CI 2014 Poster Abstracts
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ACI20140247: Hearing Assistive Technology and Assistive Listening Device Options for Pediatric Cochlear Implant Users

S. Cheung, BS1 , H. F. Teagle,Au.D.1 , L. R. Park,Au.D.1 , J. S. Woodard,Au.D.1 , E. B. Gagnon,Au.D.1 , L. A. Greaver, BA1 , C. A. Buchman, MD1

1University Of North Carolina At Chapel Hill, Ear And Hearing Center, Durham, NC USA

Topic: Audiology

Keywords: Assistive Listening Devices

Introduction: It has been well documented that many children with cochlear implants perform well on speech perception testing in a clinical setting, but some struggle to understand in the presence of noise. Hearing assistive technology (HAT), which includes FM systems and electromagnetic transduction devices, improves the listening abilities of individuals with hearing loss, especially in challenging listening environments. It is also well established that adults benefit from assistive listening devices (ALDs), such as streaming device for the phone or music, but little has been documented in the pediatric population. With newer cochlear implant technology, more options are available to cochlear implant recipients but guidelines for determining factors that enable successful use of HAT and ALDs among children are lacking. The purpose of this study is to examine the use of HAT and ALDs among the pediatric population at a large cochlear implant clinic. The goal is to determine what criteria, including age and/or speech perception performance, should be considered when making recommendations to introduce HAT and ALDs in the pediatric cochlear implant population.

Methods: Speech perception scores from open-set word and sentence level tests [Phonetically Balanced Kindergarten (PBK), Hearing in Noise Test for Children in quiet (HINT-C-Q), Hearing in Noise Test for Children with 5 dB signal-to-noise ratio (HINT-C-Noise), Az Bio Pediatric Sentence Test, Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN)], and questionnaire data regarding use of FM systems and use of ALDs were collected and analyzed.

Results: Results suggest variability among patients, suggesting that HAT and ALD use should be considered on a case by case basis. Children and parents may not be aware of many available ALD options.

Conclusion: A variety of factors should be considered when recommending the use of HAT and ALDs for pediatric cochlear implant recipients. These include age, speech perception skills, maturity of the child and the presence of support to structure and monitor use of this technology.

Poster Number: 1

ACI20140275: Outcomes and Consequences of Revisions in Pediatric Bilateral Cochlear Implant Patients

E. B. Gagnon,Au.D.1 , H. F. Teagle,Au.D.1 , L. Park,Au.D.1 , J. Woodard,Au.D.1 , L. Greaver1 , S. Cheung1 , C. Buchman, MD1

1University Of North Carolina At Chapel Hill, Durham, NC USA

Topic: Audiology

Keywords: Reimplantation , Outcomes , Binaural Hearing

Introduction: The incidence of cochlear implant revision among pediatric recipients is relatively low but when it occurs, it creates significant concerns about a child’s ability to function with reduced auditory information and then adapt to a new signal. During the revision process the child could spend a significant amount of time without sound and adapting to a new device. Many bilateral cochlear implant patients have a perceived ear of preference or a better performing ear. Often this is the first sided implant. When a sequential bilateral recipient requires revision surgery in the better performing ear, what happens to speech perception in the contralateral ear? If the ear with poorer speech perception requires revision, does this hinder long term speech perception ability? Previous research has focused on speech perception scores of the revised ear only pre and post revision. The objective of this study is to compare speech perception scores in the binaural and individual ear conditions pre and post revision.

Methods: A retrospective chart review examined twenty two bilateral cochlear implant recipients who underwent revision surgery. Nine recipients had revision of the first sided implant, 10 had a revision of the second sided implant and 3 had multiple revisions of one or both sides. Speech perception measures include: Phonetically Balanced Kindergarten (PBK), Multisyllabic Lexical Neighborhood Test (MLNT), Lexical Neighborhood Test (LNT), CNC Word List, Hearing in Noise Test for Children in quiet (HINT-C-Q) and with 5 dB S/N ratio (HINT-C-N).

Results: While results varied, overall, speech perception scores for recipients who underwent revision returned to or exceeded pre-revision status in the revised ear. Subjects who had the first implanted ear revised generally demonstrated improvement in speech perception scores of the later implanted ear while waiting for the initial stimulation of the revised ear. Children who underwent a revision of the second sided implant had stable or improved speech perception scores in the first implanted ear. Long term, recipients demonstrated an improvement in binaural speech perception scores post revision.

Conclusion: With an increasing scope of experience with cochlear implant revision, we have learned that auditory skills return to or exceed previous performance levels for most children. For binaural recipients, the loss of hearing in one ear impacts use in the opposite ear. Reliance on the contralateral ear may force improvement in that ear; this is an unintended but positive consequence of the revision process.

Poster Number: 2

ACI20140364: Some New Robust Speech and Language Outcome Measures in Early-Implanted Long-Term Cochlear Implant Users

K. F. Faulkner, Ph.D.1,2 , W. G. Kronenberger, Ph.D.2 , D. B. Pisoni, Ph.D.1,2

1Indiana University, Department Of Psychological And Brain Sciences, Bloomington, IN USA ; 2Indiana University School Of Medicine, DeVault Otologic Research Laboratory, Indianapolis, IN USA

Topic: Audiology

Keywords: Outcomes , Pre-/Perilingual Adolescents

Introduction: Almost all research on speech perception in CI users has been carried out under quiet listening conditions using low-variability test materials that require few cognitive processing demands. However, in everyday speech communication listeners must adapt quickly, switch attention, and adjust to multiple sources of variability in both the signal and listening environments. Thus, there is a pressing clinical need to include additional ecologically-valid spoken language measures to assess outcome and benefit that reflects real-world listening environments. Objective: The objective of this study was to compare performance on conventional spoken language outcomes with several new robust measures of speech and language processing as part of an ongoing large-scale longitudinal study of early-implanted, prelingually deafened, long-term cochlear implant users (e.g., Kronenberger & Pisoni, 2013). The spoken language measures employed in this study place a greater processing load on CI listeners than traditional low-variability sentence and word-recognition tests and were designed to uncover the role of executive functioning in everyday spoken communication.

Methods: Two groups of listeners participated in this study: Normal Hearing (NH) N=21 and Cochlear Implant (CI) N=24; Groups were age-matched and were 9-16 years old (mean=13y). The CI group had used their implants for seven years or more (mean years of use=10y). All participants completed conventional speech and language assessments (e.g., HINT-C, LNT, PPVT), robust measures of spoken language (e.g., PRESTO, PRESTO-FAE, Non-Word Repetition), and several measures of verbal learning and memory.

Results: Not surprisingly, CI users performed more poorly than age-matched normal hearing controls on all measures of spoken language. For the CI users, greater variability was observed with no ceiling effects on the robust measures of spoken language. All spoken language assessments were highly correlated with each another, as well as language measures and several key demographic variables (e.g., age, length of CI use). Robust spoken language assessments were also strongly correlated with several measures of learning, memory and executive function.

Conclusion: This study demonstrates the clinical value of including robust speech and language measures to assess outcome and benefit in long-term CI users. These new measures provide additional information beyond the conventional product-based clinical assessments and offer new insights into the elementary foundational sensory, perceptual and neurocognitive mechanisms underlying the robustness of spoken language processing in real world listening situations.

Poster Number: 3

ACI20140092: Relationship Between Reading Performance and Cognitive Functions in Children with Cochlear Implants

S. V. Bharadwaj, Ph.D.1 , D. Maricle, Ph.D.2 , K. Downing2 , M. LaSpata2

2Texas Woman's University, Department Of Psychology, Denton, TX USA ; 1Texas Woman's University, Department Of Communication Sciences And Disorders, Denton, TX USA

Topic: Rehabilitation/Educational Aspects

Keywords: Cognitive and Social Development of Implanted Children

Introduction: Auditory deprivation in the early postnatal life not only impacts auditory, speech and language functions but also cognitive functions. According to the auditory scaffolding hypothesis, lack of auditory stimulation at an early age affects cognitive abilities related to learning, such as recalling and producing sequential information in children with hearing loss. Specifically, executive functions such as verbal working memory have been shown to be associated with reading comprehension in children with reading deficits. Further, in high school-age children with cochlear implants, longer working memory spans have been associated with higher reading scores. It has been suggested that severe-profound hearing loss in early years may lead to cortical reorganization in the pre-frontal cortex and possibly decreased maturation in the fronto-temporal regions in deaf children compared to their peers, resulting in limitations in the executive functions. The objective of this study was to further examine whether short-term memory, specifically verbal and visual working memory, are associated with reading measures in elementary school-age children with cochlear implants.

Methods: Ten children between the ages of 7 to 11 years with severe-profound hearing who used cochlear implants participated in the study. Auditory verbal working memory subtests from Woodcock Johnson III:Tests of Cognitive Abilities, Normative Update, visual working memory (spatial span) subtests from Wechsler Intelligence Scale for Children-IV, Integrated, short-term memory subtests (number recall, word order, hand movements) from the Kaufman Assessment Battery for Children II and the complete Woodcock Reading Mastery Test-III were administered to all children. Non parametric Spearman correlations were conducted to examine relationships between reading ability and cognitive measures.

Results: As a group children with cochlear implants showed low average scores on passage reading comprehension and listening comprehension subtests. The scores on the listening comprehension subtest were positively correlated with the backward digit span subtest (r=.65, p< 0.05). Performance on passage comprehension was positively correlated to spatial span forward (r=.86, p< 0.01) and spatial span backward scores (r=.76, p< 0.05). Further, the short-term-memory subtests and cluster scores were positively correlated (r = .63 - 0.99; p < 0.05) with most of the reading measures assessed: word identification, word attack, word comprehension, passage comprehension, listening comprehension, and oral reading fluency.

Conclusion: A moderate to strong relationship was found between performance on reading subtests and cognitive measures such as short term memory and visual working memory capacity in elementary school-age children with cochlear implants. While the findings are preliminary, these suggest that rehabilitation efforts should incorporate goals to strengthen cognitive functions.

Poster Number: 4

ACI20140250: Sequential Bilateral Cochlear Implants: Using Rehabilitation to Increase Confidence In and Dependence On “Non-Preferred Ears.”

D. Brackett, Ph.D.1 , K. Dilaj, Ph.D.1 , K. Eddins, MS1 , J. Hasbrouck, MS1

1New England Center For Hearing Rehabilitation, Hampton, CONNECTICUT USA

Topic: Audiology

Keywords: Binaural Hearing , Outcomes

Introduction: The benefits of bilateral cochlear implants include improved sound localization and speech understanding in noise (Corsetti & Waltzman, 2011; Grieco-Calub & Litovsky, 2010; Litovsky et al., 2009; 2010; Zeitler et al., 2008). A 2007 survey of cochlear implant clinics worldwide indicated that 70% of bilateral cochlear implant surgeries occurred in children through age 18 (Peters, Wyss & Manrique, 2010) with children under the age of three being the most likely to receive simultaneous cochlear implants. As of 2010, the number of children under age three receiving two implants had risen from 33% in 2007 to 47% (Peters et al., 2010). Objective: Since simultaneous implantation only recently became a viable option, there are a large number of CI users who acquired their second implant from one to 15 years after the first implant (Reeder et al., 2014). This group of sequentially implanted individuals presents a unique challenge to audiologists as they attempt to program the devices and counsel the clients about outcomes. Many of these CI users have indicated an ear preference during programming sessions, which in some cases, has resulted in limited use of the second side. This “non-preferred ear (NPE) was not always the second implanted ear nor the ear with the poorest speech perception. This leads to two questions: 1) What determines side preference?? and 2) can the preference level of the NPE ever increase, or will it always be a NPE even following rehabilitation?

Method: A survey was created and distributed to sequential bilateral cochlear implant users, ranging from 8 years of age through adulthood. The survey gathered information on age of implantation for each side, types of internal and external devices, and amount of daily use with each device. Specific questions targeting the amount of time between first and second implant, motivation for becoming bilateral, and why intermittent use for one ear was reported were included in the survey. Questions were asked to gather information on situation-specific use of bilateral vs. unilateral implants. A small sample of the surveyed group was recruited to complete a two month rehabilitation program designed to increase satisfaction with and confidence in their NPE. This group was selected based on their availability and motivation to participate in the program.

Conclusion: Survey results and pre and post speech perception data will be presented. Survey responses suggest that life-style changes, motivation, perceived benefit, self-image, and sound quality all impact use of the NPE. Preliminary results in the rehabilitation suggest that short term benefits are noted in the NPE and this may impact acceptance and use of the NPE.

Poster Number: 5

ACI20140282: Binaural Pitch Fusion And Integration In Children With Bimodal Cochlear Implants

J. Fowler,Au.D.1 , J. Eggleston,Au.D.1 , G. Stark, BS1 , M. Heston2 , L. Reiss, Ph.D.1

1Oregon Health And Science University, Department Of Otolaryngology/Head & Neck Surgery, Portland, OR USA ; 2Johns Hopkins University School Of Medicine, Baltimore, MD USA

Topic: Audiology

Keywords: Bimodal Hearing , Contralateral Hearing Aid Use

Introduction: There is significant variability in the speech perception benefit that children with cochlear implants (CIs) receive from combining information across ears, whether the devices worn are bilateral CIs or a CI in one ear with a hearing aid in the contralateral ear (bimodal CI+HA). Some individuals even experience interference with two hearing devices compared to one hearing device worn alone. One potential factor may be changes in the central processing of binaural inputs, which may occur due to experience with interaural pitch mismatches introduced by the CI programming. Previously, we have shown that adult bimodal CI+HA users have abnormally broad binaural pitch fusion associated with this mismatch, and that this abnormal fusion leads to spectral averaging. Similar effects may also explain variability of outcomes in children. Objective: The objectives of this study were to determine whether children with bimodal CIs also exhibit broader binaural pitch fusion between ears, and if so, whether this fusion leads to increased binaural pitch averaging.

Methods: Bimodal CI+HA users between the ages of 6-11 years were recruited for the study. Subjects were tested on three tasks: 1) Interaural pitch matching, in which a reference electrode was pitch-matched to sequentially presented acoustic tones in the contralateral ear; 2) Dichotic fusion range measurement, in which a reference electrode was presented simultaneously with an acoustic tone in the contralateral ear, and the tone frequency was varied to determine the frequency range that fused with the reference; 3) Fusion pitch matching, in which a fused electrode-tone pair was pitch-matched to sequentially presented tones in the contralateral ear.

Results:Preliminary findings with 3 subjects show broad dichotic fusion ranges compared to normal-hearing adults, but similar to adult CI+HA users. Unlike adult CI+HA users, the children did not exhibit pitch averaging between ears. Additional data will be collected in more subjects to confirm these findings.

Conclusion:Our preliminary findings suggest abnormal binaural pitch fusion and integration in the pediatric CI population. Further study is needed to determine how experience affects development of binaural pitch fusion in pediatric CI+HA users.

Poster Number: 6

ACI20140360: Do intraoperative NRT results predict post-operative auditory outcomes?

D. P. Sladen, Ph.D.1 , M. DeJong,Au.D1 , A. Breneman,Au.D.1 , L. Belf,Au.D.1 , A. Olund,Au.D.1 , A. Peterson, MA1 , C. Beatty, MD1 , B. Neff, MD1 , C. Driscoll, MD1

1Mayo Clinic, Rochester, MN USA

Topic: Audiology

Keywords: Objective Measures , Outcomes

Introduction: Speech understanding performance outcomes among children with cochlear implants vary greatly. Previous research demonstrates that pre-operative predictors of performance include age of implantation, severity of preoperative hearing levels, and pre-operative use of hearing aids. Intra-operative neural responses may be another predictor of post-operative performance. Objective: To determine if intra-operative neural responses predict long-term post-operative speech understanding scores.

Methods: Retrospective chart review of children implanted between 2004 and 2009. Intraoperative neural response thresholds obtained using NRT software and were collected along with single word and sentence recognition data.

Results: A total of 84 cases were found to have sufficient data for data analyses. Results demonstrate moderate negative, yet significant correlation between average neural response threshold and single word understanding. There was not a significant correlation between neural response threshold and sentence understanding.

Conclusion: Threshold values from neural response testing predict the word understanding performance abilities of children. The data may be useful for constructing appropriate rehabilitation programs. Implications will be discussed.

Poster Number: 7

ACI20140010: A Teletherapy Pilot Program for Children with Cochlear Implants or Bimodal Amplification

K. Dominguez1 , K. Harhager1 , J. Aubuchon1

1Nationwide Children's Hospital, Speech Pathology, Columbus, OHIO USA

Topic: Rehabilitation/Educational Aspects

Keywords: Rehabilitation for Children , Children and Recommended Rehabilitation , Speech and Language Development with CI

Introduction: Children with hearing loss often face many challenges in accessing quality speech therapy services including distance and access to skilled professionals. Teletherapy has the potential to improve the way services are delivered for these patients as well as improve their speech, language, and audition outcomes. The teletherapy pilot program was created in order to expand access to speech services and meet evolving patients’ needs.

Methods: Five patients with cochlear implants or bimodal amplification and their caregivers participated in 6 months of speech therapy to address speech, language, and audition targets through in person and teletherapy sessions. Families connected with the speech therapist via real-time audio and visual connection every other session and traditional in person speech therapy on the opposite session. Assessment of progress, ease of use of technology, and quality of connection were assessed from both the therapist and families' perspectives each month through surveys/questionnaires.

Results: All five families and clinicians reported a high level of satisfaction with teletherapy as a service delivery model. Parents reported that the sessions reduced travel time and cost and were more convenient than traditional therapy sessions. The pilot program also identified areas for improvement including sound quality and connection strength during the session.

Conclusion: Teletherapy can be an appropriate and effective service delivery model for children with cochlear implants or bimodal amplification. Utilizing teletherapy creates the opportunity to provide high quality speech services for children with hearing impairments regardless of their location. Future plans include research to compare speech, language, and audition progress in children receiving only teletherapy versus in person therapy only.

Poster Number: 8

ACI20140048: Participation Patterns of Children With and Without Hearing Loss

M. P. Gronski,OTD1,2 , T. E. Hullar2

1Washington University, Occupational Therapy, St. Louis, MO USA ; 2Washington University, Otolaryngology, St. Louis, MO USA

Topic: Rehabilitation/Educational Aspects

Keywords: Quality of Life , Children and Recommended Rehabilitation , Cognitive and Social Development of Implanted Children

Introduction: Research on children who are deaf and hard of hearing (d/hh) has historically focused on speech and language development. However, while communication is a critical element for participation in daily life activities, children who are d/hh face barriers that extend beyond speech and language. Responsibility for chores, building with blocks, going to the department store, attending a birthday party, and playing on a soccer team all incorporate skills that reinforce learning in natural contexts. Involvement in daily life activities, especially meaningful leisure pursuits, has a positive influence on self-efficacy and quality of life.

Methods: The current pilot study examines participation patterns of school-aged children with and without sensorineural hearing loss (SNHL) using an expanded childhood participation card sort measure. Twenty-nine children, ages five to twelve years, were interviewed using a modified version of the Pediatric Activity Card Sort. Particiants were shown 68 daily life activities and indicated (yes/no) whether they had participated in each activity within the past 6 months.

Results: Results indicate that overall, children with sensorineural hearing loss participate in fewer daily life activities than normal hearing peers. One noteworthy finding is the pattern of children with SNHL participating in fewer social and low physical demand leisure activities. However, geographic or economic factors must be considered for the participation patterns in the high physical demand leisure activities.

Conclusion: Participation in fewer and less diverse activities in and out of school results in decreased academic performance, lower perceived quality of life, and various delays in social, emotional and cognitive development in later childhood that continues into adolescence and adulthood. Research exploring the play and participation of young children with developmental disabilities has repeatedly shown that these children participate in fewer activities, have less diverse activity selection, choose less physically active occupations, spend more time in solitary activity participation and spend significantly more time in activities that require direct assistance than their non-disabled peers. Occupational therapy has a unique and critical role with children with SNHL to focus on priorities beyond speech and language. By highlighting the limited participation patterns of children who are d/hh, we are better able to focus on children’s performance of meaningful skills required to engage in everyday occupations, and we are more equipped to work toward functional intervention strategies beyond speech and language aimed to improve the quality of life of children who are d/hh.
COI: Advanced Bionics1

Poster Number: 9

ACI20140114: Comprehension of Wh-Questions in Children with Cochlear Implants: Insights from an Eye Tracking Study

Z. Waldman, BS,MS,Doctoral Student1,2 , R. Schwartz,CCC-SLP1,2 , S. Steinman1 , G. Drakopoulou1,2 , D. M. Houston3 , E. Ying,CCC-SLP1

1New York Eye & Ear Infirmary At Mount Sinai, The Ear Institute, New York, NY USA ; 2The Graduate Center Of The City University Of New York, Speech-Language-Hearing Sciences, New York, NY USA ; 3Indiana University School Of Medicine, Dept. Of Otolaryngology, Head-Neck Surgery, Indianapolis, IN USA

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI , Rehabilitation for Children , Cognitive and Social Development of Implanted Children

Introduction: Children with cochlear implants (CI) often have difficulty with complex syntax, namely wh-questions involving syntactic movement. In syntactic movement, one element of the sentence is relocated and the canonical order of the sentence is disrupted. The listener must then hold this relocated element, or trace, in working memory until its original location is identified. The trace is then reactivated to restore the canonical order of the sentence and enable comprehension. The ability to resolve syntactic movement depends upon trace reactivation ability, which may be affected by differences in working memory capacity. Early research using digit span has exposed working memory to be an area of deficit in children with CI, which may be related to their difficulties with syntactic movement. Research presented in this poster explores the relationship between trace reactivation behavior and working memory capacity in children with CI as compared to their typical peers, using an online language processing task.

Methods: Twenty children (10 CI, 10 TLD), aged 7-12 years, participated in an eye tracking study that asked them to listen to a question and look at four pictures. The participant was asked to then select the picture that answered the question via mouse click. Eye gaze data was collected while the participant listened to the question, at probe points related to gap locations in subject and object questions using "who" and "which." The working memory load of question stimuli was manipulated by the addition of adjectives, creating high and low working memory load conditions. Mouse click data was collected to ensure general comprehension. Eye gaze data reveals trace reactivation abilities and the effect of working memory load on trace reactivation. In addition, children completed a battery of working memory tasks, for comparison to task performance.

Results: Mouse click data revealed accuracy in comprehension over 80% for all participants. Eye gaze data was analyzed using a customized MatLab program, which identified eye gaze fixations longer than 50 ms during the probe points. Preliminary data suggest that typical children will demonstrate similar trace reactivation to normal adults. Conversely, preliminary analyses suggest that children with CI will demonstrate delayed trace reactivation, most likely in questions with higher WM demands. Growth curve analyses will also examine the time course of eye gaze across the course of the sentence.

Conclusion: It is probable that this research will show WM as a critical component of complex syntax comprehension. Results of this study will likely indicate a need for more explicit instruction of complex syntactic structures, especially those with movement, in children with CI.

Poster Number: 10

ACI20140130: Oral language development in children with cochlear implants: the influence of parents' academic level.

D. C. Ramos, MD1 , J. X. Jorge2 , M. Alves1 , H. Alves1 , J. Martins1 , C. Ribeiro1 , A. Paiva1

1Centro Hospitalar E Universit_rio De Coimbra, Servi_o De Otorrinolaringologia, Coimbra, S_O MARTINHO DO BISPO Portugal ; 2Faculdade De Medicina Da Universidade De Coimbra, Universidade De Coimbra, Coimbra, COIMBRA Portugal

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI

Introduction: Several factors influence the linguistic capacity in children with implant coclear1,2,3. Parent’s academic level is referred be one of this factors1,4. The objective of this study is to evaluate the influence of parents’ academic level in the development language in children with severe congenital deafness, with unilateral cochlear implant.

Methods: Oral language was studied in 30 children of both genders, aged between 8 years and 1 month and 10 years, with congenital bilateral profound sensorineural deafness, with cochlear implant. The assessment instrument used was the Observation Grid of Language – School Level, which assesses the skills, semantic, morphosyntax and phonology. Children were divided in 3 groups according to the parents’ academic level: 1 - basic level, 2 - secondary level and 3 - high level. For statistical analysis Oneway Anova-SPSS 20 was used, with a minimum significance of p=0.05. Results are presented as mean ± standard deviation.

Results: There were no statistically significant differences in the hearing age average of implanted children according to the academic level of their parents. In the analysis of semantics, according to the fathers academic level, the scores for group 1 vs. 2 vs. 3 were 11.63±7.44 vs. 19.10±10.34 vs. 25.00±7.70; p=0.01. In morphosyntax, the scores were: 12.56±10.74 vs. 22.30 ± 12.57 vs. 30.25±9.77, p=0.01. In phonology, the scores were: 22.06±11.21 vs. 29.40±9.84 vs. 35.00±2.16, p<0.05. In the analysis, according mother’s academic level, the scores showed the same trend, in semantics and morphosyntax, since, in general, the fathers and mothers of each child have similar academic levels. In phonology, however, the difference was not statistically significant, p=0.062.

Conclusion: The linguistic gains of implanted children increased significantly with the increase of the parents’ academic level. This study demonstrated that the parents academic level influences significantly the language improvements of children with cochlear implants.

Poster Number: 11

ACI20140131: Longitudinal Trajectories of Social Competence in Children with Cochlear Implants and Normal Hearing

M. F. Hoffman, MS1 , I. Cejas2 , A. Quittner, Ph.D.1

1University Of Miami, Department Of Psychology, Miami, FL USA ; 2University Of Miami Miller School Of Medicine, Department Of Otolaryngology, Miami, FL USA

Topic: Rehabilitation/Educational Aspects

Keywords: Social Situation of implanted children , Cognitive and Social Development of Implanted Children , Patterns of Early Social-emotional Development in Young Children with Cochlear Implants

Introduction: Children with cochlear implants (CIs), who have substantial delays in language development, are likely to experience deficits in several aspects of social competence, including social skills, emotional awareness, and interpersonal problem-solving. To date, few studies have measured and compared social competence in children with CIs and their hearing peers, and no studies have compared their longitudinal outcomes. This study compared social competence in children with CIs and hearing peers from 3-8 years post-implantation using parent, teacher and child report.

Methods: Data was obtained from the Childhood Development after Cochlear Implantation study (CDaCI), the largest and most nationally representative longitudinal study of children with CIs. Social competence was assessed utilizing multiple respondents on the Behavior Assessment System for Children, Second Edition (BASC-2) and Social Skills Rating System (SSRS) at 48, 72, and 96 months post-implantation. Separate analyses were conducted to examine social competence from the parent and teacher perspective, using a latent variable of social competence, which allowed us to combine both measures (BASC, SSRS). To examine social competence from the child perspective, the CI and hearing groups were compared using scores from the SSRS at 96 months post-implantation. Two hypotheses were tested: 1) Children with CIs would have significant delays in social competence compared to their hearing peers at all time points and, 2) Using longitudinal modeling from parent report, children with CIs would display worse social competence at 48 months, but exhibit more improvement in social skills than their hearing peers over time.

Results: Results showed that children with CIs were rated as significantly delayed on the social competence latent variable compared to hearing peers at all time points, according to both parent and child report. However, teachers reported no differences between the CI and hearing groups. Contrary to predictions, longitudinal modeling of the parent data revealed that children with CIs were significantly delayed in comparison to their hearing peers at 48, 72, and 96 months post-implantation, with minimal evidence of catch-up over a 5-year period.

Conclusion: These results indicated that children with CIs continue to experience delays in social competence 8 years following implantation. To date, no interventions have been developed or tested to address these deficits. As children with hearing loss are diagnosed and implanted at earlier ages, it is likely that they will need interventions to assist them in navigating their social environments at home, at school and in the community. Future directions will evaluate potential moderators of social competence, such as oral language abilities and maternal sensitivity.

Poster Number: 12

ACI20140134: Assessment of Spectral and Temporal Resolution in Pediatric Cochlear Implant Users

A. Del Tufo,Enrolled in AuD/ PhD1 , J. H. Won1 , P. Johnstone1 , M. Hedrick1 , E. Humphrey,AuD1 , K. Yeager,AuD1

1University Of Tennessee Health Science Center At Knoxville, Audiology And Speech Pathology, Knoxville, TN USA

Topic: Audiology

Keywords: Young and Very Young Children , Outcomes

Introduction: Psychoacoustic tests have been shown to significantly correlate with speech perception in cochlear implant (CI) users among the adult population in the past, specifically, temporal modulation detection (TMD) and spectral ripple discrimination (SRD). This study is designed to utilize similar strategies and to obtain analogous results among the pediatric population, in order to gain further knowledge about speech perception in pediatric CI users.

Methods: Normal hearing children and CI users aged 8-12 years old were tested and their results were compared to previously reported adult data (Moon et al., 2014, ARO). In order to evaluate the subject’s sensitivity to temporal cues in speech, voice-onset-time (VOT) was varied using a two continua (beer-pier, deer-tier), and identification performance was measured. In order to evaluate the subject’s sensitivity to spectral cues in speech, formant transitions were adjusted, and a /ba/-/da/ continuum was made via modified natural speech, and the subject’s performance was measured by identification. Logistic regression was used to model the subject’s psychometric functions along the acoustic cue continua. The psychometric functions were quantified using the model coefficients corresponding to the manipulated cues. The same group of subjects was also tested for SRD and TMD. Correlations between coefficients for the speech tasks and thresholds for SRD and TMD were computed. The normal hearing group of children were tested using two different conditions of stimuli: vocoded (used to simulate CI listening) and not vocoded. The CI group only listened to the not vocoded condition.

