Cochlear implants Expanding into China

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Cochlear implants- Expanding into China

• Robert Hong, M.D., Ph.D.
• Anna Hong, M.A.
• University of Iowa
• Iowa City, Iowa, USA

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The Cochlear Implant (CI)
Photos are from websites of Cochlear Corporation
and Advanced Bionics
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Individuals worldwide with hearing loss
From website of Cochlear Corporation
Individuals with cochlear implants gt100,000
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Cochlear implants in China
Over 4,000 multi-channel cochlear implants have
been performed in China
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How a cochlear implant works
From Cochlear Corporation
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Normal hearing
From website of Cochlear Corporation
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Hearing with a cochlear implant
From website of Cochlear Corporation
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Audiological Candidacy Criteria in China
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Audiological Candidacy Criteria in China

• Prelingually deafened (12 m.o.-5 y.o.)
• Severe to profound SNHL bilaterally
• Lack of progress in auditory skills after 3-6
  months of hearing aid trial
• No medical contraindications
• Appropriate family expectations and high
  motivation
• Have support from aural rehabilitation
• Best aided conditions
• Open-set short sentences recognition ?30
• Or, disyllabic word recognition ?70
• Children younger than 3 y.o. can be observed
  through parent-child interaction for assessment
  in speech and language development

?????????(2003?,??)
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Audiological Candidacy Criteria in China

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• ???????12??5?
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• ??????????,???????????????????30???????70
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Audiological Candidacy Criteria in China

• Postlingually deafened (after 5 y.o.)
• Severe to profound SNHL
• Lack of progress in auditory skills with open-set
  sentence recognition ?30
• No medical contraindications
• High motivation, appropriate expectations
• Family support
• History of wearing hearing aids
• Aided Speech and language ability
• Age of onset of deafness and duration of deafness
  influence CI outcomes
• Life style and work after CI surgery also have
  impact on CI effectiveness

??????????(2003?,??)
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Audiological Candidacy Criteria in China

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• ???????????,???????30
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• ??6?????????????? ??????,??????????????????
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Which ear to implant?

• If both ears are equally poor in hearing, choose
  the ear with a shorter duration of deafness
  (better ear)
• If one ear still provides some benefit via a
  hearing aid, choose the contralateral worse ear
• Recently, many people have opted for bilateral
  cochlear implants (controversial)

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Medical considerations for CI

• General health
• Ability to physically tolerate surgery
• Ability to use CI (eg. psychiatric disorders)
• Purulence in middle ear -gt postpone CI
• Meningitis etiology -gt earlier CI
• High-resolution CT scan of temporal bone
• Evaluate patency of cochlea
• Complete agenesis of cochlea or cochlear nerve
  are contraindications

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Cochlear implant surgery

• Mastoidectomy and cochleostomy
• Electrode inserted into scala tympani near the
  round window
• Surgery takes 1.5-2.5 hours
• Outpatient surgery go home same day or day after
  surgery

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Turning on the cochlear implant1 month after
surgery
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Post-op Care Audiological management

• Activation 4 weeks post-op
• Check physical fit of device
• Program speech processor
• Instruct patient and family to different parts
  and function of the device
• Adult appointments
• 1 day, 1 mo, 6 mo, 12 mo post initial fit, annual
  after
• Stable MAP within 6 mo
• Child appointments
• 1 day, 2 week, 1 mo, 2 mo, every other month for
  the 1st year, 18 mo, 24 mo, annually afterward
• Stable map within 8-18 mo

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Mandarin Chinese- tonal language

• Four tonal patterns in Mandarin

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Speech and language development in
Mandarin-speaking children

• Acquisition order
• Tones? vowels? consonants
• Tone acquisition order
• Tone 1 and 4
• Tone 2 and 3 (changes in F0 and complex contour)
• By 20 mo. Old
• Distinguish tones consistently in all
  monosyllabic and disyllabic words

Chen (1986)
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Cochlear implant outcomes in Mandarin-speaking
children

• Tone Production
• NH vs. CI
• NH perform better
• Range of CI performance is big
• Some CI users perform similarly as NH

Han, et al., (2007)
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Cochlear implant outcomes in Mandarin-speaking
children
Peng, et al. (2004)

• Tone Production
• Tone 1 and 4 were most frequently produced
• Monotone Speech
• Tone 2 and 3 were least frequent produced
• More complex frequency contour

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Cochlear implant outcomes in Mandarin-speaking
children

