In most classrooms, where information is presented orally via spoken language, accurate knowledge of a student's hearing status is crucial so that the interdisciplinary team can ensure appropriate service provision. Audiologists play a key role on the interdisciplinary team to provide other professionals with information about children's hearing status, communication needs, device use, and intervention strategies. Conversely, audiologists gain valuable information and strategies from other team members.

No description available.

A great deal of evidence suggests that parental communication and involvement are essential for the development of language in young children. However, hearing parents of deaf children face unique challenges in providing appropriate stimulation and language input to their deaf children. To date, few studies have determined which types of input are best. This study utilized data collected from the largest, youngest, nationally representative sample of deaf children receiving cochlear implants. The purpose of this study was to identify the facilitative language techniques that are most effective in facilitating receptive and expressive language development in young deaf children. Ninety-three deaf children, ages 2 years and under were enrolled at six implant centers. Deaf children were assessed prior to implantation and then followed for three years post-implantation. At each assessment, parent-child interactions were videotaped in an unstructured Free Play and structured Art Gallery task. All parent and child speech, vocalizations, and sign language were transcribed from the 10 minute videotaped parent-child interactions and coded using the Parenting Strategies for Communication coding system. Results revealed that the most frequently used lower-level strategies used by parents were directives, comments, and close-ended questions. The most frequently used higher-level strategies were parallel talk, open-ended questions, and recast. In addition, the Art Gallery task facilitated more parent utterances and longer mean length of utterances compared to Free Play, but the frequency of facilitative language techniques was not different. Using bivariate latent difference score modeling, higher-level strategies predicted growth in expressive language scores across three years post-implantation. Further, higher-level strategies had a delayed effect on receptive language, with techniques used at 24 months post-implantation predicting growth in receptive language at 36 months post-implantation. These results suggested that parent's play an active role in facilitating their child's language development. Interventions for parents should be developed using a coaching model, where parents receive hands-on training and practice using these effective facilitative language techniques. Future studies should evaluate the effectiveness of this intervention, as well as the effectives of these language techniques in children implanted after 2 years of age.

Recent data regarding social-emotional challenges indicate elevations in behavior problems (BPs) in deaf and hard of hearing (DHH) children (Austen, 2010; Stevenson et al., 2010; van Eldik et al., 2004). Factors affecting this include family and social contexts, language development (LD), and cochlear implantation (CIs). The purpose of this dissertation was to analyze findings across studies for trends in BPs in DHH children. Specifically, a model of the effect of deafness, CI use, and LD on the emergence of BPs in DHH children as compared to hearing children was examined. Studies were collected through systematic searches of psychology databases supplemented by studies referenced in other sources therein discovered. Random-effects meta-analyses using the restricted maximum likelihood estimation method were non-significant (g = 0.31, SE = 0.20, CI [-0.09, 0.71]), as were subgroup analyses (g = 0.36, SE = 0.22, CI [-0.07, 0.80]). A metaregression using CIs as a predictor evidenced a nonsignificant reduction in BPs for deaf children with CIs and CIs did not significantly predict BPs in deaf children. Unexplained heterogeneity remained elevated in all cases (I2 above 96%). In sensitivity analyses, I2 decreased to 87%, suggesting that designs of included primary studies may have impacted those studies’ data collection, analysis, and interpretation. Unmeasured variables such as LD may explain much of the remaining heterogeneity. Collaborating with researchers worldwide, using more inclusive selection criteria, and enacting a longitudinal design could collect a greater variety of data, creating a more complete understanding of the effect of hearing loss on BPs.