Results: Coefficients from both the spectral and temporal speech tests in the NH group were higher than those for CI subjects, indicating that NH subjects were generally more efficient at utilizing the cues for categorization. Significant correlations were found between the performance in the psychoacoustic tests and speech cue perception tests. Data for children with CIs will be compared to adult CI users.

Conclusion: The current paradigm underscores the relationship between speech perception and non-linguistic psychoacoustic measures. Although speech is a complex signal with multiple cues, the ability to recover those cues bears some relationship with basic psychophysical abilities. These speech perception tasks, in which spectral and temporal cues are manipulated orthogonally in speech stimuli, may be a useful tool to evaluate CI performance with different encoding strategies or mapping parameters. This potential tool may be extremely useful, and exceptionally vital, particularly among the pediatric population, due to the fact that access to speech is crucial among the school aged pediatric population.

Poster Number: 13

ACI20140141: The Effects Of Increased Semantic Information On Vocabulary Learning In Children With Hearing Loss

E. Lund, Ph.D.1 , W. M. Douglas2 , L. Ackal,MED2 , H. Mason,Student1 , C. M. Schuele2

1Texas Christian University, Communication Sciences And Disorders, Fort Worth, TX USA ; 2Vanderbilt University Medical Center, Hearing And Speech Sciences, Nashville, TN USA

Topic: Rehabilitation/Educational Aspects

Keywords: Rehabilitation for Children , Speech and Language Development with CI , Speech Production of Early Implanted Children

Introduction: Vocabulary knowledge represents a linguistic weakness for preschool children with hearing loss as compared to same-age peers with normal hearing (e.g., Ganek, Robbins & Niparko, 2012). Children with cochlear implants perform less proficiently than same-age children with normal hearing on word-learning tasks (Houston, Stewart, Moberly, Hollich, & Miyamoto, 2012; Walker & McGregor, 2013). If children with hearing loss are to enter school with vocabulary knowledge comparable to their hearing peers, then they will have to catch up to the vocabulary knowledge of their peers. For this achievement to be possible, preschoolers with implants must display a rate of vocabulary growth that is steeper than that of their peers to compensate for later onset of word learning. A growing body of evidence indicates that the word learning performance of children with hearing loss is malleable (Lund & Schuele, 2014). Lund and Schuele (2014) used a single subject, multiple probe design across participants to measure the impact of a training administered by a researcher on children’s rapid word-learning performance. The functional relation indicated that the receptive rapid word-learning performance of children with cochlear implants is malleable. Research has not evaluated the impact of classroom-based intervention on the performance of preschool children with hearing loss. The primary purpose of this study was to evaluate how three levels (i.e., intervention conditions) of semantic information offered during a vocabulary lesson – (a) no information, (b) only linguistic information, and (c) physical experience-based information – related to word learning performance of children with implants. A secondary purpose was to discover characteristics of children most affected by different levels of intervention.

Methods: A single-subject, adapted alternating treatments design was employed. Participants were ten children with aids and implants who were developing spoken language. Each week, each child received vocabulary intervention following a standardized protocol for one of the three experimental conditions. Each child participated in each intervention condition three times. An assessment was administered to each child at the end of each week.

Results:Most children demonstrated better word learning in the (b) and (c) conditions (respectively, semantic linguistic information and semantic physical experience-based information) than in the (a) condition (no semantic information). Children with fragile phonological systems, as evidenced by articulation errors and standardized testing, tended to learn more words in the (c) condition than in the (a) and (b).

Conclusion: These findings demonstrate that including linguistic and physical experience-based semantic information during structured vocabulary interventions is likely to improve the vocabulary learning of some children with hearing loss, particularly those with fragile phonological systems.

Poster Number: 14

ACI20140162: Device fixation in cochlear implant: outcomes of bone well technique.

R. A. Lauria1 , G. M. Truzzi1 , E. M. Silva1 , G. M. Carvalho1 , A. C. Guimar_es1 , S. B. Curi1 , W. A. Bianchini1 , A. M. Castilho1

1Unicamp, Departamento De Otorrinolaringologia E Cabe_a E Pesco_o, Campinas, XX - OTHER STATE/PROVINCE/TERRITORY Brazil

Topic: Surgery/Medical

Keywords: Alternative Surgical Approaches , Medical/Surgical Issues , Complications

Introduction: Cochlear implantation is a worldwide procedure that provides hearing rehabilitation and improves speech perception. One of the described complications is the device migration, which can result of failure of receiver-stimulator (R/S) fixation. With the increase of operative experience and refinement of the procedure, plenty techniques of R/S fixation was described in the literature, such as suture fixation, temporalis pocket, drilling a bony seat or well. However, the ideal technique to avoid complications still remains a point of debate. Objective: To compare general complications and device migration for a group undergoing fixation of R/S using a bone well with a group undergoing cochlear implantation without this fixation technique (subperiosteal pocket).

Methods: It was performed a retrospective case review in the department of otorhinolaryngology, head and neck surgery of a tertiary referral center. Clinical sample included all patients with severe-to-profound or profound hearing loss who underwent cochlear implant surgery between October 2008 and April 2013 using devices from the same manufacturer. These patients were divided into two groups: one with the bone well fixation technique, other without device fixation. It was applied clinical forms to all patients and analyses device migration with XR exam.

Results: Thirty-two patients were included, with ages ranging from 5 to 70 years. Follow-up period ranged from 5 to 60 months. The patients, divided into two groups (pocket and bone well), were analysed through major and minor complications. No intraoperative, wound or intracranial complications have been observed in either groups. Discussion: The fixation of cochlear implant device is a discussed topic in literature, with a wide variety of techniques described. Most series have low rate of complications, on par with our results. In our review, there were no statistically significant difference between both groups regarding overall complications and device migration.

Conclusion: Both techniques, using a subperiostal pocket and a bone well, showed low rates of complications in our study, with few differences between the groups.

Poster Number: 15

ACI20140266: Cochlear implant benefit in patients with Usher Syndrome

P. H. Skarzynski, MD,Ph.D.1,2,3 , E. Tomanek1,2 , A. Panasiewicz1,2 , B. Krol, MD1 , M. Sosna, MD1 , H. Skarzynski, MD,Ph.D.,Prof.1

1Institute Of Physiology And Pathology Of Hearing, World Hearing Center, Warsaw, MAZOWIECKIE Poland ; 2Medical University Of Warsaw, Warsaw, MAZOWIECKIE Poland ; 3Institute Of Sensory Organs, Kajetany, MAZOWIECKIE Poland

Topic: Audiology

Keywords: Outcomes

Introduction: Usher syndrome is a rare disease with incidence depending on population, on the level 3.5 to 6.2 in 10,000 individuals. The most characteristic features of the disease are: different types of deafness and partial deafness, vestibular disorders and blindness onset at different ages. Objective: The main aim of the study is to evaluate preservation of the residual hearing after the partial deafness cochlear implantation in the Usher syndrome patients.

Methods: A cochlear implantation surgery was performed according to a 6-step Skarzynski’s method. In the majority of cases electrode had been inserted through the round window, but in some cases, depending on patient’s anatomic condition, through cochleostomy.

Results: Results of pure tone audiometry tests performed in the same setting before and after the implantation, show preservation of the pre-operative hearing in almost all cases.

Conclusion: Most cases of the Usher syndrome are characterized by the progressive hearing loss. Therefore, in the post-implantation follow up, changes in the sound coding strategy depending of the electrode channel may be needed. Pre-surgical assessment of the electrode insertion depth is essential, recommended insertion depth is between 25 and 28mm. Follow-up visits for implantees with Usher syndrome should be scheduled more often than normal post-cochlear implantation protocol.

Poster Number: 16

ACI20140277: Flat-Panel Computed Tomography Imaging of the Temporal Bone: Comparison of Image Quality and Radiation Exposure to Conventional Multi-Detector Computed Tomography

N. Connell, MS3 , T. Kennedy, MD1 , T. Szczykutowicz, Ph.D.2 , K. Royalty, MS4 , S. Schafer, Ph.D.4 , S. Nace, MD1 , B. Gartrell, MD5 , S. Gubbels, MD5

1University Of Wisconsin Hospital And Clinics, Radiology, Madison, WI USA ; 2University Of Wisconsin Madison, Medical Physics, Madison, WI USA ; 3University Of Wisconsin School Of Medicine And Public Health, Madison, WI USA ; 4Siemens Medical Solutions, Hoffman Estates, IL USA ; 5University Of Wisconsin Hospital And Clinics, Otolaryngology, Madison, WI USA

Topic: Surgery/Medical

Keywords: Radiology/Imaging

Introduction: While CT scanning is not routinely performed after cochlear implantation, there is interest in using CT imaging to determine depth of electrode insertion, scalar location and distance of each electrode from the stimulated neural elements. Computerized tomography exposes patients to ionizing radiation, which is of special concern in the pediatric population. Flat-panel CT (FPCT) has been shown to reduced the appearance of artifacts and improve upon the resolution of conventional multi-detector CT (MDCT). The directed nature of the FPCT beam should result in decreased radiation exposure to the patient when compared with MDCT, though direct comparison of the total dosage of radiation delivered with imaging of the temporal bones in whole cadaveric heads has not been performed. Objective: This study will evaluate the utility of a commercially available FPCT platform for temporal bone imaging using cadaveric whole head specimens. Anatomic resolution and radiation exposure of FPCT will be compared to MDCT.

Methods: Radiation doses were measured using thermoluminescent dosimeters, or TLDs. Radiation dose maps for FPCT and MDCT were constructed using a phantom head with an array of 30 TLD chips placed within its structure. Subsequently, four cadaver heads were scanned with MDCT and FPCT. For MDCT a standard clinical temporal bone imaging protocol was used (slice thickness of 2.5 mm, axial bone reconstructions of 0.625 mm). For FPCT two image sets were acquired, one capturing the full field of view (FOV) and a second capturing a small FOV in high resolution mode centered over each temporal bone. Radiation dose to the ocular lens was measured during each scan by placing TLD chips under the eyelids. Images were analyzed by three neuroradiologists who were blinded to the type of CT and were instructed to rate 31anatomical structures using a four point scale.

Results: Image quality of FPCT was determined to be at least equivalent to MDCT. Radiation dose measured at the ocular lens with FPCT was 57% that of MDCT for full field scans and 5% for small field of view scans. Total integral doses measured for FPCT were 83% and 43% of MDCT values for full field of view and small field of view respectively.

Conclusion: We have shown that FPCT provides images of the temporal bone with resolution at least equivalent to MDCT while exposing patients to less radiation. Given these findings, use of FPCT for routine imaging of the temporal bone may be preferable to MDCT. Ongoing studies are being conducted to evaluate the performance of FPCT for imaging of cochlear implant electrodes, which may aid in optimization of array positioning and device performance.
Siemens Medical Solutions 1 , GE HealthCare2 Siemens Medical Solutions 3

Poster Number: 17

ACI20140301: Why Syllable Repetition: Auditory Perception and Vocalization Characteristics

M. K. Fagan, Ph.D.1

1University Of Missouri, Communication Science And Disorders, Columbia, MO USA

Topic: Basic Research

Keywords: Speech Coding

Introduction: Hearing loss impacts speech sound development in infancy. Infants with hearing loss produce fewer consonants, fewer canonical syllables, and fewer vocalizations overall in comparison to hearing infants. Infants with hearing loss also show delayed onset of repetitive vocalizations, vocalizations containing sequential syllable repetitions. However, few studies have examined vocalization characteristics of infants with profound hearing loss following relatively early cochlear implantation. Objective: The goal of this research was to document vocal development in infants who received cochlear implants at a mean age of 12 months in comparison to hearing peers.

Methods: Participants were 27 infants with normal hearing and 16 infants with profound hearing loss. Mean age at cochlear implantation for infants with hearing loss was 12.4 months (SD = 1.5 months); mean age at cochlear implant activation was 13.6 months (SD = 1.6). Spontaneous speech samples were obtained in the second half of the first year, before infants with hearing loss received cochlear implants, and early in the second year, four months after cochlear implant activation for infants with hearing loss. Dependent variables included number of overall vocalizations, number of total consonants, number of different consonants, and number of vowel and syllable repetitions.

Results: Infant vocalizations increased significantly within four months of cochlear implantation. Consonant inventory and number of repetitions also increased significantly.

Conclusion: Infant productions and vocalization development will be discussed in relation to infants with normal hearing and children who receive cochlear implants at later ages, with an emphasis on the implications of repetition for speech and cognitive development.

Poster Number: 18

ACI20140354: Sibling Perspective of Family Dynamic in Families of Children with Cochlear Implants

K. Wiseman, BS1 , A. Warner-Czyz, Ph.D.1 , B. Loy,Au.D.2

1University Of Texas At Dallas, Dallas, 75235 USA ; 2Children's Medical Center Of Dallas, Dallas, 75235 USA

Topic: Rehabilitation/Educational Aspects

Keywords: Deaf Families , Quality of Life

Introduction: Siblings are an important part of a child cochlear implant (CI) user’s experience. In general, siblings both support and challenge each other. They learn from each other in ways unique to that of parents or friends, particularly in regards to communication (an area of challenge for young CI users). And yet little research has been devoted to their experience and perspective. Research has explored both positive and negative effects on family dynamic of children with disability, including parental differential treatment, sibling jealousy, resentment, and overprotection. It is unclear how siblings of CI users feel the experience has affected them and their own family relationships. Objective: This study explored how siblings of children with CI perceive their family dynamics and relationships.

Methods: Participants included twenty-one children ages 9-19 (mean = 12.2 years, SD = 2.8) who had one sibling with at least one CI. CI users were ages 10-17 (mean = 12.4 years, SD = 2.7). 10 participants were older than their CI-user sibling. Participants were recruited and tested at a summer camp for families of young CI users (2013 and 2014). All participants were administered a questionnaire that asked participants to rate the effect of their sibling’s hearing loss on their familial relationships on a Likert ranging from “Not at all” to “Most of the time.” Participants were administered the questions via an online survey program, Qualtrics. Descriptive statistics were calculated, and correlations were examined, looking for relationships between questionnaire responses and demographic data (age, birth order, etc).

Results: The majority of siblings expressed feeling no effect on their other family relationships and very little resentment towards their parents and CI sibling over the hearing loss. Responses were mixed regarding jealousy over parental attention toward CI sibling. Majority of the siblings stated that they are frequently treated differently than their sibling with CI. Those who frequently felt overprotective of their CI sibling were most often older than that sibling. Siblings who felt an effect on other family relationships were significantly more likely to feel unequal treatment and resentment towards CI sibling.

Conclusion: Siblings of young CI users perceive the hearing loss as having an effect on certain parts of their lives, particularly differential treatment from their parents. Birth order effects were present in regards to overprotection, suggesting that older siblings may be taking on a more parental role than younger siblings. Results indicate that siblings who feel the effect on the family dynamic may be more likely to have resentment towards the CI user, which may negatively affect the sibling relationship. It is important for clinicians and family members to understand the sibling perspective in order to foster a healthy family dynamic to help support all areas of growth and development for the CI user.

Poster Number: 19

ACI20140375: Atypical Impedance Patterns in Cochlear Implant Recipients

J. Harris,AuD1 , M. Neault, Ph.D.1,2 , M. Kenna, MD,MPH1,2 , G. Licameli, MD,FACS1,2

1Boston Children's Hospital, Department Of Otolaryngology And Communication Enhancement, Waltham, MA USA ; 2Harvard Medical School, Department Of Otology And Laryngology, Boston, MA USA

Topic: Technology

Keywords: Cochlear Implant Hardware

Introduction: Cochlear implant programming centers are not required to report individual electrode malfunctions (short or open circuits) to the device manufacturer, although independent studies place incidence of these faults at approximately 10%. These faults, limited to one or two electrodes, have not been shown to indicate impending device failure. They are typically managed by the audiologist to avoid degradation in performance. However, we have observed a third pattern of unusual impedances, in Cochlear devices only, consisting of alternating almost-short circuits in a zigzag pattern. Because the low values often do not meet the manufacturer’s definition of a short circuit (<565 ohms), the affected electrodes are not flagged by the software. This pattern deserves investigation, as its management depends upon the recipient’s performance and may provide important clues into device integrity. Objective: To examine the course and implications of an atypical impedance pattern not currently identified by cochlear implant programming software.

Methods: This retrospective study examined records of our population of cochlear implant recipients who were implanted at our pediatric tertiary care center. Of our patients who were implanted with a Cochlear device, patients were included in the study if they had been implanted for at least six months, and had received a CI 24-generation implant or later (due to lack of telemetry on N22 devices). Records were examined to identify patients exhibiting this atypical pattern, and to analyze impedance changes and performance over time.

Results: In those ears found to have this pattern, we found varying quantities of affected electrodes and varying performance for these recipients. The number of affected electrodes typically increased over time. Performance varied with the number of affected electrodes, in which grounding modes the pattern was observed, and the steepness of impedance changes in alternating electrodes. When reprogramming could not reach prior performance levels, the device was replaced.

Conclusion: This atypical impedance pattern can be indicative of known fault of the electrode array, although programming software will not alert the programming audiologist, as it does not meet current short circuit criteria. Although this pattern may indicate faulty electrodes, their presence does not automatically indicate a need for device replacement. Management includes monitoring of all impedance values, NRT values, and most importantly performance. We advocate, in accordance with Cochlear recommendation, that for young children for whom performance measures are not yet available, the audiologist may consider turning off those electrodes with unusually low impedances to minimize possible detriment to developing hearing and language. Further evaluation of this pattern in greater numbers may allow identification of specific parameters to be included in future versions of mapping software.

Poster Number: 20

ACI20140011: "Hear the Beat": Investigating the Effects of an Early Intervention Group Using Music and Speech Therapy Including Children with Hearing Loss and their Parents/Caregivers.

S. Lucius1 , K. Dominguez1 , G. Hounam1

1Nationwide Children's Hospital, Speech Pathology, Columbus, OHIO USA

Topic: Rehabilitation/Educational Aspects

Keywords: Music Therapy , Rehabilitation for Children , Speech and Language Development with CI

Introduction: We found a need for implementing direct hearing impaired speech services at an earlier interval than 12 months of age. Early Auditory-Verbal therapy for the child with hearing loss is essential to maximize the newly diagnosed infant’s progress with communication and to guide and coach parents on early communicative behaviors. The literature also supports music as a means of helping develop these early listening and language skills. “Hear the Beat” was designed to provide direct intervention to children with hearing loss. The sessions guided caregivers on early language and music milestones. Additionally, the literature supports that the diagnosis of congenital hearing loss can be accompanied by parental stress. This group also provided support for families experiencing the diagnosis of congenital hearing loss at the earliest stage possible.

Methods: Four children, age birth-12 months with newly diagnosed sensorineural hearing loss and their parents were enrolled in “Hear the Beat”. The group met once a month for 3 consecutive months, each session lasting 60 minutes. Parents/caregivers were given the IT-MAIS prior to the start of the first session as well as a modified bonding survey. Each session was designed to include speech and listening targets from the Auditory Learning Guide and materials from a music kit specifically designed for parents of infants with hearing loss. Sessions involved language rich music experiences and followed the Auditory-Hierarchy in terms of language skill development. Additional coaching support was provided to promote home carry-over.

Results: Four parents/caregivers and their children with hearing loss attended three sessions of “Hear the Beat”. A certified music therapist, two AVTs, and an audiologist were present for the sessions. The modified bonding survey revealed the following trends: parent/caregivers had greater understanding of hearing loss and strategies to maximize listening and talking with their infant, greater feelings of support from families experiencing a similar diagnosis, and improvements were noted in the caregiver’s confidence in integrating singing and music into daily routines. The IT-MAIS revealed an increase in child vocalizations, awareness of environmental sounds, and consistency of device use.

Conclusion: The initial “Hear the Beat” program assisted with EI by providing families an earlier opportunity for specialized speech services, a natural parent support group, and a proven early intervention method using music therapy. Future Directions for “Hear the Beat” will compare pre/post IT-MAIS scores, pre/post Parental Stress Index (PSI) to assess parent/caregiver stress levels and pre/post music milestones measure to determine impact on reaching music milestones. These measures will be used with participants of “Hear the Beat” as well as a control group. This project has been submitted to the IRB for further investigation.
COI: Advanced Bionics 1

Poster Number: 21

ACI20140031: Adaptation of a Medication Inventory Management System for Cochlear Implant Equipment

E. Tournis,Au.D.1 , D. Thomas,Au.D.1

1Ann & Robert. H Lurie Children's Hospital Of Chicago, Chicago, IL USA

Topic: Economics and Public Policy

Keywords: Health Economics

Introduction: As a large pediatric cochlear implant program serving over 1200 implanted ears implanted with devices from the three major manufacturers, our program faces many challenges related to managing implant external hardware. To deal with this issue, we began using a computer based inventory management system originally designed to stock medications and other inpatient hospital supplies. This system has been highly beneficial in managing our complex inventory. It has enabled us to streamline our ordering and billing as well as help to ensure that equipment is available. This system has resulted in less administrative time, more accurate billing, and reduced purchase of excess inventory. Implementation of this system is an example of how “Lean” processes in the healthcare environment can introduce both time and cost efficiencies while simultaneously improving customer care.

Methods: We will describe the computer based inventory management system currently used by our cochlear implant program to manage externally worn hardware and accessories. We will discuss the infrastructure necessary to adapt the comerrcial machine, designed for medications and other hospital supplies, for cochlear implant supplies. We will provide examples of cost and efficiency savings.

Results: This system allows our center to minimize time spent ordering supplies and performing inventory. The inventory management system collects data on frequency of use for each supply. Reports generated are useful in determining if the amount of inventory should be adjusted and whether stocking specific items should be discontinued. The system allows us to set a specific level of inventory that can be customized for each item. This customization is invaluable when accounting for differences in color preference or magnet strength.

Conclusion: Adoption of a computer based inventory management system has been an effective way for our large implant program based at a tertiary care children’s hospital to efficiently maintain the large variety of supplies necessary to meet the needs of our patients and families. We have found that this system allows us to inventory our stock easily which is critical not only for daily use but when new products are released or older products are declared obsolete. This system has enabled us to be efficient with administrative and staff time, improve billing and reduce overhead related to maintaining sufficient inventory.
COI: Cochlear Americas1

Poster Number: 22

ACI20140034: Sensitivity of cochlear-implanted children to complex tone sweeps

M. L. Deroche, Ph.D. , C. J. Limb1 , M. Chatterjee2

1Johns Hopkins University School Of Medicine, Otolaryngology, Baltimore, MD USA ; 2Boys Town National Research Hospital, Auditory Prostheses And Perception Laboratory, Omaha, NE USA

Topic: Basic Research

Keywords: Maturation and Plasticity of The Auditory System , Sound Processing , Speech Coding

Introduction: Sensitivity to pitch is critical for children as they acquire their native language, especially in the case of tonal languages. In earlier studies, we measured sensitivity of normally-hearing (NH) and cochlear-implanted (CI) children to static pitches. CI children displayed large deficits compared to their NH peers, which translated into deficits in intonation recognition and emotion recognition. Here, we examine sensitivity to complex tone sweeps by the same populations to determine whether psychophysical data on tone sweeps can predict performance on tasks which rely on the pitch of intonated utterances.

Methods: Participants were NH and CI children between 6 and 18 years of age. Sweeps were created from harmonic complexes, low-pass filtered below 10 kHz, with sine-phase partials based on a linearly rising or falling fundamental frequency. Up- and down-sweeps always covered the same F0 range, and the starting F0 of up-sweeps was roved across trials between 100 and 150 Hz. The range of sweep rates was adjusted by the experimenter in view of performance during training sessions. Most often, it ranged from 0.5 to 16 semitones per second for NH children and from 2 to 64 semitones per second for CI children. Performance was examined in a direction task (1-interval, 2-alternatives) and a discrimination task (3-intervals, 2-alternatives). Stimuli were 300-ms long, and presented at 65 dB SPL with a level roving of +/- 3 dB, via loudspeakers. CI children listened through their every-day speech processors. Hits and false alarms were translated into d’ and beta values.

Results: As for static pitches, NH children had finer sensitivity than CI children to tone sweeps. In addition, performance in the discrimination task was overall poorer than in the direction task, and this was particularly the case for CI children. Age at implantation, duration of CI experience, and age at profound hearing loss did not considerably affect the results.

Conclusion: CI children (even those implanted at a very early age or with a large experience with their device) have limited access to F0 information, and this constraint translates into deficits in recognizing the direction of tone sweeps, consistent with their deficit in intonation and emotion recognition tasks. In addition, CI children face some form of cognitive load when comparing three sweeps covering the same F0 range.

Poster Number: 23

ACI20140102: Initial Speech Perception Outcomes with Fine Structure Processing (FSP) versus High-Definition Continuous Interleaved Sampling (HDCIS)

S. N. Obarowski,BHS1 , M. Dillon,AuD2 , E. King,AuD3 , E. Pearce,AuD3 , M. Adunka,AuD3

1University Of North Carolina At Chapel Hill, Speech And Hearing Sciences, Chapel Hill, NC USA ; 2University Of North Carolina At Chapel Hill, Otolaryngology/Head & Neck Surgery, Chapel Hill, NC USA ; 3University Of North Carolina At Chapel Hill, Audiology, Chapel Hill, NC USA

Topic: Technology

Keywords: Speech Coding Strategies , Sound Coding

Introduction: Cochlear implant signal coding strategies have traditionally provided the envelope of a signal to the listener, such as in the High-Definition Continuous Interval Sampling (HDCIS) strategy. The aim of Fine Structure Processing (FSP) is to provide the user with both fine structure and amplitude information. Theoretically, providing both of these cues should result in improved speech perception, especially in the presence of challenging background noise (Moore, 2008). However, prior studies comparing FSP to HDCIS performance, using an intersubject design with experienced listeners, have reported mixed results. Arnoldner and colleagues (2007) found that speech perception scores improved in noise using FSP; however, Magnusson (2011) and Riss et al. (2008) found no statistical difference in speech perception scores or subject preference between the two strategies long-term. Currently, it is unclear whether listening exclusively to one coding strategy starting at initial activation will provide improved speech perception outcomes. The purpose of this study was to compare speech perception outcomes between FSP and HDCIS during the first six months of listening experience.

Methods: Adult subjects were randomly assigned to either the HDCIS or FSP coding strategy. Mapping was conducted at initial activation, along with one, three and six months post-activation. The mapping procedure included loudness balancing, as well as evaluation of rate, maplaw, sensitivity, threshold and comfort levels. The audiologist completing speech perception testing was blinded to the specific signal coding strategy. Recorded materials were presented in sound field at 60 dB SPL. The test battery included: CNC words in quiet, HINT sentences in quiet and noise (SNR+10), AzBio sentences in quiet and noise (SNR+10, +5) and BKB-SIN.

Results: A repeated-measures ANOVA was used to evaluate the change in speech perception over time by each cohort. Speech perception performance was similar between the two cohorts in both quiet and noise. Though there appeared to be a difference in performance on the AzBio sentences in noise and BKB-SIN tasks, this was not significantly different.

Conclusion: Subjects achieved similar speech perception outcomes when listening exclusively with either the FSP or HDCIS strategy up to the six-month follow-up encounter.
MED-EL Corporation1 , MED-EL Corporation2

Poster Number: 24

ACI20140117: Cochlear Implantation in Children with Usher Syndrome

J. C. Fainberg, MA1 , M. K. Chaikof2 , S. Trotochaud3 , N. Parkin-Bashizi, MA4

3Usher 2020 Foundation, Atlanta, GA USA ; 4Vision Rehabilitation Services, Smyrna, GA USA ; 1Atlanta Speech School, Audiology, Atlanta, GA USA ; 2Vision For A Cure, Newtonville, MA USA

Topic: Audiology

Keywords: Binaural Hearing , Outcomes

Introduction: Usher Syndrome is a rare genetic disorder that is the leading cause of deaf-blindness in the world. It was named for a British Ophthalmologist from the early 1900s, Charles Usher, who recognized it as a syndrome through a number of his patients. Although it is rare, only about 45,000 people in the U.S., it is devastating for those who are affected by it. Caused by an autosomal recessive gene, it manifests itself in three clinical types. Early diagnosis is critical for children with Usher syndrome. While there is currently no cure, the best treatment involves early identification so that educational programs and assistive technologies can begin as soon as possible. Early, bilateral cochlear implantation is one possible treatment for children with severe to profound hearing loss. Parents rely on audiologists for information and guidance in working with their children who have hearing loss, so the audiologist is often expected to counsel and help parents through their choices and decisions. The purpose of this paper is to educate the audiologist about Usher Syndrome and its relevance to newly identified children and their families.

Methods: We will describe the symptoms and sub-types of Usher Syndrome with regard to hearing, vision and balance including specific information on current genetic information and research. We will review the case histories and outcomes of six children (three sets of siblings) with Usher syndrome who received bilateral cochlear implants at an early age.

Results: Early, bilateral cochlear implantation in children with Usher Syndrome is an effective treatment for children diagnosed with severe to profound hearing loss.

Conclusion: It is important for the audiologist to be familiar with Usher Syndrome as they guide families of children with hearing loss. From our experiences, we offer a suggested protocol to facilitate early identification of this disorder.

