftheinnerear.Placementofstandardlengthelectrodearraysmorethan20mmintothescalatympaniusuallyresultsinsignificantdamagetothescalamedia,OrganofCortiandsupportingcells.PreservationofthesupportingcellsintheOrganofCortimightbeofparticularinterestasthesecellshavebeenshowntobetheprogenitorsofhaircellsinbirdsandotheranimals.Thepurposeofthisfeasibilitystudyistoevaluatewhethertheuseofashorterlengthcochlearimplantinoneearandastandardelectrodeinthecontralateralearisaviableoptionforchildrenwithprofoundbilateralsensorineuralhearingloss.Asecondarypurposeofthisstudyistodetermineiftheearwiththeshorterlengthelectrodeperformssimilarlytothestandardlengthelectrode.Methods:ThisFDA-approvedinvestigationaldeviceexemptionstudyisbeingconductedasarepeated-measure,single-subjectexperiment.Ninepediatricsubjectsbetweentheagesof12-24monthswithprofoundbilateralsensorineuralhearinglosswereimplantedwitha10mmelectrodeinoneearanda24mmelectrodeinthecontralateralearand8pediatricsubjectsbetweentheagesof12-24monthshavebeenimplantedwitha16mmelectrodeinoneearanda24mmelectrodeinthecontralateralear.Speechperceptionwasevaluatedpre-andpost-operativelyusingtheIT-MAISparentquestionnaire.TheEarlySpeechPerceptiontest(ESP),Children’sVowel,andPB-KwordswereusedtoevaluatespeechperceptionandtheMinnesotaChildDevelopmentInventoryandPreschoolLanguageScales-3wereusedtoevaluategloballanguagedevelopment.Results:Preliminaryresultsforallchildrenhavebeencollectedpre-andpost-operativelyusingtheIT-MAIS.Allchildrenshowedincrementalimprovementsintheirscoresovertime.TheESPandChildren’sVowelresultsindicatednodifferencebetweentheindividualearsforthechildrentested.SomedifferencesbetweenearsfavoringthelongerelectrodewereindicatedusinganopensetPBK-wordtest.Performancecomparedtoage-matchedchildrenimplantedwithstandardbilateralcochlearimplantsshowedsimilarresultsforspeechperceptionandlanguageoutcomes.Conclusion:Theuseofashorterlengthcochlearimplantinoneearandastandardlongelectrodeinthecontralateralearmightprovideanotheroptionforbilateralcochlearimplantationinchildrenwithbilateralprofoundsensorineuralhearingloss.Waitinguntilchildrencanperformanopen-setwordscorepost-operativelyisnecessarytodeterminesimilaritiesordifferencesbetweentheears. SessionID:S6-1SessionTitle:ElectrodeArrayAbstractID:473Title:SurgicalOutcomeswithaNewSlimModiolarCochlearImplantElectrodeArrayAuthors:JacquesHerzog,MD1,JonathanMcjunkin,MD2,NedimDurakovic,MD3,CraigBuchman,MD4;1Ctr.forHearingandBalanceDisorders,Chesterfield,MO,2Otolaryngology,WashingtonUnivesrity,StLouis,MO,3Otolaryngology,WashingtonUniv.,StLouis,MO,4WashingtonUniv.,StLouis,MO.Abstract:Introduction:Theobjectiveofthisstudyistodescribethesurgicaloutcomesofpatientsimplantedwithanew,slimmodiolarcochlearimplantarrayfromatertiarycochlearimplantcenter.Methods:Allpatientsmetconventionalcochlearimplantcandidacycriteria.Pre-andpostoperativepuretoneaudiometryandspeechperceptiontestingwerecarriedoutinastandardfashion.Intraoperativeradiographicimagingresults,electrodeimpedances,andNRTwerecollected.Results:100consecutivepatientshavebeenimplantedtodate.Intraoperativeelectrodetiprolloverswereidentifiedusingplainfilmradiographswhilestillintheoperatingroom.Therewerenotactileorvisualclues,impedanceanomalies,orNRTabnormalitiesthatidentifiedtiprolloversduring/followinginsertion.Alltiprolloverswereresolvedwithelectrodere-insertionatthesamesetting.Manypatients


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hadpreservedauditoryfunctionatthe3-monthpostoperativeinterval.Consistent,full-lengthscalatympaniinsertionswereconfirmedusingpostoperativeCTimaginginasubsetofindividuals.Conclusion:Whenusingtheslimmodiolarcochlearimplantelectrodearray,intraoperativeradiographsarenecessarytoconfirmplacementandavoidintraoperativetiprollovers.Techniqueswillbedescribedtoavoidthisoutcome.TheSlimmodiolararrayhasexcellentperi-modiolarplacementwithinscalatympani.Hearingpreservationispossiblewiththisdevice. SessionID:S6-2SessionTitle:FittingAbstractID:175Title:MAPOptimisationwithArtificialIntelligenceAuthors:PaulJ.Govaerts,MD,MSc,PhD,MiguelArtaso,MSc,PhD,GeertDeCeulaer,Eng.,DavidPascoal,M.Aud.,MatthiasMeeuws,MSc,MartineCoenen,MA,PhD;TheEargroup,Antwerp-Deurne,Belgium.Abstract:Introduction:Thefittingofcochlearimplantstodateisanartinthehandsofexperts.Thesteadyincreaseincochlearimplantrecipientsandtheneedforevidencebasedmedicinerequiretheoptimisationofthisprocess.TheauthorshaveintroducedtheconceptofTargetdriven,computerassistedfitting.Targetreferstoaudiometry,spectraldiscrimination,loudnessscalingandspeechaudiometry.Computer-assistedreferstoapplicationsbasedonArtificialIntelligence(AI).Methods:ConceptTheconceptandworkingprinciplesofthisnewapproachwillbeexplained.Theswitch-onischaracterizedbyanincrementalseriesofprebuiltMAPs.TestresultsareenteredintoFOX,thesoftwareapplicationwithAI.Afteranalysis,FOXrecommendsMAPchangestoimprovethetestresults.Atypicalfittingsessiontakes30-60’timeandatypicalfirstyearfittingseriesconsistsof4sessionsforadultsand1-2additionalsessionsforchildrenunder6years.Adults:retrospectivestudySincethemeasurableimpactofthisfittingapproachcanbestbeshowninadults,eightysixadultCIrecipientswithpostlingualdeafnessandwhoreceivedaCIbetween1999and2015underwentannualassessmentsincludingspeechaudiometrywithopensetmonosyllablesandphonemescoring.Aweighedaveragephonemescoreat40,55,70and85dBSPLpresentationlevelisplottedasafunctionoftime.Children:casedemonstrationAgirlwithcongenitaldeafnessduetoCMVinfection,receivedafirstCI(CochlearNucleus)attheageof8monthsandasecondCIat11months.ShereceivedanincrementalseriesofprebuiltMAPsatswitch-on.Theswitch-ontookonlyafewminutesandwillbeshownonvideo.Subsequentsessionscomprisedaudiometryandspectraldiscrimination.Results:Thisnewandsystematicapproachcomprises(1)therepetitivemonitoringoftheCIrecipient’sfunctionalstatebywelldescribedoutcomemeasures,whichcomewithpre-settargets;(2)anindepthknowledgeandmodellingoftheCIbehaviourintheacoustical,electronicandelectricaldomains;and(3)artificialintelligencetosuggestMAPchangestobringthefunctionalstatetotarget.Theretrospectivestudyin86adultsshowsanincreaseintheaveragespeechaudiometricscoresfrom56%phonemescorein2008to76%in2016.Wewillarguethatthisimprovementisunlikelytobetheresultofprocessorupgradesorlearningeffects.Thecasedemonstrationwillshowatypicalanduneventfulswitch-onandearlyfollow-upofanearlyimplantedchild.Itwillshowhowthis(semi-)automatedswitch-ondoesnotrequireobjectivemeasuresandisverycomfortableforthechild.Conclusion:TheintroductionofArtificialIntelligenceinCIfittingisessentialinthisnewapproachoftarget-driven,computer-assistedCIfitting.Thisapproachissystematicand(semi-)automatedandhelpstheaudiologisttoobtaingoodpsychoacousticresultswithsmallvariation. SessionID:S6-2SessionTitle:Fitting


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AbstractID:442Title:FromActivationtoComplexProgramming:TheWhen,WhyandHowofPediatricNRTAuthors:YettaAbrahams,MastersofClinicalAudiology,AleishaDavis,MastersofSpeechPathology;TheShepherdCtr.,Newtown,Australia.Abstract:Introduction:Neuralresponsetelemetry(NRT)hasbeenavailableforclinicaluseformanyyearsandiswellestablishedasatoolthatprovidesaneffectivebasisforthemanagementofpediatriccochlearimplantrecipients.Thereishoweversignificantvariationinhowcliniciansapplythesetools,andverylittlepediatricdatatodescribedtheoptimalfrequencyofmeasuringNRTthresholds.Withrecentadvancesinprogrammingtools,themeasurementofNRTthresholdshasbeenfurtherdevelopedandrefinedresultinginsignificantimprovementsintheeaseandefficiencyofmakingthesemeasurements.Thisstudyaimstogatherrecentinformationtosupportclinicaldecisionsaboutwhenandwhycliniciansshouldmeasuretheseresponsesandwhatclinicalimpactthismighthave.Methods:AretrospectivereviewofclinicaldatawasconductedanalysingtheNRTresponsesof180paediatricearsfromasinglecochlearimplantprogram.Responseswerecollectedfromintraoperativetesting,initialactivationandanysubsequentappointmentswhereNRTresponsesweremeasured.TheamountofvariationinNRTthresholdsovertimeforeachindividualwasreviewedinconjunctionwithelectricalimpedancevaluesandmeasuresoftheirfunctionallisteningabilities.Results:TheanalysisofindividualpatternsofvariationandstabilityinNRTthresholdsprovidethebasisfortheevolutioninclinicalprogrammingprotocols.Asaresultofthisanalysisarangeofclinicalprocesseshavebeenappropriatelystreamlined,improvingtheoverallclinicalefficiencywithinthepediatriccochlearimplantserviceandtheexperienceforchildrenandtheirfamilies.Thisisdemonstrableinbothstraightforwardandmorecomplexclinicalcases.Overallforthiscochlearimplantprogram,thenumberandfrequencyofprogrammingappointmentsimmediatelyafteractivationhasbeenreduced,ashasthedurationoftimetakenforchildrentodemonstrateoptimalaccesstosound.Conclusion:AclearunderstandingofNRTstabilityandchangeovertimeisextremelyusefulforcliniciansinvolvedinoptimisinglisteningoutcomesforchildrenandprovidesthebasisforimprovingchildren’soutcomesandclinicalefficienciesintheshortandlongerterm. SessionID:S6-2SessionTitle:FittingAbstractID:477Title:ClinicalTrialResultsWirelessProgrammingPodAuthors:SaraNeumann,AuD,MilaMoraisDuke,AuD;HeartsforHearing,OklahomaCity,OK.Abstract:Introduction:Cochlearimplanttechnologyhascontinuedtodeveloprapidlyinrecentyearsespeciallywithregardtowirelesstechnology.Historically,hardwiredprogrammingcableshavebeenareliableandwidelyacceptedsolutionforclinicalprogrammingsessions.Someclinicallimitationstohardwireprogrammingcablesmayincluderoomset-up(distancefromcomputertopatientchair),activepediatricpatients,andoccasionalprogrammingcablemalfunction.Asanovelsolutiontothesechallengingprogrammingsituations,Cochlearhasdevelopedawirelessprogramminginterface,namedtheCochlearWirelessProgrammingPod(WPP).TheWPPwasrecentlyevaluatedaspartofaclinicalmulti-centerclinicaltrial.Methods:ThirtyunilaterallyimplantedparticipantsacrossthreeclinicalsiteswereprogrammedwiththeWirelessProgrammingPodinthemulti-centerclinicalstudy.Studyparticipantswereseenfortwoclinicalvisitsapproximatelyonemonthapart.Subjectivefeedbackwasobtainedfromtheaudiologistateachprogrammingsession.ThisfeedbackincludedreliabilityofWirelessPodduringthestudy