FFifteen to thirty-five percent of the population in the United States experience tinnitus, a subjective "ringing in the ears". Up to 10% of tinnitus patients report their symptoms are severe and disabling. Tinnitus was induced in FBN rats using 116 dB (SPL) unilateral octave-band sound exposures centered at 16 kHz for one hour in an anesthetized preparation. Rats were assessed behaviorally by an operant conditioning paradigm as well as a gap detection method to verify the development of tinnitus. Both young (7 mos.) and aged (30 mos.) sound exposed rats showed significant elevated auditory brainstem-evoked response (ABR) thresholds for clix and all tested frequencies immediately after the sound exposure. Eighty days post-exposure, ABR thresholds for the young exposed rats were significantly close to the initial young control values while aged exposed rats showed residual thresholds shifts relative to aged controls. Sixteen weeks following sound exposure, young exposed rats showed significantly reduced gap detection at 24 and 32 kHz, suggestive of high frequency tinnitus. Aged exposed animals showed significant tinnitus-related behavioral changes near 10 kHz by both behavior methods. Message and protein levels of &alpha1-3 glycine receptor subunits (GlyRs), gephyrin, BDNF and its receptor TrkB were assessed in dorsal cochlear nucleus (DCN) fusiform cells 4 months post exposure utilizing quantitative in situ hybridization and immunocytochemistry. Young exposed rats showed significant decreases of GlyR &alpha1 protein at middle and high frequency regions in DCN unlike the contrasting increase of their message levels. Aged exposed rats showed higher &alpha1 subunit protein levels in the same high and middle DCN frequency regions. The GlyR anchoring protein, gephyrin, was significantly increased in both young and aged exposed rats, suggesting an intracellular receptor trafficking change following acoustic trauma. BDNF and TrkB were also increased over fusiform cells in both young and aged exposed rats. [3H] strychnine binding was used to evaluate DCN GlyR pharmacology and function following sound exposure. The age-related decrease in GlyR α1 protein was reflected in the significant age-related down-regulation of GlyR (Bmax). Tinnitus-related changes in GlyR &alpha1 protein level was reflected in the decline of the GlyR (Bmax) in young exposed rats and up-regulated GlyRs in aged exposed animals. The GlyRs in DCN of young exposed animals also demonstrated an increase in affinity, further suggesting a post-exposure receptor composition change. These findings suggest that both aging and/or sound exposure/tinnitus are associated with GlyR changes capable of altering alter the output of the DCN. Detailed characterization of these GlyR modifications could advance the development of novel selective drugs for tinnitus and age-related hearing loss.