Poster Number: 25

ACI20140142: Relation Between Instructions To Teachers Of The Deaf And Use Of Novel Words During Vocabulary Lessons

E. Lund, Ph.D.1 , W. M. Douglas2 , H. Mason,Student1 , C. M. Schuele2

1Texas Christian University, Communication Sciences And Disorders, Fort Worth, TX USA ; 2Vanderbilt University Medical Center, Hearing And Speech Sciences, Nashville, TN USA

Topic: Rehabilitation/Educational Aspects

Keywords: Children and Recommended Rehabilitation , Speech and Language Development with CI , Speech Production of Early Implanted Children

Introduction: Strategies employed by teachers in preschool classrooms affect the learning outcomes of children with normal hearing (e.g., Dickinson & Porche, 2011). For example, repeated exposure to novel vocabulary is associated with vocabulary growth (e.g., Pan et al., 2005). The “repetition” strategy of teaching vocabulary may be particularly necessary for children who have difficulty learning new words, including children with cochlear implants (Houston et al., 2012). Thus, research must address how teacher training affects the ability of teachers of the deaf to implement teaching strategies for students in their classrooms. Targeted training improves teacher-child interactions in preschool classrooms (Tanyel & Knopf, 2011). Information about the effects of teacher training on strategy use in the deaf education classroom is necessary to inform teacher-training practices. This study is preliminary model for the evaluation of teacher training practices. The purpose was to evaluate the effects of instructions provided to teachers on the use of a word “repetition” strategy in the classroom during vocabulary instruction.

Methods: A single-subject, adapted alternating treatments design was employed for this study, in the context of a larger single-subject design assessing child outcomes. Four teachers of the deaf in were video-recorded during vocabulary instruction across nine weeks. There were three conditions and each teacher participated in each condition three times (non-consecutive weeks). Each week each teacher received condition-specific instructions for vocabulary teaching. In the first condition, teachers were given minimal instruction beyond being asked to repeat a new word at least six times. In the second condition, teachers were asked to verbally elaborate on the new words for children during the lesson, but not given a specific number of times to repeat a word. In the third condition, teachers were asked to incorporate a physical object into the lesson as they verbally elaborated on the meaning of a word, but not given a specific number of times to repeat a word. The outcome variable was teacher repetition of target words. The videotapes were coded by two authors for teacher repetition of target words in each condition.

Results:Teachers used the “repetition” strategy most frequently during interactions with children in the third condition and least frequently in the first condition. This finding is particularly interesting given that teachers were asked to focus primarily on repetition only in the first condition.

Conclusion:Preliminary results indicate that, in addition, to providing children with additional semantic information about new words, asking teachers to use an elaboration model of teaching vocabulary may also lead to increased use of word repetition.

Poster Number: 26

ACI20140147: Preliminary Investigation of Binaural Interaction Component of Cortical Auditory Evoked Potentials as a Measure of Binaural Hearing in Bilateral Cochlear Implant Users

J. Ceruti1 , K. Vasil-Dilaj,Au.D.2

1University Of Connecticut, Department Of Speech, Language & Hearing Sciences, Storrs, CT USA ; 2New England Center For Hearing Rehabilitation, Hampton, CT USA

Topic: Audiology

Keywords: Binaural Hearing , Objective Measures , Outcomes

Introduction: The binaural interaction component (BIC) is an analysis of evoked potential waveforms that examines binaural processing by comparing the difference between the summed monaural (Right + Left) waveforms and binaural waveform. The summed monaural response is larger in normal hearing individuals than the binaural waveform, which is thought to be the result of the interaction between inhibitory and excitatory pathways within the brainstem. The BIC objectively demonstrates binaural interaction at all levels of the auditory pathway, though it is largest from the cortex, and is highly correlated to performance on behavioral measures of binaural hearing (Leigh-Paffenroth et al, 2011). The objective of the present investigation is to determine if the BIC can be used as an objective marker of binaural hearing in individuals with bilateral cochlear implants (CI). Similar to the P1 biomarker, this may serve as a clinically useable tool, in conjunction with therapy, to assess binaural processing improvements over time in individuals with bilateral CIs (Sharma et al, 2005).

Methods: All participants will be over seven years of age, have symmetrical aided audiograms, and have ≥70% word recognition score in each ear. Participants will complete electrophysiological (EP) testing to determine an N1-P2 binaural interaction component. The HEARLab system will be used to obtain the N1-P2 auditory evoked potential therefore stimuli will consist of speech sounds /m/, /t/, /g/, /s/ and will be presented at 65 dB SPL. All testing will be completed in the sound field. Individuals will utilize their typical everyday listening program on their processor. Results of EP measures will be compared to previously obtained behavioral tests of auditory processing. The test battery will include measures of temporal processing (gap detection), speech in noise (BKB-SIN), and dichotic listening (dichotic digits, competing sentences, dichotic rhyme).

Results: Preliminary results will aim to evaluate if the HEARLab system can be used to record the BIC in individuals with bilateral CIs and, secondarily, to determine there is a correlation to behavioral and EP measures of binaural hearing, as previously seen in other populations (Levine, 1981; Furst, 1985; Pratt et al, 1998).

Conclusion: Gopal and Pierel (1998) suggest that the BIC may serve as “an index of binaural processing”. Preliminary results will aim to provide a framework for rehabilitation (i.e. Dichotic Interaural Intensity Differences, LISN and Learn) that incorporates improving binaural processing in individuals with bilateral CIs .

Poster Number: 27

ACI20140151: Unusual Complication of Cochlear Implant Recipient on CPAP and a Simple Solution: A Case Report

A. D. Person1 , R. Kang2

1Creighton University, Department Of Surgery, Omaha, NE USA ; 2Boys Town National Research Hospital, Department Of Otolaryngology, Omaha, NE USA

Topic: Surgery/Medical

Keywords: Complications , Medical/Surgical Issues

Introduction: The development of a pocket of air around a cochlear implantation site after surgery is relatively rare. The reported cases suggest that Valsalva or Toynbee maneuvers are the cause of these complications and are usually easily resolved by conservative means. This report describes a patient who had chronic pain and difficulty adapting to his cochlear implant and was found to have developed a pneumocele around the device.

Methods: Aspiration of the subcutaneous air resulted in instant pain relief but the swelling and air recurred within two days of initial presentation. Thinking that chronic, nightly continuous positive airway pressure (CPAP) use (at high pressure) may be the cause of his recurrent pneumocele, a tympanostomy tube was placed and the pneumocele resolved without further recurrence.

Results: The use of CPAP for the treatment of obstructive sleep apnea has been known to cause the collection of subcutaneous air in surgically and traumatically manipulated tissues of the head and neck. Never previously, however, has the development of a pneumcele around a cochlear implant been connected to the use of CPAP. Previously documented cases of air collection around a CI have been treated with either conservative management or Eustachian tube ablation.

Conclusion: Patients undergoing extensive ear surgery, such as cochlear implantat, and also use CPAP, should be cautioned about possible development of subcutaneous air. The placement of a tympanostomy tube as the relief valve appears to be a simple option for both prevention and remediation if temporary holiday from high pressure CPAP is not possible.

Poster Number: 28

ACI20140157: Longitudinal Analyses of Caregiver Stress: Parents of Children with Cochlear Implants versus Normal Hearing

A. Madan, MPH,Ph.D.1 , D. H. Barker, Ph.D.2 , I. Cejas, Ph.D.1 , A. L. Quittner, Ph.D.1

1University Of Miami, Miami, FL USA ; 2Brown University School Of Medicine, Providence, RI USA

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI

Introduction: Parents of children with hearing loss report greater parenting stress than parents of children with normal hearing (Lederberg & Golbach, 2002; Pipps-Siegel et al., 2002; Quittner et al., 1990; Quittner et al., 2010). However, findings are more consistent on condition-specific, rather than general, measures of stress. This study examined trajectories of parenting stress over a three-year period in parents of children with cochlear implants (CIs) vs. normal hearing (NH). We examined both general and context-specific measures of stress.

Methods: Participants included 285 children (188 CI, 97 NH) and parents participating in the Childhood Development after Cochlear Implantation (CDaCI) study. Measures of parenting stress and oral language were completed at four time points: Baseline (CI mean age in years: 2.22, SD=1.21; NH mean age in years: 2.29, SD=1.09), 12, 24, and 36 months post-implantation. At each point, language age was assessed using the MacArthur-Bates Communicative Development Inventories (Fenson et al., 1993) and the Reynell Developmental Language Scales (Reynell & Gruber, 1990). Language age was calculated by averaging age-equivalent scores on each measure for each assessment. Language delay was then computed by subtracting children’s chronological age from their language age. To evaluate parenting stress, parents completed both a general (Parenting Stress Index [PSI]; Abidin, 1995) and context-specific measure (Family Stress Scale [FSS]; Quittner et al., 1990; Quittner et al., 2010). The FSS assessed stressors specific to parents of young deaf and hearing children. Hierarchical linear modeling (HLM) was used to compare longitudinal trajectories of both general and context-specific measures of stress.

Results: Sixteen percent of data were missing; these data were estimated using Full Information Maximum Likelihood (FIML). HLM analyses indicated that parents of children with CIs showed higher scores on both the PSI and FSS (PSI: b=5.42, p<.01; FSS: b=.39, p<.001). After controlling for language delay, parents of children with CIs no longer had elevated PSI scores. On the FSS, scores marginally decreased over time (b=-.06, p=.05), but parents continued to have higher scores (b=.37, p<.001). Further, language delay independently predicted overall levels of PSI and FSS (PSI: b=-1.77; FSS: b=-.06; all p<.05).

Conclusion: These findings confirmed that parents of children with CIs experience higher levels of parenting stress than parents of children with NH. Moreover, even after accounting for language delay, parents of children with CIs showed higher levels of context-specific stress, although levels of stress showed a trend of decreasing over time. These analyses highlighted the critical role of language in parents’ levels of stress. Thus, interventions should provide parent training to support parents of children with hearing loss and severe language delays. (Funding: R01 DC004797 to John K. Niparko)

Poster Number: 29

ACI20140171: Bilateral hearing in pre-school and school-age children with cochlear implants

A. Obrycka, MS1 , A. Piotrowska, MD,Ph.D.1 , A. Lorens, MS,Ph.D.1 , M. Zgoda, MA1 , A. Lutek, MA1 , H. Skarzynski, MD,Ph.D.,Prof.1

1Institute Of Physiology And Pathology Of Hearing, World Hearing Center, Warsaw, Poland

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI

Introduction: Regardless of increasing number of studies concerning bilateral implantation in children there is still lack of compelling evidences in favor of the benefit from two devices. Most studies compare the benefit from one implant to the outcomes in two implants within the group of bilaterally implanted children. There is a need for comparison between two groups: unilaterally implanted and bilaterally implanted. Another important question is whether the bilateral advantage by means of bilateral implantation is sufficient to close a gap in speech outcomes between implanted children and normal hearing children. The aim of the study is to assess the speech perception ability in bilaterally implanted children by comparing the results of three groups of children: bilaterally implanted, unilaterally implanted, and normal hearing.

Methods: Three groups of pre-school and school-age children were selected for the study. First group constitutes of 30 bilaterally implanted children, the second group includes 59 children implanted unilaterally with no amplification of the opposite ear and 60 normal hearing children were recruited to the third group. Age of implantation matching was obtained in first and second group. The Polish version of the Adaptive Auditory Speech Test (AAST) was used in order to assess the level of speech discrimination and to facilitate the group comparison.

Results: Bilaterally implanted children perform significantly better than unilaterally implanted ones but still worse than normal hearing.

Conclusion: Two implants reduce the gap in speech outcomes achieved by one implant users as compared to normally hearing subject. The work was supported by Polish National Science Centre, decision no. DEC-2013/09/B/ST7/04213

Poster Number: 30

ACI20140256: Bimodal Benefit For Children: Pushing The Envelope

E. S. Preston,AuD1

1Utah State University, Communicative Disorders And Deaf Education, Logan, UT USA

Topic: Audiology

Keywords: Bimodal Hearing , Young and Very Young Children , Outcomes

Introduction: Traditionally, cochlear implantation is recommended for children who have a severe to profound hearing loss with less then 30% accuracy with aided word recognition bilaterally. The current candidacy guidelines do not include children who have little to no benefit from a hearing aid in one ear and have good benefit from a hearing aid in the other ear. These children should not have to wait until they become a “cochlear implant candidate” to reap the benefits of hearing binaurally. Research shows us that central summation along with listening in noise and localization are all improved when listening with both ears. Research has also taught us when we can take advantage of acoustical stimulation with electrical stimulation, people have a better appreciation of music, do better in noise and localize better. These are advantages children with hearing losses not falling within the FDA guidelines for cochlear implantation could benefit from when receiving a cochlear implant in one ear a hearing aid in the other ear. Objective: The objective of this poster is to describe clinical cases of children whose hearing was better than the FDA recommendation for cochlear implantation in at least one ear; however, their ability to function and learn language was not adequate.

Methods: This study is a retrospective chart review of children between 3-6 years of age who had a hearing loss better than the FDA guidelines of cochlear implant candidacy with poor word/sentence discrimination and who struggled significantly in the classroom and/or socially. We will look at word/sentences discrimination scores pre and post implantation for each ear separately and together as well as performance in the classroom.

Results: Results have shown that performance for each of the children improved in the bimodal condition compared to performance with binaural hearing aids in a very short period after implantation.

Conclusion: Research has shown the importance of binaural hearing for adults for localization and listening in noise. These cases provide evidence that children can have success when we are proactive when considering candidacy for cochlear implantation. Trends are showing that if a child is benefiting somewhat from their hearing aid, they will quickly benefit with the cochlear implant and surpass how they were functioning with the hearing aid.

Poster Number: 31

ACI20140306: Predictors and Detractors on Self Advocacy in Children with Hearing Loss

H. D. Pourchot1 , A. D. Warner-Czyz1 , B. A. Loy,Au.D.2 , A. Biever,Au.D.3 , D. Kelsall3 , E. A. Tobey1

1University Of Texas At Dallas, Richardson, TX USA ; 2Children's Medical Center, Dallas, TX USA ; 3Rocky Mountain Ear Center, Eaglewood, CO USA

Topic: Rehabilitation/Educational Aspects

Keywords: Social Situation of implanted children , Quality of Life

Introduction: Self-advocacy, an individual’s ability to take actions on their own behalf, relates to academic and personal success in children. Past research has found that personal motivation, self-discipline, and consistency of attendance in school contribute positively to academic success whereas inconsistent use of amplification, poor completion of class assignments, late identification, and poor motivation relate negatively to academic success in children with hearing loss. We have less information on factors that relate to self-advocacy in this population. Objective: This study examined which factors (demographic, temperament, etc.) are associated with self-advocacy skills, and the relationship between self-advocacy skills and academic success in children with hearing loss wearing hearing aids (HA) and cochlear implants (CI).

Methods: Fifty-five children (32 female) with a mean age of 12.73 years (SD=2.41) participated. All children used either HA’s (n=11) or CI’s (n=44). Average age at device fitting was 40.2 months (SD= 26.11) and the average duration of use was 9.42 years (SD=3.26). Materials included the Early Adolescent Temperament Questionnaire- Revised (EATQ-R) to assess personality characteristics (e.g., shyness, frustration, attention, etc.); and an ad hoc survey created by the Dallas Cochlear Implant Program (DCIP), which included items about self-advocacy, confidence, and academic achievement. All children independently completed the questionnaire via an online survey generator, Qualtrics. Spearman correlation coefficient analysis was computed to assess associations between demographic factors, confidence ratings, personality characteristics, and self-advocacy.. Additionally we used rho to examine association between self-advocacy and academic achievement.

Results: Children who reported higher confidence and lower levels of shyness were significantly more likely to advocate for themselves. Personality also contributed to a child’s self-advocacy. For example, shyness emerged as a detractor to self-advocacy. Self-advocacy also contributed positively to a child’s academic success. No demographic factors (e.g., age at device fitting) significantly correlated with self-advocacy.

Conclusion: Self-advocacy appears to be more reflective of the individual’s confidence and temperament (e.g., shyness) versus demographic characteristics in children with hearing loss. Results emphasize the need to look beyond demographic characteristics such as age at device fitting and duration of use to determine factors related to academic success. Additionally, detractors from self-advocacy may indirectly impact academic success. Therefore, clinicians and parents need to recognize confidence and temperamental aspects of children with hearing loss to identify children at risk for lower academic achievement.

Poster Number: 32

ACI20140339: Radiologic Evaluation of Anterior Sigmoid Sinus and Correlation with Length of Operation

K. O. O'Connor, BA1 , L. Hansen1 , C. W. Yates1

1Indiana University School Of Medicine, Indianapolis, IN USA

Topic: Surgery/Medical

Keywords: Radiology/Imaging , Medical/Surgical Issues

Introduction: High-resolution computed tomography has been a useful tool in evaluating patients requiring otologic surgery. The fine detail exhibited by these scans have allowed surgeons to identify anomalies and anticipate potential areas requiring additional attention in order to complete the surgery safely and efficiently. Subjective observation have noted that an anterior sigmoid sinus can cause difficulty in obtaining access for many otologic procedures where a mastoidectomy is required for treatment or completion. Potter [1] noted that if anterior wall of sigmoid sinus is anterior located, the post-auricular approach may be impossible. Furthermore, Tomura et al [2] analyzed the variant of no anterior-posterior distance between the posterior EAC and the sigmoid sinus (1.6% incidence 10/629 cases), making this variant rare.As noted by Xing et al [3], the average distance from the posterior EAC to the anterior wall of the sigmoid sinus is 12.98 +/-2.71mm. Less than 10.27mm is considered to be anteriorly displaced. Although a lack of anterior posterior distance between the posterior EAC and the sigmoid sinus makes the approach to the mastoid impossible, it is unknown if an anterior displaced sigmoid sinus increases surgical complexity and increases operative time. Objective: To determine if an anterior sigmoid sinus, defined as <10.27mm, increases length of otologic surgical time, indicative of a more complex surgery, when compared to cases where the sigmoid sinus is not anteriorly displaced.

Methods: In a retrospective study, 101 patients of one surgeon were identified in last 10 months requiring mastoidectomy for treatment or access. Of these 101 patients, 37 met inclusion criteria and were analyzed by measuring axial distance between the posterior external canal and the anterior sigmoid sinus on CT scan. Those patients excluded were due to prior mastoid surgery among others. 26 of the 37 patients underwent cochlear implantation.

Results: Two groups were assigned. Group 1 (n=26) did not have an anterior sigmoid sinus, group 2 (n=11) had anterior displacement of the sigmoid sinus. Operative times were recorded in minutes. Averages were calculated for these groups and compared using a two tailed t-test. No statistical significance could be elucidated, although there was a trend toward the anterior sigmoid sinus cases having a longer operative time (162 minutes vs 156 minutes).

Conclusion: Operative time lengths of patients with an anterior sigmoid sinus are similar to those without this anomaly. Despite the complexity of approaching a mastoid with an anteriorly displaced sigmoid, one can reliably predict operative length. Further expansion of this study to include a larger patient population would be helpful in increasing the power and significance of this study and potentially identify other anatomic varients that would lead to greater operative time.

Poster Number: 33


ACI20140341: Predictors of Social Competence in Young Children with Cochlear Implants

K. Peters, Ph.D.1 , J. Beer2 , D. Pisoni2

1Western Washington University, Communication Sciences And Disorders, Bellingham, WASHINGTON USA ; 2Indiana University School Of Medicine, DeVault Otologic Research Laboratory, Indianapolis, IN USA

Topic: Rehabilitation/Educational Aspects

Keywords: Cognitive and Social Development of Implanted Children , Patterns of Early Social-emotional Development in Young Children with Cochlear Implants , Speech and Language Development with CI

Introduction: Social understanding is a developmental phenomenon which refers to a child’s knowledge of the social and psychological worlds. Recent research demonstrates that such knowledge of and reasoning about how intentions, emotions, and beliefs relate to behavior are associated with a child’s social competence (his or her ability to adapt appropriately to a dynamic social environment). Children who are born deaf to hearing parents frequently experience a period of auditory language deprivation in infancy as well as a delay in access to a fluent language; consequently these children are at risk for delays in expressive and receptive language. Language delay may cause deficits in developmental domains that contribute to social understanding such as theory of mind and emotion understanding. Objective: The first goal of this study was to identify group differences in performance on measures of social understanding as well as other domains which might interact with social understanding to affect social competence between children with cochlear implants and those with normal hearing. The second goal was to determine which of those variables best predict social competence for both groups.

Methods: Participants were 24 children with cochlear implants ages 3;4 years to 9;4 years who had used a cochlear implant for an average of 4 years, and 27 chronological age and gender matched typically hearing children. The test battery included measures of general language, executive function, theory of mind, emotion recognition and comprehension, home environment, and internal state vocabulary knowledge. Social competence was measured using the Social Skills Improvement System (SSiS) parent questionnaires which provide standard scores for Social Skills and Problem Behaviors.

Results: There were no differences between children with cochlear implants and typically hearing peers on the social competence measure (SSiS). Children with normal hearing performed significantly better than children with cochlear implants on a 5-item ToM Scale, expressive language, knowledge of internal state vocabulary, and immediate memory. Children with cochlear implants demonstrated significantly better emotion recognition based on facial expression than children with normal hearing. Social skills for both groups were predicted best by knowledge of mental state terms and the interaction between expressive language and hearing status. None of these variables predicted problem behaviors in the groups. Contrary to our hypothesis, neither ToM nor emotion recognition were significant predictors of social competence in deaf or hearing children.

Conclusion:Results sugges that children with cochlear implants who have age appropriate language skills demonstrate social skills comparable to their peers with normal hearing and that expressve langugage delays in combination with hearing loss (but not theory of mind delays) put a child at increased risk for social deficits.

Poster Number: 34

ACI20140342: Can the Scalar Location of Cochlear Implant Electrodes be Determined Using Computed Tomography? A Comparison of Conventional Multi-Detector Computed Tomography and Flat-Panel Computed Tomography.

N. Connell, MS2 , T. Kennedy, MD1 , T. Szczykutowicz, Ph.D.3 , K. Royalty, MS4 , S. Schafer, Ph.D.4 , J. Jeffery, BS5 , S. Nace, MD1 , B. Gartrell, MD6 , S. Gubbels, MD6

1University Of Wisconsin Hospital And Clinics, Radiology, Madison, WI USA ; 2University Of Wisconsin School Of Medicine And Public Health, Madison, WI USA ; 3University Of Wisconsin Madison, Medical Physics, Madison, WI USA ; 4Siemens Medical Solutions, Hoffman Estates, IL USA ; 5University Of Wisconsin Carbone Cancer Center, Madison, WI USA ; 6University Of Wisconsin Hospital And Clinics, Otolaryngology, Madison, WI USA

Topic: Surgery/Medical

Keywords: Radiology/Imaging

Introduction: Cochlear implants provide patients with hearing loss of all ages improvements in speech understanding and quality of life. However, audiologic outcomes have some variability and are influenced by a number of factors. Some device-related factors that can affect outcomes include the scalar positioning of the electrode array and its depth of insertion. Measurement of these electrode-related variables using conventional multi-detector CT (MDCT) can be complicated by image artifact created by the metallic components within the electrode and insufficient scalar resolution. Flat-panel CT (FPCT) has been shown in some studies to improve upon the resolution of MDCT while reducing the appearance of artifacts. Though there are a number of studies evaluating the use of FPCT for temporal bone imaging, most of them have employed isolated cadaveric temporal bones and prototype imaging equipment, limiting somewhat their clinical relevance. Objective: We sought to determine whether a commercially available FPCT scanner may be used to more accurately determine location of the cochlear implant electrode array in comparison to conventional MDCT using whole cadaveric heads.

Methods: Four cadaver heads (8 temporal bones in situ) were used for this study. Each cochlea was accessed via standard mastoidectomy and facial recess approach. In all but one case multi-channel electrode arrays were inserted through the round window membrane, with one array inserted via scala vestibuli cochleostomy. Once inserted, the implants were cut at the facial recess and fixed in place with cyanoacrylate. The implanted heads were then imaged using MDCT and FPCT. The implanted cochleae were then isolated and imaged with micro-CT to allow for comparison.

Results: Flat panel CT showed less metallic artifact than MDCT in all post-implanted cochleae. Although the osseous spiral lamina could not be reliably seen with either FPCT or MDCT, cochlear implant scalar location could be inferred more accurately with FPCT than MDCT in all specimens, based on the relative position of the array within the cochlea.

Conclusion: Neither FPCT nor MDCT provided adequate resolution of individual scalae to allow for precise determination of the scalar position of the electrode array. Though the osseous spiral lamina is not unambiguously visible with either FPCT or MDCT, the reduced metallic artifact in the FPCT images allows for improved visualization of the electrode array within the cochlea with minimal distortion of surrounding structures. Given these results, FPCT may offer advantages when used to evaluate cochlear implant electrode position within the cochlea. The commercial availability of intraoperative FPCT imaging systems with real time imaging capabilities may enable more precise electrode placement in the future.
Siemens Medical Solutions 1 , Siemens Medical Solutions 2 GE HealthCare3

Poster Number: 35

ACI20140373: Examining Novel Word Learning by Children With Cochlear Implants

R. Stoeckel, Ph.D.1 , B. Baas1 , D. Sladen2

1Mayo Clinic, Speech Pathology, Rochester, MN USA ; 2Mayo Clinic, Rochester, MN USA

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI , Children and Recommended Rehabilitation

Introduction: Lederberg & Spencer (2009) found that direct instruction led to more rapid acquisition of novel vocaulary than indirect instruction and that word-learning abilities appear to be linked to vocabulary size rather than age. A study by Walker & McGregor (2013) showed that, in a direct instruction task, children with cochlear implants demonstrated deficits in novel word-learning compared to age-mates, but performed similarly to vocabulary-matched younger children. Direct instruction techniques that have been suggested for teaching children with cochlear implants often suggest an emphasis on novel information as a way to compensate for the artificially enhanced acoustic signal. There have been no studies directly assessing the efficiency or efficacy of specific strategies for attacting a child's attention to novel information. Objective: This study examined the response of children with cochlear implants to three types of direct instruction (repetition, acoustic highlighting, and context) for teaching novel vocabulary.

Methods: Children with cochlear implants, age 4-10, were recruited from patients implanted at our center. Children with typical hearing, matched on vocabulary, were recruited as controls. Both groups were exposed to a training task in which sets of unfamiliar objects were associated with nonvwords using a specific strategy. The sets of words and objects were randomized, as was the order of how the associations were taught. Strategies were: 1) Repetition. The child was presented with the nonword in association with an object a total of 10 times. 2) Acoustic highlighting. The child was presented with the nonword in association with an object 10 times, but the nonword was emphasized through increased loudness of the instructor's voice. 3) Context. When presented with the nonword-object association, the child was encouraged to think of why that name might be a good one for the object, and how it might be used. Following each training set, the child was asked to label the novel objects. Following all three training sets, the child was asked to label each of the target objects from all three training sets, presented in random order.

Results: Data collection is still under way. Preliminary results indicate that children with cochlear implants outperformed their vocabulary-matched peers, possibly due to the fact that they were older than the control group children. There was no clear effect of type of instruction among repetition, acoustic highlighting, or context for either group.

Conclusions: 1) Children with cochlear implants may outperform vocabulary-matched peers on acquisition of novel vocabulary because of their familiarity with this type of task. 2) Age differences and expectations for attention and cooperation among younger vs slightly older children should be considered when comparing performance of children with cochlear implants to peers on instructions tasks.

Poster Number: 36

ACI20140389: Outcomes of Cochlear Implantation in Children with Cochlear Nerve Deficiency: A Case-Matched Series

M. DeJong,Au.D.1 , A. I. Breneman,Au.D.1 , J. Breen1 , C. L. Driscoll1

1Mayo Clinic, Rochester, MN USA

Topic: Audiology

Keywords: Outcomes , Young and Very Young Children

Introduction: Cochlear nerve deficiency (CND) has become an increasingly important consideration in determining candidacy for cochlear implantation since use of MRI has become more prevalent. The presence of CND has often been thought of as an absolute contraindication to cochlear implantation, however research has shown that some of these patients have benefited from cochlear implantation and should be considered as candidates. Benefit from cochlear implantation in children can be defined as ranging from improving quality of life to becoming an auditory/oral communicator and will be impacted by the presence of CND. The aim of this study is to share the outcomes of 7 children with CND who have been implanted at Mayo Clinic Rochester. Objective: To review performance outcomes following cochlear implantation in children with cochlear nerve deficiency (CND) and compare their performance to matched controls with normal cochlear nerve anatomy.

Methods: A prospectively maintained pediatric CI database was utilized to identify all implanted patients with CND as determined by preoperative MRI. For each of the identified study patients, a single control subject was chosen. Control patients were matched for age, duration of deafness, length of CI use, degree of preoperative hearing loss and when possible co-morbidities. Results from outcome measurements including functional gain audiograms, parent questionnaires, and developmentally appropriate speech recognition tests were compared between the two groups. Additional functional outcomes reviewed included compliance with CI use and primary mode of communication.

Results: Of the 7 children with CND who received a cochlear implant, one achieved open set word recognition ability, but continues to require sign language support for communication and academic learning. The remaining children have detection of sound through their cochlear implant, but have not achieved open set word recognition. In the control group, all 7 children achieved open set word recognition ability and are primarily auditory/oral communicators. Additional data on outcomes, CI compliance and primary mode of communication will be further defined for both groups.