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programmingsession,easeofuse,clinicalconsiderationsandpreferenceofprogramminginterfaceforfuturesessions.Results:SubjectiveaudiologistfeedbackindicatedtheWirelessProgrammingPodwasreliableandeasytouseinanoverwhelmingmajorityofprogrammingsessions.Withregardtofutureprogrammingsessions,cliniciansstronglypreferredtheWPPinterfaceinlieuofstandard/hardwireprogrammingmethods.Conclusion:Inthisdataset,theCochlearWirelessProgrammingPodappearstobeaneffectivealternativeforcochlearimplantprogrammingsessions.Thistechnologydevelopmentmaybeabeneficialinterfaceforprogrammingsessionsinthefuturecomparedtostandard/hardwireprogrammingconfigurations. SessionID:S6-2SessionTitle:FittingAbstractID:478Title:RealWorldListeningEnvironmentsandtheSuccessofChildrenUsingSCANAuthors:YettaAbrahams,MastersofClinicalAudiology,AleishaDavis,MastersofSpeechPathology;TheShepherdCtr.,Newtown,Australia.Abstract:Introduction:Sincetheintroductionofdataloggingandautomatedauditorysceneanalysissoundprocessing(SCAN)intheNucleus6soundprocessor,clinicianshavebeendividedabouttheappropriatenessoftheseapplicationsforthepedicatricpopulation.Datalogginghasprovideddetailsaboutthevarietyandnatureoflisteningenvironmentschildrenareinwithalevelofdetailpreviouslyunobtainable.Cliniciansnowhaveaccesstosignificantevidencetodriveclinicaldecisionstoensurelisteningisoptimalforallchildren,particularlygiventheamountofbackgroundnoisechildrenaretypicallyexposedto.ThisdetailedinformationprovidedbydataloggingcanbeusedtosupporttheuseofSCANforalllistenersandbycloselymonitoringlisteningandspokenlanguageperformance,children’slisteningcancontinuetobeoptimisedforthetruebreadthoflisteningenvironmentstheyarelivingandlearninginonadailybasis.Methods:Aretrospectivereviewofclinicalprogrammingdatafromchildrenwithcochlearimplantsfromasinglepediatriccochlearimplantprogramwasconducted.Dataloggingandprogramsettingsforover100childrenunder10yearsofagewerereviewedinconjunctionwithmeasuresoffunctionallisteningandlanguageabilities.Detailedanalysiswasundertakentoreviewthefeaturesoflisteningenvironmentsfordifferentagegroups,aswellastheimpactoftheuseofSCANforlisteningandspokenlanguagedevelopment.Results:Childrenfrom6monthsthroughto10yearsofagespendtimeinavarietyoflisteningenvironments,andareexposedtoarangeofbackgroundnoisefargreaterthanpreviouslyexpectedbycliniciansandfamilies.TheuseofSCANinthispopulationhasnotinanywayimpededtheprogressoffunctionallisteningorspeechandlanguagedevelopmentandhasbeenwellacceptedbyallrecipients.Conclusion:Children,familiesandcliniciansbenefitpositivelyfromamorerealisticunderstandingofthelisteningenvironmentschildrenarespendingtimeinoutsideofaclinicalsetting.Acrossavarietyofages,childrenspendtimeinextremelyvariedlisteningenvironments,andcanthereforeintheorybenefitsignificantlyfromautomatedoptimisationofsoundprocessingsuchasSCAN.Whenthisisappliedinthepediatriccontext,listeningandlanguageperformanceisinnowayhindered,andthelearningexperiencefortherecipientisconsistentlyenhanced. SessionID:S6-2SessionTitle:FittingAbstractID:488


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Title:EvaluationoftheKansoSoundProcessor:ClinicalTrialresultsAuthors:WilliamShapiro,AuDNewYorkUniv.,NewYork,NY.Abstract:Introduction:ResultsoftwoclinicaltrialsevaluatingtheKansoSoundProcessorwillbepresented.TheKansoSoundProcessorisauniqueoff-the-ear(OTE)configurationofsoundprocessorwithintegratedcoilandmagnetforthoseindividualsseekingadiscreetofftheearsolution.ThisdualmicrophoneOTEprocessorallowsaccesstoNucleus6technologyandwirelessconnectivity.TheobjectiveofthesestudieswastoevaluatetheacceptanceoftheKansoSoundProcessorwithemphasisonsubjectivehearingperformance,retention&comfort,reliabilityandeaseofuse.Methods:Forthetwostudies,50participantswereupgradedtotheKansoSoundProcessor.TheseparticipantswereacrossthreecentersintheUnitedStates(30participants)andoneinSydney,Australia(20participants).Bothstudiesutilizedasingle-subject,repeatedmeasuresdesignwhichallowedforeachparticipanttoactastheirowncontrol.Subjectivedatawascollectedviadiariesandquestionnairesfromall50participatingindividualswithregardtoretention,comfort,easeofuse,subjecthearingperformanceandconnectivity.ThisdatawillbepresentedinadditiontosupportingspeechperceptiondataonasubsetofparticipantsusingtheN6behind-the-ear(BTE)processorandtheKanso(OTE)processor.Testmetricsavailableforthe20aforementionedparticipantsincludesCNCWordsinquiet,andSpeechReceptionThreshold(SRT)withadaptiveco-locatednoise.Results:QualitativeusabilitydataindicatedtheKansoSoundProcessorprovidesamorediscreetlifestylewearingoption.ParticipantsratedtheOTEprocessorbetterwithregardtocomfort,retention,easeofusewhencomparedtotheirownBTEprocessor.SpeechperceptionresultsdidnotindicatesignificantdifferencesbetweentheKansoOTEandtheN6BTEsoundprocessoronCNCwordsinquietoradaptiveSRTtestingwithco-locatednoise.Conclusion:Participantself-reportedratingsfollowingtakehomeexperienceindicatethattheKansoOTEsoundprocessorprovidesbenefitparticularlyforparticipantsseekingamorediscreteandeasytousedevicecomparedtoconventionalBTEsoundprocessorofferings.ClinicalspeechperformancealsodemonstratesthebenefitsofdualmicrophonedirectionalprocessingintheKansoOTEprocessor. SessionID:S7-1SessionTitle:Telehealth/DeliveryAbstractID:194Title:Telehealth:RemoteProgrammingofCochlearImplantsAuthors:AllisonBiever,Au.D.RockyMountainEarCtr.,Englewood,CO.Abstract:Introduction:Theremotemodelofservicedeliveryisgainingtractionacrossmedicaldisciplinesandisthenextstepforthefieldofcochlearimplants.Becausecochlearimplantsrequireregularfollowupvisitswithanaudiologist,remoteprogrammingisalogicalandvaluableoptionforrecipientswhohavedifficultygettingtoaclinic.Thismulti-centerinvestigationexploredthesafetyandefficacyofremotecochlearimplantprogrammingforthepurposeofestablishingpracticeguidelinesandincreasingrecipients’accesstocare.Methods:Fortycochlearimplantrecipients(ages12-88)wererecruitedatfourUSsitesandcompletedspeechperceptiontestingattheirregularclinic.Atthesecondvisit,thesubjectsparticipatedinaremoteprogrammingsessionwherebythesubjectandtheaudiologistwereindifferentphysicallocations.Programmingwasconductedthroughavideoconferencingplatform,allowingthesubjectandtheaudiologisttoseeandhearoneanotherthroughthecomputerastheaudiologistremotelycontrolledtheprogrammingsoftware.Atthethirdvisit,thesubjectrepeatedthespeechperception


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testing,andcompletedsubjectivequestionnairesabouttheirexperience.Thisvisitsequencewascompletedoncewithadesignatedfacilitatorpresent,andoncewiththesubjectalone.Results:Subjectsweresuccessfullyprogrammedremotely,andcliniciansdocumentedthetechniquestheydevelopedforensuringasatisfactorysession.Meanspeechperceptionscoresshowednosignificantdifferencebetweenprogrammingconditions,indicatingperformanceequivalencyofin-officeprogrammedmapsandremotelyprogrammedmap.Feedbackfromsubjectsandcliniciansindicatedthattelehealthisaviablealternativetotraditionalin-officeprogrammingthathasbenefitsforbothrecipientsandclinics.Conclusion:Telehealthisasafeandeffectiveoptionforcochlearimplantuserswhocannoteasilytraveltoregularaudiologyvisits.Audiologistsshouldbetrainedinthenuancesofusingremoteprogrammingtechnologyandshoulduseclinicaljudgmentwhenselectingsubjectswhoareappropriatefortelehealth.Furtherdiscussionpointsonthistopicinclude:remoteprogramminginvariouspopulations,statelicensurerequirements,andreimbursement. SessionID:S7-1SessionTitle:Telehealth/DeliveryAbstractID:521Title:RemoteProgrammingofCochlearImplants-AccessOpportunitiesandChallengesAuthors:TomWalsh,MBAAdvancedBionics,Valencia,CA.Abstract:Introduction:CIrecipientsrequirealifetimeofcareandaudiologistsmustfindwaystoserveestablishedrecipientswithoutcompromisingaccesstoCIbynewcandidates.PreviouspresentationsatthisconferencehaveexploredthefeasibilityandefficacyofCIremoteprogramming.SeveralchallengesexisttowidespreadadoptionofCIremoteprogrammingservices,andthissessionwillfocusontheregulatory/legalhurdles.Methods:ThistalkwillbrieflyreviewtheliteratureonCIremoteprogrammingfeasibility/efficacytodateanddiscusstheregulatory/legalissuesimpactingtheuseofremoteprogrammingforcochlearimplants.Results:Thepresentationwillidentifyspecificregulatory/legalhurdlestoCIremoteprogramming,andwilldiscusspotentialactionstoaddressthosechallenges.Conclusion:Manufacturers,clinicians,andprofessionalsocietieshavetheopportunitytocollaboratetoaddressregulatory/legalissuesimpactingaccesstoremoteprogramming,andultimately,accesstoCIservicesforthegrowingpopulationofCIrecipients. SessionID:S7-1SessionTitle:Telehealth/DeliveryAbstractID:60Title:TelehealthforTeens:RemoteProgrammingBenefitsintheAdolescentPopulationAuthors:LisaR.Park,AuD1,HollyTeagle,AuD1,JenniferWoodard,AuD1,ErikaGagnon,AuD2;1Otolaryngology/HeadandNeckSurgery,Univ.ofNorthCarolinaatChapelHill,Durham,NC,2Otolaryngology/HeadandNeckSurgery,Univ.ofNorthCarolinaatChapelHill,Raleigh,NC.Abstract:Introduction:Forquitesometime,audiologistsatthisinstitutionhaveusedtelehealthasawaytoevaluatedevicefunction(impedanceandevokedresponsemeasures)intheoperatingroomforbothchildrenandadults.Thesuccessfulimplementationofthistechnologyalongwiththenotedfinancialandpracticalbenefitsproposesinvestigationintoremoteprogrammingofcochlearimplants.Othermedicaldisciplineshavesuccessfullyimplementedtelehealthprogramswithpatients.StudiesinvestigatingremoteprogrammingwithadultshaveshownsimilarperformancewithremoteMAPs


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whencomparedtoprogrammingperformedintheoffice.Forpatientswhohavesignificanttravelneeds,healthconcerns,andtransportationlimitations,remoteprogrammingisanattractiveoption.Thisstudypresentsasubsetofdatafromalargermulticenterstudyinvestigatingtheefficacyandsafetyofremotecochlearimplantprogramming.Forthetechnologicallysavvyteenagepopulation,remoteprogrammingcangiveownershipandautonomytothemappingprocesswhilemaintainingtheintegrityofsoundquality.Methods:Dataandvideofrom10subjectsbetweentheagesof12and17areincluded.TheseindividualsweretestedinthesoundboothwithrecordedCNCwordsbeforeandaftertworemoteprogrammingsessions.Thefirstprogrammingsessionwasfacilitatedin-personwithatrainedassistant,whilethesecondwasnot.Aftereachremotesession,thesubjectworethenewprogramforseveralweeksbeforereturningtotheclinicforsoundfieldtesting.Theseresultswerecomparedtothoseobtainedwiththesubject’sfamiliarMAP.Subjectivedataontheefficiencyofthesessionwererecorded.Results:Theremoteprogrammingprocesswassimpleforalloftheadolescentsubjectsandminimaltrainingwasrequired.SpeechperceptionforprogramscreatedthroughtelehealthwerecomparabletothoseobtainedwithfamiliarMAPscreatedinperson.Forafewsubjects,outcomeswereslightlybetterwiththeremoteprograms.Anecdotalobservationforthesesubjectsincludedanincreaseinsubjectengagementduringremoteprogrammingwhichmayaccountfortheincrease.Conclusion:Programmingcochlearimplantsviaatelehealthmodelcanbeaneffectiveandsafemethodofdeliveryforadolescents.Potentialuse,strategies,andcaveatswillbereviewed. SessionID:S7-1SessionTitle:Telehealth/DeliveryAbstractID:467Title:ChallengesandOutcomesAssociatedwithProvidingTeletherapytoVulnerableChildrenwithHearingLossAuthors:MatthewFitzgerald,Ph.D.1,MegFarqhar,MSW1,JoyKearns,M.S.2,JannineLarky,M.A.1,KathleenSussman,M.S.2,ArturoManriquez,B.S.1,NikolasBlevins,M.D.1;1Otolaryngology-HeadandNeckSurgery,StanfordUniv.,PaloAlto,CA,2WeingartenChildren'sCtr.,RedwoodCity,CA.Abstract:Introduction:Languageacquisitioninchildrenwithprelingualhearinglossisoftendelayedwithoutappropriateearlyintervention.Unfortunately,manychildrenwithhearinglosslackaccesstonecessarytherapy.Thisisparticularlytruefor‘vulnerable’populations,havinglowsocioeconomicstatus,lackofsocialsupport,orlanguage/culturalbarriers.Workingwiththesepopulationspresentsmultiplechallenges.TheBabytalkprogramhasprovidedlisteningandspoken-languageteletherapy,socialworkservices,andaudiologiccounselingforvulnerablechildrenthroughoutCaliforniasince2012.Methods:Ourobjectiveswere:(1)Tocharacterizeobjectivemarkerstoidentifyvulnerablechildren.(2)Toidentifyspecificneedsandstrategiestodeliverteletherapytovulnerablepopulations.(3)Toquantifyauditoryandlanguageoutcomesinvulnerablepopulations,andrelatethosetoobservedchallenges.WeretrospectivelyexamineddemographicdatafromparticipantsintheBabytalkprogramregardingsocioeconomicstatus,geographicisolation,familialeducation,andothersocialissues.Wecorrelatedthesewithfamilialperformanceinteletherapy,includingratesofattendancetoteletherapyandclinicalappointments,hoursofcasemanagementneededperhouroftherapydelivered,andtheParentalStressIndex.Weexaminedourstrategiestooptimizeteletherapy.Thesewereprovidedbyreportsfromprogramtherapistsandsocialworker.Auditoryandlanguageoutcomeswerequantifiedbyseveralmeasures,includingtheLittlEarsQuestionnaire(LEQ),thePreschoolLanguageScales,5thedition(PLS-5),andtheMacArthurBatesCommunicationDevelopmentIndex(CDI).