In deafness, which is caused by the malfunctioning of the inner ear, an implantation of a cochlear implant (CI) is able to restore hearing. The CI is a neural prosthesis that is located within the cochlea. It replaces the function of the inner hair cells by direct electrical stimulation of the auditory nerve fibers. The CI enables many deaf or severe hearing-impaired people to achieve a good speech perception. Nevertheless, there is a lot of potential for further improvements. Compared to normal-hearing listeners rate pitch discrimination is much worse. Rate pitch discrimination is the ability to distinguish the pitch of two stimuli with two different pulse rates. This ability is important for enjoying music as well as speech perception (in noise). Further, the small dynamic range in electrical hearing (compared to normal-hearing listeners) and therefore the small intensity resolution limits the performance of CI users. Both, rate pitch coding and dynamic range were investigated in this doctoral thesis. For the first issue, a pitch discrimination task was designed to determine the just-noticeable-difference (JND) in pitch with 200 and 400 pps as reference. Additionally to the default biphasic pulse (single pulse) the experiment was performed with double pulses. The double pulse consists out of two biphasic pulses directly after each other and a small interpulse interval (IPI) in between. Three different IPIs (15, 50, and 150 µs) were tested. The statistical analysis of JNDs revealed no significant effects between stimulation with single-pulse or double-pulse trains. A follow-up study investigated an alternating pulse train consisting of single and double pulses. To investigate if the 400 pps alternating pulse train is comparable in pitch with the 400 pps single-pulse train, a pairwise pitch comparison test was conducted. The alternating pulse train was compared with single-pulse trains at 200, 300 and 400 pps. The results showed that the alternating pulse train is for most subjects similar in pitch with the 200 pps single-pulse train. Therefore, pitch perception seemed to be dominated by the double pulses within the pulse train. Accordingly, double pulses with different amplitudes were tested. Based on the facilitation effect, a larger neuronal response was expected by stimulating with two pulses with a short IPI within the temporal facilitation range. In other studies, this effect was shown to be maximal in CIs of the manufacturer Cochlear, with first pulse amplitudes set at or slightly below the electrically evoked compound action potential (ECAP) threshold. The second pulse amplitude did not influence the facilitation effect and therefore could be choose at will. Similarly, this effect was tested in this thesis with CIs of the manufacturer MED-EL. Nevertheless, to achieve a proper signal-to-noise ratio, technical issues had to be addressed like a high noise floor, resulting in incorrect determination of the ECAP threshold. After solving this issues, the maximum facilitation effect was around the ECAP threshold as in the previous study with Cochlear. For future studies this effect could be used in a modified double pulse rate pitch experiment with the first pulse amplitude at ECAP threshold and the second pulse amplitude variable to set the most comfortable loudness level (MCL). The last study within this thesis investigated the loudness perception at two different loudness levels and the resulting dynamic range for different interphase-gaps (IPG). A larger IPG can reduce the amplitude at same loudness level to save battery power. However, it was unknown if the IPG has an influence on the dynamic range. Different IPGs (10 and 30 µs) were compared with the default IPG (2.1 µs) in a loudness matching experiment. The experiment was performed at the most comfortable loudness level (MCL) of the subject and the amplitude of half the dynamic range (50%-ADR). An upper dynamic range was calculated from the results of MCL and 50%-ADR (therefore not the whole dynamic range was covered). As expected from previous studies a larger IPG resulted in smaller amplitudes. However, the observed effect was larger at MCL than at 50%-ADR which resulted in a smaller upper dynamic range. This is the first time a decrease of this dynamic range was shown. / Bei einer Taubheit, welche durch eine Schädigung des Innenohres hervorgerufen wird, ist es möglich das Gehör mittels eines Cochlea-Implantates (CI) wieder herzustellen. Das Implantat befindet sich innerhalb der Hörschnecke und ist in der Lage, die Funktion der inneren Haarzellen zu ersetzen. Dies geschieht durch direkte elektrische Stimulation der auditorischen Nervenfasern. Dadurch ermöglicht das CI Ertaubten oder stark Schwerhörigen, ein gutes Sprachverstehen zu erlangen. Dennoch gibt es weiterhin Verbesserungspotential. Im Vergleich zu Normalhörenden ist unter anderem die Tonhöhenunterscheidung stark eingeschränkt. Die Unterscheidung von Tonhöhen ist sowohl für den Musikgenuss als auch für das Sprachverstehen (im Störgeräusch) wichtig. Ebenso verfügen CI Träger über einen vergleichsweise kleinen Dynamikbereich und einer daraus resultierenden geringen Auflösung der Intensitäten. Dies kann zu einer Beeinträchtigung des Hörens führen. Sowohl die Fähigkeit der Tonhöhenunterscheidung als auch der Dynamikbereich werden in der vorliegenden Doktorarbeit untersucht. Hierfür wurde zunächst ein Tonhöhenunterscheidungs-Experiment entworfen, bei welchem der kleinste wahrnehmbare Unterschied zweier Pulsraten ermittelt wurde. Die Pulsraten 200 und 400 pps dienten als Referenzwert. Neben dem standardmäßig verwendeten Biphasischen Puls, wurden Doppelpulse genutzt. Diese bestehen aus zwei aufeinander folgenden biphasischen Pulsen gleicher Amplitude, welche durch ein kurzes interpuls Intervall (IPI) separiert sind. In dem Experiment wurden drei unterschiedliche IPIs getestet (15, 50 und 150 µs). Die Analyse des kleinesten wahrnehmbaren Tonhöhenunterschieds ergab keine signifikanten Unterschiede zwischen dem einfachen Puls und den Doppelpulsen. Ein Folgeexperiment beschäftigte sich mit einer alternierenden Pulsfolge bestehend aus dem einfachen und dem Doppelpuls. In einem paarweisen Vergleichsexperiment wurde die alternierende Pulsfolge bei 400 pps mit einem Einfachpuls bei 200, 300 und 400 pps in ihrer Tonhöhe verglichen. Es zeigte sich, dass die alternierende Pulsfolge bei 400 pps mehrheitlich mit dem Einzelpuls bei 200 pps vergleichbar war. Demzufolge scheint die Tonhöhenwahrnehmung der alternierenden Pulsfolge von dem Doppelpuls dominiert zu werden. Auf beide Experimente aufbauend, wurden Doppelpulse mit unterschiedlichen Amplituden untersucht. Basierend auf den Bahnungseffekt (Facilitation-Effekt), kann eine größere neuronale Antwort hervorgerufen werden, indem mit Doppelpulsen mit kurzem IPI stimuliert wird. In einer anderen Studie konnte anhand von CIs der Firma Cochlear gezeigt werden, dass dieser Effekt maximal war, wenn die Amplitude des ersten Pulses nahe der Schwelle zum elektrisch evozierten Summenaktionspotential (ECAP) liegt. Die Amplitude des zweiten Pulses dagegen hatte keinen Einfluss auf den „Facilitation“-Effekt und konnte beliebig gewählt werden. Dieser Effekt wurde mit CIs der Firma MED-EL in der vorliegenden Doktorarbeit nachgestellt. Es zeigte sich, dass auch hier der größte „Facilitation“-Effekt auftrat, wenn die Amplitude des ersten Pulses nahe der ECAP-Schwelle lag. In zukünftigen Studien könnte dieser Effekt für einen modifizierten Doppelpuls genutzt werden, um mit diesem das ursprüngliche Tonhöhenunterscheidungs-Experiment zu wiederholen. Dabei würde die Amplitude des ersten Pulses der ECAP-Schwelle entsprechen, während die zweite Pulsamplitude variiert wird, um den größten, möglichst angenehmen, Lautheitspegel zu erhalten. In einer letzten Studie wurde das Lautheitsempfinden bei zwei unterschiedlichen Lautheiten bei unterschiedlichen Interphasen-Gaps (IPG) untersucht und der daraus resultierende Dynamikbereich. Eine Vergrößerung des IPGs führt bei gleich bleibendem Lautheitsempfinden zu geringeren Stimulations-Amplituden und ist dadurch in der Lage die Batterie schonen. Allerdings ist der Einfluss auf den Dynamikbereich bisher unbekannt. In einem Lautheits-Experiment wurden Pulse mit verschiedenen IPGs (10 und 30 µs) mit dem standardmäßig verwendeten IPG (2.1 µs) in ihrer Lautheit angeglichen. Dieses Verfahren wurde bei MCL und der Amplitude des halben Dynamikbereichs (50%-ADR) durchgeführt. Aus den ermittelten Werten konnte ein „oberer“ Dynamikbereich zwischen MCL und 50%-ADR ermittelt werden. Es zeigte sich, dass sich die Amplituden mit größerem IPG, wie erwartet, verringerten. Jedoch zeigte sich ein stärkerer Effekt bei MCL, was eine Verringerung des Dynamikbereichs zur Folge hat. Dies ist das erste Mal, dass eine Verringerung des Dynamikbereichs gezeigt wurde.