Conclusion: Our experience agrees with the growing consensus that patients with CND can derive some benefit from cochlear implantation, but speech perception outcomes are likely to be inferior compared to implantees with normal cochlear nerve anatomy. Given these outcomes, a careful consideration of the risks, benefits, and costs should be undertaken before implantation. Careful counseling of family members prior to implantation is necessary to ensure realistic expectations.
COI: Cochlear Corporation, Advanced Bionics And MedEL1

Poster Number: 37

ACI20140027: Pain with Failure of Cochlear Implant Device: A 5-Patient Pediatric Experience

N. W. Todd, MD,MA,MPH1 , J. C. Fainberg, MA1,2 , C. C. Ukatu1 , C. Y. Venable3 , P. Segel4 , D. B. Koch5

1Emory University School Of Medicine, Otolaryngology, Atlanta, GA USA ; 2Atlanta Speech School, Audiology, Atlanta, GA USA ; 3Children's Healthcare Of Atlanta, Anesthesiology, Atlanta, G USA ; 4Cochlear Corporation, Centennial, CO USA ; 5Advanced Bionics Corporation, Valencia, CA USA

Topic: Surgery/Medical

Keywords: Complications , Medical/Surgical Issues

Introduction: Cochlear implantation has become common and complications are infrequent. When complications do occur they manifest as malfunction of the stimulator or electrode array, or as medical/surgical complications. Instances of the latter include dizziness and facial nerve stimulation (typically managed non-surgically by programming) and wound infections. A less common complication is pain at the site of the receiver-stimulator package, unrelated to either clinical infection or trauma, including excessive magnet pressure on the intervening scalp tissues. We present data of five cases of pain of unknown origin, from a sole-surgeon pediatric practice (600+ implant surgeries; about even proportions of Advanced Bionics, Cochlear Corporation, and MED-EL devices). The onset of pain ranged from 2 to 16 years post implantation, was not associated with infection or trauma or external hardware event, and was not amenable to conventional medical therapy. In all cases pain was present regardless of whether or not the external appliance was "on", or even being worn on the head. Interestingly, 4 of the 5 patients were bilaterally implanted, but the "painful failure" was only at one ear.

Methods: We present data of five cases of pain of unknown origin, from a sole-surgeon pediatric practice (600+ implant surgeries; about even proportions of Advanced Bionics, Cochlear Corporation, and MED-EL devices). The onset of pain ranged from 2 to 16 years post implantation, was not associated with infection or trauma or external hardware event, and was not amenable to conventional medical therapy. In all cases pain was present regardless of whether or not the external appliance was "on", or even being worn on the head. Interestingly, 4 of the 5 patients were bilaterally implanted, but the "painful failure" was only at one ear.

Results: Clinical management ultimately included revision surgery in all 5 cases, with immediate resolution of the pain in 4 of 5 cases. For those 4 cases, the replacement CI performed well, without pain; the other patient fears pain if her replacement device is used, but continues enjoying her contralateral implant.

Conclusion: From our experiences, we offer a flowchart for the care of "painful CI failure" patients, encourage a worldwide registry of such cases, and offer ideas to try to understand better the problem.

Poster Number: 38

ACI20140030: Cochlear Implant Mapping in Children: Correlations of eCAP and eSRT with Most Comfortable Loudness

J. C. Fainberg, MA1,2 , N. W. Todd1 , V. Wauchope,AuD3

1Emory University School Of Medicine, Atlanta, GA USA ; 2Atlanta Speech School, Atlanta, GA USA ; 3Children's Healthcare Of Atlanta, Audiology, Fayetteville, GA USA

Topic: Audiology

Keywords: Objective Measures

Introduction: Mapping a cochlear implant in a child is challenging. Objective measures of physiologic effects of electrical stimulation, e.g., compound action potentials (eCAP) and stapedius reflex thresholds (eSRT), may prove facilitative. The primary aim of this study is to better understand the correlations between eSRT and eCAP, and the most comfortable loudness (MCL). A secondary aim is to better understand the correlations between eSRT determined intra-operatively by visualizing the stapes, versus post-operative eSRT determined by immittance.

Methods: Prospective study with MED-EL cochlear implants into 20 imaged-normal cochleae. Intra-operatively, stapedius reflexes were detected by viewing through the operative microscope; then post-operatively, eSRT by immittance and eCAP and behavioral responses were done through four months post-operatively.

Results: In surgery, eSRTs for apicad and middle and basal electrodes were seen in two-thirds of ears. At firing-up and one and three months later, eSRTs by immittance were found in less than a third of the ears. eCAPs were obtained in nearly half the ears at firing-up, and at one and three months later. The "qu" for eCAP thresholds, for apicad and middle and basal electrodes, generally were less than for most comfortable loudness levels, which were less than for eSRT by immittance. Intra-operative "qu" values for visualized eSRT, were about the same as were found by immittance through 4-months post-operatively. Post-operatively, obtaining eCAP was easier than determining the most comfortable loudness, which was easier than obtaining eSRT.

Conclusion: These preliminary data do not appear promising for eSRT having efficacy in mapping MED-EL cochlear implants in children. However, the data may endorse the usefulness of eCAP.

Poster Number: 39

ACI20140060: Hearing Loss in Culturally and Linguistically Diverse Children

C. E. Lopez, MA1

1Arkansas Children's Hospital, Speech Pathology, Little Rock, AR USA

Topic: Rehabilitation/Educational Aspects

Keywords: Children and Recommended Rehabilitation , Social Situation of implanted children , Rehabilitation for Children

Introduction: Professionals in the United States are encountering increasingly more children who are Deaf/hard of hearing (D/HH) who live in monolingual Spanish-speaking and bilingual environments. The goals of this survey were to determine the level of experience of individual participants who work with D/HH children who come from culturally and linguistically diverse households, identify how the language of assessment/intervention is decided, and ascertain how supported clinicians feel in terms of resources, interpreter availability, knowledge base, and time allotment for sessions.

Methods: This study was completed in a survey format with 19 questions and 341 participants. There were multiple choice and open-ended questions presented. This survey was sent to a wide variety of professionals.

Results: The majority of respondents work with D/HH children >10 hours weekly and a large number receive > 10 hours of continuing education with this population yearly. The majority of participants reported < 3 hours of continuing education with the culturally and linguistically diverse population, and a third have not received continuing education in this area since they graduated. The majority of respondents were monolingual English speakers, yet have had at least one child who is D/HH on their caseload in the last six months who was bilingual or monolingual Spanish-speaking. Responses varied widely regarding the typical language used during sessions. There was a trend to evaluate and intervene in English when the family and child were bilingual, but this was even present for the monolingual Spanish-speaking families. Respondents indicated that more resources are needed to work with these children. The areas of greatest need were materials in Spanish, interpreter availability for intervention, and obtaining the overall knowledge base.

Conclusion: It can be concluded that despite the current research in this field there is not yet a widespread, consistent practice for assessment and intervention for children who are D/HH and who come from culturally and linguistically diverse backgrounds. There are various paths and programs for clinicians to receive training to work with children who are D/HH; however, the results of this survey indicated the education and knowledge base for working with bilingual or monolingual Spanish speakers was comparatively low. As the Latino population continues to grow in the United States, this will increasingly become a greater problem, one that will likely continue until clinicians and educators are trained in a standardized way.

Poster Number: 40

ACI20140068: Measuring amount of daily cochlear implant use in pediatric recipients using parent report and objective data logging measures

E. Walker, Ph.D. , T. Van Voorst,AuD1 , S. Gogel,AuD1 , C. Dunn1

1University Of Iowa, Department Of Otolaryngology - Head And Neck Surgery, Iowa City, IA USA

Topic: Rehabilitation/Educational Aspects

Keywords: Rehabilitation for Children

Introduction: Few studies have documented the consistency of cochlear implant (CI) use in young children. One recent study (Walker et al., 2013) conducted interviews with parents of infants and children with mild to severe hearing loss, asking them to estimate daily hearing aid (HA) use and rate consistency across several settings. Results from that paper indicated that 1) HA use varied across settings, 2) HA use was inconsistent early in life and became more consistent with age, and 3) maternal education level and chronological age were significant predictors of amount of daily use. Similar research has not been explored in children with CIs. Recognizing which variables predict CI use time could help direct audiological counseling practices. The objective of the current study was to identify patterns and predictors of average cochlear implant (CI) daily use for children with CIs. An additional goal included examining the reliability of parent report estimates of CI use.

Methods: Audiologists collected data logging at 1 month, 3 months, and 10 months post-initial stimulation. In addition, caregivers estimated the average amount of time children wore their CIs on a daily basis.

Results: Thus far, data logging and parent report measures have been collected on five different children. On average, children wore their CIs for 9.4 hours per day, but results ranged from a minimum of 0.4 hours to a maximum of 14.3 hours per day. Preliminary findings indicated that longer daily CI use was associated with older chronological age and longer duration of CI experience. Data collection for this study is ongoing and we intend to conduct a linear regression analysis to investigate the relationships among the independent predictor variables (chronological age, age at CI stimulation, gender, maternal education level, and pre-operative better-ear PTA) and the dependent variable (average daily CI use, based on data logging). We will also determine the accuracy of parent report of average HA usage by comparing data logging values to parents’ estimates of daily CI use.

Conclusion: There is wide variation in the amount of time children wear CIs on a daily basis. Additional data collection regarding daily use practices of children with CIs will help inform clinical practices and counseling for families of pediatric CI recipients.

Poster Number: 41

ACI20140077: Relationship Between The Physiologic Spread Of Excitation And Spectral-Ripple Discrimination In Cochlear Implant Users

J. H. Won, Ph.D.2 , A. A. Martinez, BS,MS2 , C. H. Robinson, BA,MS2 , E. L. Humphrey,Au.D2 , K. R. Yeager,Au.D2 , K. Mills2 , P. Johnstone,Au.D2


Topic: Audiology

Keywords: Objective Measures , Outcomes

Introduction: Currently, numerous studies have evaluated the many factors that could affect spectral-ripple discrimination (SRD) for cochlear implant (CI) users, however the physiologic account of SRD has not been reported yet. This study examined the relationship between electrophysiological measures of channel interaction and SRD in CI users. Spectral ripple discrimination provides a time-efficient, nonlinguistic measure of spatial spectral selectivity that is correlated with perception of speech and music by CI users. It was hypothesized that broader patterns of spread of excitation (SOE) in the local region of the electrode array are associated with poorer spectral resolution in the same region of the cochlea.

Methods: To measure the amount of SOE, the electrically evoked compound action potential (ECAP) was measured with a standard forward-masking subtraction paradigm, where the probe and recording electrodes were fixed in location and the masker electrode varied systematically across all electrodes. Multiple probe electrodes were tested to examine the spread of excitation in different locations within the cochlea. To assess the local spatial selectivity, SRD was measured using narrow-band rippled noise stimuli with a bandwidth that covers two more apical and basal electrodes centered on the tested probe electrode. The width of the ECAP SOE function was compared to SRD performance.

Results: When looking at the data obtained from our subjects a high variability in the thresholds for the SRD tasks as well as in ECAP amplitude functions is observed. This variability was seen across subjects as well as within subjects tested with both implants independently. However there was a significant correlation found between the ECAP amplitude functions and the performance on the SRD task.

Conclusion: Spread of excitation in a given implanted ear can be a contributing factor in the variability seen in the perceptual performance of CI users. The results of this study suggest that spectral resolution can be associated with the amount of SOE present, less amounts of SOE would be indicative of better spectral resolution in that region of the cochlea.

Poster Number: 42

ACI20140103: Factors influencing outcomes in Romanian cochlear implanted children

V. Necula, MD,Ph.D.1 , M. Cosgarea1

1"Iuliu Hatieganu" University Of Medicine And Pharmacy, ENT Department, Cluj-Napoca, CLUJ Romania

Topic: Rehabilitation/Educational Aspects

Keywords: Rehabilitation for Children , Social Situation of implanted children , Speech and Language Development with CI

Introduction: Cochlear implant is nowadays the best solution for patients with profound sensorineural hearing loss, who do not evolve favorable with hearing aids in the best auditory rehabilitation conditions. It is known, however, that not all patients reach maximum performance. Our study aims to assess the factors that could influence the rehabilitation outcomes in Romanian cochlear implanted children.

Methods: The study was conducted on a sample of 105 children cochlear implanted in our department since 2003 to 2013. We included in study only children with severe-to-profound sensorineural hearing loss with prelingual onset, with a minimum of 6 months experience with the processor. The assessment of the outcomes was based on CAPR and SIR scores and the results were reported to the prognostic factors systematized in the Nottingham Children’s Implant Profile.

Results: Besides of young age of implantation, good results were correlated with the permanent wearing of hearing aids in the preoperatively period, with no associated diseases, proper educational environment, child’s cognitive abilities, learning skills and attention, which on depends the learning process that followed implantation. Poor auditory and verbal outcomes were associated with the presence of other diseases, inadequate educational environment with family or child exaggerated, unrealistic expectations, less developed cognitive skills, lack of language, lack of learning and attention training.

Conclusion:Cochlear implant facilitates patient access to speech sounds but the performance to understand and produce speech depends largely on the child’s intellect, the environment and how it is educated but also by desire to communicate.

Poster Number: 43

ACI20140120: Unilateral Cochlear Implantation For Asymmetric Bilateral Hearing Loss

M. Laferri_re,MOA

1Institut De R_adaptation En D_ficience Physique De Qu_bec (IRDPQ), Qu_bec, QU_BEC Canada

Topic: Audiology

Keywords: Bimodal Hearing , Outcomes

Introduction : According to FDA, cochlear implants are designed to help severely to profoundly deaf adults and children who get little or no benefit from hearing aids in both ears. As bilateral implantation is now often considered as a standard clinical practice, issue can be raised on implantation of individuals presenting an asymmetrical hearing deficit, with good aided results in the better ear. In order to address this question, the Quebec Cochlear Implant Program initiated in 2013 a clinical project where unilateral implantation is proposed to candidates with an asymmetric bilateral hearing loss. These candidates present ? in the better ear, a generally severe hearing loss associated with good auditory skills, ? in the ear to be implanted, a generally profound hearing loss and/or very limited auditory skills with a well-fitted hearing aid. Methods : A retrospective file review is undertaken for participants implanted between February 2013 and September 2014. Auditory performance data on speech perception tests are retrieved for the aided and the implanted ears in children and adults at 2 weeks and at 3 months. Complementary information on duration of deafness, age at implantation, history of hearing aid use and other deficits are also retrieved. Results : Preliminary results with 12 users show that the majority of subjects develops auditory skills on the implant side that appear similar to those observed on the hearing aid side before implantation. Final results will be presented and discussed. Conclusion : Unilateral implantation of candidates with asymmetric bilateral hearing loss is a promising avenue. The duration of deafness in the implanted ear, considering the chronological age, and the history of hearing aid use appear to be the major determinants of prognosis.

Poster Number: 44

ACI20140133: Performance on the Structured Photographic Expressive Language Test: Third Edition (SPELT-3) in a Cohort of Children with Cochlear Implants

B. S. Baas, MA , R. E. Stoeckel1 , D. P. Sladen1 , G. P. Thompson1

1Mayo Clinic, Rochester, MN USA

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI

Introduction: The Structured Photographic Expressive Language Test: Third Edition (SPELT-3) (Dawson, Stout, & Eyer, 2003) targets the assessment of morphology and syntax (morphosyntax) skills in children from ages 4-0 through 9-11. The SPELT-3 has empirical support for the purpose of differentiating between children with normal language and those with impaired language (Perona, K, Plante, E, & Vance, R, 2005). It elicits responses from a child through structured visual and auditory stimuli. Boones et al. (2013) conducted systematic research on specific language domains and error analyses on 70 school-age children with cochlear implants. Error analyses showed difficulties with morphological and syntactic rules and inefficient narrative skills. There are very few standardized assessments devoted to assessing morphosyntactic skills. The use of the SPELT-3 with children with cochlear implants has not been reviewed in the literature.

Methods: This study retrospectively reviewed 16 children with cochlear implants who were given the SPELT-3 as part of routine language assessment at a large tertiary care medical center. Patient demographics that are typically recorded include bilateral versus unilateral implantation, age at implantation, educational intervention and performance across speech and language measures. These factors were taken into account as scoring profiles were examined.

Results: Findings indicate that the SPELT-3 was sensitive in identifying language impairment in children with cochlear implants similar to other expressive language assessments that they were given. At the same time, for a subset of these children, standard scores were significantly lower on the SPELT-3 than other language assessments.

Conclusion: The authors share their hypotheses for the variability in performance. Implications for modifying intervention services and including a specific assessment such as the SPELT-3 into a standard testing protocol for children with cochlear implants will be discussed.

Poster Number: 45

ACI20140138: The Benefit of Early Fitting of Cochlear Implant Speech Processor: Assessment of the Direct Cost.

E. A. Hajr, MD1,2 , F. A. Al-Muhawas, MD1 , A. A. Hagr, Ph.D.1

1King Saud University, Medical Collage - ORL H&N Department (KAUH), Riyadh, Saudi Arabia ; 2King Fahad Medical City, ORL H&N Department, Riydh, Saudi Arabia

Topic: Rehabilitation/Educational Aspects

Keywords: Social Situation of implanted children , Quality of Life

Introduction: As a general practice, the activation of the cochlear implant takes place four to six weeks post implantation. This waiting period could rather serve to extend the implant process and consequently leading to personal and financial burdens for some individual patients. However, early fitting of the speech processor could facilitate this process by decreasing both the waiting period and the number of hospital visits for those individuals which could lead to a decrease in the direct cost associated with cochlear implantion.

Methods: Retrospective chart review of cochlear implant patients with early fitting was used. The direct cost for one hospital visit which included transportation and accommodations was estimated through questionnaire administered to all individuals. Cost effectiveness was estimated based on eliminating the need for an additional hospital visit for the activation. Patients with incomplete data were excluded from this study.

Results: Within the last year, around 100 cochlear implant surgeries were performed utilizing the early fitting approach. None of these cases developed post-op complications such as wound dehiscent or flap infection. The direct cost of next hospital follow up was assessed separately. On average, a higher cost was noticed for patients traveling from remote areas. These results highlight the effectiveness of using the early fitting approach in addressing the financial difficulties for these patients.

Conclusion: The increased number of implants every year necessitates searching for additional measures in order to optimize patients’/caregivers’ satisfaction which could influence their decisions to pursue a cochlear implant once they consider the difficulties associated with the implantation process. Early fitting of the speech processor serves as one of those measures with the aim of alleviating some of the financial and personal hardship associated with implantation.

Poster Number: 46

ACI20140155: Cochlear Implant Co-treatment Mapping Sessions: Collaborative Appointments with Audiologists and Auditory-Verbal Speech-Language Pathologists

J. T. Weingarten,AuD1 , S. Lucius,MS, CCC-SLP, LSLS Cert. AVT1

1Nationwide Children's Hospital, Audiology, Columbus, OH USA

Topic: Audiology

Keywords: Outcomes , Pre-/Perilingual Adolescents

Introduction: Collaboration amongst pediatric cochlear implant providers enhances the success of a patient’s speech and language outcomes. For young children, it can be difficult to determine if speech errors are related to articulation or auditory access. Audiology and speech co-treatment mapping sessions provide an opportunity for both disciplines to address this challenge together.

Methods: Children who receive cochlear implant (CI) mapping and are enrolled in Auditory-Verbal or auditory-based speech-language therapy are scheduled for co-treatment sessions when concerns arise due to persistent speech errors. Patients referred for co-treatment mapping sessions are at least 12 months post CI activation and are producing developmental speech errors and/or errors possibly attributed to their auditory access. Ideally, co-treatment appointments include (1) aided detection, (2) detection and loudness scaling mapping, and (3) live voice and/or recorded speech babble and perception measures, including consonant and vowel phonemes and monosyllabic words. The Auditory-Verbal therapist (AVT) scores speech perception measures and documents phonetic/phonological errors to determine if there is a pattern that could be addressed through mapping. Methods are adjusted based on the developmental capabilities of the individual patient.

Results: Patients often attend to listening tasks better for the AVT providing therapy on a weekly or biweekly basis. The AVT becomes more familiar with the child’s responses than the managing audiologist who may only see the patient on a quarterly basis. Therefore, more reliable results may be obtained when these professionals work together. Furthermore, the AVT is the most qualified professional to phonetically score speech perception testing and identify if a pattern in speech errors is present. In our current clinical experience, 8 families have had the opportunity to receive co-treatment sessions. All families reported increased communication amongst the AVT and audiologist. Furthermore, the mapping changes that were made resulted in improved perception and articulation of error pattern sounds.

Conclusion: Enhanced patient and family outcomes may be obtained with the co-treatment mapping approach. Appointment time is optimized and more reliable information is obtained from the patient. This approach increases and improves collaboration across specialties (audiology and speech-language pathology). Co-treating has enabled the audiology and speech team to optimize hearing and ensure appropriate access to speech. Through this approach, the AVT can differentiate between articulation delays, phonological errors, and errors related to hearing, which in turn affects treatment goals. Parents have reported increased satisfaction with this comprehensive approach and have further reported better hearing and better speech outcomes for their children as a result.

Poster Number: 47

ACI20140165: Impact of auditory access on sleep quality of individuals who use cochlear implants

U. Soman,M.E.D.1 , A. M. Tharpe, Ph.D.1

1Vanderbilt University Medical Center, Hearing And Speech Sciences, Nashville, TN USA

Topic: Rehabilitation/Educational Aspects

Keywords: Quality of Life

Introduction: Continuous advances in hearing technologies have provided auditory access for children and adults with hearing loss. Typically, these devices are worn during waking hours only, and most individuals with hearing loss have minimal, if any, access to sound during sleep. Sleep is deemed restorative and necessary for adequate physical, emotional and cognitive functioning. Individuals who have normal hearing have continued auditory access during the night, and do not have the option of fully eliminating auditory access. We propose that the restorative function of sleep is particularly important for individuals with profound hearing loss who often experience listening fatigue, and any disturbances in quality of sleep will have a greater negative impact on individuals with hearing loss when compared to individuals with normal hearing. In this pilot study, we examine the following research questions: 1) Do individuals with profound hearing loss sleep more soundly/differently than individuals with normal hearing? 2) Do sleep patterns of individuals with profound hearing loss change when they have auditory access via hearing technology during sleep? 3) Does access to sound throughout the night impact the restorative function of sleep for individuals with profound hearing loss?

Methods: Adults who use cochlear implants participated in this 28-day study. Participants wore at least one cochlear implant during sleep for 14 consecutive days. Participants' cortisol activity levels were monitored periodically throughout the duration of the study. Participants completed questionnaires related to sleep habits, sleep quality, fatigue and next-day functioning.

Results: The primary focus of data analyses will be to examine the impact of the independent variable, presence or absence of auditory access during sleep, on two dependent variables, sleep quality and fatigue. Within subject differences across time and conditions will be analyzed. Correlational analyses will be conducted on the subjective and objective measures of sleep quality. The fatigue scale and next day functioning scale will provide data on the participants’ perceived stress level over the course of the study. Within subject differences in fatigue and next day functioning as reported by the participants will be analyzed.

Conclusion: We hypothesize that 1) individuals with profound hearing loss sleep more soundly/differently than individuals with normal hearing, 2) sleep patterns of individuals with profound hearing loss change when they have auditory access during sleep, 3) access to sound throughout the night negatively impacts the restorative function of sleep for individuals with profound hearing loss.

Poster Number: 48

ACI20140180: Post-language patients following cochlear implant: Hearing and life quality assessment

G. M. Truzzi1 , R. A. Lauria1 , E. M. Silva1 , G. M. Carvalho1 , A. C. Guimar_es1 , S. B. Curi1 , W. A. Bianchini1 , A. M. Castilho1

1Unicamp, Departamento De Otorrinolaringologia E Cabe_a E Pesco_o, Campinas, S_O PAULO Brazil

Topic: Rehabilitation/Educational Aspects

Keywords: Quality of Life , Speech and Language Development with CI

Introduction: Hearing loss affects millions of people worldwide, leading some of those to economic impairment, social segregation, and a worse quality of life. Cochlear implants have shown advantages over other treatment alternatives, for it provides considerable hearing gains and therefore greater social interaction possibilities to the affected individuals. Objectives: To assess the hearing perception and the quality of life of post-lingual individuals with severe and profound bilateral neurosensorial hearing loss who received med-EL cochlear implant, using speech perception testing and the World Health Organization´s Quality of Life Questionnaire (WHOQOL).

Method: speech perception tests were applied to selected subjects prior to and following the cochlear implant using Med-EL, Sonata Ti100 and flex devices; the questionnaires assessing quality of life were answered afterwards.

Results: there was an improvement in the audiometry thresholds, and the patients presented a good quality of life after cochlear implant.

Conclusion: the evaluation of these subjects permits to conclude there are improvements in hearing, and that patients perceive their quality of life to be good after being subjected to cochlear implant.

Poster Number: 49

ACI20140186: Optimizing Cochlear Implant FM settings for Today's Classrooms

J. Cox,Au.D.1 , K. Vasil-Dilaj, Ph.D.1 , A. Marinelli, BA1

1New England Center For Hearing Rehabilitation, Hampton, CT USA

Topic: Audiology

Keywords: Assistive Listening Devices , Fitting

Introduction: Over the past ten years, teachers are using more cooperative and inquiry-based learning methods. Changes in teaching style are requiring an increase in listening for peer responses during classroom instruction as well as listening in groups. This change poses significant challenges for the student with a cochlear implant. FM technology, coupled directly to a student's implant processor, is the standard recommendation for students and is effective in a teacher-focused classroom. In a student-centered classroom, students need to rely on listening through their environmental microphone. Numerous studies support the benefit of FM for listening to one person in a noisy environment. To the author's knowledge, no study has strictly focused on determining the effects on the processor environmental microphone when an FM receiver is directly plugged into the implant processor. Having settings which optimize environmental listening is critical to success in competitive mainstream classrooms. Factors such as distance listening and localization play a role. Therefore it is critical that the speech processor be programmed as effectively as possible for environmental awareness and listening.

Methods: All participants will be thirteen or older. 20 cochlear implant users will be tested. Detection levels will be measured through their cochlear implant microphone with no FM plugged in, with FM plugged in but FM microphone off, and with FM active but muted. Speech perception will be assessed at a soft (35 dB HL) and conversational (50 dB HL) presentation level.

Results: Preliminary results suggests that by plugging in an FM receiver, speech perception through the implant processor decreases at soft presentation levels.

Conclusion: Students with cochlear implants need to rely on their environmental microphone much of the day in today's classrooms for peer listening. It is important to determine if speech perception ability decreases when an FM receiver is plugged in to a processor. Parameters that can be manipulated to overcome these effects will be discussed.

Poster Number: 50

ACI20140210: Sense of coherense, social networks and mental health among children with cochlear implants

L. M. Anmyr, MD1,2 , M. Olsson, MD2 , K. Larsson, MD2,3

1Karolinska Institutet, CLINTEC, Stockholm, Sweden ; 2Department Of Neurobiology, Care Sciences And Society, Stockholm, Sweden ; 3Department Of Public Health And Caring Sciences, Uppsala University, Uppsala, Sweden

Topic: Rehabilitation/Educational Aspects

Keywords: Social Situation of implanted children , Quality of Life , Patterns of Early Social-emotional Development in Young Children with Cochlear Implants

Introduction: Pediatric cochlear implantation (CI) has been a treatment option in Sweden since 1990 for children with a severe or profound hearing impairment. More than 600 children have to date received cochlear implants in Sweden. Over time, the age at CI has gradually decreased, and currently children from 5 months of age undergo surgery. Since CI was introduced as a treatment, intensive research and development have taken place in the field, but still few studies have focused on children’s social and emotional function and health-related quality of life, especially from the children’s own perspective. Objective: The aim of this study was to explore the personal and social resources of children with CI.

Methods: A cross-sectional study of 32 children, aged 6-12 years, with CI, using the Childrens's Sense of Coherence (CSOC) scale, the Network map, and the Strengths and Difficukties Questionnaire (SDQ).

Results: Children with a high SOC also had good mental health. Closeness of the social network, especially in school, was seen as important for god mental health. Children with CI did not show more difficulties or mental health compared to normal hearing children; still, some of the children with implants had a low SOC and poor mental health.

Conclusion: Children with CI showed good personal and social resources. This, however, does not mean that difficulties do not exist. The child's own perspective on e.g. mental health problems needs to be attended to.

Poster Number: 51

ACI20140212: Cochlear implantation for children with unilateral hearing loss: A review and early findings from three case studies

L. A. Greaver, BA1 , H. F. Teagle,AuD1 , J. S. Woodard,AuD1 , L. R. Park,AuD1 , E. B. Gagnon,AuD1 , S. Cheung, BS1 , C. A. Buchman, MD1

1University Of North Carolina At Chapel Hill, Ear And Hearing Center, Durham, NC USA

Topic: Audiology

Keywords: Binaural Hearing

Introduction: Unilateral hearing loss (UHL) is defined as normal hearing sensitivity in one ear and hearing loss of any severity in the contralateral ear. Studies have shown that oral language skills are poorer for school-aged children with UHL compared to their peers with normal hearing. Furthermore, children with UHL are more likely to fail a grade and be labeled with behavioral problems than children with normal hearing. Similarly, children with UHL report a poorer quality of life than their normal-hearing peers. Despite known adversities that children with UHL encounter, professional practices regarding intervention for UHL are inconsistent. Until recently, UHL has been considered a contraindication for cochlear implantation. The purpose of this literature review was to identify current evidence regarding the efficacy of cochlear implantation in children with UHL and to present case studies of three pediatric cochlear implant recipients with unilateral profound hearing loss and normal hearing to mild hearing loss in the opposite ear.