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Results:Todate,85familieshavebeenenrolledforteletherapywithBabyTalk,withanadditional42familiesreceivingcounselingservicesonly.Approximately77%couldbeclassifiedasvulnerable.Severaltrendsemergedfromanalysisofdatafromvulnerablechildren.First,consistentparentalengagementwaschallenging,resultinginhigherratesofmissedsessions.Asaresult,considerablymoreresourcesfromsocialwork,teletherapists,andsupportstaffwerenecessarytoprovideexpectedservices.Asecondkeytrendwasthatimprovedcommunicationandrapportinitiatedbyprovidersappearedtoimprovecompliance,andthereforeoveralloutcomes.Empathyandflexibilitywerekeycontributorstofacilitationofservices.Finally,despitethechallengesassociatedwithvulnerablechildren,improvementsinauditoryandlanguagebehaviorswerenoted.Forexample,LEQ,PLS-5andCDIscoresgenerallyimprovedrelativetoapre-therapybaseline.Insomeinstances,vulnerablechildrenobtainedscoressimilartothoseobtainedbychildrenwithnormal-hearing.However,moststillshowedsignificantdelaysdespiteimprovingduringteletherapy.Conclusion:Vulnerablechildrenandfamiliesaffectedbyhearinglossarelikelytorequireadditionaltime,effort,andresourceswhenenrolledinateletherapyprogram.Suchfamiliescanbeprospectivelyidentifiedthroughexaminationofdemographicdata.Strategiesandresourcestoincreasecommunicationandparentalengagementandcanmitigatethesechallenges,therebyenablingimprovementsinauditoryandlanguagedevelopment.Thisinformationislikelytobeusefultoestablishexpectationsforresourceallocationasteletherapyprogramsbecomeincreasinglycommonplace. SessionID:S7-1SessionTitle:Telehealth/DeliveryAbstractID:390Title:DeliveringCochlearImplantationtoUnderservedPopulations:Cost-EffectivenessandOutcomesamongthePlainPopulationAuthors:RobertC.O'Reilly,M.D.1,ThierryMorlet,PhD2,LieslLooney,AuD3,KevinStrauss,M.D.4;1Otolaryngology,ChildrensHosp.ofPhiladelphia,Philadelphia,PA,2BiomedicalResearch,AIduPontHosp.forChildren,Wilmington,DE,3Audiology,AIduPontHosp.forChildren,WIlmington,DE,4TheClinicforSpecialChildren,Strasburg,PA.Abstract:Introduction:Providingcochlearimplantationtoarural,technologically-limited,andfinanciallyimpoverishedpopulationprovidessignificantchallenges.Inthispaperwereviewanalgorithmforcost-effectiveevaluationandtreatmentoffourteenchildrenwithprofoundhearinglossinthePlainpopulationwhoreceivedcochlearimplantation.Modelsforhabilitation,useoftelemedicineformapping,andspeechandlanguageoutcomeswillbediscussed.Methods:ThemedicalrecordsandfamilyquestionnairesoffourteenchildrenfromthePlainpopulationundergoingcochlearimplantationthroughaspecialtymedicalclinicinruralPennsylvaniawerereviewedforexpenseofwork-up,patientdemographics,relatedmedicalconditions,andspeechandlanguageout-comes.Results:Theaverageageatimplantationwas20.9months(range9-53mo.)andtheaveragefollow-upwas28months(range9-50mo.).Therewere8malesand6femalesimplanted;10patientshadbilateralimplantationand4unilateralimplantation.Tenpatientshadanidentifiedgeneticdisorder,onehadcongenitalCMV,andthreehadanunknownsourceofhearingloss.SpeechandlanguageoutcomemeasureswereassessedwithLittleEARSandpre-andpost-implantfamilysatisfactionwiththechild’sspeechperception.Thereweresignificantcost-savingstofamiliesthroughuseofastream-linedwork-upandlimitationoftravelutilizingtelemedicineformappingandprogramming,andhomelisteningandspokenlanguagetherapy.Allchildrenmetorexceedtheirhearingageontestingandtherewasahighfamilysatisfactionratingwithspeechperception.


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Conclusion:Useofcost-effectivemeasures(focusedevaluation,telemedicine,andhometherapy)allowsforsuccessfulhabilitationwithcochlearimplantationofarural,underservedpopulationofchildren. SessionID:S7-2SessionTitle:AudiologyAssessmentandIndicationsAbstractID:304Title:RelationshipbetweenObjectiveandBehaviouralAudiologyforInfantsBeingAssessedforCochlearImplantation:ImplicationsforCICandidacyAssessmentAuthors:JaimeLeigh,PhD1,RebeccaFarrell,MAud1,DeniseCourtenay,MSpPath1,RichardDowell,PhD2,RobertBriggs,FRACS1;1CochlearImplantClinic,RoyalVictorianEyeandEarHosp.,EastMelbourne,Australia,2AudiologyandSpeechPathology,Univ.ofMelbourne,Carlton,Australia.Abstract:Introduction:Thewidespreadintroductionofuniversalnewbornhearingscreeninghasresultedinadramaticreductiontotheageofdiagnosisforchildrenwithcongenitalhearingimpairment.Parentsofchildrenwithhearingimpairmentcannowseekintervention(languageinterventionanddeviceoptions)fortheirchildwithinthefirstfewmonthsoflife.Theageachildreceivesacochlearimplant(CI)iswellacceptedashavingasignificantimpactonthespeechperception,speechproductionandorallanguageoutcomesforchildrenwithsevere-to-profoundhearingloss.Earlyimplantationprovidesachildwithcongenitalsevere-to-profoundhearinglosstheopportunitytodeveloporallanguageskillsataratecomparabletotheirtypicallyhearingpeers.RecentevidencesuggeststhatchildrenwithhearinglossinthesevererangemaynowalsobenefitfromaCI.Asthesefindingsbecomemorewidelyaccepted,paediatricCIservicesareunderincreasedpressuretomakeCIrecommendationsforinfantsasearlyaspossible.Providingevidence-basedandtimelyrecommendationsforimplantationisasignificantchallengeforpaediatricCIprograms.ClinicalpracticesatmosttertiaryinstitutionsprovidingCIservicesforyoungchildrenrequiretheestablishmentofreliablebehaviouralaudiologicalresultspriortorecommendingaCI.Recentclinicaldatafromamajortertiarymedicalfacility,providingCIservicesforchildrenformorethan30years,suggeststhatthetimeframefromtheinitialhearinglossdiagnosis(objectiveaudiology)totheestablishmentofconsistentbehaviouralhearinglevelscanvaryconsiderably(fromfourweekstooneyearandfourmonths)withseveralpossibleinfluencingfactors.Thetimebetweenhearinglossdiagnosisandconfirmationofbehaviouralhearingisakeyfactoraffecting,andpotentiallydelaying,theageachildreceivesaCI.ThisstudyaimedtochallengetheneedforbehaviouralaudiologyandevaluatefeasibilityofmakingCIrecommendationsbasedonobjectiveaudiology,withthegoalofreducingthetimetakenforCIcandidacyevaluation.Methods:Retrospectivereviewofpatientfilesforallchildren(N=124)referredtothepaediatricCIservicebeforethreeyearsofageoverathree-yearperiodwasundertaken.Resultsforclick-ABR,ASSRandbehaviouralaudiologyat500,1k,2kand4kHzandtympanometrywerecollectedandrelationshipswereinvestigatedfor64childrenwhomettheinclusioncriteria.Datawereexcludedfor59childrenduetothepresenceofANfindings,MEpathologyatthetimeoftesting,ifnoresponsewasobtainedonASSRat85dBandtestingwasdiscontinuedand/orbehaviouraltestingwasjudgedtobeunreliablebytwoexperiencedclinicians.Results:Resultsforobjectivemeasures(click-ABRandASSR)weresignificantlycorrelatedwithbehaviouralresults.Thecorrelations,however,werepoorerthanexpectedwithlimitedpredictivevalue.Potentialexplanationfortheweakcorrelationswillbediscussed.Conclusion:FindingsofthisstudydonotsupportmakingCIrecommendationsbasedonthefindingsofclick-ABRandASSRalone.Reducingtheaverageagechildrenwithsevere-to-profoundhearingloss


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receiveaCIisapriorityfortheinstitutionwerethisstudywasconducted.Analternateevaluationpathwayforinfantswhichincorporatesamultifacetedassessmentiswarrantedandwillbeproposed. SessionID:S7-2SessionTitle:AudiologyAssessmentandIndicationsAbstractID:188Title:TheEffectofFront-EndProcessingonSpeechPerceptionofCochlearImplantUsersAuthors:KristenRak,Priv.-Doz.Drmed.1,SebastianSchraven,Priv.-Doz.Drmed.1,AndreasRadeloff,Priv.-Doz.Drmed.2,AlexanderMöltner,Audiologist3,RudolfHagen,Prof.Dr.Dr.h.c.1;1DepartmentofOto-Rhino-Laryngology,Plastic,AestheticandReconstructiveHeadandNeckSurgeryand,Univ.ofWuerzburg,Wuerzburg,Germany,2DepartmentofOto-Rhino-Laryngology,HeadandNeckSurgery„OttoKörner“,Univ.ofOldenburg,Oldenburg,Germany,3MED-ELGmbH,Innsbruck,Austria.Abstract:Introduction:Overthepastfewyears,mostcochlearimplant(CI)developmentsthataimedatenhancingspeechrecognitionhavefocusedonsignal-processingstrategiesandelectrodedesign.However,considerableimprovementsmayalsobereachedbyemployingfront-endprocessing.TheSONNETaudioprocessorprovidesusersofaCIwithtwofront-endprocessingfeatures:MicrophoneDirectionality(MD)andWindNoiseReduction(WNR).Bothfeaturesareavailablein3differentmodes:MDOmnidirectional,MDNatural,MDAdaptiveandWNROff,WNRMild,WNRStrong,whichcanbecombinedinvariousways.TheaimofthestudywastoassessspeechperceptionoutcomeswithdifferentcombinationsofMDandWNRimplementedintheSONNETaudioprocessercomparedtotheOPUS2audioprocessor.Methods:31adultunilateralCIuserswithaminimumof6monthsexperiencewiththeirprioraudioprocessorwereupgradedtotheSONNET.Threetestvisitswereconducted,visitIatupgrade,visitII3weeksandvisitIII6weeksaftertheupgrade.Duringthestudy,subjectsonlyusedtheSONNET.Ateachvisitthesubjectsweretestedwiththeirprioraudioprocessor(OPUS2)andwiththeSONNETprogrammedwithdifferentcombinationsofMD(omnidirectional,naturalandadaptive)andWNR(off,mildandstrong)modes.Alltestswereconductedinaquietoffice-likeroomwithanaveragereverberationtimeof0.55seconds.Atvisit1subjectsweretestedusingtheOldenburgadaptivesentencetest(OLSA)withthespeechsignalpresentedfromthefrontandbackgroundnoisepresentedcontinuouslyfrom90°,180°and270°.Thistestwasdoneinthesameconditionwithbabblenoise.Atvisit2subjectsweretestedusingtheOLSAwithwindblowingtotheaudioprocessorfromanangleof45°ataspeedofapproximately7km/hwithnoadditionalbackgroundnoise.Atvisit3subjectsweretestedinquietusingtheFreiburgmonosyllablestest.Results:TheresultsofspeechtestsinbothspeechshapedandbabblenoisewiththeSONNETinitsdefaultsetting(MD“natural”andWNR“mild”)showedsignificantbenefitforspeechperceptioninnoisyconditionscomparingtotheOPUS2.Comparingtheresultsofspeechtestwithall9combinationsofMDandWNRinwindrevealedthatinwindyconditionsspeechperceptionisalwaysbetterwithWNRturnedoncomparedtoWNR“Off”.TheresultsoftheFreiburgermonosyllabictestinquietresultedinbetterspeechperceptionwiththeSONNETthanwiththeOPUS2.Conclusion:Employingfront-endprocessinginCIaudioprocessorsimprovesspeechrecognitionindifficulthearingconditions.Thetwonewfeatures,microphonedirectionalityandwindnoisereductionintheSONNETinitsdefaultmodegiveCIuserssignificantbenefitforspeechperceptioninnoisyandwindyconditions. SessionID:S7-2SessionTitle:AudiologyAssessmentandIndicationsAbstractID:107