Background: A review of literature shows that cochlear implant (CI) users face difficulties in terms of music interpretation when compared to regular hearing (RH) counterparts. The electrically pulsing nature of the CI acts differently than sound waves in a normally functioning ear, leading to different interpretations of musical concepts such as pitch or timbre. An exceptional case however has been observed in a university-level violinist with bimodal hearing (congenitally deaf in the right ear, and with very minimal residual hearing in the left; they use one CI and one hearing aid) at the University of Ottawa. Objective: This study will compare the pitch recognition, timbre preference and audiation (linked to pitch and rhythmic perception) abilities between an exceptional CI user and case-control RH violinists. Data has previously been collected on CI users not playing the violin due to CI technology's limitations in pitch processing. Since the violin is considered a pitch-heavy instrument to play, it is expected that the study participant has exceptional pitch recognition skills when compared to other CI users (and perhaps RH peers), while still demonstrating comparable timbre preference and rhythmic audiation abilities to an RH comparison group. Method: Three tests were administered relating to pitch recognition on a violin-like interface, timbre preference between two heard tones, and an Advanced Measures of Music Audiation (AMMA) test for general musical knowledge in pitch and rhythm-based melodic discrimination. Results were compared between the critical case-study with CIs and RH control participants to quantify a basis in pitch perception, timbre preference and melodic audiation (applied to pitch and rhythm) skills. Implications: The study participant demonstrated comparable timbre preference and rhythmic discrimination skills to an RH comparison group. The study participant demonstrated pitch perception skills higher than previously tested CI users, despite being lower than the RH comparison group. The CI-using study participant would have developed these higher-than- average pitch perception skills through rigorous early-age training, and passion and persistence of music training on a pitch-heavy instrument despite known recommendations. This sheds light on the CI's technology not necessarily limiting users' choice of instrument due to its pitch processing, despite previous recommendations.