Methods: A systematic search of the literature was conducted in three electronic databases (i.e., PubMed, Google Scholar, and CINAHL) using the following key words: unilateral hearing loss, pediatric, children, and cochlear implant. Criteria for inclusion were: studies published in peer-reviewed journals, publications in English, and studies including patients with UHL receiving cochlear implants. Due to the general lack of studies about cochlear implantation in children with UHL, studies including adults with UHL receiving implants were also included. Results were summarized and evidence related to the efficacy cochlear implantation in patients (both adult and pediatric) with UHL was compiled. Psychophysical features of speech processor programs and speech perception outcomes are reported for three children.

Results: Review of the literature suggests overall positive results in regards to cochlear implantation of patients with UHL. In the adult studies, results pointed to improved speech perception in noise and greater localization ability. Children with unilateral deafness who receive cochlear implants demonstrated open set word understanding in the ear of implant soon after device activation and improved binaural hearing.

Conclusion: Further research is needed to determine the efficacy of cochlear implantation for children with UHL, however, preliminary evidence suggests that implantation may be a viable option for this population.

Poster Number: 52

ACI20140238: Relationship between speech perception, social affiliation, and social participation in children and adolescents with hearing loss

C. Evans, MS1 , A. Warner-Czyz1 , B. Loy,AuD2 , E. Tobey1,3

1University Of Texas At Dallas, Behavioral And Brain Sciences, Dallas, TEXAS USA ; 2Children's Medical Center, Enterprise Planning, Dallas, Tx USA ; 3University Of Texas Southwestern Medical Center, Otolaryngology _ Head And Neck Surgery, Dallas, TX USA

Topic: Audiology

Keywords: Outcomes

Introduction: Cochlear implants and hearing aids provide children with hearing loss access to speech, resulting in improved communication skills such as speech perception and spoken language use, but we have less information about how improvements in communication skills impact the quality of friendships, social participation, and social affiliation in children with hearing loss. Children with significant hearing loss are at risk for difficulties in social interaction, even after receiving hearing aids and/or cochlear implants, due to differences in speech perception abilities, speech intelligibility, and language skills. While children with hearing loss report friendships with deaf and hearing peers the quality of these relationships are variable. Effective communication with peers is important to the development of quality friendships, and because strong social relationships with peers are associated with less risk for psychological difficulties, we need to understand components that contribute to social competence in children with hearing loss to maximize their quality of life. Objective: This study examined the relationship between speech perception abilities and ratings of social affiliation (sense of belonging with peers) and social participation (self-reported total number of extracurricular activities) in children and adolescents with hearing loss.

Methods: Participants included 55 children and adolescents with hearing loss (M=12.8 years, SD=2.3) wearing either cochlear implants (n=44) or hearing aids (n=11). Participants completed a demographic survey and the Early Adolescent Temperament Questionnaire. Each participant’s social affiliation and social participation ratings were compared to their self-reported speech perception abilities in noise and quiet.

Results: 85% of children reported having either several friends or lots of friends. A majority of the participants reported participation in social activities after school with 84% of participants reporting involvement in at least one extracurricular activity. Speech perception abilities in noise significantly positively correlated with social participation, r = .37, p = .009, and social affiliation ratings, r = .29, p = .037. Speech perception in quiet was not significantly correlated with either social affiliation or social participation ratings.

Conclusion: Speech perception performance in noise may provide unique information about potential risk for social difficulties in adolescents with hearing loss that may not be gleaned from speech perception performance in quiet. Simultaneous examination of these factors will help clinicians identify children with hearing loss potentially at risk for difficulties in social interactions and forming quality friendships. Such identification will help generate referrals for intervention to enhance quality of life beyond communication skills in children with significant hearing loss.

Poster Number: 53

ACI20140243: Baha Attract bone conduction system-review of the patients and evaluation of the first results in Poland

P. H. Skarzynski, MD,Ph.D.1,2,3 , K. Osinska1 , L. Olszewski, MS1 , A. Ratuszniak, MS1 , H. Skarzynski, MD,Ph.D.,Prof.1

1Institute Of Physiology And Pathology Of Hearing, World Hearing Center, Warsaw, MAZOWIECKIE Poland ; 2Medical University Of Warsaw, Diagnostics And Rehabilitation Department Of Ophthalmology And Sense Organs, Warsaw, MAZOWIECKIE Poland ; 3Institute Of Sensory Organs, Kajetany, MAZOWIECKIE Poland

Topic: Surgery/Medical

Keywords: Quality of Life

Introduction: Baha Attract is a new bone conduction system which is used in treatment of conductive, mixed hearing loss, some unilateral deafness and chronic otitis media in those cases when other methods are insufficient. This hearing device uses the vibrations of the cranial bones to transmit the sound to the inner ear. The main aim of our study was to assess the results of the new bone conduction system procedure.

Methods: The analyzed group consists of 10 patients, who underwent the procedure of Baha Attract implantation at the World Hearing Center Institute of Physiology and Patology Hearing in Kajetany. Implantations were performed between October and December 2013. In this group we had 4 males and 6 females. The youngest patient was 12 years old, and the oldest was 54. Our research concerns the etiology of hearing loss among patients who underwent bone implantation. Furthermore we analyzed the coexisting factors of hearing impairment. As an assessment of the outcomes of the procedure we evaluated the results of pure tone audiometry before and after surgery and speech audiometry - 1 month after speech processor connection.

Results: Etiology of the hearing loss in studied cases contains chronic otitis media- cholesteatoma in 50% of patients, congenital malformation of the outer and/or middle ear in 40% (microtia, atresia of the external auditory canal) and posttraumatic damages of the pyramid of temporal bone in 10%. In our analysis 60% of the procedures were performed on the right ear and 40% on left side. 40% of the patients had hearing impairments of the contralateral ear- from mild hearing loss to deafness. In the group of congenital malformation other defects coexisted in 60% cases (for example hypoplasia of the mandible, cleft palate, pre-ear galls).

Conclusion: Baha Attract system is beneficial to patients with persistent conductive, mixed hearing loss and some cases of unilateral deafness. It is an ultimate method of treatment of hearing loss in congenital malformations, radical or modify radical surgery. Hearing device Baha Attract is more convenient in comparison to the percutaneous system Baha, but amplification is a little lower. Good assessment and cooperation with patient is crucial to achieve benefits from this procedure .

Poster Number: 54

ACI20140265: Initial experience with single sided deafness cochlear implantation

H. Skarzynski, MD,Ph.D.,Prof.1 , A. Lorens, MS,Ph.D.1 , L. Olszewski, MS1 , A. Walkowiak, MS1 , P. H. Skarzynski, MD,Ph.D.1,2,3

1Institute Of Physiology And Pathology Of Hearing, World Hearing Center, Warsaw, MAZOWIECKIE Poland ; 2Medical University Of Warsaw, Warsaw, MAZOWIECKIE Poland ; 3Institute Of Sensory Organs, Kajetany, MAZOWIECKIE Poland

Topic: Audiology

Keywords: Outcomes

Introduction: Single sided deafness influences the quality of life. Patients face different problems such as sound localization. in some cases they suffer from tinnitus and vertigo. Cochlear implantation is one of the possible treatment for those patients. Objective: The aim of the study was evaluation od initial experience of cochlear implantation with single side deafness.

Methods: Material consists of 20 patients. The co-factors which indicated surgical procedure with cochlear implantation were tinnitus and vertigo. Patients had former experience with bone conduction devices on headband and Cross hearing aids solutions. Important fact was to construct postoperative outcomes protocol.

Results:Initial experience was obtained and different data was collected.

Conclusion:It will have influence for future clinical procedures in single side deaf patients.

Poster Number: 55

ACI20140333: Audiological outcomes of children with cochlear implant after ophthalmologic evaluation and intervention

P. A. Samuel, BS1 , A. M. Magalh_es1 , M. Goffi-Gomez1 , R. K. Tsuji1 , R. Brito1 , R. F. Bento, Ph.D.1

1Hospital Das Cl_nicas Da Faculdade De Medicina Da Universidade De S_o Paulo, Otorrinolaringologia, S_o Paulo, SP Brazil

Topic: Audiology

Keywords: Outcomes

Introduction: After the diagnosis of deafness, all interventions are directed to hearing rehabilitation, developmental delays are often justified by deafness, and few families are guided to perform ophthalmologic evaluation to rule out the possibility of visual difficulties. In our team, some children had to wear eyeglasses, and after ophthalmologic intervention, also showed improvement in their oral communication and listening skills. Objective: To determine the number of children with cochlear implant (CI) who underwent ophthalmologic evaluation, and analyze the impact of the correction of visual abnormalities on auditory and communicative abilities.

Methods: during routine monitoring between 2012 and 2014, families of CI users aged one to 12 years old were asked if the child had already performed ophthalmologic evaluation, results, and if wearing glasses was required. Children who underwent ophthalmologic evaluation after activation of the CI and had to wear glasses were selected. Of these, we selected those with myopia degree from mild (more than or equal to 3 degrees), hyperopia degree from moderate (more than or equal to 3.25 degrees), and astigmatism associated (Otsuka, 1967 and Murray et al., 2005 classification). The mean pure tone thresholds in free field audiometry, the speech perception (Geers, 1994) and language category (Protocolo Latino Americano, 2003) of these children were analyzed. Thus, cases that had different results before and after the glasses were described.

Results: We asked 95 families on ophthalmologic evaluation and 50 (52 %) reported having undergone it. Of this total, 30 children (60 %) have some type of ophthalmologic abnormalities, most frequently myopia and wear glasses for correction. Fifteen children (30%) have visual abnormality in accordance with the aforementioned classification, and from these were selected two children who showed differences in their evolution after wearing eyeglasses. A female child, seven years old, four years of CI use, had never collaborated to perform audiometry and speech perception tests, and six months after the diagnosis of eight degrees of myopia and wearing glasses, started to respond to free field audiometry and reached category 4 of speech perception. Another case, five-year-old girl, four years of CI use, had access to speech sounds and category 4 speech perception; after diagnosis with four degrees of hyperopia and astigmatism, showed progression to category 4 of speech perception and improvement in oral language.

Conclusion: We found the incidence of 60% of children wearing eyeglasses, of which 30% have significant visual difficulties. Two patients had significant impact on hearing and communicative development after fitting of eyeglasses. The ophthalmologic evaluation of children candidates and users of CI should be done routinely, given the incidence of visual difficulties and benefit the ophthalmologic intervention can cause to the development of these children.

Poster Number: 56

ACI20140349: Hearing Preservation in Children after Cochlear Implantation

D. R. Schramm, MD,FACS,MS1 , E. Shaw-Pickard1 , Y. Beauregard1 , L. Moran1 , J. Whittingham1

1University Of Ottawa, Department Of Otolaryngology, Ottawa, Ontario Canada

Topic: Surgery/Medical

Keywords: Hearing Preservation , Medical/Surgical Issues

Introduction: Cochlear implantation is used for the management of bilateral severe-to-profound sensorineural hearing loss. Residual hearing is typically lost when conventional surgical techniques and standard electrode arrays are utilized. The development of less traumatic electrode arrays and the utilization of “soft surgery” techniques have allowed for the possibility of residual hearing preservation. Objective: The purpose of this study was to evaluate preservation of residual hearing in children undergoing cochlear implantation.

Methods: Immediately prior to surgery, all patients received intravenous dexamethasone and prophylactic antibiotics. A cortical mastoidectomy-facial recess approach was utilized to visualize the round window. The bony overhang of the round window niche was removed with a Skeeter drill to visualize the anterior aspect of the round window. If there was sufficient visualization, round window insertion was performed. An extended round window approach cochleostomy was utilized if round window access was limited. Insertion of the Med-El FlexSoft or Flex 28 electrode into the scala tympani was performed slowly. The electrode array was directed antero-inferiorly during insertion. A fascia graft was placed around the electrode array at the round window to seal the cochlea.

Results: Eight children (12 ears) between 1 and 14 years of age (mean age 7.5 years) have undergone implantation of the Med-El system with the FlexSoft or Flex 28 electrode array. Post implant audiograms demonstrated preservation of residual low frequency hearing.

Conclusion: Less traumatic flexible electrode arrays and “soft surgery” techniques have allowed for the possibility of residual hearing preservation in children undergoing cochlear implantation.

Poster Number: 57

ACI20140379: Experiences with Cochlear Implantation in Children with Asymmetrical Hearing Loss

J. Baum,Au.D.1 , R. Cullen1 , S. Zlomke,Au.D.1 , K. Lewis,Au.D.1

1Saint Luke's Midwest Ear Institute, Kansas City, MO USA

Topic: Audiology

Keywords: Bimodal Hearing , Outcomes , Young and Very Young Children

Introduction: With the excellent outcomes noted in children with cochlear implants, recent focus has turned to children with asymmetric hearing loss. Over the years we have implanted children with asymmetric hearing loss on a case-by-case basis. A review of outcomes in these cases may provide insight to how childrent with asymmetric hearing loss can benefit from cochlear implantation. Objective: To determine if, and to what degree, children with asymmetric hearing loss can benefit from cochlear implantation.

Methods: Children with asymmetric hearing loss who received a cochlear implant at Midwest Ear Institute were evaluated by chart review.

Results: Outcomes for cochlear implantation in children with asymmetric hearing loss will be presented, including audiometric and speech perception data.

Conclusion: Children with varying degrees of asymmetric hearing loss can benefit from cochlear implants.

Poster Number: 58

ACI20140398: The 35delG Mutations Across Europe

L. R?dulescu, MD1 , C. M_r?u, MD1 , G. Damean1 , S. Cozma, MD1

1University Of Medicine And Pharmacy _Gr.T. Popa_, ENT, Iasi, IASI Romania

Topic: Basic Research

Keywords: Genetics

Introduction: The previous published papers before 2009 show a high carrier rate of 35delG in the Southern part of the Europe, demonstrating a South to North gradient. The papers published after 2009 bring new data about the distribution of the 35delG mutation in the Eastern part of the Europe. Objective: The aim of this study is to describe and to compare the carrier rates of 35delG in different European populations.

Methods: We have performed a search on PubMed using keywords:”35delG”,”GJB 2” and ”carrier”. We obtained data from 29 European countries including 25422 healthy random choosed individuals from which 517 were 35delG carriers.

Results: The mean carrier frequency of 35delG for Europe was 2.1%. In the East part of the Europe we found a rate of 35delG carriers higher (Estonia - 4.5%, Belarus -5.73%) or at least similar (Ukraine - 3.3%, Romania - 3.38%) with those found for the South of Europe (Greece being considered, untill now, the country with the highest carrier frequency in the world - 3,54%). We found also that the highest carrier rate of 35delG mutation was in Belarus (5,73%).The lower carriers frequencies were found in countries from North (Norway - 0.52%, Sweden - 1.51%), Central (Austria - 1.3%, Slovenia - 0.55%, Bulgaria 0.64%) and West of Europe (UK 1.34%).

Conclusion: Our study confirm once more the South-to-North gradient in the carrier frequency of 35delG in Europe and brings in the attention the East part of the Europe where was found a rate of mutation at least similar with that found in the South suggesting an East-to-West European gradient.

Poster Number: 59


J. S. Fredriksen,M.Ed. , T. Sands,SLP, LSLS1

1MED-EL Corporation, Durham, NC USA

Topic: Rehabilitation/Educational Aspects

Keywords: Children and Recommended Rehabilitation , Rehabilitation for Children , Speech and Language Development with CI

Introduction: : Language Acquisition & Development (e.g. Giving therapists tools to evaluate and maximize auditory development on an ongoing basis for the first 3 years of acquisition.) Early intervention along with technology advances, have given children an extraordinary opportunity to advance auditory brain development. The Little Ears Auditory Questionnaire and Diary helps to provide the clinician/therapist with early auditory development information based on lack of auditory stimulation. The assessment, which was standardized based on normal listening milestones, can help to identify delays as well as be used to monitor auditory development pre and post CI implantation/activation or Hearing Aid stimulation. The Diary is designed to guide parents’ observations of their child and allow them to share that information with their therapist or clinician. It can be used as an evaluation tool in the first year after fitting. Beyond that, it can help optimize the child’s rehabilitation process and device fitting.

Methods: Case study and practice of filling out the Auditory Skills and Questionnaire form and evaluating the process.

Results:Video of Parents who use auditory strategies/techniques with their CI Child.

Conclusion:Primary auditory skill development takes place within the first few years after access to sound. Monitoring skill development is necessary to provide timely intervention and to make sure progression occurs appropriately and naturally. Professional’s knowledge of the auditory hierarchy of skills, and timelines of expectation for acquisition of these skills, is paramount. Using this assessment will provide the documentation needed to assess progress. Using the Diary helps the therapist to focus on the listening strategies and techniques needed to facilitate development of auditory skills with the family, including a review of auditory skills hierarchy that progress from awareness, discrimination, identification and comprehension.
COI: MED-EL Corporation1

Poster Number: 60

ACI20140053: Outcomes Of Auditory Brainstem Implants In Children : Report Of 2 Cases


1University Hospital Beni Messous, Department Of Otorhinolaryngology Head And Neck Surgery, Algiers, Algeria

Topic: Other Implantable Devices

Keywords: Auditory Brainstem Implants

Introduction: Auditory brainstem implants are commonly indicated for patients with neurofibromatosis type 2 who had bilateral schwannoma removed. The indications are extended to nontumor patients with cochlear nerve aplasia or malfunctions and with bilateral complete ossification of the cochlea.

Methods: We present a retrospective study that includes two cases of auditory brainstem implantation performed in our department in december 2012. Both patients were children aged respectively : 8 and 15 years old at the time of implantation. They presented with acquired bilateral profound hearing loss following bacterial meningitis. Preoperative assessment included audiological testing, and radiological imaging of the temporal bone (computed tomography and magnetic resonance imaging). Postoperative audiophonological performances was evaluated by using category of auditory performance CAP and meaningful auditory integration scales (MAIS).

Results: Computed tomography revealed in both cases bilateral complete ossification of the cochlea , Magnetic resonance imaging showed total fibrosis bilaterally. Auditory brainstem implantation via retrosigmoid approach was performed in a delay ranging from 5months to 6years following meningitis. In our two patients, the numbers of active electrodes were respectively 19/22 and 13/22. Postoperatively, we observed in one patient cerebrospinal fluid leak that resolved and did not require surgical revision. Activation was carried out on average at 30 days after surgery, with the patients in a surgical setting with cardiac monitoring. One year postoperatively, both patients reported auditory sensations with activation of various numbers of electrodes.One patient aged 15years at surgery, was able to perceive environment sounds and perform speech recognition and production. The other patient aged 8 years old at implantation surgery, could perceive only low frequencie sounds, and did not show any improvement in speech production performances.

Conclusion: Auditory brainstem implantation is considered as an therapeutic option for the treatment of profound hearing loss in patients who cannot benefit from cochlear implant surgery. However, Its outcomes could be less predictable than cochlear implants. Our preliminary results show that auditory brainstem implants restore the hearing perception of environmental sounds.Speech production performances could progress slowly particularly in prelingually deaf children with a long period of deprivation.

Poster Number: 61

ACI20140062: Electrophysiological Verification of Advanced Bionics ClearVoice Strategy in Adults

A. Smith, MA1 , E. Jeon,AuD1 , C. J. Brown1

1University Of Iowa, Iowa City, IA USA

Topic: Audiology

Keywords: Objective Measures , Fitting

Introduction: Advanced Bionics recently introduced a noise reduction algorithm called ClearVoice(CV). CV automatically identifies and reduces gain of frequency bands with high noise levels. Acceptance of this noise reduction strategy is not universal and currently there is no consensus as to how aggressive the noise reduction setting should be. Still, many clinicians encourage adults to use CV and it seems likely that this recommendation will soon be extended to children. Pediatric CI users may not be able to express their preference for CV, thus, it would be helpful if there were an objective measure of benefit that could help guide clinical decision making. In this study we ask whether cortical auditory evoked potentials (CAEPs) can be used to assess benefit from the use of CV. We measured CAEPs in background noise from a group of 10 Advanced Bionics CI users and hypothesized that CAEPs recorded when CV was on would be larger than when CV was off. Additionally, that participants who gained the most from the use of the CV strategy – as measured using speech in noise tests – would exhibit the largest difference in CAEP amplitudes.

Methods: The stimulus was an 800-ms digital sample of a clarinet playing C4 and then switching to F4 after 400 ms. All stimuli were presented in the sound field in continuous background noise. Signal to noise ratios (SNR) from +10 dB to 0 dB were used. For each stimulus, 2 CAEPs were recorded: an onset response and a change response. Testing was repeated twice: once with CV on and once with it off. Speech perception in noise was also measured with and without use of CV.

Results: AZ Bio scores decreased as the SNR decreased. At 0 dB SNR, paired T-tests revealed a significant improvement in AZ-Bio scores with CV on compared to CV off (T=-5.56, dF = 8, p=0.003). CAEPs were recorded from all participants. Onset responses were larger than change responses and neither showed evidence of stimulus artifact contamination. Increases in the noise level resulted in a decrease in CAEP amplitudes. At 0 dB SNR, three of the 10 participants had a measureable change response with CV off compared with six of 10 who had a measureable change response with CV on. Mean data showed larger CAEP amplitudes when CV was used than when it was not, however, the effect size was small and the difference was not significant (p>0.05).

Conclusion: The use of CV can result in improved speech perception scores in high noise conditions. CAEP amplitudes were slightly larger when CV was used compared to when it was not, however, the the effect size was small and not significant. Our conclusions may have been different if we had used a different stimulus or a more aggressive setting for CV.

Poster Number: 62

ACI20140080: Performance testing for RealLife

A. Buechner, Ph.D.1 , A. Moeltner2 , U. Baumann3 , I. Anderson5 , D. Scholer5 , T. Braecker5

1Medizinische Hochschule Hannover, ENT Department, Hannover, Germany ; 2University Of Wuerzburg, Department Of Oto-Rhino-Laryngology, Plastic, Aesthetic And Reconstructive Head And Neck Surgery, Wuerzburg, Germany ; 3Goethe University, ENT Dept., Frankfurt Am Main, Germany ; 4University Of Bochum, ENT Dept., Bochum, Germany ; 5MedEl Elektromedizinische Geraete Gesellschaft M.b.H., Innsbruck, Germany

Topic: Audiology

Keywords: Outcomes , Speech Test Theory

Listening in real-life everyday situations is difficult because of background noise and reverberation. Many hearing implant users complain that they have difficulty understanding speech in background noise and that listening in noisy situations requires a lot of listening effort. Although noisy situations are common in everyday life, clinicians have not traditionally evaluated patients using tests that simulate real life listening. In order to fully understand patient performance and subjective benefit, we need to assess both aspects. This study looks at objective performance measures that may provide the clinician with a comprehensive and realistic profile of listening performance, for all hearing implant users. Unilateral and bilateral cochlear implant users, SSD cochlear implant users, EAS users, ABI users, Vibrant Soundbridge users and Bonebridge users will be assessed on the following real-life tests: - Roving level test -Just understanding speech test (JUST) -Performance-Perceptual Test (PPT) -VAS for listening effort -HISQUI -Munich Music Questionnaire This paper will explain the tests, show outcomes from the normal hearing data and demonstrate preliminary outcomes from the study.
MedEl1 , MedEl2 MedEl3

Poster Number: 63

ACI20140086: Recovery Function of the Auditory Nerve in Cochlear Implant Surgery Under Local Anesthesia and Sedation - Comparison with General Anesthesia.

R. K. Rezende1 , R. Hamerschmidt1,2 , M. Mocellin1,2 , G. Wiemes1,2

1IPO, UFPR, Curitiba, PARAN_ Brazil ; 2IPO, Curitiba, XX - OTHER STATE/PROVINCE/TERRITORY Brazil

Topic: Surgery/Medical

Keywords: Alternative Surgical Approaches , New Indications_ , Middle Ear Implants

Introduction: The Custom Sound EP software connected to the Cochlear’s Freedom Implant Contour Advance™, can measure the Neural Recovery Function (REC) in Cochlear Implant (CI) Surgery. There are studies showing alterations in REC intraoperatively and postoperatively of CI surgery. The ability to perform cochlear implant surgery performed under local anesthesia and sedation has already been proven.

Methods: Prospective study with two groups: "A”, comprising 5 patients who underwent CI surgery under local anesthesia and sedation, and "B”, comprising 5 patients who went surgery under general anesthesia. The measurement of the recovery function was made accessing Advanced NRT software on three electrodes: basal, medial and apical. The results for each patient were saved in the software program, with series corresponding to each electrode. For analysis of the results we used statistical test: non-parametric Mann-Whitney test. The level of significance was set at <0.05

Results: No significant difference was observed in the values of To, A and Tau. The function of neural recovery in the group undergoing surgery with local anesthesia and sedation is similar when compared to general anesthesia except in measures of "tau" for the basal electrode that showed a level of statistical significance at p = 0.004.

Conclusion:The type of anesthesia, sedation and location did not affect the values ??of "To", "A" and "tau" in recovery function, except in the basal electrode, the valeu of “tau”, we found a statistically significant difference.

Poster Number: 64

ACI20140095: Single-Site Objective and Subjective Outcomes of Electric-Acoustic Stimulation

M. Anderson,AuD1 , M. Dillon,AuD1 , M. Adunka,AuD2 , E. King,AuD2 , O. Adunka, MD1 , C. Buchman, MD1 , H. Pillsbury, MD1

1University Of North Carolina At Chapel Hill, School Of Medicine, Dept Of Otolaryngology/Head & Neck Surgery, Chapel Hill, NC USA ; 2UNC Health Care, Dept Of Audiology, Chapel Hill, NC USA

Topic: Audiology

Keywords: Residual Hearing , Outcomes

Introduction: Traditionally, the treatment options for individuals with steeply sloping mid-to-high frequency hearing loss have been limited. While they experience minimal benefit from conventional amplification, these individuals frequently have too much residual hearing to be considered candidates for conventional cochlear implantation. Recent advances in electrode array design and surgical techniques have resulted in hearing preservation postoperatively in the implanted ear. These recipients utilize the combination of acoustic and electric technologies in an ipsilateral listening condition, known as Electric-Acoustic Stimulation (EAS). Previous studies have reported postoperative benefits when listening in the combined mode (EAS) as compared to either stimulation modality alone.

Methods: Subjects were followed preoperatively, and at 3, 6 and 12 months post-initial EAS activation. The objective test battery included CNC words in quiet and CUNY sentences in steady-state noise at SNR+0. Recorded materials were presented at 70 dB SPL in the sound field. Subjective report was assessed with the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Hearing Device Satisfaction Scale (HDSS).

Results: Thirty-one (31) subjects completed the study endpoint. Subjects experienced a significant improvement on speech perception tasks in both quiet and noise with EAS as compared to their preoperative listening condition. Speech perception performance was significantly improved when listening in the combined mode as compared to either stimulation modality alone. Subjective reports indicated greater satisfaction postoperatively with EAS as compared to the preoperative listening condition.

Conclusions: Subjects with preserved residual hearing experienced improved speech perception and subjective benefit from utilizing hearing aid and cochlear implant technologies in an ipsilateral listening condition. EAS may be a viable treatment option for patients with severe-to-profound high-frequency thresholds who do not benefit from appropriately fit amplification.
MED-EL Corporation1 , MED-EL Corporation2 MED-EL Corporation3

Poster Number: 65

ACI20140096: A Qualitative and Quantitative Analysis of the new Advanced Bionics Naida CI Q 70 Speech Processor and the Ultrazoom Feature in the Paediatric Population.

R. Richards, BS1 , J. Martin1 , M. Jenkins1 , T. Thomas1

1St Thomas Hearing Implant Centre, Paediatric Hearing Implants, London, United Kingdom

Topic: Audiology

Keywords: Pre-/Perilingual Adolescents , Objective Measures , Outcomes

Introduction: Advanced Bionics (AB) have released the Naida CI Q 70 sound processor. Children upgraded from the Harmony to the new device now have a variety of new features available. We would like to investigate the newest feature, Ultrazoom. This technology relies on fixed directional microphones or beamformers, which are more sensitive to sound arriving from the front of the microphone for improved speech understanding in noisy settings. AB also recommend that the new Optima S speech processing strategy is used with the new processor. Optima S is claimed to take advantage of AB’s current steering technology to reduce power requirements of the system and improve battery life, without sacrificing performance. This study will assess in the paediatric population 1) a significant improvement in speech understanding in noise with the ultrazoom feature 2) a difference in performance between the Hi-Res120 and the Optima S strategies and 3) a subjective benefit reported with the ultrazoom feature and the Naida CI Q70 processor and also assess how practicable is it for children to utilize the feature independently via questionnaire.