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Title:UpdateonthePediatricMinimumSpeechTestBatteryforChildrenwithHearingLossAuthors:AndreaD.Warner-Czyz,Ph.D.1,KristinUhler,Ph.D.2,ReneGifford,Ph.D.3;1CommunicationSciencesandDisorders,TheUniv.ofTexasatDallas,Dallas,TX,2SchoolofMedicine,Univ.ofColorado-Denver,Aurora,CO,3VanderbiltUniv.,Nashville,TN.Abstract:Introduction:Assessmentofpatientoutcomesanddocumentationoftreatmentefficacyserveasanessentialcomponentof(re)habilitativeaudiology.However,nostandardizedprotocolexistsfortheassessmentofspeechperceptionabilitiesforchildrenwithhearingloss.Infact,individualclinicians,sites,andresearchersuseawidevarietyofpracticesandprotocolstoevaluatethispopulation.Thispresentsasignificantchallengeintrackingperformanceofchildrenwhoutilizevarioushearingtechnologiesforwithin-subjectsassessment,between-subjectsassessment,andevenacrossdifferentfacilities.Theadoptionandadherencetoastandardizedassessmentprotocolcouldhelpfacilitatecontinuityofcare,assistinclinicaldecision-making,allowcliniciansandresearcherstodefinebenchmarksforanaggregateclinicalpopulationand,intime,aidwithpatientcounselingregardingexpectationsandpredictionsregardinglongitudinaloutcomes.Methods:ThePediatricMinimumSpeechTestBattery(PMSTB)workinggroup,comprisedofclinicians,scientists,andindustryrepresentatives,commencedin2012andworkedcollaborativelytoconstructthefirstPMSTB.Results:ThispaperwillpresentthePMSTBhierarchicalprotocol,whichincludesmeasuresdesignedtoevaluatespeechdiscriminationforinfantsandword/sentencerecognitioninquietandinbackgroundnoiseforchildrenusinghearingtechnologybeforeschoolentranceattheageof5yearsoralanguageequivalentoffiveyears.Conclusion:Thisconsensusstatementrepresentsanevidence-basedapproachtopediatricspeechperception,incorporatingclinicalexpertise,researchsupport,andpatient/familyconcerns.Implementationofthedata-drivenandclinically-relevantPMSTBinclinicalpracticeanddisseminationofassociateddataarebothcriticalforachievingthenextlevelofsuccessforchildrenwithhearinglossandforelevatingpediatrichearinghealthcareensuringevidence-basedpracticefor(re)habilitativeaudiology. SessionID:S7-2SessionTitle:AudiologyAssessmentandIndicationsAbstractID:291Title:ImplantationofNon-TraditionalPediatricCochlearImplantCandidates:AnEvaluationofOutcomesandFactorsContributingtoPost-OperativePerformanceAuthors:ChristineL.Brown,Au.D.1,DavidS.Haynes,M.D.2,LinseyW.Sunderhaus,Au.D.1,TimothyJ.Davis,Au.D.1,JourdanT.Holder,Au.D.1,RenéH.Gifford,Ph.D.1;1DepartmentofHearingandSpeech,VanderbiltBillWilkersonCtr.,Nashville,TN,2DepartmentofOtolaryngology-HeadandNeckSurgery,VanderbiltBillWilkersonCtr.,Nashville,TN.Abstract:Introduction:CurrentFDAlabelingforcochlearimplantmanufacturersseverelylimitsthenumberofpediatricpatientsthatcouldpotentiallybenefitfromcochlearimplantation.However,manyimplantcentersarecurrentlyimplantingpediatricpatientsthatdonotmeetFDAlabeledindicationsforcochlearimplantation.Thepurposeofthisstudywastofurtherexaminethedegreeofbenefitderivedbychildrenwhohaveeitherasymmetrichearinglossorbetterthancriterionhearingand/orspeechunderstandingandfurtherinvestigatefactorsthatmaybeusefulinpredictingoutcomesinthisnon-traditionalpopulation.Methods:Datafor38subjectswereobtainedfromaretrospectivereviewofmedicalrecordsforpediatricpatientsundertheageof18implantedatatertiaryacademicreferralcenter.Inclusioncriteriawereasfollows:1)puretoneaverage(PTA)lessthan70dBHLinoneorbothearsforchildrenbetween


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theagesof2and18andlessthan90dBHLforchildrenundertheageof2and/or2)betterthancriterionspeechunderstandingforolderchildren.Demographicinformation,pre-andpost-implantationspeechperceptionscoresinthecochlearimplant(CI)onlyconditionandbimodalcondition,scoresonauditoryquestionnaires,parentalandpatientreportofdeviceusage,anddatalogginginformationwillbeusedinsubsequentmulti-variateanalyses.Results:Atthetimeofabstractpreparation,dataanalysisfor38subjectsrevealedthatnon-traditionalpediatriccochlearimplantrecipientsexhibitedsignificantimprovementinspeechperceptionscoresinboththeCIonlyandbimodalconditionsfollowingimplantation(p<0.05).Additionally,ageatimplantationwasinverselycorrelatedwithperformanceintheCIonlycondition,buttherewasnotasignificantcorrelationbetweenageattimeofimplantationandpost-implantationperformanceinthebimodalcondition,likelyduetotheprevalenceofasymmetrichearinglossinthispopulation.Wewillcontinuetoaddpatientstothedatasetandfurtheranalyseswillbecompletedinordertodeterminewhetherthesefindingsareconsistentforalargernumberofpatients,variousdegreesofasymmetrichearingloss,andwhetherweobserveapointofdiminishingreturn.Conclusion:Thesedataprovidefurtherevidencethatnon-traditionalpediatricCIrecipientsderivesignificantbenefitfromcochlearimplantation.Theseresultshavesignificantclinicalimplicationsfortheexpansionofpediatriccandidacycriteria.Furtheranalysismayrevealclinicallyrelevantfactorsthatcanbeusedtopredictpostoperativeoutcomesandshouldbeconsideredwhenevaluatingthisnon-traditionalpopulation. SessionID:S7-2SessionTitle:AudiologyAssessmentandIndicationsAbstractID:324Title:IsEarlyInterventionNecessaryforChildrenwithPartialHearing?Authors:KateHanvey,BScHons,MSc1,KatherineWilson,MSc2,MaretteAmbler,MSc1,MarshaJenkins,MSc2,JustineMaggs,MSc1,KonstanceTzifa,MPhilFRCS1,DanJiang,MBBSPhDFRCS2;1TheMidlandsHearingImplantProgramme-Children'sService,BirminghamChildren'sHosp.NHSFndn.Trust,Birmingham,UnitedKingdom,2StThomas’HearingImplantCentre,Guy'sandStThomas'NHSFndn.Trust,London,UnitedKingdom.Abstract:Introduction:‘Soft’or‘Atraumatic’cochlearimplantsurgeryisnownormalpracticeinmanyCIcentres.Thissurgicaltechnique,usedalongwithspeciallydesignedelectrodearrays,canresultinpreservationofhearingforpeoplewhohavepartialhearing.Thereisthereforeagrowingpopulationofpartiallyhearingpeoplewhoarebenefitingfromcochlearimplantation.However,thereremainsareticenceaboutimplantingyoungchildrenwithpartialhearing.Earlyinterventionisanestablishedprincipleforcongenitallydeafchildren.InEngland,childrenwithunaidedthresholdsat2and4KHzof90dBHLorgreatermaybeconsideredforbilateralimplantation.Despitethis,thereareconcernsaroundofferingacochlearimplant,letalonesimultaneousbilateralcochlearimplants,toyoungchildrenwithpartialhearing.Thepurposeofthisstudywastolookatthenegativeimpactthatpartialhearingcanhaveonadevelopingchild,andtodemonstratethatearlyinterventionofcochlearimplantationcanmitigatethisnegativeimpact.Discussionwillincludetheconsequencesofanimpairedsystem,topdownprocessing,redundancy,andhowhearingaidscannotadequatelycompensateforthis.Methods:SinceOctober2014,twohearingimplantprogrammeshaveworkedcollaborativelyonaretrospectivereviewtolookintopartiallyhearingchildrenwhohavereceivedcochlearimplants.45childrenwhoreceivedtheircochlearimplantsbetween2008and2016wereincludedinthereview.Acomprehensiveanalysisofthedatawillbepresented,includingratesofhearingpreservationandpreandpostaudiologicalandspeechoutcomes,(e.g.,SIR,CAP).


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Results:Immediatelypost-operatively,hearingwaspreservedinallears.Longtermfollowupsuggestsmostlystablehearingthresholds.Ofgreaterimportance,functionallisteningandspeechclarityimprovedforallchildrenwhowereimplantedpriortospeechpatternsbecomingestablished,butthiswasnotthecaseforsomechildrenwhowereimplantedlaterinchildhood.Conclusion:Cochlearimplantationearlyinlifeisequallyimportantforchildrenwithcongenitalpartialhearingasitisforchildrenwithcongenitalseveretoprofoundhearingloss.Beingunabletodetectanddiscriminatemidtohighfrequencyspeechsoundscanresultinpoorspeechclaritythatcannotberemediatedlaterinchildhood.SessionID:S7-3SessionTitle:RehabilitationandOutcomesAbstractID:382Title:TheRelationshipbetweenFactorsofCognition,SpeechPerception,andLanguageinChildrenwithCochlearImplantsAuthors:ElizabethAdamsCosta,Ph.D.1,JulieVerhoff,Au.D.,Ph.D.2,SharleneWilsonOttley,Ph.D.3,ChristineMitchell,ScM4,NancyMellon,M.A.5,MeredithOuellette,M.A.5,ColleenCaverly,M.A.1;1DepartmentofPsychology,TheRiverSch./RiverREACHClinic,Washington,DC,2DepartmentofAudiology,TheRiverSch./RiverREACHClinic,Washington,DC,3DepartmentofSpeechandLanguagePathology,TheRiverSch./RiverREACHClinic,Washington,DC,4Epidemiology,JohnsHopkinsBloombergSch.ofPubl.Health,Baltimore,MD,5TheRiverSch./RiverREACHClinic,Washington,DC.Abstract:Introduction:Outcomedataforchildrenwithcochlearimplantscontinuestoshowhighvariability.Researchsuggeststhatageofimplantation,degreeofresidualhearingpriortoimplantation,maternalsensitivity,socioeconomicstatus,andnonverbalcognitiveabilitiesinfluencelanguageoutcomes.StudiesinvestigatingthecognitiveprofilesofchildrenwithCIsarealsovariable,butgenerallyreportlowerscoresonmeasuresofverbalabilitiesandworkingmemorytaskscomparedtohearingpeers.Itishypothesizedthatworkingmemoryiscriticaltothedevelopmentofspokenlanguage,andpositivecorrelationshavebeenfoundbetweenworkingmemoryandlanguagedevelopmentinchildrenwithCIs.Nittrouer(2016)emphasizedtheimportanceofconsideringhowchildrenwithCIsfunctioninrealworldversuscontrolledlaboratorysettings.ManychildrenwithCIsexperienceconsiderabledifficultyhearinginnoise.Thereisalsoadevelopmentaleffectassociatedwithspeechrecognitionperformanceinthepresenceofbackgroundnoise:childrenundertheageoffiveareatanevengreaterdisadvantagethanolderchildreninclassroomswithpooracoustics.Performanceislikelyinfluencedbymediatingfactorsofmaturation,cognition,languagecomprehension,andworkingmemory.Thegoalofthecurrentstudywastoinvestigatetherelationshipbetweencognitivefactors,languageabilities,andspeechrecognitionforchildrenwithcochlearimplantsinafullyinclusiveeducationalmodelwheretheyhaveaccesstotypicallydevelopingpeers.Methods:Thiscross-sectionalstudyexamineddatafor22childrenbetweentheagesoffiveandeighttoexploretherelationshipbetweencognitiveflexibility(FluidReasoningIndex),workingmemory(WorkingMemoryIndex),speechrecognition(ArticulationIndex),listeninginnoise(Bamford-Kowal-BenchSpeech-In-Noise),receptivevocabulary(PeabodyPictureVocabularyTest),andcorelanguage(ComprehensiveAssessmentofSpokenLanguage).Results:Significantcorrelationswerefoundbetweenworkingmemoryandspeechperception(p=0.02),workingmemoryandcorelanguage(p=0.01),andreceptivevocabularyandcorelanguage(p=0.00).Arelationshipapproachingsignificancewasfoundbetweenreceptivevocabularyandspeechdetectioninnoise(p=0.06).Therelationshipbetweenworkingmemoryandcorelanguagewasonlyfoundinchildrenwithlanguagescoresbelowthemean(p=0.008),butwasnotpresentinchildrenwithlanguagescoresabovethemean(p=.86).Anolderageatactivationwasassociatedwithalowerlanguagescore.Noneof


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theexaminedvariablesweresignificantlyassociatedwithspeech-in-noisescores,andunlikewiththelanguageoutcome,thereappearstobelessofaneffectofactivationage.Conclusion:Theresultsofthecurrentstudysuggestthatrelationshipsaredemonstratedbetweenaudiological,cognitive,andlanguagefactors.InterindividualvariabilityinneurocognitiveprocessinglikelyaccountsforthedemonstratedscatterinoutcomesforchildrenwithCIs.Studiesfurtherexaminingtheneurocognitiveprofilesofchildrenwithhighandlowlanguageoutcomesmayhelptoclarifyriskfactors,indentifyareasforintervention,andpredictoutcomes. SessionID:S7-3SessionTitle:RehabilitationandOutcomesAbstractID:410Title:BilateralCochlearImplantationinChildrenwithAutismAuthors:AdrienEshraghi,MD,FACS,KadriIla,MD,FredF.Telischi,MD,SandraPrentiss,MD,MichaelHoffer,MD,DianeMartinez,MD,SandraValendia,MD,JeenuMittal,MSc,RonenNazarian,MD;Univ.ofMiamiMillerSch.ofMed.,Miami,FL.Abstract:Introduction:Benefitsofbilateralcochlearimplantation(CI)inchildrenwithseveretoprofoundhearinglosshavewellbeendocumented;however,outcomescontinuetovary.Benefitsofcochlearimplantationbecomeunclearinthoserecipientspresentingwithadditionalneedssuchasautismspectrumdisorder(ASD).ThepurposeofthisstudywastoinvestigatethebenefitsofbilateralimplantationinchildrenwithASDandcompareperformancetotheunilateralimplantedkidswithASDandagroupofagedmatchedneurotypicalpeersimplanted.Methods:AretrospectivestudyofunilaterallyandbilaterallyimplantedchildrenduallydiagnosedwithdeafnessAutismSpectrumDisorder(ASD)wasconducted.Outcomesofreceptiveandexpressivelanguagescorespre-andpost-implantionoffivebilaterallyimplantedASD,10unilaterallyimplantedASDchildrenand15agematchedcontrolneurotypicalkidswerecompared.Additionally,aparentalcommunicationsurveywasadministeredtoassesscommunicationandbehavioralscores.Scoreswerecomparedacrossgroups.Results:Receptivelanguagescoresweresignificantlybetterinthebilaterallyimplantedgroupcomparedtotheunilaterallyimplantedgroup;however,lowerthantheneurotypicalage-matchedpeers.Expressivelanguageinthebilaterallyimplantedgroupshowedimprovementsovertheunilaterallyimplantedgroup,butwerenotstatisticallysignificant.Inthebilaterallyimplantedgroup,parentsreportedmostimprovementinmusicenjoyment,reactingtosoundsandvocalizationfollowingimplantion,whileforunilaterallyimplantedchildren,parentsreportedmostimprovementinnamerecognition,respondingtoverbalrequestsandmusicenjoyment.Conclusion:AlthoughoutcomesfollowingcochlearimplantationofchildrenwithASDlagbehindtheirneuro-typicaldevelopingpeers,significantbenefitsinlanguageandbehaviorwereobservedinbilaterallyimplantedchildren. SessionID:S7-3SessionTitle:RehabilitationandOutcomesAbstractID:89Title:DevelopmentofSchool-AgeandParent-ProxyHealth-RelatedQualityofLifeMeasuresforChildrenwithCochlearImplantsAuthors:MichaelHoffman,M.S.1,IvetteCejas,Ph.D.2,AlexandraQuittner,Ph.D.3;1Psychology,Univ.ofMiami,Miami,FL,2Otolaryngology,Univ.ofMiamiMillerSch.ofMed.,Miami,FL,3BehavioralHlth.SystemsRes.,Miami,FL.