• Tone Perception
• Tone 1 and 4 are the easiest to identify
• Higher ID score with tone 4 pair, due to shortest
  duration cue in tone 4

Peng, et al., (2004)
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Cochlear implant outcomes in Mandarin-speaking
children

• Correlation between tone production and
  identification was significant
• 3 subjects had very high tone production and
  identification scores

Peng, et al., (2004)
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Cochlear implant outcomes in Mandarin-speaking
children

• Age of Implantation
• lt 3 years old
• Better word recognition
• Better tone perception
• Better vowels and consonant perception and
  production
• Better receptive and expressive language skill
  (predicted by initial syllable consonant
  production skill)
• Better performance if the child is implanted
  before age 3 consistent with the outcome measures
  in English speaking children

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Cochlear implant outcomes in Mandarin-speaking
children

• Age of Implantation

Wang, et al. (2007)
Wu, et al. (2007)
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• Age of Implantation

Wu Yang (2003)
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Cochlear implant outcomes in Mandarin-speaking
children

• Duration of implant use
• Longer implant use
• Better tone identification
• Better tone production

Peng, et al., (2004)
Han, et al., (2007)
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Cochlear implant outcomes in Mandarin-speaking
children

• Duration of implant use
• Performance was significantly improved in Chinese
  spondee, vowel and consonant tests over time in
  children with cochlear implant

Wu, et al. (2007)
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Cochlear implant outcomes in Mandarin-speaking
children

• Outcomes varies greatly
• This cannot be fully explained by the limitation
  of device
• Variables that can potentially affect outcomes
• Family support
• Educational support
• Frequency of device use
• Rehabilitation support

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Pediatric Assessment Tools

• Mandarin Pediatric lexical tone and
  disyllabic-word Picture IDentification test in
  Noise (MAPPID-N)
• Mandarin Early Speech Perception (MESP)

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Mandarin Pediatric lexical tone and
disyllabic-word Picture IDentification test in
Noise (MAPPID-N)

• Validation test on speech recognition performance
  in children 4-9 years old over time with
  intervention
• Computerized software (touch screen)
• Disyllabic words
• Everyday object
• Body parts
• clothing items
• animals
• Lexical tones
• 4 words
• Different lexical tones

Yuen, K. et al (2007)
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MAPPID-N

• Disyllabic words
• Everyday object
• Body parts/clothing items
• animals
• Lexical tones
• 4 words with different lexical tones

Yuen, K. et al (2007)
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Mandarin Early Speech Perception (MESP)

• Compare speech perception performance in children
  2-5 years of age with hearing peers
• Battery of tests in picture cards
• Sound detection
• Speech pattern perception
• Spondees words perception
• Consonant perception
• Vowel perception
• Tone perception

Zheng, Y. Soli, S. (2007)
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References ????

• ??????????(2003?,??)
• Chen, J. L. (1986). Phonological acquisition in
  Mandarin by Hearing-impaired Children A
  longitudinal Case Study. Fu Jen Catholic
  University
• Han, D., Zhou, N., Li, Y., Chen, X., Zhao, X.,
  Xu, Li. (2007). Tone production of Mandarin
  Chinese speaking children with cochlear implants.
  International of Pediatric Otorhinolaryngology,
  71, 875-880
• Peng, S.C., Tomblin, B.T., Cheung, H., Lin, Y.S.,
  Wang, L.S.(2004). Perception and production of
  Mandarin Tones in prelingually deaf children with
  cochlear implants. Ear and Hearing, 25, 251-264
• Wang, N.M., Huang, T.S., Wu, C.M., Kirk, K.L.
  (2007). Pediatric cochlear implantation in
  Taiwan Long-term communication outcomes.
  International of Pediatric Otorhinolaryngology,
  71, 1775-1782
• Wu, J.L., Lin, C.Y., Yang, H.M., Lin, Y.H.
  (2006). Effect of age at cochlear implantation
  on open-set word recognition in Mandarin speaking
  deaf children, 70, 207-211
• Wu, J.L. Yang, H.M.(2003). Speech perception
  of Mandarin Chinese speaking young children after
  cochlear implant use effect of age at
  implantation, International of Pediatric
  Otorhinolaryngology, 67, 247-253
• Yuen, K. et al, Zheng, Y. et al. (2007)
  Implantable Hearing Solutions. Cochlear
  corporation 1(3), October,17-21 44-46

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Thank you, ?? !

• Questions?
• ??(???)????