Methods: The McCormick Toy test in noise will be used to evaluate the ultrazoom feature in the paediatric population. Speech will be presented from one speaker located at 0 degrees from front of the subject while white noise will be simultaneously presented from two other speakers located at 90 degrees. The test will be carried out in the following 4 conditions: a) with the child wearing the Harmony speech processor with the HiRes 120 processing strategy, b) with the child wearing Naida CI Q70 speech processor with HiRes 120 processing strategy, c) with the child wearing Naida CI Q70 speech processor with Optima S strategy and d) with the child wearing the Naida CI Q70 speech processor using Optima S stragety and Ultrazoom feature. A group of 26 children with ages ranging from 7 years to 17years will be involved in this study, all of whom were upgraded from the Harmony speech processor to the new Naida CI Q 70 processor between October 2013 and March 2014.

Results: The difference in speech perception scores will be analysed to see if there is a significant improvement in speech understanding in noise with the Optima S strategy and also with Ultrazoom. The outcome of the client questionnaire will provide insight into the subjective benefit and practicability of ultrazoom use with the Naida CI Q 70 sound processor in the paediatric population.

Conclusion: The outcome of this investigation will highlight whether there is a significant difference in speech understanding in noise using the ultrazoom feature both qualitatively and quantitatively. This analysis will also find out if there is a difference in performance with the change from Hi-Res120 to the Optima S strategy for our population of children. The overall subjective satisfaction of the new Naida CI Q70 speech processor will also be reported on in this population.

Poster Number: 66

ACI20140098: Hearing Loss And m.1555A>G Mitochondrial Mutation

R. G. Bonhin1 , H. F. Pauna1 , P. Z. Ramos1 , A. C. Guimar_es1 , A. M. Castilho1 , E. L. Sartorato1 , G. M. Carvalho1 , E. M. Silva1

1Unicamp, Departamento De Otorrinolaringologia E Cirurgia C_rvico-Facial, Campinas, S_O PAULO Brazil

Topic: Basic Research

Keywords: Gene Therapy , Genetics , Speech Coding

Hearing loss (HL), one of the commonest sensory disorders, can be caused by a variety of environmental and genetic factors 1. Genetic HL of non-syndromic form can be caused by mutations in both nuclear and mitochondrial genes 3. Mitochondrial mutation (m.1555A>G) in theMTRNR1 gene is related to HL. The aim of this study is to describe the m.1555A>G genetic mutation in the MTRNR1 gene and its relationship with hearing loss plus medical literature review. A retrospective study of medical records of a patient who was diagnosed with profound hearing loss and m.1555A>G mutation. The medical literature review was performed using the MeshTerms: genetic hearing loss; non-syndromic hearing loss and m.1555A>G. Female, 16 years-old, hearing loss since birth, whith a sister and niece profoundly deaf since birth too, no change in the physical examination. Imaging studies without anatomical alterations. Auditory evoked potential in 90 dB HL bilaterally.Genetic study identified the presence of m.1555A>G mutation in the MTRNR1 gene without aminoglycoside exposure. The m.1555A>G mutation is a common cause of genetic HL in Brazil. Genetic counseling regarding maternal inheritance, and assist pharmacological strategies for the prevention or diminution of HL progression. Early treatment can allow many infants to develop normal language skills, using hearing aids, cochlear implants, audiologic rehabilitation, speech-language therapy and pharmacological therapy. Gene transfer by viral vectors or nanoparticles represents a promising approach for delivering therapeutic genes into the inner ear18. Stem cells have been the subject of intense speculation as they open radically new therapeutic possibilities18.

Poster Number: 67

ACI20140113: Long-Term Hearing Preservation and Aided Speech Perception Outcomes of Electric-Acoustic Stimulation

A. Bucker, BA1 , M. Dillon,AuD2 , E. King,AuD1 , M. Adunka,AuD1 , C. Buchman, MD,FACS2 , O. Adunka, MD,FACS2 , H. Pillsbury, MD,FACS2

1UNC Health Care, Audiology, Chapel Hill, NC USA ; 2University Of North Carolina At Chapel Hill, Otolaryngology/Head And Neck Surgery, Chapel Hill, NC USA

Topic: Audiology

Keywords: Residual Hearing , Outcomes

Introduction: Electric-Acoustic Stimulation (EAS) combines hearing aid and cochlear implant technologies in an ipsilateral listening condition. The ability to utilize EAS relies on hearing preservation in the implanted ear. Advances in electrode array design and soft surgical techniques have allowed for postoperative hearing preservation. Recipients with postoperative hearing preservation have reportedly improved aided speech perception outcomes in quiet and noise with EAS as compared to preoperative abilities with conventional amplification. This study examines whether postoperative hearing preservation and aided speech perception abilities can be maintained with long-term listening experience.

Methods: All subjects were participants in the EAS clinical trial. Enrollment was dependent on the following criteria: English as a primary language, age at implantation between 18-70 years, documentation of stable residual hearing, normal middle and inner ear anatomy, aided monosyllabic word scores of 60% or less, and residual hearing within candidacy guidelines. Subjects had at least 4 years of listening experience with EAS. Subjects were assessed preoperatively, at 3, 6, and 12 months and then annually, post initial EAS activation. Residual hearing thresholds and aided speech perception were measured at each interval. The objective test battery included CNC words in quiet and CUNY sentences in steady-state noise (SNR+0).

Results: One subject lost hearing completely prior to cochlear implant activation. Variation in hearing preservation was noted over the reviewed intervals. All subjects, irrespective of residual hearing status experienced statistically significant improvement on speech perception tasks in both quiet and noise as compared to their previous listening condition. This marked improvement was maintained after 4 years of listening experience.

Conclusion: Patients with preserved low-frequency residual hearing experienced improved speech perception from utilizing hearing aid and cochlear implant technologies in an ipsilateral listening condition. EAS is a viable treatment option for patients with severe-to-profound high frequency thresholds who do not benefit from appropriately fit amplification.
MED-EL Corporation1 , MED-EL Corporation2 MED-EL Corporation3

Poster Number: 68

ACI20140152: Considerations in Intervention for Children with Autism

F. Bathgate, MA,DClinPsych1

1Great Ormond Street Hospital For Children, Cochlear Implant Programme, London, United Kingdom

Topic: Rehabilitation/Educational Aspects

Keywords: Multiple Handicapped Children

Children with cochlear implants who also have a diagnosis of Autism Spectrum Disorders (ASD) can prove a challenge to professionals working with them. This presentation aims to review the literature on dually diagnosed children, highlighting the difficulty in diagnosising ASD in children with hearing impairment (HI) and discussing the impact of ASD on outcomes post-cochlear implant. There is very little research on ASD and hearing impairment, so we have to draw on the ASD literature to help inform rehabilitation post-cochlear implant. We must also acknowledge that the autistic spectrum is broad and children with ASD and HI will be highly varied. This raises the questions of how best to intervene, and how do we measure outcomes in such a hetergeneous popultation? Whilst professionals may view these children as a potential challenge, they and their families are also a rich source of learning for us. I will describe the group of children with ASD seen at our cochlear implant centre and what our team feels they have taught us.

Poster Number: 69

ACI20140160: Changes In Children’s Speech Reception Thresholds And Spatial Release From Masking From 2 To 4 Years Post Sequential Cochlear Implantation.

C. H. Raine, MD,BS,MS,FRCS1 , C. Killan1 , E. Killan2

1Yorkshire Auditory Implant Service, Bradford Royal Infirmary, Bradford, West Yorkshire United Kingdom ; 2School Of Healthcare, University Of Leeds, Leeds, West Yorkshire United Kingdom

Topic: Audiology

Keywords: Binaural Hearing , Outcomes , Pre-/Perilingual Adolescents

Introduction: Knowledge of long-term outcomes in sequential implantation is needed for optimum candidacy selection and patient counselling. Studies to date describe speech outcomes up to two years post 2nd implant only. Up to this point results are asymmetrical across ears, with 1st-implanted ears providing better speech reception thresholds (SRTs), and less spatial release from masking (SRM) experienced if noise is closest to the 1st-implanted ear. Objective: To extend knowledge of clinical outcomes beyond 2 years post 2nd implant we compare results at 2 and 4 years post 2nd implant to test the following hypotheses: Hypothesis 1: Monaural SRTs in quiet will improve in both 1st and 2nd implanted ears. Hypothesis 2: Binaural SRTs in noise will improve. Hypothesis 3: SRM will improve. Hypothesis 4: SRM will become more symmetrical.

Methods: This is a longitudinal study where children act as their own controls. From our caseload we identified 17 sequentially implanted children who by two years post 2nd implant were optimally programmed users of both implants, tested at both intervals. They participated in the McCormick Toy Discrimination Test with toy names presented from 0° azimuth, monaurally in quiet and binaurally with pink noise presented from 0°, -90°, and +90°. SRTs were calculated using an adaptive procedure to find the 71% correct level. SRM was calculated from SRTs in noise. Data were analysed via two-level hierarchical regression models with measurement and subject as levels one and two respectively.

Results: Hypothesis 1: Both ear and test interval had a significant effect on SRTs in quiet (p<0.05 and p<0.0001 respectively) with 1st-implanted ears performing better. 1st-implanted ears improved by a mean value of 6.4dB and 2nd-implanted ears by 8.1dB over the two year period, however the difference in improvement was not significant. Hypothesis 2: Noise location and test interval both had a significant effect on binaural SRTs in noise (p<0.0001). Noise and speech from 0° was the most challenging condition and noise 90° towards the 2nd-implanted side was the easiest. There was also a significant interaction (p<0.01) showing that the change over time was dependent on the direction of the noise. While SRTs with noise from 0° improved by 2.7dB, larger improvements of 7.2dB and 5.7dB were seen for noise presented 90° towards 1st and 2nd-implanted ears respectively. Hypothesis 3: SRM significantly improved over time (p<0.001). This improvement was not dependent upon noise location. Hypothesis 4: Analysis of the change in absolute differences in SRM with noise at +90° and -90° found a small but non-significant increase in symmetry over time.

Conclusion: Our findings support hypotheses 1, 2 and 3, i.e. monaural SRTs in quiet, binaural SRTs in noise and SRM improved from 2 to 4 years post 2nd implant. However our results did not support hypothesis 4. This may be due to a persistent effect of auditory deprivation prior to 2nd implantation

Poster Number: 70

ACI20140167: Cochlear Implantation in Labyrinthitis Ossificans

M. S. Lavor1 , G. M. Carvalho1 , G. V. Coelho1 , E. M. Silva1 , A. C. Guimar_es1 , C. Onuki1 , W. A. Bianchini1 , A. M. Castilho1

1Unicamp, Departamento De Otorrinolaringologia E Cabe_a E Pesco_o, Campinas, S_O PAULO Brazil

Topic: Surgery/Medical

Keywords: Vestibular Dysfunction Cochlear Implantation , Difficult or atypical patients

Introduction Labyrinthitis ossificans is a pathologic ossification in the otic capsule due to an inflammatory or destructive process. The main causes are meningitis, trauma and otosclerosis. Cochlear ossification results in sensorineural hearing loss and its presence is associated with technical difficulties and poorer functional results. Advances in surgical techniques and bioengineering provided the development of special etectrodes for this condition. The aim of this study is to evaluate the functional results with partial standard and double-array cochlear implantation in ossified cochleas and further the performance using the device, the complication rate and patient's satisfaction. Methods A retrospective and transversal analysis of data on the demographic aspects, auditory performances, surgical findings and quality of life was made. A satisfaction questionnaire was implemented and a transorbital radiograph was used to evaluate migration and depth of insertion of the electrode and the position of the internal component. All patients who underwent either partial insertion of a standard electrode array or double-array electrode insertion for their cochlear implantation in a quaternary centre in the last five years were included. Results Eight patients (six adults and two children) were included. The cause of labyrinthitis ossificans was bacterial meningitis in six cases, Cogan's syndrome in one patient and trauma in one patient. The majority of patients were implanted in adulthood and the average duration of deafness was 104.5 months. Displacement of basal electrode was observed in one patient, he went through a new surgical procedure with successfully repositioning. Discussion Bacterial meningitis was the most common cause of cochlear ossification in the sample. In adult patients, meningitis acquired in childhood resulted in a longer deafness than in children , that may explain poorer auditory results. Conclusion Patients with ossified cochleas benefits significantly from double-array and compressed short array cochlear implantation.

Poster Number: 71

ACI20140173: Auditory development in very young profound deaf children

A. Obrycka, MS1 , A. Lorens, MS,Ph.D.1 , A. Piotrowska, MD,Ph.D.1 , J. L. Padilla, MS,Ph.D.2

1Institute Of Physiology And Pathology Of Hearing, World Hearing Center, Warsaw, Poland ; 2University Of Granada, Department Of Methodology Of The Behavioural Sciences, Granada, Spain

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI

Introduction: Much of the research on paediatric HAs and CIs has been using audiological outcome measures including a variety of hearing or speech tests which do not take into account the existence of interactions between auditory development of implanted child, it’s learning environment and interactions with parents and caregivers. The aim of the study is to investigate the auditory development in early implanted children and in children early fitted with HA using the approach based on parental observations of the child in its everyday environment.

Methods: 122 children with profound hearing loss, aged from 7.87 months to 23.47 months (M = 14.30, SD = 3.97) were longitudinally evaluated with the Polish versions of the LittlEARS questionnaire. The delay of hearing development calculated as a difference between metrical age and hearing age assessed with the LittlEARS questionnaire was compared in both groups.

Results: The delay in hearing development less than 4 months was observed in 84.4% CI children and 5.2% children with HA. The delay of 4 to 8 months was identified in 15.6% CI children. The delay of 8 to 12 months was identified in 26.3% of HA users and the delay over 12 months was recognized in 68.5% HA users.

Conclusion: The cochlear implants provides better opportunity for auditory development than hearing aids in very young profoundly deaf children. The work was supported by Polish National Science Centre, decision no. DEC-2012/05/N/ST7/02006

Poster Number: 72

ACI20140176: Estimation of abnormalities of Cochlear Implant electrode placement using Spread of Excitation measurement

A. Walkowiak, MS1 , A. Lorens, MS,Ph.D.1 , B. Kostek, MS,Ph.D.,Prof.2 , A. Obrycka, MS1 , A. Wasowski, MS,Ph.D.1 , H. Skarzynski, MD,Ph.D.,Prof.1

1Institute Of Physiology And Pathology Of Hearing, World Hearing Center, Warsaw, Poland ; 2Gdansk University Of Technology, Faculty Of Electronics, Telecommunications And Informatics, Gdansk, Poland

Topic: Audiology

Keywords: Fitting , Objective Measures

Introduction: To evaluate possible dependence between Spread of Excitation profile and electrode placement assessed by CT scans in Advanced Bionics HiRes90K implant users

Methods: Postoperative Spread of Excitation profiles recordings were made using RSPOM software for electrode 4, 8 and 12. CT scans according to cochlear view technique was performed for 1 selected patient with discovered disturbed shape of SoE profile

Results: Abnormalities in implant electrode placement in the cochlea was found, accompanied by disturbed spread of excitation profiles.

Conclusion: A dependence between disturbance of Spread of Excitation profile and abnormalities in implant electrode placement for selected patient was found. Further investigation in bigger group of implant users is planned to check if it is a general correlation. A confirmation of mentioned correlation would provide an useful, objective tool to assess implant electrode position and placement and would supply clinicians with important information, crucial for speech processor fitting. In case of children this method could be a “first screening” when looking for possible electrode displacement and/or loops. In comparison to computer tomography considered as a “gold standard” it doesn’t need any sedation nor anesthesia which sometimes could be crucial.

Poster Number: 73

ACI20140178: Strategies for Management of Complex Pediatric Patients with Unexpected Outcomes Following Cochlear Implantation

J. A. Kolb,AU.D.1

1Children's Hospital Colorado, Audiology, Aurora, CO USA

Topic: Audiology

Keywords: Young and Very Young Children , Fitting , Outcomes

Introduction: Though the goal of cochlear implantation is full time device use from activation onwards, this can be challenging with expanded candidacy criterion including very young children and those with other medical conditions and/or developmental delays. Unexpected outcomes such as rejection of the processor following an aversive reaction or stalled progress can occur. Literature describing techniques to reintroduce the speech processor following a significant aversive reaction is limited. However, clinical experiences with a large, complex pediatric caseload have provided skills to guide recovery efforts to return to expected rehabilitation outcomes. Recovery strategies to improve and re-implement device use (as appropriate) are discussed.

Methods: Case examples of three children in whom unexpected outcomes post implantation occurred are presented. This presentation will describe techniques for identifying the root cause of unexpected negative outcomes in children with cochlear implants. Troubleshooting efforts, mapping strategies, and counseling suggestions to affect recovery of cochlear implant function are offered.

Results: Case 1: Aversive reaction in a 3 year old boy with previously consistent and beneficial device use, following complications with a VP shunt near the implant site. The processor was ultimately rejected, and child would become frightened when processor was placed in his view. Efforts to successfully reprogram and reintroduce the speech processor are discussed. Case 2: Aversive reaction in an 8 year old boy with multiple medical involvement and developmental delays, following a period of established device use bilaterally. Ultimately, a unilateral device failure was identified, after troubleshooting other contributing factors to rejection of processor. Counseling strategies following identification of failed device and recommendations for future will be outlined. Case 3: Good processor use in a 2 year old girl, despite lack of auditory and speech-language development as expected. Progress was stalled despite multiple mappings, early intervention, and parental support. Strategies to re-evaluate the programming of the device and counseling will be discussed as well as an update on current progress.

Conclusion: These cases illustrate just a few of the challenges encountered when working with a very young and medically complex pediatric population, as well as the considerations for overcoming unexpected and negative outcomes following cochlear implantation. As these cases demonstrate, these challenges can be addressed with specific techniques to address mapping inaccuracies, identifying reasons for rejection that are not evident initially, counseling strategies, and the importance of teaming with parents and early interventionists.

Poster Number: 74

ACI20140185: Cochlear implantation in a child with additional diseases: a discussion of auditory rehabilitation

J. R. Bosso, MS1 , M. B. Redondo,undergraduate1 , P. B. Redondo,undergraduate1

1Educational Foudation Of Fernandopolis, Audiology And Speech Patology, Fernandopolis, SAO PAULO Brazil

Topic: Rehabilitation/Educational Aspects

Keywords: Children and Recommended Rehabilitation , Multiple Handicapped Children , Rehabilitation for Children

Introduction: Additional Disease is the condition where two or more failures occur simultaneously. The Cochlear Implant (IC) in this cases is controversial . For a long time the existence of comorbidities item was excluded from the indication of the IC process. With more experience of the IC teams, this is not the reality. However, the nomination process of the IC and especially hearing rehabilitation should consider the conditions attached. Objective: To analyze the process of auditory rehabilitation post IC of a child with additional disease.

Methods: ( 1 ) Case Presentation : Child, male , 4 years old. Born prematurely , with 6 months of pregnancy . Showed intra-and periventricular hemorrhage grade III and IV followed by hydrocephalus and cerebral palsy. Has lowered visual acuity and bilateral sensorineural profound hearing loss, diagnosed at 16 months. Used hearing aids since he was 18 months and at 3 years of age performed IC surgery on the right ear ; ( 2 ) Evaluation : The evaluation after 9 months from date of activation of the IC , indicated absence of oral language , however with communicative intent , interaction with the toy and initial processes established symbolism . Communicates by gestures not standardized. He understands for your name and simple commands with verbal stimuli .Was classified as Category 1 - hearing categories.

Results: The treatment planning was established with Aurioral and Perdoncini Approaches, based therapeutic goals established in auditory ability and pre linguistic stage . Five scenes / themes for the beginning of therapy activities , which were analyzed to follow the rehabilitation process were organized .

Conclusion: Despite the restrictions , the IC is an alternative for children with additional disease . Auditory rehabilitation is a cornerstone to the success of the intervention process and should be carefully planned .

Poster Number: 75

ACI20140193: Evaluation of Listening & Spoken Language Services Delivered through Telepractice: Provider Effectiveness, Parent Effectiveness and Satisfaction, and Child Communication Outcomes

H. R. Eskridge1 , K. Houston2

1University Of North Carolina At Chapel Hill, CASTLE, Chapel Hill, NC USA ; 2University Of Akron, School Of Speech-Language Pathology & Audiology, Akron, OH USA

Topic: Rehabilitation/Educational Aspects

Keywords: Children and Recommended Rehabilitation , Rehabilitation for Children , Speech and Language Development with CI

Introduction: Applications of telehealth service delivery models are increasing across health care disciplines and providers, including Medicine, Audiology, & Speech-Language Pathology. Likewise, children with cochlear implants and their families are being served through telepractice service delivery models. For young children with cochlear implants who are learning to listen & acquire spoken language, telepractice has created new opportunities to receive these services from qualified professionals. Parents often can connect with a provider and receive coaching that fosters improved language facilitation with their child with cochlear implants. However, few studies have measured provider effectiveness, parent satisfaction & effectiveness, & communication outcomes of children with cochlear implants who have received listening and spoken language services via telepractice.

Methods: Surveys, video analysis, rating scales and direct observation were used to measure parent (n=20) and provider (n=10) effectiveness. Age-appropriate and standardized receptive and expressive language assessments were administered at timed intervals to measure communication outcomes of the children (n=20) with cochlear implants.

Results: With training, providers are consistent and effective in telepractice service delivery. Parents, with appropriate coaching, can improve their language facilitation skills and expressed a high-level of satisfaction with telepractice. Children with cochlear implants demonstrated average to above average skills acquisition in receptive and expressive spoken language.

Conclusion: Telepractice can be an effective service delivery model that can lead to improved parental language facilitation and average to above average spoken language outcomes in children with cochlear implants. Professionals need training but can also be effective providers when delivering services via telepractice. Continued research is needed to further evaluate the roles that professionals and parents play in telepractice service delivery modules and how these roles support improved outcomes in children with cochlear implants.

Poster Number: 76

ACI20140211: Are stimulation parameters equivalent for the Freedom and 422 electrode arrays?

M. Polonenko, BS,MClSc1,2 , S. L. Cushing1,3 , K. A. Gordon, BS,MS,Ph.D.1,2,3 , B. Allemang,n/a1 , B. C. Papsin1,3

1Hospital For Sick Children, Otolaryngology, Toronto, Ontario Canada ; 2University of Toronto, Institute Of Medical Science, Toronto, Ontario Canada ; 3University of Toronto, Otolaryngology - Head And Neck Surgery, Toronto, Ontario Canada

Topic: Audiology

Keywords: Fitting , Outcomes

Introduction: Currently there are two electrode arrays available for cochlear implants (CIs): a pre-curved array, which lies in a peri-modiolar position (peri-modiolar); and thin straight array, which resides more laterally in the scala tympani (anti-modiolar). Objective: In the present study, we sought to determine whether the peri- and anti-modiolar electrode arrays function similarly in the same children.

Methods: Twenty children who qualified for bilateral CIs were simultaneously implanted at 3.5 ± 1.0 years (mean ± SE) with two electrode arrays from the same company: a peri-modiolar array in one ear and an anti-modiolar array in the other ear. Parameters of electrode impedance, stimulation threshold (T-levels), comfortably loud current levels (C-levels) and average daily power consumption were collected from children’s CI maps created during the first 3 months of CI use (CI activation/day 1, week 1, month 1, month 3). Impedances were also collected in the operating room. Repeated measures analyses of variance were conducted using device, time, and electrode as within-subject factors, using Bonferroni corrections for pairwise comparisons.

Results: The anti-modiolar electrode array had significantly lower impedance (F(1,22)=74.3, p=.03) but required higher levels for threshold and comfort (F(1,19)=22.7, p=.00), particularly at the basal and mid-array electrodes, than the peri-modiolar array across all time points. These values were within a clinically acceptable range and did not significantly impact battery life (p=.113). Open electrodes were more frequent in the straight array (n=6) than the pre-curved array (n=1).

Conclusion: Significant but clinically acceptable differences in stimulation parameters between the peri- and anti-modiolar electrode arrays persist for four months after surgery in children using bilateral CIs. Methods to optimize stimulation parameters in bilateral CI users might account for differences such as these.
COI: Cochlear Corporation1

Poster Number: 77

ACI20140223: Educational and Vocational Outcomes of Young Adults Who Received Their First Implant During Childhood

J. Woodard,Au.D.1 , H. F. Teagle,Au.D.1 , L. Park,Au.D.1 , E. Gagnon,Au.D.1 , S. Cheung1 , L. Greaver1 , C. Buchman1

1University Of North Carolina At Chapel Hill, Department Of Otolaryngology/Head & Neck Surgery, Chapel Hill, NC USA

Topic: Rehabilitation/Educational Aspects

Keywords: Integrated/Inclusive Education , Speech and Language Development with CI , Cognitive and Social Development of Implanted Children

Introduction: To date, little research has examined the educational and vocational outcomes of young adults who received their first cochlear implant during childhood. The opportunity to learn about long term outcomes is possible now that multichannel cochlear implants have been available for children for almost 30 years. This is an important topic to consider so parents of newly identified infants with severe-profound hearing loss can appreciate the long term impact of making informed decisions about treatment options and communication mode early in their children’s lives. In North Carolina, most families who pursue cochlear implantation choose spoken language as their child’s primary mode of communication. As a result, the vast majority of children with hearing loss are educated in the public school system as opposed to residential schools for the Deaf. This makes standardized tests of academic achievement available for study. For the purpose of this study, we examined the total number of recipients implanted since 1993 at one large cochlear implant center and documented educational achievement and pursuance of higher education beyond grade school. Additionally, queries were made and results were compiled of post high school and post college employment and the use of government support services.

Methods: Retrospective chart review in a large tertiary pediatric CI clinic.

Results: 300 young adults were identified for this chart review. Findings suggest that children who received cochlear implants at this center who are now at least 18 years of age typically graduate from high school. Many pursue secondary education. Approximately half of the recipients have entered the work force. This is a significant difference compared to historical records from Project Hope , 2001.

Conclusion: Cochlear implant technology has had an epic impact on educational outcomes and opportunities for children who are deaf. Long term data is now available to evaluate larger cohorts. This information supports a positive transformation in the independence of young adults with profound hearing loss.
Advanced Bionics1 , Cochlear Americas2 , Advanced Bionics3 , Cochlear Americas4 MED-EL Corporation5

Poster Number: 78

ACI20140235: The Relationship Between English Morphological Accuracy and Performance on Phonology Tests in Bimodal Bilingual Children with Cochlear Implants

C. Goodwin1

1University Of Connecticut, Linguistics, Storrs, CT USA

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI , Speech Production of Early Implanted Children

Introduction: This study compares the performance of bimodal bilingual (BiBi) children with cochlear implants (CCIs) on receptive and productive phonology tests to their accuracy using English morphemes. Previous research has found morphological deficits in monolingual CCIs (1; 2) and that speech perception skills were correlated with later performance on morphological tasks (1). Other researchers (3; 4) found that BiBi CCIs performed similarly to hearing BiBis on several phonology tasks. Do BiBi CCIs show a morphological deficit like monolingual CCIs? Is BiBi CCIs’ performance on phonological tasks correlated with their morphological skills as in monolingual CCIs?

Methods: Five CCIs (M age = 5;05, SD = 0;10) who were implanted before the age of 3 (M age = 1;09) and 7 hearing BiBis (M age = 5;08, SD = 0;06) participated in this study. Both groups were born to deaf parents and began to learn American Sign Language (ASL) from birth. The hearing group also acquired English from birth, while the CCIs began learning it after implantation. Our comparison group allowed us to rule out bilingualism effects as the cause of any deficits. Participants completed the Goldman-Fristoe Test of Articulation 2 (GFTA), as well as a receptive phonological test called Minimal Pairs. This test was a matching task in which children heard two words that differed by a single phoneme and had to point to the picture that correctly depicted the words out of a set of three. Morphological accuracy was calculated by analyzing speech samples obtained from narrative and picture matching tasks that were designed to elicit a range of morphemes.

Results:Our BiBi CCIs produced English morphology significantly less accurately than the hearing BiBi group (t(10)=-2.46, p=.03). Yet there were no significant differences between the groups on the phonology tests (ps>.1). For the CCI group, morphological accuracy did not correlate with performance on the phonological tests (rs<.8, ps>.1). Target sounds in the phonology tests were coded for morphological relevance. Performance on this subset of phonemes was significantly correlated with morphological accuracy, but only for the hearing group (r=.89, p=.007).

Conclusion:BiBi CCIs showed a deficit in English morphology similar to that observed in monolingual CCIs. While there was no relationship between our phonology tests and morphological accuracy in the CCIs, this could be due to the small number of subjects. The significant correlation in the hearing group suggests that some children’s apparent morphological errors may stem from inaccuracies in articulation. 1. Guo, et al. (2013). Journal of Deaf Studies and Deaf Education, 18(2), 187-205.2. Svirsky et al. (2002). Annals of Otology, Rhinology & Laryngology, 111, 109–112.3. Davidson et al. (2014). Journal of Deaf Studies and Deaf Education.4. Cruz et al. (2014). Proceedings of the Boston University Conference on Language Development 38.