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Abstract:Introduction:Severetoprofoundhearinglossisassociatedwithlowerhealth-relatedqualityoflife(HRQoL),whichreflectsthewide-rangingeffectsofdeafnessonorallanguage,cognition,andsocial/behavioraldevelopment.However,therearecurrentlynoCI-specificHRQoLmeasuresthatweredevelopedusingtheFDAprocess.ThisstudypresentsthefirstHRQoLinstruments(CI-QoL)forchildrenwithCIs,ages6to12,andtheirparents.Methods:TheseinstrumentsweredevelopedfollowingtheFDAGuidanceonPatient-ReportedOutcomes(2009).PhaseIconsistedofaliteraturereviewtohypothesizeaconceptualframeworkanddiscussionguidestoelicitinformationfromstakeholderfocusgroups(e.g.,physicians,speechpathologists),andopen-endedinterviewswithchildrenandtheirparents.DuringPhaseII,stakeholders(n=30)andparent-childdyads(n=21;M=9.1years;Matimplantation4.4)wererecruitedfromCIClinicsinMiamiandPhiladelphia.InterviewsweretranscribedanduploadedintoAtlas.tiforcodingofcommonthemesusingcontentanalysis.Basedontheseresults,theconceptualframeworkwasrevisedandinitialinstrumentswerecreatedusingthemostfrequentandimpactfulconcepts.Theinstrumentsweredesignedtobeadministeredonatabletforautomaticscoring.Theself-report,childversionutilizesamultimodalapproachtomaximizeunderstanding(i.e.,pictorialrepresentations,audiorecordingofitems,writtentext).Childrencansimplypointandclickonthepictureorrating.Anewsetofchild-parentdyads(n=20;Mage=9.2)wererecruitedatbothsitestocompletecognitivetestingoftheinstrumentstoensureclarity,easeofuse,andcomprehensiveness.Basedonthisfeedback,theitemsweremodified,andfinaldraftinstrumentswerecreated.Results:Theinitialversionofthechildmeasurecontained33itemsclusteredinto8domains:NoisyEnvironments,AcademicFunctioning,ChildAcceptance,OralCommunication,SocialFunctioning,Fatigue,EmotionalFunctioning,andDeviceManagement.Basedthecognitiveinterviewdata,3itemswereremovedduetolackofclarityandresponsevariability(e.g.,howoftendoesyourteacherhelpyouinclass?)and3itemswereadded(e.g.,howoftendoesyourCIfeeluncomfortable?).Theinitialdraftoftheparent-proxyincluded55itemsgroupedinto10scales:thoselistedabove,BehaviorProblems,andParentingStress.Followingcognitiveinterviews,5itemsweredropped(e.g.,howoftenisyourchildteased?)and1itemwasadded(e.g.,howconcernedareyouaboutsplittingtimebetweenyourchildwithaCIandsiblings?).Conclusion:CI-specificHRQoLinstrumentshavenowbeendevelopedforschool-agechildrenwithCIsandtheirparentsusingtheFDAprotocol.Followingapsychometricvalidation,theseCI-specificmeasureswillenableustotracklong-termoutcomes,identifykeytargetsforintervention,andanalyzecost-effectiveness. SessionID:S7-3SessionTitle:RehabilitationandOutcomesAbstractID:106Title:PEARLS:AParentingInterventionforPediatricCIRecipients&TheirFamiliesAuthors:IvetteCejas,PhD1,MichaelHoffman,MS2,DomitilleLochet,MS1,AlexandraL.Quittner,PhD3;1BartonG.KidsHearNowCenter,Univ.ofMiami,Miami,FL,2Psychology,Univ.ofMiami,Miami,FL,3BehavioralHlth.SystemsRes.,Miami,FL.Abstract:Introduction:Earlyinterventionshavethepotentialtoimprovelanguagedevelopmentindeafchildrenusingcochlearimplants(CIs);however,fewinterventionsforthispopulationhavebeendevelopedorevaluated.RecentstudieshavehighlightedthecriticalroleparentsplayinfacilitatinglanguageinchildrenwithCIs.Inparticular,thequalityofparent-childinteractions,specificallymaternalsensitivity(MS)anduseoffacilitativelanguagetechniques(FLTs),havebeenshowntopositivelyaffect


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children’sgrowthinorallanguage.Todate,fewparent-focusedinterventionshavebeendevelopedtoimproveparent-childinteractionsinthecontextoflanguagelearning.ThepurposeofthisstudyistodevelopandevaluateaninterventionthatfocusesonparentsensitivitytrainingandtheuseofFLTstoimproveparent-childinteractionsandcommunicationinchildrenwithCIs(Parent-ChildEarlyApproachestoRaisingLanguageSkills;PEARLS).Methods:AdraftmanualforthePEARLSinterventionwasdevelopedanditsfeasibilitywastestedinahandfulofchildren.Theinterventionconsistedof10,1-hoursessionsover3-monthsandcombinedstandardauditory-verbaltherapywithtraininginsensitiveparentingandhigher-levelFLTs.Therapistsmodeledanewparentingorlanguagetechnique,coachingparentsinhowtointeractinpositive,warmwaysthatencouragechildautonomy.Familieswhoagreedtoparticipatecompletedabaselineassessment,whichincluded:1)videotapedparent-childinteractionscodedforbothMSandFLTs(FreePlayandArtGalleryTask);2)self-reportedparentalself-efficacyandinvolvement(SPISE);3)parentalreportofauditoryskills(IT-MAIS);and4)languageusingthePLS-5.Familiesalsocompletedapost-assessmentfollowingthePEARLSinterventionanda6-monthfollow-uptoevaluatesustainabilityofskills.Results:Sixfamilieswithdeafchildren,ages12to48monthsparticipatedinthisstudy.Themeanageofthesamplewas28.8monthsandoneparenthadlessthanahighschooldiplomaand5hadacollegedegree.Cognitivescoresofthechildrenwerewithintheaveragerange(M=113).Post-intervention,parentsreportedhigherself-efficacyandparentalinvolvement.Improvementswerealsoobservedincodedmaternalsensitivityandauditoryskills.Motherswerehighlysatisfiedwiththeinterventionanddescribedtheinterventionas,“helpful,”“flexible,”“balanced&realisticapproach,”andlikedthatitwas“tailoredtothefamily’sskilllevel.”Importantly,parentsreportednoproblemsattendingthesessionsandtheAVtherapist,whoconductedtheinterventiondescribedPEARLSashelpfulandeasilyintegratedintopractice.Conclusion:Parentinterventionsarecost-effective,ecologicallyvalid,andcanbetranslatedto“realworld”clinicalsettings.PEARLSisthefirstevidenced-basedinterventiondesignedtoimproveparent-childinteractionsandcommunicationinchildrenusingCIs.Preliminaryresultsrevealedapositiveeffectontheparent-childrelationship,parentalinvolvementandself-efficacy.Theplanistopilotthisinterventioninalargergroupofchildren.Ifeffective,thisinterventionhasthepotentialtooptimizethebenefitsofcochlearimplantationandguidepediatriccochlearimplantprogramsnationally. SessionID:S9-1SessionTitle:TechnologyandInnovationAbstractID:458Title:RestorationoftheHighFrequencyAngularVestibulo-ocularReflexwithVestibularImplantsAuthors:NilsGuinand,MD1,RaymondvandeBerg,MD2,ErichSchneider,Prof.3,MaurizioRanieri,Ing.1,SamuelCavuscens,Ing.1,RobertStokroos,Prof.2,HermanKingma,Prof.2,Jean-PhilippeGuyot,Prof.1,AngelicaPerezFornos,PhD1;1HUG,Geneva,Switzerland,2MUMC,Maastricht,Netherlands,3Ludwig-Maximilians-Univ.,Munich,Germany.Abstract:IntroductionvHIT(videoHeadImpulseTest)hasbecomeagoldstandardinvestibulartesting.Itallowssidespecific,independentassessmentofthe6semicircularcanalsinthehighfrequencyrange.ThereforevHITisanoptimaltestfortheevaluationoftheperformanceofvestibularimplants,whicharedevicesdesignedtoprimarlyrestorethecanalfunctionininpatientswithabilateralvestibularloss(BVL).Thepurposeofthisstudywastoevaluatewhetheritispossibletorestorethehigh-frequency,angularvestibulo-ocularreflex(aVOR)withavestibularimplant.


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MethodsTwopatientswithabilateralvestibularlosswerefittedwithavestibularimplantprototype.Thedeviceconsistsinamodifiedcochlearimplant(MED-EL,Innsbruck,Austria)where3electrodesweretakenoutofthecochleararrayandputinseparatebranchesthatwereimplantedintheampullaeofeachsemicircularcanal.Thehigh-frequency,aVORwasassessedusingthevHIT(EyeSeeCamsystem)whilemotion-modulatedelectricalstimulationwasdeliveredviaoneoftheimplantedvestibularelectrodes(S1–lateralampullarynerve,S2–superiorampullarynerve).aVORgainswerecomparedtocontrolmeasurementsobtainedinthepatientswhenthedevicewasnotactivated.ResultsTheaVORgainintheplaneanddirectionoftheimplantedearincreasedmonotonicallywithincreasedmodulationdepths,reachingamaximumgainof0.48(S1-horizontal)and0.90(S2-RALP)atthelargestmodulationdepthtested.Thegainsawayfromtheimplantedearweremuchlower(<0.30).TherewasasignificantpositivecorrelationbetweenaVORgainsandmodulationdepth(Pearson’slinearcorrelation;S1:R2=0.98,p<0.001;S2:R2=0.94,p<0.01).BothpatientspresentedlowaVORgains(<0.20)whenthesystemwasnotactivated,asexpected.ConclusionUsingthevHIT,theseresultsdemonstratethatitispossibletorestorethehigh-frequencyaVORusingmotion-modulatedelectricalstimulationofthevestibularafferents,deliveredwithachronicallyimplanted,prototypevestibularimplant.Thisresultextendspreviousfindings,confirmingthatourdevicesuccessfullyrestoresmultimodalvestibularfunction,providingclearevidencethatavestibularimplantmightbecomeaneffectiverehabilitationalternativeforpatientswithaBVLinanearfuture. SessionID:S9-1SessionTitle:TechnologyandInnovationAbstractID:292Title:PreliminaryFindingsofaParent-focusedInterventionUsingMobileandWearableTechnologytoEnrichtheEverydayLanguageEnvironmentsofYoungChildrenAuthors:DawnChoo,MasterofSpeechPathology1,ShaniDettman,PhD2,RichardDowell,PhD2,RobertCowan,PhD3,JaimeLeigh,PhD2;1TheUniv.ofMelbourneandTheHEARingCRC,Melbourne,Victoria,Australia,2AudiologyandSpeechPathology,TheUniv.ofMelbourne,Melbourne,Victoria,Australia,3TheHEARingCooperativeRes.Ctr.,Melbourne,Victoria,Australia.Abstract:Introduction:Timelyaccesstoauditionandengagementinearlyintervention(EI)arethecornerstonesofenhancingcommunicationoutcomesforchildrenwithsensorineuralhearingloss.Children’slanguageenvironmentandfamilyparticipationintheearlyyearshavealsobeenrecognisedasinfluentialfactorsinthedevelopmentoflisteningandorallanguageskills.Withthegrowingnumberofpaediatriccochlearimplant(CI)recipientsanddemandsonspeechpathology/EIservices,thereisanimpetustoexplorecomplementarymodelsofcarewhichadvocateaparticipatoryapproach.RecentadvancesintechnologyhaveprovidedfamiliesofpaediatricCIuserswiththeopportunitytobemoreinvolvedintheirowncaremanagementoutsideofclinicalappointmentsthroughdigitalandmobilehealth.Thisstudyaimsto:(1).exploretheuseofwearableandmobiletechnologytopromotepositivechangesinparentallanguagebehavioursindailylifeand;(2).understandclinician/parentsperspectivesregardingtechnologyinsupportingearlylanguage.Methods:Part1.DyadswithtypicalhearingwererecruitedinAustraliaforaprospectivecrossoverstudy.Childrenwereagedbetween6monthsand3years.Mother/childinteractionsampleswereanalysedfrom8(16-hour)weeklyrecordingsusingtheLENAwearablelanguageprocessor.Theuseofamobileappwhichpromptedparentswithstrategiesforcreatingsharedparent-childinteraction