Für die Cochlea-Implantat-Versorgung ist die Kenntnis der individuellen Anatomie der Hörschnecke im perioperativen Kontext essenziell, um ein suffizientes audiologisches Resultat sicherzustellen. Ein akkurates Verfahren hierfür stellt die 3D multiplanare Rekonstruktion (3D-curved MPR) in Schnittbildgebung dar. Notwendige Voraussetzung ist jedoch eine hinreichende Bildqualität. In dieser Arbeit wurde das Augenmerk auf die sekundäre Rekonstruktion von Primärdatensätzen der Flachdetektor-Volumen-Computertomographie (fpVCTSECO) gerichtet. Diese bietet nämlich die Möglichkeit, die Bildqualität zu steigern, ohne jedoch eine als kritisch einzuschätzende Dosissteigerung in Kauf nehmen zu müssen. Es konnte gezeigt werden, dass es für die Messung der Länge von 2 Schneckenwindungen (2TL), der gesamten cochleären Länge (CDL) und dem Winkelmaß (AL) mittels 3D-curved MPR in der fpVCT keinen signifikanten Unterschied gegenüber der Mehrschicht-CT gibt. In beiden Modalitäten wurden alle drei Parameter gegenüber der Referenzbildgebung micro-CT deutlich unterschätzt. Durch die fpVCTSECO war es möglich, die Genauigkeit der Messungen zu steigern und den Werten der Referenz anzunähern. Lediglich für AL muss eine geringfügige systematische Unterschätzung beachtet werden. Postoperativ zeigte sich mit einliegendem Elektrodenträger für 2TL eine ebenso präzise Messung wie präoperativ ohne. Jedoch wurde die CDL um circa 0,5 - 0,7 mm unterschätzt. Ursächlich hierfür dürften vor allem Metallartefakte gewesen sein. Auch wenn die 3D-curved MPR in Kombination mit der fpVCTSECO postoperativ zur Visualisierung der räumlichen Beziehung von Elektrodenträger, Modiolus und ossärer lateraler Wand sehr gut geeignet war, so muss sich der Einfluss dieser Diskrepanz für die audiologische Anpassung in Zukunft erst noch zeigen. / Knowledge of the individual anatomy of the cochlea is essential for optimal hearing perception outcomes in cochlear implantation. 3D-curved multiplanar reconstruction (3D-curved MPR) in cross-sectional imaging is a very precise method. But for this purpose, high-resolution quality is an indispensable requirement. In this study, special attention was turned to secondary reconstruction of primary data of flat-panel volume computed tomography (fpVCTSECO). This postprocessing application provides an opportunity to increase image quality. Beneficially, there is no need of applying additional radiation dose, which should always be regarded critically. For the cochlear duct length (CDL), the two-turn length (2TL) and the angular length (AL), there were no statistically significant differences between fpVCT and multislice computed tomography applying 3D-curved MPR. In contrast to reference imaging modality micro-CT, a clinically relevant underestimation of all three parameters was evident. Using fpVCTSECO, precision of measurements could be increased significantly. It was possible to reach the accuracy of the reference. Only concerning AL, a slight and systematic underestimation must be considered. Postoperatively, after insertion of the electrode into the cochlea, measurement of 2TL was as precise as the preoperative one. For CDL, an underestimation of approximately 0.5 - 0.7 mm was evident. Most likely, this fact was linked to postoperative metal artifacts. Even though 3D-curved MPR in combination with fpVCTSECO is a great possibility to visualize the spatial relation of electrode, modiolus and bony lateral wall, the influence of this difference on audiological fitting procedures has still to be investigated in future studies.

No description available.

No description available.