Poster Number: 79

ACI20140239: Parent Perspectives of the Benefits and Challenges of Cochlear Implantation in Deaf Children with Additional Disabilities

R. Chia, MS,RAud1 , A. Zait-Zaidman, Ph.D.5,6 , D. Curle, MS,CCC-SLP4 , J. Jamieson, Ph.D.4 , F. Kozak, MD,FRCSC3

1BC Children's Hospital, Cochlear Implant Services, Vancouver, BC Canada ; 3BC Children's Hospital, The University Of British Columbia Department Of Surgery, Division Of Otolaryngology, Vancouver, BC Canada ; 4The University Of British Columbia, Department Of Educational And Counselling Psychology And Special Education, Vancouver, BC Canada ; 5The University Of British Columbia, Department Of Human Early Learning Partnership, Vancouver, BC Canada ; 6Tel-Aviv University, Department Of School Counseling And Special Education, Tel Aviv, 6997801 Israel

Topic: Rehabilitation/Educational Aspects

Keywords: Multiple Handicapped Children , Quality of Life , Integrated/Inclusive Education

Introduction: Candidacy for recommending cochlear implantation has expanded over time and an increasing number of deaf children with additional disabilities are receiving implants (CI). This group of children pose unique and heterogeneous challenges in assessment, treatment and determination of suitable mode of communication, both pre- and post-implantation. Little is known about family perspectives of the benefits and challenges of cochlear implantation in this population. Our objective was to examine parent perspectives of the benefits and challenges of cochlear implantation in deaf children with additional disabilities.

Method: Twenty-three families of deaf children with additional disabilities ranging from 4–6 years participated in this study. This was a mixed methods study, which included a survey and interviews. The predominant disabilities included learning disabilities, autism spectrum disorder, vision impairment and language disorder. Six of the 23 children had >1 disability. Parents completed a Child and Family Background questionnaire; Services Inventory; and Everyday Problems, Challenges and Associated Stress Questionnaire. Also, 17 parents (73.9%) agreed to participate in individual semi-structured follow-up interviews which were analyzed through inductive thematic analysis.

Results: Predominant benefits of the CI included the child’s enjoyment of music and awareness of environmental sounds; increased communication ability; increased safety awareness; and contributions to their child’s overall well being. The predominant benefits cited in the interviews related to various aspects of communication performance and improvement. Predominant challenges included problems across nine domains, with the most frequently reported being communication difficulties, followed by implant drawbacks (e.g., equipment issues), child’s behavior and temperament and child’s use of the CI. The challenges identified in the interviews were closely related and included concerns about the equipment, challenges in school and social-emotional well being. Based on the qualitative inductive content analysis of the interviews, parents described three overreaching themes related to service provision, including management and coordination of services, service availability and accessibility and family-professional partnership. Each theme was perceived as having both benefits and challenges.

Conclusion:Results suggest that children with additional disabilities benefit from CIs, but also face unique challenges that professionals should consider. The findings underscore the crucial need for coordinated interdisciplinary collaboration when supporting children with complex needs who have CIs. Parents’ criteria of successful outcomes differ in some important ways from those typically used by professionals. Overall, the findings underscore the importance of including parent perspectives in the decision-making process when considering candidacy and ongoing follow-up support.

Poster Number: 80

ACI20140254: Correlation between Distance during Parent-Child Interactions and Language Outcomes in Young Children with Cochlear Implants

J. Jung, MS1 , G. Hollich, Ph.D.2

1Purdue University, Speech, Language, And Hearing Sciences, West Lafayette, IN USA ; 2Purdue University, Department Of Psychological Sciences, West Lafayette, IN USA

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI , Rehabilitation for Children

Introduction: This preliminary study examined the possibility of distance as a predictor of young cochlear implant (CI) recipients’ language outcomes by assessing 2-minute parent-child interactions. Research has shown that considerable information can be gleaned by raters without any special training within a short period of time (i.e., < 5 minutes; ‘thin slice’, Ambady, Koo, Rosenthal, & Winograd, 2002). However, to our knowledge, the thin slice method has never been explored to predict aspects of language development. Distance between parents and children is of special interest because of three reasons: First, distance affects the quality of signals through multi-modalities (i.e., auditory and visual [AV] cues for speech perception). Such a multi-modal redundancy is critical for young children to perceive speech (e.g., Hollich, Newman, & Jusczyk, 2005). Second, distance may affect the quality of social interactions. Parents who sit close to their children might respond more sensitively than parents who do not and this could facilitate children’s language development (e.g., Tamis-LeMonda, Bornstein, & Baumwell, 2001). The third potential is its ease of measurement. Distance can be measured in short observations without specialized training and easily implemented into interventions. Objectives: To demonstrate that 2-min observations of perceived distance can be used both as a significant predictor of language outcomes in children with CIs and as an important marker/measure in clinical settings.

Methods: Free-play between eight young CI recipients (oral communicators with no other disabilities and a range of age at activation between 9-27 months) and their parents was videotaped at 3 months post-activation. Three raters assessed distance between parent and child using a 5-point Likert scale (close vs far) while watching randomly selected 2-min video clips. Expressive vocabulary size was assessed by administering the MacArthur Communicative Development Inventories (CDIs; Fenson, Dale, Reznick, Bates, Thal, Hartung, & Reilly, 1993) at 6 month intervals (6, 12, 18, and 24 months post-activation).

Results: Intraclass correlation analysis indicated that distance can be measured reliably (average = .876). Analysis also showed significant Pearson correlations between values of distance by age and CDIs scores at each interval: (1) at 6 months post-activation (r = .794, p = .019), (2) at 12 months post-activation (r = .864, p = .006), (3) at 18 months post-activation (r = .884, p = .004), and (4) at 24 months post-activation (r = .839, p = .009). We also found significant partial correlations between distance and CDIs when the effect of age was removed.

Conclusion: These findings support: (1) the notion that having close proximity could contribute to young CI recipients’ language outcomes, and (2) distance has great potential for use in clinical settings due to its reliability, ease of measuring, and the ease of implementation in intervention.

Poster Number: 81

ACI20140273: Multifactorial Approach to Language Acquisition in Young Children with Cochlear Implants

S. A. Assmann1 , A. Warner-Czyz1

1University Of Texas At Dallas, Callier Center For Communication Disorders, Dallas, TX USA

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI

Introduction: Children with severe-to-profound hearing loss who receive a cochlear implant (CI) show greater variability in spoken language acquisition than their normal hearing peers. This variability is often attributed to demographic factors such as age at implantation and duration of CI experience. Other factors such as audiometric thresholds, functional auditory performance (parent report), and temperament may impact outcomes. The present study investigated the pattern of vocabulary development, specifically the use of nouns and verbs. Children with normal hearing often develop nouns before verbs. Here we examined whether similar patterns are displayed in CI children and in a group of hearing-impaired children fitted with hearing aids. OBJECTIVES: This study examined aspects influencing early vocabulary development displayed by pediatric CI users.

Methods: Participants included 10 prelingually deafened, English-learning pediatric CI users implanted <2 years, with a mean chronologic age of 30 (SD = 3.58) months, and 3 moderate to profound sensorineural hearing impaired, pediatric hearing aid users whose mean chronologic age was 31 (SD = 5.13) months. Mean duration of CI experience was 18.5 (SD = 4.54) months. Mean duration of time with hearing aids was 17 (SD=4.95) months. Data were collected following onset of meaningful words as established by the parent and referring professional. Audiologic demographic factors such as age at CI activation and duration of CI use were collected. Parents completed three questionnaires: (1) Functional audition was assessed using the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), (2) Childhood temperament was evaluated using the Early Childhood Behavioral Questionnaire, and (3) Vocabulary size was explored using the MacArthur-Bates Communicative Developmental Inventory.

Results: Both age at CI implantation and duration of CI use correlated with early vocabulary size such that children who received CIs at a younger age and children with longer duration of device experience exhibited larger vocabulary size. Children with CIs displayed a noun bias in early vocabulary development similar to children with normal hearing. Child temperament correlated with vocabulary size on several domains, including cuddliness temperament and discomfort temperament. Audiometric pure-tone thresholds and parent report of functional auditory behavior showed little to no relation to vocabulary outcomes.

Conclusion: Results provide further understanding of early lexical acquisition in hearing impaired children with CIs or hearing aids, specifically the patterns in the types of words that are developed earlier (nouns vs. verbs). Temperamental characteristics provide complementary information to traditional audiological variables in the prediction of language abilities in young CI recipients.

Poster Number: 82

ACI20140288: Please Enter a Title COCHLEAR IMPLANT IN ENT HOSPITAL HoChiMinh City-VIETNAM FROM 2009- 2012

L. T. Minh1 , N. T. Dung1

1ENT Hospital, Otolaryngology, HoChiMinh, SOUTH Viet Nam

Topic: Surgery/Medical

Keywords: Hearing Preservation

Introduction: In ENT Hospital HCMC,South Vietnam, we had the first single- channel implant in 1998. In few years later, we had only 3 single- channel implant cases. From 2009 to now, we have operated ourselves the multiple- channel devices. Objective: We have 54 patients from September, 2009 to December, 2011 in ENT Hospital HCMC. Some criterions: Patients are more than 1 year old. Bilateral severe and profound hearing loss. Cochlear nerve is normal.

Methods: Descriptive case study.

Results: Sexual ratio: Male 53,7%. Female 46,3%. Age < 2 years old: 02 (3,7%) 2-5 years old: 44 (81,5%) 6- 15 years old: 6 (11,1%) > 15 years old: 2 (3,7%) The most popular age: 2-5 years old (81,5%). If children were implanted as soon as possible, the language developments will better. Classification Congenital Deafness: 51 (94,4%) Acquired Deafness: 3 (5,6%) Most of our patients are children, 03 cases of acquired deafness which happen after meningitis. Hearing loss degrees 50 cases (92,6%) profound hearing loss. 04 cases (7,4%) severe hearing loss. CT Scan, MRI 52 cases (96,3%) Pre-op CT Scan are normal. 02 cases (3,7%) Pre-op CT Scan were bilateral cochlear deformity. 54 cases (100%) have normal MRI, they have not the cochlear nerve lesions. Pre-op CT Scan has the important role to identify the anatomic landmarks. Especially in case of meningitis, accuracy of detection of cochlear ossification is best by CT Scan. Position Right side: 37/54 (68,5%). Left side: 10/54 (18,5%). Bilateral: 7/54 (13%). Surgery We have 52 patients with antero-inferior round window niche cochleostomy. 02 cases (3,7%) have common cavity deformity. We used the 24 multichannel straight electrodes with 10mm long. Complications No severe complications. Minor complications happen in 03 cases: echymosis (5,6%). Post-op is good, the incisions were intact after 1 week : 54 cases (100%). Speech rehabilitation results We have 4 degrees depends on our hospital standards of language developing score (5 scores/ factor): Excellent: 20,4% (25 scores). Good: 46,3% (20- 24 scores). Fair: 24,1% (15-19 scores). Moderate: 9,2% (10-14 scores)

Conclusion: Technique of antero-inferior cochleostomy was applied in 52 cases with good result. In operating room, we check the activity of electrode and impedance. The minimally invasive surgical technique has some advantages: more quickly, less trauma of skin and flaps, more comfortable for the patients. For the speech rehabilitation results, we have 66,7% of 02 groups: excellent and good. These children can hear the whispers, they also talk with the strangers and study with the same age. In 2012, we have 07 bilateral cochlear implantation cases, this is special thing because most of Vietnamese have low income and parent must pay for their children. In future, we hope to have some more cases in order Vietnamese patients can have more chances to integrate with the society.

Poster Number: 83

ACI20140331: Please Enter a Title LATE COCHLEAR IMPLANT

M. A. Barros, MS,Oral Therapist1

1Desear Escuchar, San Isidro, BUENOS AIRES Argentina

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI

Introduction: Late Cochlear Implant opnes doors for children older than 6 years of age providing a better quality of life improving lip reading,oral and written language. Objective: Demostrate that children older than 6 with different communicative situations could improve listening skills and achieve lip reading and oral and written competence.

Methods: 25 children were tested, ages between 7 and 12 who were implanted at ages between 7 and 10,with sensory deprivation tima 2 to 7 years. They have with different language skills: -8 children using sign language. -10 children using spoken language who manage augmentative systems like lip reading or cued speech. -7 children using spoken language whose sole support is lip reading. They were assesed 2 years after they started using their cchlear implant.

Results:The results were 2 children using sign language and 3 children using spoken language with augmentative systems,could identify words by multiple spectral differences and basic spoken language. 5 children using spoken language and lip reading,could identify words using vowels and better reading comprehension and progress in their language skills.

Conclusion: All children in which the Auditory Verbal Oral Therapy was applied -Could improve speech perception in a noisy environment. -Could better development in language,oral and written competence. -Still need support of lip reading and writting. -Children implanted during adolescence fail to speak by phone. -Achieve limited open set. Better speech production at suprasegmental level. -20 % of children achieved segmental aspect with multiples cues.Access Category 3(ESP Geers&Moog) -20% of children achieved word identification varying vowels.Access Category 4 ESP. Late Cochlear Implant in children older than 6 gives more opportunities.

Poster Number: 84

ACI20140128: Considerations for Programming Outlying Electrodes (A Case Study)

B. A. Holstad,AuD1 , V. G. Sonneveldt,AuD1 , A. L. Birath,AuD1 , M. E. Cahill,AuD1

1The Moog Center For Deaf Education, St. Louis, MO USA

Topic: Audiology

Keywords: Fitting , Young and Very Young Children

Introduction: The goal of cochlear implant programming is to provide the best access to sound for optimal speech perception. In doing so, it is essential to ensure each threshold level is perceived as soft and each comfort level is perceived as loud for every electrode. When creating a new program within Custom Sound software, default channel visibility indicates assessment of 5 electrodes distributed evenly along the array. However, interpolation of intermediary channels may not result in balanced loudness across the electrode array when neighboring electrodes have significantly different electrical requirements. Objective:To report the occurrence of outlying electrodes for one subject and implications of findings for clinical decision making.

Methods: Case study, over a 1-year period, of a child at ~3 years post cochlear implantation with a Cochlear CI512 device at the right ear and a CI24RE(CA) device at the left ear who presented with lower behavioral and Neural Response Telemetry (NRT) thresholds on a single electrode at each ear compared to all other electrodes.

Results:Initial programming focused on training this 3 ½ year old child to perform a counted threshold task coupled with loudness scaling. Threshold and comfort levels for every electrode were obtained over multiple sessions due to time constraints, the child’s attention span, and the need for pulse width (PW) adjustments at each ear. In this case, electrode 4 (right) and electrode 3 (left) required varied PWs compared to all other electrodes. When the resulting charge was calculated, the outlying electrodes produced substantially less charge at T- and C-levels. Impedance levels were similar for all electrodes across each array. Internal device related issues were ruled out via integrity testing. NRT thresholds were obtained and found to be in agreement with behavioral thresholds. Given no change in behavioral responsiveness and appropriate loudness growth on each electrode, neither was deactivated. Appropriate aided detection and progress in auditory skill development has supported continued inclusion of these electrodes.

Conclusion:In attempting to provide the best representation of sound to allow for optimal speech perception, it’s important to consider moving beyond manufacturer defaults. Using only the 5 initially available default channels will inherently miss identification of outlying electrodes. Interpolation may result in notable over-or under-stimulation. Sound quality may be compromised based on loudness growth patterns of outlying electrodes. Assessment of each electrode and implementation of loudness scaling during psychophysical measurements provided valuable information for creating an optimal listening program for this child. If the child’s ability to participate in loudness scaling for each electrode had been discounted based on perceived ability due to age, optimization of his programs including outlying electrodes would not have been possible.

Poster Number: 85

ACI20140197: The effects of cochlear implant surgery on unaided hearing in children, a collection of case studies.

C. L. Pitt,AuD

1Utah State University, Communicative Disorders And Deaf Education, Logan, UT USA

Topic: Audiology

Keywords: Residual Hearing

Introduction: Hearing and cochlear structural preservation has been a topic of consideration for many years. Challenges to accomplishing the ideal range from electrode design and surgical technique to a definition of preservation of hearing. The purpose of this report is to highlight the effects of surgical implantation on unaided hearing thresholds in children.

Methods: This study is a retrospective analysis of pre-and post-operative unaided pure tone thresholds of 5 children implanted with Cochlear and MedEl cochlear implants.

Results: The subjects in this study all have residual hearing with some noted decrease in pure tone thresholds.

Conclusion: Subjects presented in this study indicate it is possible to implant children with cochlear implants and maintain measureable hearing, although it is prudent to counsel parents that there is a risk of losing hearing following implantation. Results also suggest a need to monitor unaided hearing as routine practice in follow-up care.

Poster Number: 86

ACI20140222: Early intervention via telepractice

C. L. Broekelmann, MA , M. Graham1 , J. Flowers1 , A. Knackstedt1

1St. Joseph Institute For The Deaf, Chesterfield, MISSOURI USA

Topic: Rehabilitation/Educational Aspects

Keywords: Quality of Life , Children and Recommended Rehabilitation , Rehabilitation for Children

Introduction: Each year two to three of every 1,000 children in the United States are born deaf or hard-of-hearing, approximately 12,000 children annually (National Institute on Deafness and other Communication Disorders [NIDCD], June, 2010). Unfortunately, almost one third of these children do not receive follow-up intervention services (Center for Disease Control and Prevention, 2009). Two common problems occur in meeting the needs of these children, deafness is a low incidence disability, and there are a limited number of professionals trained in developing spoken language through listening according to ASHA (ASHA, retrieved January 15, 2014). Yet, the evidence of the success of early intervention for children who are deaf or hard of hearing and the family’s involvement in early intervention is stated in many studies (Moeller, 2000; Yoshinaga-Itano, 2003). The internet can provide services to children who have little to no access to qualified specialists trained to develop spoken language through listening. In delivering listening and spoken language therapy through the internet, empowerment and competency are built naturally through the coaching model utilizing a triadic model, parent/ caregiver, specialist and child. There is a paucity of research regarding the efficacy of using the internet as a service delivery model. A descriptive, quantitative analysis of the data was conducted to determine the efficacy of using the internet to deliver services to children who are deaf or hard of hearing.

Methods: Baseline data on the child’s present level in receptive and expressive language was collected prior to entering the program and again every 6 months for the last two years. Receptive and expressive language objectives were established and activities planned by the therapist based on assessment, but also responsive to the functional needs of the family to encourage involvement during the session. In addition a survey was conducted to understand how early intervention via the internet impacts the quality of life for the child who is deaf or hard of hearing and their family. This survey has two parts: Part A establishes baseline measures before starting the internet therapy program and Part B reflects the family’s current status and the progress to date.

Results:87% of families felt their quality of life improved and 85% of the children increased their standard score age 0-6.

Conclusion:~~The information provides a better understanding of the progress made since families/children started the program in some key quality of life areas. It is important to note that this survey report is based on only the 21 surveys received. Due to the small population, the survey results are directional only and cannot be taken with a high degree (80 %+) of accuracy. Also, the baseline, before starting early intervention, was completed in the same survey, asking participants to reflect back in time.
COI: St. Joseph Institute For The Deaf1

Poster Number: 87

ACI20140232: Improved patient service through innovative “cloud-based” technology

A. Biever,Au.D.1

1Rocky Mountain Ear Center, Englewood, CO USA

Topic: Economics and Public Policy

Keywords: Health Economics

Introduction: Cochlear implant clinics are busy places. Often, it can be a challenge to see patients, service repair needs, and complete all administrative work within the typical office hours. Cloud-based technology is the current and future means of conducting business around the world from financial services to retail and now to healthcare. Use of innovative, cloud-based technology may help support patient needs as well as streamline our office work. Today we report on a pilot to bring cloud-based services to the cochlear implant industry. Objective: Provide patient services in a timely manner with help from secure, internet communication systems connected directly with a manufacturer.

Methods: This multi-center pilot project used proprietary, encrypted, enterprise software to help clinics automatically register recipients, check existing warranties, and provide hearing profiles for service sound processors with minimal intervention from the clinic.

Conclusion: Increased service levels ffor the clinic and patients were measured during this pilot and will be presented. This new method of registration along with service requests reduced turnaround times as reported here.

Poster Number: 88

ACI20140242: I Am A “Fife” Musician – One Boy’s Journey Into Music

A. K. Isaacson,B. Sp. Path. (Aust)1

1SCIC (Sydney Cochlear Implant Centre) - A Service Of RIDBC, Canberra, AUSTRALIAN CAPITAL TERRITORY Australia

Topic: Rehabilitation/Educational Aspects

Keywords: Music Therapy , Quality of Life , Social Situation of implanted children

Introduction: This poster will discuss an individualised music program developed for a 10-year-old “Rufus” who has bilateral cochlear implants and cerebral palsy. His desire was to join his school’s Fife and Drum band, which required an audition. To prepare him for this audition, a music training program was developed over 10 sessions targeting rhythm and pitch skills. The details and results of this training program will be presented in this poster. Objective: Our objective was to improve Rufus' understanding and skills in both pitch discrimination and rhythm through a direct training program to prepare him for participation in a school-based group music program.

Methods: Ten one-hour face-to-face sessions were conducted by a habilitationist over a 14-week period. In addition, Rufus was required to practise for 20 minutes each day using a variety of training activities specified by the habilitationist. Rhythm-based tasks included following the beat of a song, same/different discrimination and imitating different rhythm patterns. Pitch-based exercises included tasks of same/different discrimination, pitch ranking, odd-ball stimuli, and pitch contour matching. In addition, a variety of non-auditory strategies were introduced.

Results: Before training, Rufus’ pitch discrimination skills were limited to inconsistently identifying when sounds were different. He could recognise rhythms of familiar songs but struggled to maintain a constant beat both with and without a metronome. Over the course of the training, Rufus developed a better concept of music pitch and the relationship between high and low pitches. He was able to reliably discriminate pitch direction at semitone intervals. He became able to match pitch contours. His ability to hum a familiar tune improved significantly, allowing for recognition of the tune by a listener. He demonstrated improved concentration and ability to maintain a steady beat. He also learned to use a variety of strategies to regain the beat after losing the tempo. Two mock auditions during training sessions duplicated the audition undertaken by the hearing children. Rufus achieved 100% during the second mock audition in the areas of rhythm, melody and pitch. In the actual school audition, Rufus performed well under more difficult conditions than expected. In an unusually skilled cohort, the cut-off was 43/50; while Rufus had guaranteed entry, his score of 41 would have secured his entry on his own merits in any other year.

Conclusion: Pitch discrimination to a semitone was possible for Rufus with his cochlear implants. Music training for Rufus improved his music perception skills and facilitated his integration into a school-based group musical activity, as well as showing that cochlear implants are not a contraindication to group music participation. The value of music training for either music and/or social skills is a topic for further investigation.

Poster Number: 89

ACI20140286: The Result of Monosyllabic tests for CI children’s who enter Japanese mainstreaming school

M. Hazama1 , N. KEI1 , S. Takema1 , K. Atushi,prof2

1Rinku General Hospital, IZUMISANO, Japan ; 2Cochlear Auditory Center Of Tokyo Medical School, ENT, TOKYO, Japan

Topic: Rehabilitation/Educational Aspects

Keywords: Integrated/Inclusive Education , Speech and Language Development with CI , Speech Production of Early Implanted Children

~Introduction: In Japan, CI children have great difficulty attaining admission and continuing to attend mainstream schools that do not have an FM system and where there are no special teachers for children with hearing loss. Currently, only 50–60% of CI children can attend school in general. However, all the 7 children who were habilitated in Rinku General Hospital went to mainstream school. Therefore, when their language test results were investigated and the listening scores were acquired before entering elementary school, it was decided to examine whether mainstream school entrance was attained. Objective: Investigation of functional threshold and speech recognition tests, consisting of tests on Japanese monosyllable recognition, speech reception threshold, and speech recognition in noise for 7 CI children.

Method: The children were given a functional threshold test, a speech reception threshold test, a speech discrimination test with Japanese monosyllables, and a recognition score with Japanese monosyllables (60 dBHL) in the speech noise condition (S/N ratio +20 +10 +5).

Results: All children obtained excellent scores, similar to that of children with normal hearing, except for slightly worse S/N ratio.

Poster Number: 90

ACI20140346: Please Enter a Title Electrode by Electrode Hearing Threshold Measurement in the Implanted Patient.

J. M. Cornejo, MS1 , M. P. Granados1 , L. C. Hern_ndez2 , N. Casta_eda1,2 , S. C. Castillo2

1Universidad Aut_noma Metropolitana, Biomedical Engeeniering Area. Electrical Engeeniering Department, M_xico, D.F. Mexico ; 2Instituo Mexicano De Audici_n Y Lenguaje, M_xico, D.F. Mexico

Topic: Audiology

Keywords: Fitting

Introduction: The operation parameters election of the cochlear implant such as sound processor gain, microphone sensibility, T and C current level for electrode array, etc., look for a safe, useful, and comfortable hearing. A way to know the patient-cochlear implant performance is through the sound field audiometry. However, when applied to implanted patient audiometry has some drawbacks. Errors in audiometric hearing threshold determination may be possible due to audiometry test tones do not match to the band frequency stimulation electrode assignation. Measurement of the incoming sound energy to the cochlear implant system could have an error as much as 30% when frequency of the test tone is in the band-pass filter wide band corresponding to an stimulation electrode, or grater if the test tone frequency is outside this wide band. Electrodes located between two contiguous audiometric test frequencies or in the utmost right part of the audiogram may not be evaluated, hence creating uncertain zones in the audiogram. At the mapping time, maximum and minimum current level value for some electrodes are establish as equal or proportional values to neighbor electrodes. Should be notice that in no way this means a same hearing threshold for the involved electrodes. Objective: To obtain an enhanced audiometry for the implanted patient by using test tones whose frequency match to the central frequency of the frequency band assigned to each active stimulation electrode.

Methods: Participants: 30 cochlear implant user ( 12 men, 18 women, ages 5 to 20 years. Mean= 12, s.d.=2.6). All participants had a at least two years of previous usage of his/her cochlear implant. Sound field standard audiometry and electrode by electrode hearing threshold were performed in two different sessions the same day. Test: Participants were tested in a sound treated booth. They were seated one meter away from the loudspeaker, 0o azimuth. Standard audiometry and electrode by electrode hearing threshold were obtained by two different technicians. Equipment: Digital tones synthesizer Stim from Neuroscan, clinical audiometer Interacoustics Model AC-40, Sound Level Meter Brûel & Kjaer type 2235, filter Brûel & Kjaer type 1625 and Sound level Calibrator Brûel & Kjaer type 4230.

Results: Nevertheless sound field audiometry and electrode by electrode hearing threshold profiles are quite similar, standard sound field audiometry is a smoother version of the electrode by electrode graph. Additionally by using frequency test tones that match stimulation electrode central frequencies allows to detect electrodes where may be necessary to adjust current level T to improve hearing threshold.

Conclusion: According the previous results could be advisable to take to the clinical practice a sound field audiometry for the implanted patient that takes into account the central frequency of the band pass filter associated to each stimulation electrode.

Poster Number: 91

ACI20140362: Tracking auditory perception and language acquisition of one patient with x-linked deafness pre and post cochlear implantation and reporting factors that may influence positive outcomes

A. N. Paoletti,AuD1 , J. Still1 , H. A. Arts1

1University Of Michigan, Ann Arbor, MI USA

Topic: Basic Research

Keywords: Anatomy

INTRODUCTION Previous research has suggested the diagnosis of xlinked deafness may be a contraindication to cochlear implantation. Furthermore, amplification may yield superior results despite the severity of the hearing loss. Recent reports suggest that new surgical techniques and tools may result in superior outcomes supporting cochlear implantation. OBJECTIVE We report on the audiologic status,speech and language acquisition, and surgical procedure of one patient with x linked deafness. METHOD Review of pre and post operative data reported in the medical record to date. RESULTS Results reported on the preschool language scale, Peabody picture vocabulary test 4, expressive vocabulary test 2, preschool language test 5, Goldman fristoe test of articulation 2, behavioral thresholds, lexical neighborhood test across time. CONCLUSION Superior speech and language outcome following cochlear implantation without surgical complications.

Poster Number: 92

ACI20140072: Guiding Expectations: Impact Factors and a Range of Outcomes

M. Therres, MS,LSLS, Cert. AVT1

1MED-EL, Education, Durham, NC USA

Topic: Rehabilitation/Educational Aspects

Keywords: Speech and Language Development with CI , Children and Recommended Rehabilitation , Rehabilitation for Children

Introduction: Counseling cochlear implant recipients and their families regarding outcome expectations is one of many important aspects on the journey of cochlear implantation. Setting appropriate expectations assists in determining a course of (re)habilitation and facilitates achievement of an child’s fullest potential. There are many factors, intrinsic and extrinsic, that go into projecting outcomes

Methods: Prior to cochlear implantation, assessment and use of tools such as a modified ChIP (Children’s Implant Profile) assist greatly in identifying areas of a child's strenths and challenges that may impact listening and spoken language outcomes.

Results: For children, there are generally three outcomes with a range in each of these categories. The categories include assist in communication, functional communication, and listening and spoken language skills that are comparable to hearing peers.

Conclusion: This presentation will discuss factors that impact outcomes, tools that may be used to assist in determining expectations, the range of expectations and how this information may be used to counsel families and to tailor therapy to meet a child’s needs.
COI: MED-EL Corporation1

Poster Number: 93

ACI20140097: The Influence of Map Parameters on Postoperative Hearing Preservation

M. Dillon,AuD1 , A. Bucker2 , E. King,AuD2 , M. Adunka,AuD2 , C. Buchman, MD1 , H. Pillsbury, MD1 , O. Adunka, MD1

1University Of North Carolina At Chapel Hill, Otolaryngology/Head And Neck Surgery, Chapel Hill, NC USA ; 2UNC HealthCare, Audiology, Chapel Hill, NC USA

Topic: Audiology

Keywords: Residual Hearing , Fitting , Outcomes

Introduction: The utilization of combined electric and acoustic stimulation (EAS) in an ipsilateral listening condition is dependent on postoperative hearing preservation in the surgical ear. Some subjects experience a decrement in residual hearing during the initial postoperative time period. Studies have also documented the progression of hearing loss in the implanted ear for some recipients over time. The goal of this study was to assess whether values of certain map parameters are reflective of postoperative hearing preservation.