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opportunitiesathomewasalsoexamined.Therewere3conditions:(A).languagerecordingsonly;(B).languagerecordingsandtheprovisionofshortfeedbacksessionsbasedonrecordedlanguagecounts(frequencyofadultwords,conversationalturnsandchildvocalisations);(C).feedbackanduseofthemobileapp.Pre-andpost-trialchildlanguageevaluationswereconductedandparent-reportquestionnairesdata(parentalknowledgeandself-efficacy)werecollected.Part2.TrialparticipantsandcliniciansworkinginEIsettingswerealsoinvitedtocompleteanonlinequestionnaireexploringtheirperspectivesonwearableandmobiletechnology.Results:Part1.Outcomesofthe8-weekpilotstudysupportedtheuseoffeedbackasafacilitatorofenrichedlanguageinputtothechild.Participantshadhigheraveragewordandconversationalturncountsafterreceivinglanguagefeedbackandafterusingthemobileapp(ConditionsBandC)relativetothecontrolcondition(A).Part2.Preliminaryquestionnaireresponsesregardingperspectivesonwearableandmobiletechnologyvariedconsiderably;respondentsindicatedthatparentaleducation,cost,andaccessibilitywerekeybarrierstotheintegrationoftechnologyinEI.Conclusion:Part1.Thisstudysuggestedthat,withadequatesupport,technologycanpromoteparentalengagementandenrichhomelanguageenvironments.Part2.Userissues,identifiedinthisstudy,willrequireconsiderationinordertoshapeimplementationofparticipatoryhealthapproachesinthispopulation. SessionID:S9-1SessionTitle:TechnologyandInnovationAbstractID:161Title:BenefitofAdaptiveDual-MicrophoneBeamformersforUnderstandingSpeechinNoiseinCochlearImplantRecipientsandBimodalListenersAuthors:LisaDahlstrom,AuD1,RichardGurgel,MD1,SmitaAgrawal,Ph.D.2;1Otolaryngology,Univ.ofUtah,SaltLakeCity,UT,2AdvancedBionics,Valencia,CA.Abstract:Introduction:Theobjectiveofthisstudywastoevaluatethebenefitofadaptivedual-microphonebeamformersforunderstandingspeechinnoiseincochlearimplant(CI)recipients.Bimodallisteners(CIinoneearandahearingaid(HA)inthecontralateralear)werealsostudiedwithanHAdesignedspecificallyforCIrecipients.Methods:TenadultAdvancedBionicsCIrecipients(3unilateral,7bilateral;medianage73years)andnineadultbimodallisteners(AdvancedBionicsCIpluscontralateralHA;medianage81years)participated.Sentenceperceptioninmulti-talkerbabble(S0N0)wascomparedbetweenomnidirectionalmicrophones(T-Mics)andadaptivedual-microphonebeamformers(UltraZoom)usingtheNaidaCIQ70speechprocessor.BimodalparticipantsweretestedwiththenewNaidaLinkHA.TheLinkwasprogrammedwithauniquebimodalfittingformulaandimplementedabeamformermatchedtothatoftheCIsoundprocessor.Eachsubjectwastestedatanindividuallydeterminedsignal-to-noiseratiothatreducedthespeechscoretoapproximatelyone-halfthescoreinquiet(range:-2to11dBSNR).Results:Bothgroupsdemonstratedsignificantimprovementinsentencerecognitionwhenlisteningwithadaptivedual-microphonebeamformers(bimodallisteners:27%;CIusers:33.5%,p<.001).BimodallistenersalsoreportedimmediateacceptanceandimprovedsoundqualitywiththenewHA.A13%bimodalbenefitwasexperiencedwhenusingjusttheomnidirectionalmicrophonesintheCIandHA.Conclusion:Adaptivebeamformingtechnologycanmakeface-to-faceconversationsinnoisyenvironmentssignificantlymoreintelligibleandeasierforCIusersandbimodallisteners. SessionID:S9-1SessionTitle:TechnologyandInnovationAbstractID:371


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Title:LegalandEthicalObligationsoftheClinician-Patient-IndustryRelationshipAuthors:MichaelPage,AuDAbstract:Introduction:Professionalrelationshipsbetweenclinicians,patientsandindustryareregulatedbylawandethicalcodes.Mostclinicianshavelimitedunderstandingofthelawsandcodestowhichtheyarebound.Patientsareusuallycompletelyunawareoftheregulationstowhichtheirprovidersareheld.Industrypartnersareonlyslowlydevelopingtrainingprogramswhichcreateawarenessandobligationtoregulationsandcodes.Methods:Thispresentationutilizesathoroughreviewandprovidesaverybriefanddescriptivecompilationoffederallawsandorganizationalcodesofethicstowhichallprovidersandindustrymembersarebound.Results:Thefollowingstatutesandcodeswillbereviewedandtheirrelevancepresented:SafeHarbor,Anti-KickbackStatute,StateUnfairandDeceptivePracticesAct,AdvaMed,AAACodeofEthics,USFoodandDrugAdministration,HIPAA,PhysicianPaymentSunshineAct,FalseClaims,andStarkLaw.Conclusion:Awarenesscreatessafeandbeneficialrelationshipsbetweenclinicians,patientsandmembersofindustry.Adherencebuildsreliable,independent,protected,lawfulandoutcomes-focusedassociations,fortheultimatebenefitofpatientsserved. SessionID:S9-2SessionTitle:Audiology/DevicesAbstractID:208Title:TheEffectivenessofaMiddleEarImplantinSomeCochlearImplantCandidatesAuthors:JosephChang,MD1,AnnaMcCraney,AuD2;1Otorhinolaryngology,TexasEarCtr.,Houston,TX,2Audiology,Ototronix,St.Paul,MN.Abstract:Introduction:Fordecades,therehavebasicallybeentwotreatmentoptionsforpatientswithsensorineuralhearingloss-hearingaids(HAs)andcochlearimplants(CIs).Hearingaidshavelongbeenusedastheprimarytreatmentmethoduntilsuchtimepatientsarestrugglingduetolimitedaidedbenefitatwhichpointtheybecomecochlearimplantcandidates.Whilehearingaidshaveimprovedsignificantlyovertheyears,recentstudieshaveshownthatpatientswithsimilarcochlearpotentialforspeechunderstanding(basedonmaximumwordrecognitionunderearphonesorPBmax)(McRackan,Hoppe)canhavesignificantlydifferentaidedoutcomeswithCNCwordrecognitionscoresvaryingbyasmuchas60%.ThisdifferencebetweenPBmaxandaidedCNCWRSiscalledtheSpeechPerceptionGap.(Dyer)So,itispossiblethatapatientmayreceivelimitedbenefitfromhearingaidsandqualifyforacochlearimplant,yetstillhavesubstantialcochlearpotentialthatissimplynotabletoberealizedthroughhearingaiduse.MiddleEarImplant(MEI)wordrecognitionscoreshavebeenshowntohavegoodcorrelationtowordrecognitiontestingunderearphones.(Dyer)Wesoughttoevaluateoutcomesforourseriesofpatientswhoreceivedaminimallyinvasive,electromagneticmiddleearimplantandalsomettherequirementsforacochlearimplantbasedonaidedspeechrecognitionscores.Methods:11ears,in9adultpatients(2female;averageage62.7years)underwentimplantationofaminimallyinvasive,electromagneticmiddleearimplantsystem.Ofthesepatients,9earshadCNCwordrecognitionscoresof30%orless(range0%-28%)andwouldmeetcochlearimplantcandidacy.Ofthose9,7alsomettheindicationsfortheelectromagneticmiddleearimplant(PBmaxof60%orgreater).EachpatientwasevaluatedforCNCwordrecognitionpre-operativelywithappropriatelyfithearingaidsandpost-operativelyfollowingimplantationwiththemiddleearimplant.PrimaryoutcomemeasuresincludedCNCwordrecognitionscorewiththeMEIcomparedwithhearingaids,andcomparisonoftheCNCwordrecognitionscoreswithhearingaidsandmiddleearimplanttoPBmax.


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Results:TheaverageMEIWRSwas67.4%(range,58%-82%),a52.6%improvement(range,44%-66%)overHAs(p<0.001).TheaveragedifferencebetweenCNCWRSwiththeMEIandPBmaxwas8.7%(range,-6%-24%),a52.6%improvement(range,44%-66%)overHAs(p<0.001).Conclusion:ThesedatademonstratethattheMEIprovidessuperiorWRSthanHAsforpatientswithsignificantdifferencesbetweenPBmaxandaidedCNCscoresinthiscohortofpatientswhoalsometcriteriaforcochlearimplantation.PBmaxwasareasonablepredictorofCNCWRSoutcomeswiththeMEI.TheMEICNCoutcomescomparefavorablyandwereactuallybetterthanaveragecochlearimplantCNCoutcomes,andtheMEIpatientshadnoadditionalhearinglossduetotheimplantationprocedure.InadvisingpatientswhomaybecandidatesforbothaCIandtheMEI,thePBmaxwillprovideusefulpredictiveinformationtohelpclinicianscounselpatientsontheirchoiceofhearingimplanttechnology. SessionID:S9-2SessionTitle:Audiology/DevicesAbstractID:125Title:BonebridgeinChildrenwithPinnaAbnormalitiesandCanalAtresiaAuthors:IngPingTang,MS(ORL-HNS)1,PrepageranNarayanan,FRCSEd2;1ENTdept,UniversitiMalaysiaSarawak,Kuching,Malaysia,2ENTdept,Univ.ofMalaya,KualaLumpur,Malaysia.Abstract:BonebridgeinChildrenwithPinnaAbnormalitiesandCanalAtresiaIntroduction:Childrenwithpinnaabnormalitiesandcanalatresia,eitherbilateralorunilateral,alwayspresentwithconductiveormixedhearinglossandthisisoneoftheindicationsofBonebridge,anewactiveosseo-integratedtranscutaneousboneconductionimplant.Methods:Thiswasaprospective,single-subjectrepeatedmesuresdesignedstudyinwhicheachsubjectservesashis/herowncontrol.Twotertiarycentreswerechosentoenrollpatientsfrom2013to2016.Sixpatientswhosufferedfromconductivehearinglosswereenrolledintothestudy.AllofthemfulfilledthecriteriaofBonebridgeimplantation.AtrialofboneconductionhearingaidwastheprerequisitebeforefinaldecisionofBonebridgeimplantationwasmade.Theirdemographicdataandmedicalparametersweredocumented.Thepreoperativepreparations,surgicaltechniquesandcomplicationswereassessed.Thesubjects’audiometricthresholds(airconduction,boneconductionandsoundfieldatfrequencies250Hzto8kHz)wereassessedpreoperatively,thensubsequentlyat6monthspostoperatively.SubjectivesatisfactionwiththedevicewasevaluatedbymeansoftheHearingDeviceSatisfactionScale(HDSS)questionnaire.TheresultswereanalysedwithIBMSPSSStatisticsversion22.Results:Sixpatients,fourmalesandtwofemales,wereincludedinthestudy.Theiragerangedfrom11to18yearsold.Allpatientshadconductivehearingloss.Fourpatientshadbilateralmicrotiaandcanalatresia.Theothertwohadunilateralmicrotiaandcanalatresia.Computedtomography(CT)scansoftemporalbonewereperformedinallthepatientspreoperativelytoassessthesuitabilityofimplantplacement.TheBoneConductionFloatingMassTransducers(BC-FMT)wereplacedatsinoduralangleinfivepatientsandatpresigmoidareainonepatient.Alltheoperationswereperformedundergeneralanesthesiaandtookbetween45to60minutes.Therewerenomajorcomplications.Onlyonepatientreportedmildinfectionoftheincisionsite,whichrecoveredwithinaweekwithlocalandoralantibiotics.Audiometricthresholdsforairandboneconductionshowednosignificantchangewithrespecttotime(P>0.05),foranyofthetestedfrequenciesuntil6monthsoffollow-up.Thisconfirmedthatthepatients’residualunaidedhearingdidnotdeterioratewithtreatment.Meanwhile,soundfieldtestingwithaidedthresholdsshowedsignificantimprovementovertime(p<0.05)atalltestedfrequenciesuntil6monthsoffollowuppostoperatively.Theaidedhearingthresholdsforfrequenciesfrom500Hzto4kHzat6monthsoffollow-uppostoperativelywerebetween21to30dB.Allthepatients


