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Hearing Disorders: HELP
Articles by Emily A. Tobey
Based on 20 articles published since 2010
(Why 20 articles?)

Between 2010 and 2020, Emily Tobey wrote the following 20 articles about Hearing Disorders.
+ Citations + Abstracts
1 Editorial Current clinical research involving cochlear implantation. 2012

Tobey, Emily A. · ·J Am Acad Audiol · Pubmed #22668759.

ABSTRACT: -- No abstract --

2 Editorial Editorial: Long-term outcomes of cochlear implantation in early childhood. 2011

Geers, Ann E / Tobey, Emily A / Moog, Jean S. · ·Ear Hear · Pubmed #21832884.

ABSTRACT: -- No abstract --

3 Article Persistent Language Delay Versus Late Language Emergence in Children With Early Cochlear Implantation. 2016

Geers, Ann E / Nicholas, Johanna / Tobey, Emily / Davidson, Lisa. · ·J Speech Lang Hear Res · Pubmed #26501740.

ABSTRACT: PURPOSE: The purpose of the present investigation is to differentiate children using cochlear implants (CIs) who did or did not achieve age-appropriate language scores by midelementary grades and to identify risk factors for persistent language delay following early cochlear implantation. MATERIALS AND METHOD: Children receiving unilateral CIs at young ages (12-38 months) were tested longitudinally and classified with normal language emergence (n = 19), late language emergence (n = 22), or persistent language delay (n = 19) on the basis of their test scores at 4.5 and 10.5 years of age. Relative effects of demographic, audiological, linguistic, and academic characteristics on language emergence were determined. RESULTS: Age at CI was associated with normal language emergence but did not differentiate late emergence from persistent delay. Children with persistent delay were more likely to use left-ear implants and older speech processor technology. They experienced higher aided thresholds and lower speech perception scores. Persistent delay was foreshadowed by low morphosyntactic and phonological diversity in preschool. Logistic regression analysis predicted normal language emergence with 84% accuracy and persistent language delay with 74% accuracy. CONCLUSION: CI characteristics had a strong effect on persistent versus resolving language delay, suggesting that right-ear (or bilateral) devices, technology upgrades, and improved audibility may positively influence long-term language outcomes.

4 Article American parent perspectives on quality of life in pediatric cochlear implant recipients. 2015

Kumar, Roshini / Warner-Czyz, Andrea / Silver, Cheryl H / Loy, Betty / Tobey, Emily. ·1Department of Pediatric Psychiatry, Children's Medical Center, Dallas, Texas, USA; 2Department of Rehabilitation Counseling Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; 3Dallas Cochlear Implant Program, Dallas, Texas, USA; 4Department of Communication Sciences and Disorders, University of Texas at Dallas, Dallas, Texas, USA; 5Department of Enterprise Planning, Children's Medical Center, Dallas, Texas, USA; and 6Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. ·Ear Hear · Pubmed #25377531.

ABSTRACT: OBJECTIVES: Cochlear implantation influences not only communication but also psychosocial outcomes in children with severe to profound hearing loss. Focusing on issues specific to cochlear implantation (e.g., self-reliance, social relations, education, effects of implantation, and supporting the child) may provide a more accurate and relative view of functional status of pediatric cochlear implant (CI) recipients. The present study analyzes parental perspectives of CI-specific health-related quality of life (HRQoL) in children with CIs to determine (a) if parents differentially rate their child's quality of life according to psychosocial domain (e.g., communication, self-reliance, education); (b) if associations exist between quality of life domains specific to cochlear implantation in pediatric implant recipients; and (c) if demographic variables (i.e., chronologic age, age at cochlear implantation, duration of device experience) mediate parent ratings of quality of life in pediatric CI recipients. DESIGN: Parents of 33 children with CIs (mean age, 9.85 years; mean age of CI activation, 2.47 years; mean device experience, 7.47 years) completed a validated condition-specific questionnaire, Children With Cochlear Implants: Parental Perspectives. RESULTS: Parents positively rated most HRQoL domains, although education and effects of implantation received significantly less positive ratings (p < 0.01). Three domains (communication, self-reliance, and well-being) significantly correlated with at least 5 other domains, suggesting that positivity in one domain co-occurs with positivity in other domains. Demographic variables (chronologic age, CI activation age, and duration of CI use) did not correlate significantly with psychosocial outcomes; rather, parents reported positive HRQoL and successful functional use of CI across demographic variables. CONCLUSIONS: Parents of children and adolescents with CIs rate overall HRQoL positively across psychosocial domains. Significantly less positive ratings of education and effects of implantation may result from limited access to CI-related accommodations and varying parent expectations, warranting further exploration to maximize psychosocial and performance outcomes in pediatric CI users.

5 Article Emergence of speech sounds between 7 and 24 months of cochlear implant use. 2014

Salas-Provance, Marlene B / Spencer, Linda / Nicholas, Johanna G / Tobey, Emily. · ·Cochlear Implants Int · Pubmed #24074439.