Methods: Twenty-nine (29) adult subjects participated in the EAS clinical trial at the study site. Test intervals included: preoperative, initial cochlear implant activation, initial EAS activation, and 3-, 6- and 12-months post-initial EAS activation. Unaided air- and bone-conduction thresholds were assessed bilaterally at each interval prior to mapping.

Results: Variability in hearing preservation was noted. One subject experienced a total loss of residual hearing in the implanted ear prior to initial cochlear implant activation. Others experienced complete or partial hearing preservation throughout the 12-month trial. Charge and stimulation rate were not predictive of postoperative hearing preservation.

Conclusion: In this cohort, map parameters were not predictive of postoperative hearing preservation. Further investigations are needed into potential influences on the variability of postoperative hearing preservation and how to maintain residual hearing with long-term listening experience.
MED-EL Corporation1 , MED-EL Corporation2 MED-EL Corporation3

Poster Number: 94

ACI20140101: Advanced Bionics? Cochlear Implants in Patients with Prelingual Hearing Loss

H. F. Pauna1 , G. M. Carvalho1 , A. C. Guimar_es1 , L. H. Schuch1 , E. B. Muranaka1 , W. A. Bianchini1 , A. N. Crespo1 , E. L. Sartorato1 , A. M. Castilho1 , E. M. Silva1

1Unicamp, Departamento De Otorrinolaringologia E Cabe_a E Pesco_o, Campinas, S_O PAULO Brazil

Topic: Surgery/Medical

Keywords: Quality of Life , Medical/Surgical Issues

Introduction: Cochlear Implants (CI) have become standard in the treatment of prelingual, postlingual and perilingual deafness in children. Bilateral implants are considered standard for bilaterally affected children. Studies also find that the CI provides better access to speech for most children, and this access results in improved speech perception. In earlier times children who did not react to acoustic stimuli and were neither able to understand speech nor to acquire it spontaneously encountered severe discrimination, being dismissed as simple-minded or worse. Different studies broadly agree that one or two of every 1000 newborns have a hearing impairment that on current evidence warrants treatment or observation, i.e., permanent hearing loss with a lowering of the absolute threshold of hearing for speech perception by at least 35 dB. Approximately 50% of severe hearing impairments arising in the inner ear are thought to be hereditary in origin. When new Cochlear Implant (CI) sound processors are being introduced by the manufacturers, usually the newest generation implants benefit first from the new technology in order to release the full potential of the new hardware. Objective: Evaluate the improvement of speech language and sound perception in patients with prelingual deafness that underwent cochlear implant using Advanced Bionics® device.

Method: Retrospective study of the medical records of the patients fitted with Advanced Bionics® cochlear implant in our institution between 2011 and 2012.

Results: Sixteen patients underwent to cochlear implantation using Advanced Bionics® devices. There were 43,75% prelingual and 43,75% postlingual patients with bilateral hearing loss. Mean age at implantation in the prelingual group was 3.6 years (ranged from 2 to 6 years). There was one case with medical history of deafness in family. All prelingual patients used hearing devices before the cochlear implant. The hearing levels improved after CI in all patients.

Conclusion: This study evaluated patients with pre-lingual deafness using the Advanced Bionics® cochlear implants demonstrated significant gains in neural stimulation and language development in children.

Poster Number: 95

ACI20140164: Performance of cochlear implant in patients with Auditory Neuropathy Spectrum Disorder

G. M. Carvalho1 , F. L. Fernandes1 , E. M. Silva1 , L. H. Schuch1 , A. C. Guimar_es1 , P. Z. Ramos1 , E. L. Sartorato1 , A. M. Castilho1

1Unicamp, Departamento De Otorrinolaringologia E Cabe_a E Pesco_o, Campinas, S_O PAULO Brazil

Topic: Audiology

Keywords: Auditory Neuropathy , Assistive Listening Devices

Background: Cochlear implant (CI) is the standard treatment for auditory rehabilitation of patients with severe to profound deafness who did not benefit from conventional hearing aids. The importance and results of CI in patients with auditory neuropathy is still under discussion and is controversial. Objective: The aim of this study is to describe the performance and results of cochlear implant in patients with auditory neurophaty, besides to perform a medical literature review of this topic.

Methods: A retrospective study of medical records of patients who underwent surgery treatment with CI in auditory neuropathy. The medical literature review was performed using the MeshTerms “hearing loss; cochlear implants; rehabilitation of hearing impaired; auditory neuropathy” at Pubmed and Scopus database.

Results: The sample was composed of ten patients. The average age at surgery was 4,09 years, ranging between 2.08 and 16.25 years. Most of the cases (4/10) had idiopathic auditory deficit. The comparison between the levels of hearing before and after the CI revealed improvement in all patients. All of them also reported an increased overall satisfaction 1 year after procedure.

Conclusion: Auditory neuropathy pacients have demonstrated significant gain in hearing levels using CI.

Poster Number: 96

ACI20140203: Reduced Cochlear Implant Performance Following the Use of Growth Hormone with Regain of Function Following Cessation of Growth Hormone Therapy

M. P. Lafer, BA1 , S. E. Heman-Ackah2 , J. E. Green,AuD1 , J. T. Roland, MD1 , S. B. Waltzman, Ph.D.1

1New York University School Of Medicine, Otolaryngology, New York, NY USA ; 2Beth Israel Deaconess Medical Center, Otolaryngology, Boston, MA USA

Topic: Surgery/Medical

Keywords: Difficult or atypical patients

Introduction: Reduced cochlear implant (CI) performance has been attributed to a wide spectrum of variables. However, no studies have evaluated whether growth hormone (GH) affects CI performance. GH is a polypeptide hormone produced in the anterior part of the hypophysis that increases in production during the adolescent growth spurt and synthetic GH has been FDA-approved for children with short stature. Objective: To assess whether GH therapy has an effect on CI performance.

Methods: Case Series: Two subjects were identified for review, S1 and S2. Data were collected regarding cochlear implantation, details of GH therapy, and speech perception before and after GH therapy. Auditory perception assessment using Phonetically Balanced Kindergarten (PB-K) and Consonant Nucleus Consonant (CNC) word recognition scores were reviewed. CI electrode impedances, threshold levels, and comfort levels were also reviewed.

Results: S1 has severe bilateral Mondini malformations and was implanted with Nucleus CI24K device (Cochlear Americas) at ages 10 months (right) and 4 years (left) with full insertion bilaterally. At age 8, S1 was noted to be of short stature with a peak serum growth hormone was 9.39 ng/ml (normal peak >10 ng/ml). After 4 months of GH therapy, PB-K word recognition scores in the right ear decreased from 90% to 72% and were stable at 40% in the left. Despite remapping, integrity testing and deactivation of additional electrodes, performance continued to decline bilaterally to 52% in the right ear and 28% in the left. GH therapy was thus discontinued with a subsequent increase in performance to 74% in the right ear and 68% in the left ear one month following. Nine months later, auditory perception increased to 84% and 72% respectively. Similarly, S2 has severe to progressive sensorineural hearing loss bilaterally and had a unilateral implantation with a Nucleus Freedom device (Cochlear Americas) at age 9 years. At age 11, S2 was started on GH therapy for a variant of growth hormone deficiency (peak GH level of 16 ng/ml). After 2 months on GH, CNC word recognition scores decreased from 92% to 82% in the implanted ear. Given that there were no apparent hardware or medical explanations for the continued decline in auditory speech perception, GH was discontinued after 10 months of therapy. One-month after cessation of GH, word recognition increased to 86% and 2 years later to 90% in the implanted ear.

Conclusion: This case series present two pediatric CI patients who experienced decline in auditory perception following the initiation of GH therapy, with no significant change in electrode impedances, threshold levels, or comfort levels. Performance was only improved after cessation of GH therapy. The mechanism of this clinical effect is unclear, and future studies are warranted to understand the mechanism by which GH negatively affects cochlear implant performance.

Poster Number: 97

ACI20140231: First Report of Cochlear Implantation in a Patient With Narrow Duplicated Internal Auditory Canals

M. Melton, BA2 , M. Kraskin,AuD4 , K. Brown, MD,Ph.D.1,3

1Weill Cornell Medical College, Department Of Otolaryngology, New York, NY USA ; 2Weill Cornell Medical College, New York, NY USA ; 3New York Presbyterian Hospital, New York, NY USA ; 4Weill Cornell Medical College, Hearing And Speech Center, New York, NY USA

Topic: Surgery/Medical

Keywords: Inner Ear Malformation , Difficult or atypical patients

Introduction: A 4-year old female recently immigrated from the Dominican Republic was referred for hearing loss. On audiologic testing she had no responses in soundfield or under headphones to either warbled or narrowband stimuli. Startle responses were not seen at the limits of the audiometer. Speech Awareness Threshold (SAT) via bone was obtained at 55/60 for at least the better ear. Auditory Brainstem Response (ABR) testing suggested a profound Sensori-Neural Hearing Loss (SNHL) at 500 Hz, 2kHZ and 4 kHz bilaterally. On imaging, the patient was found to have narrow duplicated internal auditory canals (IACs) bilaterally. This is the first case of cochlear implantation (CI) in the presence of duplicated IACs. Objective: To document the course and outcomes of pediatric CI in a patient with narrow duplicated IACs and Oculo-Auriculo-Vertebral (OAV) syndrome

Methods: Analysis of CT, MRI, and audiological results

Results: Computed tomography (CT) of the temporal bone was performed. The right side demonstrates a severe stenosis of the oval window. The round window niche is narrow with an abnormal oblique orientation. In addition, a portion of the facial nerve is found passing in front of the round window. The vestibule is markedly dysplastic. The adjacent lateral semicircular canal is likewise dysplastic. The anterior, posterior and superior semicircular canals are normal. The IAC is duplicated with a stenotic inferior division. On the left side there are multiple abnormalities as well. The oval window is atretic while the round window is normal. There is a mal-developed cochlea with apical dysplasia; a duplicated internal auditory canal is seen with the inferior division markedly stenotic and housing the cochlear nerve. Magnetic resonance imaging (MRI) was performed and revealed thick and cordlike 7th and 8th nerve complexes exiting the brainstem on the left. The MRI reported congenital absence of CNVIII on the right. Her left ear was implanted. An uneventful implantation was performed with a perimodiolar electrode. Her facial nerve was noted in this surgery to be anterior and medial to its typical location. An extended round window insertion was performed. At her 3 week activation she was able to repeat /ba/ /m/ /sh/ and /ah/ 3/3 times each with visual cues. At 1 month responses were in the mild range with a 25dB SAT. The Early Speech Perception (ESP) test was utilized at 55dB HL.

Conclusion: This is the first ever reported cochlear implantation in a patient with duplicated, narrow IACs. Even though CI is possibly contraindicated in the presence of narrow IACs, this patient was successfully implanted and has shown marked improvement in hearing abilities.

Poster Number: 98

ACI20140380: Revision Surgery In A Case With Device Extrusion : Downward Rotation Of The Receiver Stimulator

H. Takeda, MD1 , K. Kumakawa, MD1 , K. Ishikawa, MD2

1Toranomon Hospital, Department Of Otolaryngology, Tokyo, Japan ; 2National Rehabilitation Center For Persons With Disabilities, Department Of Otolaryngology, Tokorozawa, Japan

Topic: Surgery/Medical

Keywords: Revision Surgery, Re-Implantation

Introduction: The skin infection with device extrusion of the receiver stimulator is known as a major complication after cochlear implantation. The revision surgery is more common in the pediatric than the adult population. Usually a plastic surgery intervention is performed in these cases. However, in younger children, the lateral skull is not thick enough to permit the creation of well for the receiver stimulator, and the skin flap is also thin. Therefore re-extrusion of the device would not be completely avoidable. We report a case of a 2 year old girl who suffered a device extrusion six months after its implantation. This presentation describes the surgical technique using a downward rotation of the receiver stimulator for patients with device extrusion.

Methods: We report a pediatric patient with device extrusion 6 months after cochlear implant surgery. This device extrusion was considered related to site of the receiver stimulator. She received a revision surgery with downward rotation of the receiver stimulator. Surgical photos are presented to demonstrate the specifics of this operative technique.

Conclusion: This downward rotation technique is possible to secure the distance from the inflamed area of flap and reduce the tension of the skin incision.The skull at this part is usually thick enough to permit the creation of an adequate well for the receiver stimulator. It was also found that the fixation technique of the indifferent electrode array at the initial operation allow this downward rotation of the receiver stimulator at revision surgery.

Poster Number: 99

ACI20140071: Successful Cochlear Implantation in a case with subjective deafness in the presence of evoked potentials

J. Langer,Dr. med.1 , W. Pethe,Dr. med.1 , K. Begall, Ph.D.,Prof. Dr. med. habil Dr. hc.1

1AMEOS Klinikum Halberstadt, ENT Department, Halberstadt, Germany

Topic: Surgery/Medical

Keywords: Borderline Cases , Difficult or atypical patients , Quality of Life

Introduction: In cases of severe hearing loss and without a possibility for rehabilitation by using conventional hearing aids a Cochlear Implant can be choosen. Sometimes we find patients with an auditory synaptopathy as candidates for cochlear implantation. These patients show potentials in measurement of OAE and Cochlear Microphonics as a response of the inner ear function while acoustic evoked potentials in Auditory Brainstem Responses are absent. These patients will also benefit from a cochlear implantation.

Methods: We will show the results of a girl which was first seen at the age of 12 with a deafness in subjective audiological testings. The investigation of objective measurements showed potentials in OAE as well as in ABR. Further psychological or psychatric disorders could not be found. An aggravation of hearing loss or a psychogenic pseudo-hypoacusis had been excluded. The girl was wearing hearing aids for years without benefit. She used dactylology for communication. A chronic otitis existed as additional desease on the right ear. Due to an extreme level of suffering we decided for a Cochlear Implantation together with an interdisciplinary team consisting of physicians, psychologists, audiologists and speech therapists. At this time the patient's age was 18.

Results: The operation took place in the left ear. The first hearing impressions were seen during the first fitting appr. 4 weeks after the operation. The following developement of hearing was so remarkable that the patient decided for implantation of the second (right) ear. This operation took place about 15 month after the first one. Discussion: The average hearing threshold is located between 25 and 50 dB. The speech comprehension is still limited, but the young woman is now using hearing supported by sign language for communication.

Conclusion: Cochlear Implantation is the standart solution for the treatment of severe hearing loss. It might be promising in particular cases of uncommon hearig loss. But there can be no categorical statement. Each of these cases and patients should be treated individually.

Poster Number: 100

ACI20140156: Performance And Results Of Hifocus 1j ® Cochlear Implants

V. B. Rocha1 , E. M. Silva1 , G. M. Carvalho1 , A. C. Guimar_es1 , A. M. Castilho1

1Unicamp, Departamento De Otorrinolaringologia E Cabe_a E Pesco_o, Campinas, S_O PAULO Brazil

Topic: Audiology

Keywords: Contralateral Hearing Aid Use , Bimodal Hearing

Background: Cochlear implant (CI) is the standard treatment for auditory rehabilitation of postlingual patients with severe to profound deafness who did not benefit from conventional hearing aids. Brazilian census (2010) showed that nearly 9.7 million people report having hearing impairment (5.1%). Severe hearing loss was reported by more than 2.1 million, the vast majority being composed of people over 15 years. Objective: The aim of this study is to describe the performance and results of Hifocus1J ® cochlear implant in postlingual patients, besides to perform a medical literature review of this topic.

Methods: A retrospective study of medical records of patients who underwent surgery treatment for severe/profound hearing loss with CI. The medical literature review was performed using the MeshTerms “hearing loss; cochlear implants; rehabilitation of hearing impaired” at Pubmed and Scopus database.

Results: The sample was composed of seven postlingual patients who underwent Hifocus 1J® CI. The average age at surgery was 36,07 years, ranging between 12.08 and 66.25 years. Most of the cases (4/7) had idiopathic auditory deficit. The comparison between the levels of hearing before and after the CI revealed improvement in all patients. All of them also reported an increased overall satisfaction 1 year after procedure.

Conclusion: Postlingual pacients have demonstrated significant gain in hearing levels using Hifocus 1J® CI.

Poster Number: 101

ACI20140163: Relationship Between Patients With Clinical Auditory Neuropathy Spectrum Disorder And Mutations In Gjb2 Gene

G. M. Carvalho1 , F. L. Fernandes1 , P. Z. Ramos1 , E. M. Silva1 , A. C. Guimar_es1 , E. L. Sartorato1 , A. M. Castilho1

1Unicamp, Departamento De Otorrinolaringologia E Cabe_a E Pesco_o, Campinas, S_O PAULO Brazil

Topic: Audiology

Keywords: Auditory Neuropathy , Objective Measures , Residual Hearing

Introduction: The auditory neuropathy or auditory dyssynchrony is a condition in which there is involvement of the auditory nerve fibers in nerve conduction with dyssynchrony. Objective: To analyze the pattern of clinical relationship between patients with clinical auditory neuropathy spectrum disorder and GJB2 gene. Study Design: Retrospective analysis. Setting: Tertiary referral center. Patients: Clinical information and genetic evaluation (GJB2) of 45 patients with AUDITORY NEUROPATHY SPECTRUM DISORDER were analyzed. Intervention: Diagnostic. Main Outcome Measures: Included in the study, 45 patients with bilateral hearing loss and clinical diagnosis of ANSD. The genetic evaluated are described bellow.

Conclusions: The diagnosis of auditory neuropathy should be considered in patients with bilateral hearing loss initiated through adolescence.

Poster Number: 102

ACI20140312: How Does A Cochlear Implant Works For Language Development In A Child With Severe Hearing Loss?

K. Kuwahara,Ed.D1 , R. R. Truax, Ph.D.2

1Niigata University Of Health And Welfare, Department Of Speech, Language, And Hearing Sciences, Niigata, Japan ; 2University Of Cincinnati, Department Of Special Education, Cincinnati, OH USA

Topic: Rehabilitation/Educational Aspects

Keywords: Cognitive and Social Development of Implanted Children , Speech and Language Development with CI

Akiko (pseudonym) has Waardenburg Syndrome Type II. Her severe hearing loss dates from the time of her birth. Akiko’s parents moved to Belgium before she was born and moved back home to Japan when she was 1 year 5 months old. At the age of 1year 6 month, Akiko had a cochlear implant in her left ear. She began using a Nucleus 24 Sprit cochlear implant at 1 year 7 months of age. Akiko’s parents are Japanese. Soon after her parents knew Akiko had a severe hearing loss, they decided to have her get a cochlear implant, because they wanted to raise her in a hearing community. Her parents wanted Akiko to succeed at school and in society. Akiko’s parents and grandparents talked to her before she had her implant. They used picture cards or photographs, picture books, actual objects, and dramatic actions to make interactions between them meaningful. Edward Reed (1997) suggests that 9 month-olds can be good communicators. First of all, they can move themselves by using their skilled crawling. Thus, they can decide whom to interact with and when and where to interact with the person by themselves. They already understand reciprocal relationship between person and person. Finally, they can use vocal intonational patterns with gestures to effectively send and receive messages with a familiar communication partner. When Akiko was 9 months old and before she had a cochlear implant, she and her mother often played together using a big toy house. Sometimes, her mother would put the toy house between them and draw Akiko’s attention. When her mother looked through the door, Akiko also looked into the house through the door on her side of the door. As soon as they saw each other, they raised their faces and looked at each other and smiled. It became a routine activity between them. Sometimes, Akiko initiated this routine and her mother responded by peeking back at Akiko by looking back through her door. When she was 9 month old, Akiko was already taking a role as a communicator, but she did not use her voice at all. Akiko had stopped vocalizing around the age of 5 months. When Akiko was 2 years 8 months old, she had been using her cochlear implant for about one year. She began having conversations with her mother. For example, one day they were sitting in front of a coloring book starting to color on the page. Her mother asked Akiko to change pens with her. Akiko did not want to change pens so she told her mother “that one is yours, please use it.” When her mother told her “you have to use this one, I am going to use that one”, Akiko ignored her mother’s suggestion and told her “do draw, draw”. Before Akiko had a cochlear implant, she did not use spoken language to communicate with others. But after she had a cochlear implant she started to use speech and movement effectively in conversations and in telling stories. Reference: Reed, E. S. (1997). Encountering the world: Toward an ecological psychology. New York, New York: Oxford University Press.

Poster Number: 103

ACI20140075: Multicentre Evaluation Of The First Swimmable Sound Processor, Neptune™: Experience In Children

N. Mathias1 , M. Brendel2

1Advanced Bionics AG, Clinical Research International, St_fa, Switzerland ; 2Advanced Bioncis GmbH, European Research Center, Hannover, Germany

Topic: Technology

Keywords: Cochlear Implant Hardware , Sound Coding

Introduction: The Advanced Bionics Neptune™ sound processor is a freestyle design swimmable processor which makes it possible to hear underwater and enjoy an active life without worrying about the robustness of the processor. The objective of the survey was to evaluate the daily use of the processor and its various wearing configurations.

Methods: A multicentre evaluation was conducted in Europe and Asia. Participants tested the Neptune and the wearing options for at least four weeks before completing the survey. Upgraded subjects compared their previous processor to the Neptune and both new cochlear implant users and upgraded users answered questions about wearing options, comfort, ease of use and sound quality with the Neptune. The presentation will be focused on outcomes from children.

Results: 73 paediatric questionnaires were analysed. The mean age of the subjects was 5.9 years old (SD=3.8; ranging from 1 to 17 years old). 32 children were new cochlear implant users and 41 were experienced users upgraded to the Neptune. Outcomes of this multicentre evaluation showed that the majority of Neptune features were very easy to use with mean scores above 6.6 out of 10. The satisfaction with the wearing options was rated very well with a higher score for the clip (8.5 out of 10; SD=1.8). Having a waterproof processor was rated to be very useful with a mean score of 9.3 out of 10 (SD=1.2). The Neptune processor was rated as being better than the previous processor, from a general point of view by most of the upgraded users (parents).

Conclusion: Results showed that the Neptune processor provided high level of satisfaction to parents and children. The wide variety of wearing options made it very practical to use. The Neptune processor allows users to live an active life without compromising their hearing performance.
COI: Advanced Bionics1

Poster Number: 104

ACI20140118: Experience Of Cochlear Implant Users With The Naída CI Q70 Sound Processor

N. Mathias1 , M. Brendel2 , D. B. Koch3

1Advanced Bionics AG, Staefa, 8712 Switzerland ; 2Advanced Bionics GmbH, Hannover, 30625 Germany ; 3Advanced Bionics LLC, Valencia, CALIFORNIA USA

Topic: Technology

Keywords: Cochlear Implant Hardware , Sound Coding

Introduction: The Naída CI Q70 (Naida CI) sound processor is the most recent processor from Advanced Bionics. This processor combines the advanced technology of Advanced Bionics and Phonak providing the opportunity to communicate comfortably in a variety of listening situations. The Naida CI is significantly smaller in volume than the previous behind-the-ear processor, Harmony™. The objective of this project is to evaluate the practicality, comfort and ease of use of the Naida CI processor as well as speech performance.

Methods: A pilot study conducted in ten experienced cochlear implant users showed a remarkable improvement when using UltraZoom compared to the omnidirectional microphone when speech is coming from the front and noise from surrounding loudspeakers. Ongoing studies, implemented in the clinical routine at multiple sites, were designed to confirm the previously obtained speech performance data. In parallel, a questionnaire is administered to users of the Naida CI processor: both adults and children; new cochlear implant user and experienced user who are upgraded to the Naida CI processor. Subjects are asked to complete this questionnaire after at least one month of experience with the Naida CI. The questionnaire contains questions about the use of the processor and upgraded users complete additional questions about the comparison between their previous sound processor and the Naida CI. This project is conducted in several centres and countries.

Results: The pilot study showed an average of 6 dB of improvement in the SRT when using the UltraZoom feature compared to the standard omnidirectional microphone, in a test set-up with five loudspeakers delivering stationary speech-shaped noise. 28 questionnaires have been collected so far from six centres. 17 questionnaires were from adults users and 11 from children. All were experienced users upgraded to the Naida CI processor, except four of them. The processor tends to be very easy to use with mean scores above 7.4 out of 10 (on a scale from 1 – very difficult to 10 – very easy) for the majority of aspects related to questions on the ease of use. New functionalities such as the internal alarms which enable users to be informed about the status of the processor and the battery lifetime, appear to be very useful with a mean score of 8.3 out of 10 (SD=1.7) (on a scale from 1 – not useful to 10 – very useful). The majority of these experienced users rated the Naida CI processor as being similar or even better than their previous processor on various aspects such as the ease of use, design or sound quality.

Conclusion: The preliminary results of this multicentre evaluation show that users are very satisfied with the Naida CI sound processor: it appears to be very easy to use every day for both adults and children. The data collection is ongoing and will enable to confirm these outcomes on a larger panel of users.
COI: Advanced Bionics1

Poster Number: 105

ACI20140081: Transcutaneous Bone Conduction with the Bonebridge

G. R. Ball, BS,MS1

1MED-EL, Innsbruck, TYROL Austria

Topic: Other Implantable Devices

Keywords: Future of Implantable Devices , Engineering

Introduction: This talk will focus on the theory of operation and the positive and challenging events surrounding the design and development of the Bonebridge, the world’s first active bone conduction implant. A new MRI safe bone conducting transducer was developed and serves as the principal drive device for the Bonebridge hearing system.

Methods: Our principal objective was to develop an active bone conduction implant that could treat patients with mixed and conductive deafness threshold of 45 dB or better. Our design team was able to leverage our many years of experience in making vibratory implant systems including the Vibrant Soundbridge.We designed a detailed list of system requirements for the transcutaneous BC system and then designed a new transducer platform called the BCI-FMT. .Having a stable reliable design platform is key to any implantable hearing system and we leveraged our implant technology in the Bonebridge design Extensive pre-clinical evaluation, design verication and surgical anatomical studies were conducted. As a result of this extensive pre-clinical work the implant and the related installation tools were successfully developed

Results:The Bonebridge has been subject to clinical trial in both adults and pediatric populations with excellent results that are consistent with our system design objectives, clinical utility and patient outcomes. The design has proven to be a robust, reliable and functional design that meets the output and frequency response requirements for successful patient outcomes and that can offer patients an alternative treatment option that can significantly improve their hearing. Another requirement was for the device to be MRI safe. Clinical results shall be presented.

Conclusion: The Bonebridge is an active implant stage that is a new platform that does not directly vibrate a vibratory structure of the ear (i.e. ossicular chain or window) but rather is the first active transcutaneus bone conduction system. The Bonebridge is now in use and approved (and/or CE marked) in approximately 60 countries world-wide including Canada for conductive, mixed and single sided deafness. The Bonebridge is not approved at the time of this abstract submission by the US FDA and cannot be purchased or obtained by US centers.

Poster Number: 106

ACI20140335: Bimodal hearing among children with hearing preservation

D. P. Sladen, Ph.D. , M. DeJong,Au.D.1 , A. Breneman,Au.D.1 , L. Belf,Au.D.1 , A. Olund,Au.D.1 , A. Peterson, MA1 , C. Beatty, MD1 , B. Neff, MD1 , C. Driscoll, MD1

1Mayo Clinic, Rochester, MN USA

Topic: Audiology

Keywords: Outcomes , Bimodal Hearing

Introduction: Hearing preservation after cochlear implant surgery allows patients access to electroacoustic stimulation (EAS). In turn, patients have access to low the low frequency cues needed for complex listening environments. Adult patients using EAS have been shown to benefit from improved speech understanding in noise, localization, and music appreciation (Gifford et al., 2013; Dunn et al., 2010). Bimodal hearing benefits have not been fully explored in pediatric patients. Objective:The goal of this study was to measure if speech understanding in noise is improved among pediatric CI patients of whom have hearing preservation on the ipsilateral side of implantation.

Methods: This prospective study examined children over age 5;0 years using their current processor, and an EAS processor. Speech in noise understanding is assessed in an R-SPACE 8-speaker array. The babble will be restaurant noise described presented at 72 dB SPL(A) and speech will consist of sentences from the Hearing in Noise Test (Nilsson et al., 1998). The speech is adjusted using an adaptive procedure to find the signal-to-noise (SNR) level at which 50% correct is attained. Children are also assessed using speech and noise coming from a single speaker direclty in front, and when noise is spatially seperated. In this test, speech stimuli are the Pediatric AzBio Sentences and noise is a 4-talker babble. Children are tested actulely and after using the EAS processor for one month.

Results: Preliminary results show an in initial decrement in performance using the EAS processor compared to the child's conventional processor. Data collection is ongoing.

Conclusion: Bimodal hearing benefits may not be present after acute fitting of EAS prcessors. Implications will be discussed.

Poster Number: 107

The mission of the American Cochlear Implant (ACI) Alliance is to advance access to the gift of hearing provided by cochlear implantation through research, advocacy and awareness.