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wereverysatisfiedwiththeimplantintermsofimprovementoftheaidedhearingthresholds(91%to98%)andacceptablecosmeticappearanceofthesoundprocessor.Conclusion:Bonebridgeisanewtranscutaneousboneconductionhearingimplantthathasbeendemonstratedtobesafeandeffectiveinimprovingpatients’hearingthresholdsfromtheageof5yearsoldandaboveinchildrenwithpinnaabnormalitiesandcanalatresia.AthoroughradiologicalandsurgicalplanningwithCTscaniscrucialtolocatethesiteforoptimalimplantplacementtoavoidunnecessarysurgicalcomplications.Itprovidesanotheralternativetreatmentforpatientswithhearinglosswhofailconventionalhearingaids. SessionID:S9-2SessionTitle:Audiology/DevicesAbstractID:167Title:CorticalAuditoryEvokedPotential(CAEP)andBehaviouralMeasuresofAuditoryFunctioninanChildwithaSingleSidedDeafnessAuthors:OscarM.Cañete,PhD1,SuzanneC.Purdy,PhD1,MichelNeeff,MD2,ColinBrown,MD2,PeterR.Thorne,PhD3;1SpeechScience,TheUniv.ofAuckland,Auckland,NewZealand,2ENT,StarshipChildren’sHosp.,Auckland,NewZealand,3SectionofAudiology,TheUniv.ofAuckland,Auckland,NewZealand.Abstract:Introduction:PromisingevidenceforthebenefitsofCochlearimplant(CI)foradultswithsingle-sideddeafness(SSD)hasbeenreportedintheliterature.StudiesshowedthataCIcouldbeeffectiveinreducingtheperceptionanddisabilityassociatedwiththetinnitusinpeoplewithSSD.Additionalpositiveeffectswereobservedandincludeimprovedspeechinnoiserecognition,soundlocalisationandself-perceivedhearingabilities.ChildrenwithuntreatedSSDareexperiencingauditorydeprivationatthesametimeasneuro-maturationisoccurringincentralauditorypathwaysandtheyareengagedincomplexlisteningtaskssuchalearninginanoisyclassroom.Changesinauditoryfunctionovertimeandtheimpactofintroducinghearingtechnologyarethereforeofgreatinterestforthispopulation.ThiscasestudyexaminesauditoryfunctionovertimeinachildwithSSDwhoreceivedaCI.Methods:Corticalauditoryevokedpotentials(CAEPs)innoise(+5dBsignaltonoiseratio)elicitedbyspeechsoundswererecordedandauditoryskillswereassessedusingtestsofsoundlocalisation,spatialspeechperceptioninnoise,andself-ratingsofauditoryabilities(Listeningforinventoryeducation,LIFEandSpeech,SpatialandQualitiesofHearingScale,SSQparentalversion).Measureswereobtainedpriortoandafteracochlearimplant(CI)fitting,includingone,sixand12monthsaftertheCIswitchon.Results:Spatialspeechrecognitionimprovedovertime.At12monthspost-CI,wordrecognitionscoresweresimilartothoseofnormalhearingchildren.Signal-to-noise-ratiosforsentencesdecreased(i.e.,improved)overtimepost-CI.Soundlocalisationmarkedlyimprovedat12monthspost-CIcomparedtobaseline.Self-perceptionofdifficultyscoresdecreasedovertime.Parentalratingsofhearingabilitiesimprovedcomparedtobaselineforallsubscales.ItwaspossibletoobservetheemergenceoftheP1-N1-P2complexat12monthspost-CI,whichwasclearerfrontallyacrossstimuli.N250responsechangesovertimesuggestthepresenceofapossible‘binauralinterference’effectand/oracochlearimplantmappingeffect.Conclusion:TheCIwasassociatedwithimprovedrecognitionofspeechinnoise,bettersoundlocalisationsoundsandimprovedperceptionindifferentlisteningenvironments.CAEPchangesindicatesomeadaptationwithinthecentralauditorysystemtothenew“binaural”condition. SessionID:S9-2


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SessionTitle:Audiology/DevicesAbstractID:104Title:MeasuringSoundProcessorThresholdLevelsforPediatricCochlearImplantRecipientsUsingVisualReinforcementAudiometryviaTelepracticeAuthors:JoshuaD.Sevier,AuD.,SangsookChoi,PhD.,MichelleHughes,PhD.;CochlearImplantResearch,BoysTownNatl.Res.Hosp.,Omaha,NE.Abstract:Introduction:Recentlytherehasbeenagrowingtrendforintegratingdistanceservicesusingtelepracticeinhealthcare.Duetoalimitednumberofcentersofferingcochlearimplant(CI)servicesacrossthecountry,usingtelepracticeforprogrammingCIsisanattractivesolution,particularlyforthepediatricpopulation.Regularvisitsarerequiredtomaintainproperprogramminglevels,butyoungchildrenhavealimitedcapacityforattentionandcooperation.Oftenthisresultsinadditionalvisitstotheclinic,whichcanincreaseburdenstofamilies.ThegoalofthisstudywastoinvestigatethefeasibilityofusingtelepracticetoprogramCIsforveryyoungchildren,specificallyusingvisualreinforcementaudiometry(VRA).ThisstudyinvestigatedwhetherVRAtestingusingalocalplayassistantandaremotelylocatedCIaudiologistcanbeusedasalternativefortraditional,in-persontesting.Wehypothesizedthatbehavioralthresholdsobtainedviaremoteandin-personmethodsoftestingwouldbesimilar.Methods:DatawerecollectedusinganAB-BAdesign(A,in-person;B,remote)overtwovisits.Participantsrangedinagefrom1-3years.BehavioralthresholdswereobtainedusingVRAforonebasal,middle,andapicalelectrode.Atestassistantofferedamilddistractionforthechildinordertoidentifybehavioralresponses.Onceconditionedtoastimuluspresentedusingclinicalsoftwareviaastandardprogrammingcable,theaudiologistusedarepeatedascendingproceduretoobtainbehavioralthresholds.Theresponseratewascalculatedastheratioofthenumberofelectrodesattemptedversusmeasured.Testdurationwasrecordedforbothconditions.Aparent/caregiverquestionnairewasusedtoevaluateperceivedqualityaspectsofremoteandtraditionalCIprogramming.Results:Preliminarydatafrom16subjectsshowednodifferenceinthresholdsbetweenin-personandremoteconditions.Datafromalargergroupwillbepresented(goalisN=20).Todate,theresponseratewassimilarbetweenin-personandremoteconditions.Regardingtestduration,preliminarydatasuggestedsimilartesttimebetweenremoteandin-persontesting.ResultsofthequestionnaireusingaLikertscaleindicatedthatcaregiversperceivedremoteandin-persontestingtoresultinsimilarefficiency/quality.Conclusion:Attimeofcurrentdatacollection,preliminarydataindicatethatremoteprogrammingutilizingVRAisafeasiblealternativetotraditional,in-personprogramming.GiventhatchildreninthisyoungestagegrouphavelimitedattentionspansandunpredictablelevelsofcooperationthatcanincreasethenumberofvisitstotheCIcenter,remoteprogrammingusingVRAtechniquescouldrelievethefinancialandtimeburdenexperiencedbyfamiliesinremotelocationswhohaveyoungchildrenwithcochlearimplants. SessionID:S9-2SessionTitle:Audiology/DevicesAbstractID:170Title:PilotResultsofCIFunctionalTestingUsingaTabletAudiometerwithoutaSound-fieldorAudiometricBoothAuthors:MatthewBromwich,MD,FRCSC,DavidSchramm,MD,FRCSC;Otolaryngology,Univ.ofOttawa,Ottawa,Canada.


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Abstract:Introduction:Cochlearimplantationcommitspatientsandcareteamstorelativelyresourceintensivepostimplantrehabilitationoverseveralmonths.Thistypeofspecializedcareisoftenonlyavailableincertaincentresandisreliantonsound-fieldtestingforobjectivethresholdandspeechmeasures.However,tabletaudiometersarenowabletousethecochlearimplantprocessorsthemselves,inacalibratedfashion,asthetransducer.Thisnewhardwareconfigurationopensupnewtestingoptionsandmayobviatetheneedforacalibratedsound-fieldandaudiometricboothforfunctionaltesting.Thisinnovationcouldsignificantlyreducecliniccosts,enableremotemonitoring,andimprovepatientaccesstoprovidersinmorelocations.Methods:Incollaborationwiththethreemaincochlearimplantmanufacturersfivedifferentspeechprocessorswerepilottestedasdirecttransducerswithatabletaudiometer.Bothspeechperceptionandfunctionalaudiometrywereevaluated.Results:Cochlearimplantrecipientsunderwentcalibratedtabletaudiometryandtraditionalaudiometry.TabletthresholdmeasureswereobtainedusingaforcedalternatechoicegamethatemployedamodifiedHughson-Westlakebracketingparadigm.Nosignificantdifferencesweredetectedinpilotdata.Conclusion:ItisnowpossibletouseselectCIprocessorsastransducerswhendirectlyconnectedtoatabletaudiometer.Thispilotstudysuggeststhatthisnewhardwaresetupdeliverscomparableresultstotraditionalmethods.Theuseofatabletaudiometermayreducetheneedforsound-fieldevaluationincochlearimplantpatients,thusenablingmobileandremotetesting,improvedaccessibility,andmorecompletecontinuedfollow-upcare. SessionID:S9-3SessionTitle:AuditoryBrainstemImplantationAbstractID:48Title:OralCommunicationAssessmentandOutcomesinChildrenwithAuditoryBrainstemImplantsAuthors:DianneM.HammesGanguly,MA1,LillianW.Henderson,MSP2,DebraSchrader,BA,AVT1,HollyF.B.Teagle,AuD2,AmyMartinez,MA1,JamieGlater,AuD1,MargaretWinter,MS1,LaurieEisenberg,PhD1,EricWilkinson,MDFACS3;1USC-CarusoFamilyCenterforChildhoodCommunication,Univ.ofSouthernCalifornia,LosAngeles,CA,2TheChildren’sCochlearImplantCenteratUNC,Univ.ofNorthCarolina,ChapelHill,NC,3HuntingtonMed.Res.Inst.s,Pasadena,CA.Abstract:IntroductionTheuseofauditorybrainstemimplants(ABIs)inchildrenwhoarenotcandidatesforcochlearimplants(CIs)duetoanatomicalissuesiscurrentlyunderinvestigativetrialsintheUnitedStates.Evidence-basedresearchwiththispopulationislimited.Therearesomereportsfromothercountries,butinclusioncriteria,assessment,andoutcomesarevaried.ChildrenwithABIsseemtoprogressdifferentlythanchildrenwithCIsintermsoftherateatwhichvariousskillsdevelopandthechildren’sabilitytouseorgeneralizeauditoryinformation.ForchildrenwithABIs,wearejustbeginningtoidentifywhichmetricsaresensitivetomeasuringoutcomesattheleveloftheindividualchild,withpotentiallydivergentratesofdevelopmentacrossthelistening,speech,andlanguagehierarchies.Duetomoregradualratesofgain,commonlyusedmetricsofspeechperception,speechproduction,orlanguagedonotcapturesubtlegainsthatchildrenwithABIsmake.Measuresthathavefallenoutofusewiththeachievementsofcurrent-dayCIusersmayhaverenewedutility.Inthistalk,wediscusschallengesofassessmentandtestselection,emergenceoforalcommunication,andimplicationsoffindingsforchildrenwithABIs.MethodsDataarecombinedfor10childrenfromtwopediatricABIcentersintheUnitedStates(5childrenfromeachcenter)thatareconductingFDA-approvedsafetyandfeasibilitystudiesofABIsinchildren.Both


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studieshavesimilarenrollmentcriteria(e.g.,trialwithCIpriortoABIunlessprecludedbyanatomy,normalcognition,similarageatABI—2–5yearsvs.18monthsto5years)andincludeasimilarrangeoftesting(e.g.,speechperceptionandproduction,language).MostchildrenhaveatleasttwoyearsofABIuse,butrangefrom1to3.5years.ResultsAsagroup,despiteaudiometricdatashowingevidenceofsoundawareness,thechildren’sgeneralizedresponsestosounddevelopslowly.Spokenlanguagegrowthisslowandchallengingtomeasurebasedontypicalstandardizedtests.Parent-childinteractionsanddiagnostictherapyareinformativetofunctionalperformance.SpeechgrowthasmeasuredbyIdentifyingEarlyPhonologicalNeedsinChildrenwithHearingImpairment(IEPN;Paden&Brown,1992)showedsomeoftheearliestgains.AttwotothreeyearspostABI,all10childrencontinuetoneedvisuallanguagesupport(CuedSpeech,SignedEnglish,orAmericanSignLanguage),butsupplementalexamplesoflonger-termABIusersshowspokenlanguagesupportedbyspeechreadingcanoccur.ItisnotyetclearhowoutcomesinUSchildrencomparetothosereportedinternationally.ConclusionsChildrenwithABIsgainsoundawareness,buthigher-levelauditoryskillsmayemergeoveranextendedperiodoftime.Oralcommunicationdevelopsslowly,necessitatingongoinguseofvisualcommunicationformost,atleastinthefirstthreeyears.Teststhatmeasureminuteincrementsinskills,suchastheIEPN,appeartocapturegrowthbetterthantestsdesignedforthemainstreampopulationofchildrenwithnormalhearingorthosewithCIs.Thepatternofauditory,speech,andlanguagegrowthinchildrenwithABIsappearstobedifferentfromthatofchildrenwithCIs,requiringdifferenthabilitationandeducationalconsiderations.SessionID:S9-3SessionTitle:AuditoryBrainstemImplantationAbstractID:282Title:PediatricAuditoryBrainstemImplant:OutcomeandEarlyAgeatImplantationAuthors:LilianaColletti,PhD1,MarcoMandalà,MD2,GiacomoColletti,MD3,VittorioColletti,Professor4;1ENTDepartment,Univ.ofMilano,Milano,Italy,2ENTDepartment,AziendaOspedalieraUniversitariaSenese,Siena,Italy,3DepartmentOfMaxillo-FacialSurgery,Univ.ofMilano,Milano,Italy,4Intl.Ctr.ForPerformingAndTeachingAuditoryBrainstemSurgeryInChildren,Milano,Italy.Abstract:Introduction:Toevaluatetheroleandsafetyofearlyageofauditorybrainstemimplantationinchildrenwithcochlearnervedeficiency.Aretrospectivelongitudinalanalysisofpediatriccochlearimplantpatients.Methods:Between2000and2016,116childrenranginginagefrom8monthsto16yearswereimplantedwithABIs,eitherCochlearorMed-Eldevices,allviatheretrosigmoidapproachatourinstitutionorelsewherefollowingourpersonalprotocolforauditorybrainstemimplants.Patientswereexcludedfromthisstudyifdatawereincompleteorifsurgerywasperformedatanoutsideinstitution,leaving84patientswhowereincludedinthisstudy.AssessmentofauditoryperceptionwasperformedinallchildrenwiththeCategoriesofAuditoryPerceptiontest(CAP),aneight-pointhierarchicalscaleofauditoryperformance.TheCAPscalerangesfromnoawarenessofenvironmentalsound(category0)toconversationaluseofthetelephonewithaknownspeaker(category7).TheCAPwasselectedbecauseitissimple,easilyadministeredandeasilyunderstoodbyspeechtherapistsandaudiologistsaswellasparentswithoutexperienceasassessmentmethodsfordeafchildren.Highlyreproducibleacrossindependentobserversoutcomemeasurescoverstheextremelywiderangeofauditoryperformance


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observedinourpreliminarystudiesonABIsurgeryinchildrenandcanbecompletedforallchildren,eventheveryyoung,alsotakingintoconsiderationthedifferentratesofdevelopmentinthesechildren.Results:Themeanageofthe84childrenwas3.81±2.89years.Therewere45malesand39females.Summaryofoutcomes:1)Formostchildren,theCAPscoreincreasedafterimplantation2)Implantationbeyondtheageof4yearshardlyeverresultedinnormalCAPscoresorinintegrationintothemainstreamprimaryschool(20to30%ofcases)3)Implantationbetweentheageof12and36monthsalwaysresultedinnormalCAPscoresafter3yearswitha66%probabilityofintegrationintotheprimary4)Significantimprovementswereattainedinchildrenasafunctionofageatimplantation,withchildrenunder2yearsperformingsignificantlybetterthanolderones(p=0.0088).5)Therewerenointraoperativeorperioperativepermanentcomplications.6)SuccesswasdefinedasfinalCAPscoresreachedorbypassedlevel5.Bythisdefinition,37.31%ofpatientsweretreatedsuccessfully.Conclusion:NewoutcomeswithABIsinchildrenshowthepowerofbrainplasticity.AllchildrenwithcongenitaldeafnesswhounderwentABIimplantationbeforetheageof2yearsappearedtobenefitfromtheimplant.Thesedataaddevidencetotheimportanceofearlyimplantation(beforetheageof2years).Interventionbeforetheageof3yearsseemedtobecriticaltoavoidirreversibleauditoryperformancelosses,andinterventionbeforetheageof2yearsseemedtobecriticaltoachieveoptimalresults SessionID:S9-3SessionTitle:AuditoryBrainstemImplantationAbstractID:253Title:LongitudinalChangesinElectricallyEvokedAuditoryEvent-RelatedPotentialsinChildrenwithAuditoryBrainstemImplantsAuthors:ShumanHe,MD,PhD1,HollyF.B.Teagle,AuD2,TylerC.McFayden,BS3,MatthewEwend,MD,FACS4,LillianHenderson,MA5,NancyHe,Diploma1,CraigA.Buchman,MD,FACS6;1BoysTownNatl.Res.Hosp.,Omaha,NE,2Otolaryngology-HeadandNeckSurgery,TheUniv.ofNorthCarolinaatChapelHill,ChapelHill,NC,3DepartmentofPsychology,VirginiaPolytechnicInst.andStateUniv.,Blacksburg,VA,4Neurosurgery,Univ.ofNorthCarolinaatChapelHill,ChapelHill,NC,5Otolaryngology-HeadandNeckSurgery,Univ.ofNorthCarolinaatChapelHill,ChapelHill,NC,6Otolaryngology-HeadandNeckSurgery,WashingtonUniv.inSt.Louis,St.Louis,MO.Abstract:Introduction:Neuralencodingandprocessingofelectricalstimuliinthecentralauditorysystemcanbeevaluatedusingelectrophysiologicalmeasuresofauditoryevent-relatedpotentials(eERPs).InUnitedStates,theauditorybrainstemimplant(ABI)hasbeenusedasaninvestigationaldeviceinFDA-approvedclinicaltrialstorestoreauditoryperceptioninnon-tumorchildrensince2013.ThefeasibilityofusingeERPstoevaluatecorticalneuralencodingofelectricalstimulideliveredbytheABIhasbeenestablishedinoneofourpreviousstudies(Heetal.,2016).ThislongitudinalstudyaimedtoinvestigatewhethereERPsrecordedinchildrenwithABIsshowedsimilarmaturationalchangesinresponsemorphologyasthosereportedinchildrenwithcochlearimplants.Methods:StudyparticipantsincludedfivechildrenwithABIs(S1-S5)ranginginagebetween4.1and7.5years.AllsubjectswereunilaterallyimplantedwithaCochlearNucleus24MABIduetocochlearnervedeficiencyinthetestside.Thestimuluswasatrainofbiphasic,charge-balancedelectricalpulseswithapulserateof250pulsespersecond.Itwaspresentedatthemaximumcomfortablelevelmeasuredforeachstimulatingelectrodeduringeachtestsessioninamonopolar-coupledstimulationmode(MP1+2).Foreachsubject,eERPswererecordedforallactiveelectrodesusedintheirprogrammingmapsatmultipletimepointsbetweenonemonthand42monthsafterinitialdeviceactivation.Intra-classcorrelationtestswereusedtoevaluatetherepeatabilityofeERPsrecordedindifferenttestsessions.


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Results:AllsubjectsshowedmorphologicalchangesineERPsovertime.However,thedegreeandthepatternofchangeshowedsubstantialinter-subjectvariations.WhereaschangesinsomeresponsesrecordedinS2andS5suggestedauditorymaturation,eERPsrecordedforasubgroupofABIelectrodesinS1andS4supportedthepossibilityofelectrodemigration.Signsand/orsymptomsofnon-auditorystimulationwerealsoobservedat41monthsinS1forthesamegroupofABIelectrodesthatshowedthegreatestchangesineERPs.Conclusions:eERPsinchildrenABIschangeovertime.Potentialfactorsaccountingforthechangeincludeauditorymaturation,changeinstimulationlevel,andelectrodemigration(althoughimagingconfirmationforthishypothesisislacking).ChildrenwithABIsneedtobecloselymonitoredforsignsandsymptomsofnon-auditorystimulationthatcouldemergeovertime.Neuroimagingcorrelatesareneededtobetterunderstandtheemergenceofnon-auditorystimulationinthesechildren. SessionID:S9-3SessionTitle:AuditoryBrainstemImplantationAbstractID:418Title:PediatricAuditoryBrainstemImplantOutcomes:AnUpdatefromoneNorthAmericanInstitution'sClinicalTrialAuthors:KevinWong,BA1,SamuelR.Barber,MS1,SidharthV.Puram,MD1,AaronK.Remenschneider,MD1,RuwanKiringoda,MD1,ElliottD.Kozin,MD1,JohnA.Germiller,MD,PhD2,BarbaraS.Herrmann,PhD3,DanielJ.Lee,MD1;1Otolaryngology,MassachusettsEyeandEarInfirmary,Boston,MA,2Otolaryngology,Children'sHosp.ofPhiladelphia,Philadelphia,PA,3Audiology,MassachusettsEyeandEarInfirmary,Boston,MA.Abstract:Introduction:Auditorybrainstemimplants(ABI)areneuroprostheticdevicesthatoffersoundperceptiontopatientswhomaybeineligibleforotherformsofauditoryrehabilitation.Althoughthefirstsuccessfulauditorybrainstemimplantoccurrednearlyfourdecadesagoforanadultwomanwithneurofibromatosistype(NF2),U.S.studiesexaminingthesafetyandefficacyoftheABIchildrenwhoarenotcochlearimplant(CI)candidatesonlybeganin2012.TherearefouropenstudiesofpediatricABIsurgeryintheU.S.HerewereportinterimsurgicalandaudiologicdatafromourongoingFDAtrialexaminingthesafetyandefficacyoftheABIinnon-NF2pediatricpatients.Methods:Retrospectivechartreview.Outof27deafinfantswithunfavorablecochlearnerveanatomywhowerescreened,sixunderwentABIsurgerywithimplantationoftheCochlearNucleus24ABIorABI541betweenOctoberandDecember2016.Aseventhsubjectisenrolled,withfuturesurgeryscheduled.Primaryoutcomemeasuresincludeperioperativecomplications,soundperception,andlanguagedevelopment.Results:EightABIswereplaced(6primary,2revision),withanaverageageatfirstsurgeryof18.3months.Onesubjectwasbornprematurelyat32weeks.OnesubjecthadCHARGEsyndromewithnormalcognition,andtwochildrenhadmildcognitivedelay.Theaveragehospitalstaywas2.9±0.8days.Therewerenocerebrospinalfluidleaks,facialnervedeficits,orothersurgicalandpostoperativecomplications.Averagetimingofdeviceactivationwas7.9±3weekspostoperatively.Onedeviceactivationelicitedagagreflex/bradycardia;theremainingsixdidnotelicitanynon-auditorystimulation.Onesubjectispre-activation.Audiometricoutcomesdemonstratebehavioralthresholdsof22-40dBHLinfoursubjects,afifthsubjectrespondingto75dBHLatthreemonthspost-activation.Twochildrenexhibitenvironmentalawarenessandimitatespeechsounds.Allchildrenutilizesignlanguageforprimarycommunication.Twosubjectsexperienceddevicefailure:onedevicefailedfollowingmildheadtraumaoverthedeviceandtheotherexperiencedspontaneousfailureoneyearaftersurgery.


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Conclusion:InthisretrospectivechartreviewofourclinicaltrialinvestigatingtheABIinnon-tumorpediatricpatients,preliminarydatasuggestthatprimaryandrevisionABIsurgeryaresafeandwelltolerated.Atthisearlystage,allsubjectswithactivatedABIsdetectsoundandtwosubjectsdemonstratepatternperception. SessionID:S9-3SessionTitle:AuditoryBrainstemImplantationAbstractID:262Title:AuditoryBrainstemImplantationIsBeneficialForPrelinguallyDeafChildrenAuthors:RobertBehr,MDNeurosurgery,KlinikumFulda,Fulda,Germany.Abstract:Introduction:Childrenbornwithseverecochlearmalformation,cochlearaplasiaorhypoplasia/aplasiaofthecochlearnervearenogoodcandidatesforcochlearimplantation(CI).Theonlypossibilityforrestorationofhearinginthesecasesisdirectstimulationofthehearingpathwaysatbrainstemlevel.Thisworkdemonstratestheeffectivenessofauditorybrainstemimplantation(ABI)eveninverysmallchildrenwithprelingualdeafnessforrestorationofhearingandspeech.Methods:A12channelABIsystem(MedEl,Austria),whichhasproofeneffectivenessandsafetyinneurofibromatosispatientssincethelast16yearswasusedforimplantation.ThepediatricABIprogramstartedin2009.Meanwhile25implantationsin24children,10maleand14femalewereperformedbythefirstauthor.TwochildrenhadasuccessfulrevisionsurgeryafterafallontheimplantsideoraspontaneousbreakdownofanotherABIsystem.Themeanagewas3.3years,median2.8.Theyoungestwas1.25,theoldest6.5yrs.Surgerywasperformedinsupinepositionusingaretrosigmoidapproachandmultimodalneuromonitoring.InallcasesintraoperativeE-BERAwererecorded.Results:ThepreoperativeevaluationwithhighresolutionMRIandCTrevealedin16childrenaplasiaofthecochlearnerve.Theothershadcochleardys-aplasiatogetherwithhypoplasiaofthe8thnerveorsyndromallesionslikeGoldenharSyndrome.Inmostcasessurgerywasdifficultduetocompleteorpartialocclusionofthelateralrecessoftheforthventricle(foramenofLuschkae).In75%branchesoftheAICAorthevesselitselfwerecrossingtheimplantsiteandhadtobedissected.Ineverycasetheelectrodepaddlewassmallenoughtofitproperlyintotherecess.E-BERArecordingscouldbederivedineachcase.TherewerenoneurologiccomplicationsandonlyminorsurgicalcomplicationsassubcutaneousCSFleaksin4children.Allchildreninwhomthedevicewasactivatedsofarregainedsoundawarenessandinsistedusingtheimplantallday.Thecategoryofauditoryperformancescores(CAP)showedin58.8%valuesbetterthanCAP3,in23.5%equaltoCAP3andin17.6%belowCAP3.Conclusion:ABIisasafeandsuccessfulsurgicalprocedureforrestorationofhearingandspeachinprelingualdeafchildren.Precioustimeofplasticityoftheauditorypathwaysshouldbeusedasearlyandintensivelyaspossible.ThereforeindoubtfulCIcandidatesABIshouldbetheprimaryindication.

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CI2017 Podium Abstracts - cdn.ymaws.com€¦ · CI2017 Podium Abstracts 3 | Page Abstract: Introduction: Preservation of residual hearing during cochlear implantation has well recognized