ABSTRACT: OBJECTIVES: To investigate the process of speech development in five 42-month-old children with profound deafness who received cochlear implants (CIs) between 19 and 36 months of age and five normal hearing (NH) age mates. METHODS: Conversational samples were collected and transcribed. Sounds produced correctly within meaningful words (target sounds) and recognizable sounds produced in spontaneous productions (target-less sounds) were analyzed for all 10 children. RESULTS: Revealed that there was overlap in the total number of vowels and consonants produced by the two groups. The differences between the two groups were more evident in the target condition, whereas the two groups were more similar in the target-less condition. DISCUSSION: The similarities documented in the target-less repertoire of CI and NH children underscore the importance of examining the emerging sound system to predict the end-point sound system in children with CIs. Using target and target-less speech sound comparisons offers a supplementary view of the emergent process of speech sound development and is a valid method of analysis. Results suggest that early implantation may help some children with profound deafness develop speech sounds in a manner similar to NH age mates.

6 Article A tribute to a remarkably sound solution. 2013

Roland, Peter S / Tobey, Emily. ·Department of Otorhinolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA. Electronic address: peter.roland@Utsouthwestern.edu. ·Cell · Pubmed #24034237.

ABSTRACT: For their work on the development of the modern cochlear implant, which bestows hearing to individuals with profound deafness, Ingeborg Hochmair, Graeme Clark, and Blake Wilson are the 2013 recipients of the Lasker∼DeBakey Clinical Medical Research Award.

7 Article Age-dependent cost-utility of pediatric cochlear implantation. 2013

Semenov, Yevgeniy R / Yeh, Susan T / Seshamani, Meena / Wang, Nae-Yuh / Tobey, Emily A / Eisenberg, Laurie S / Quittner, Alexandra L / Frick, Kevin D / Niparko, John K / Anonymous6250754. ·Department of Otolaryngology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. ·Ear Hear · Pubmed #23558665.

ABSTRACT: OBJECTIVES: Cochlear implantation (CI) has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence of the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation-a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the present study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost utility of pediatric CI by age at intervention will be analyzed. DESIGN: Prospective, longitudinal assessment of health utility and educational placement outcomes in 175 children recruited from six U.S. centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent CI before 5 years of age, and had up to 6 years of postimplant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratified by preoperative, operative, and postoperative expenditures. Incremental costs and benefits of implantation were compared among the three age groups and relative to a nonimplantation baseline. RESULTS: Children implanted at <18 months of age gained an average of 10.7 quality-adjusted life years (QALYs) over their projected lifetime as compared with 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different among the three age groups. In addition, mean lifetime costs of implantation were similar among the three groups, at approximately $2000/child/year (77.5-year life expectancy), yielding costs of $14,996, $17,849, and $19,173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared with 57 and 63% for the middle and oldest groups, respectively (p < 0.05) after 6 years of follow-up. After incorporating lifetime educational cost savings, CI led to net societal savings of $31,252, $10,217, and $6,680 for the youngest, middle, and oldest groups at CI, respectively, over the child's projected lifetime. CONCLUSIONS: Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with CI was associated with greater and longer quality-of-life improvements, similar direct costs of implantation, and economically valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to CI at older ages.

8 Article Influence of implantation age on school-age language performance in pediatric cochlear implant users. 2013

Tobey, Emily A / Thal, Donna / Niparko, John K / Eisenberg, Laurie S / Quittner, Alexandra L / Wang, Nae-Yuh / Anonymous4710751. ·Dallas Cochlear Implant Program, University of Texas at Dallas, Dallas, Texas, USA. etobey@utdallas.edu ·Int J Audiol · Pubmed #23448124.

ABSTRACT: OBJECTIVE: This study examined specific spoken language abilities of 160 children with severe-to-profound sensorineural hearing loss followed prospectively 4, 5, or 6 years after cochlear implantation. STUDY SAMPLE: Ninety-eight children received implants before 2.5 years, and 62 children received implants between 2.5 and 5 years of age. DESIGN: Language was assessed using four subtests of the Comprehensive Assessment of Spoken Language (CASL). Standard scores were evaluated by contrasting age of implantation and follow-up test time. RESULTS: Children implanted under 2.5 years of age achieved higher standard scores than children with older ages of implantation for expressive vocabulary, expressive syntax, and pragmatic judgments. However, in both groups, some children performed more than two standard deviations below the standardization group mean, while some scored at or well above the mean. CONCLUSIONS: Younger ages of implantation are associated with higher levels of performance, while later ages of implantation are associated with higher probabilities of continued language delays, particularly within subdomains of grammar and pragmatics. Longitudinal data from this cohort study demonstrate that after 6 years of implant experience, there is large variability in language outcomes associated with modifiers of rates of language learning that differ as children with implants age.

9 Article A comparative study of psychosocial development in children who receive cochlear implants. 2013

Warner-Czyz, Andrea D / Loy, Betty / Roland, Peter S / Tobey, Emily A. ·Dallas Cochlear Implant Program, Dallas, TX, USA; University of Texas at Dallas Callier Advanced Hearing Research Center, Dallas, TX, USA. ·Cochlear Implants Int · Pubmed #23394623.

ABSTRACT: OBJECTIVES: This study assessed self-reported quality of life of children with a cochlear implant (CI), comparing results with two published reports from the past decade. METHODS: Participants included 33 pediatric CI recipients with a mean age of 10.12 years (SD = 3.59), mean implantation age of 1.36 years (SD = 0.46), and mean CI experience of 6.23 years (SD = 1.75). Children in all three studies completed a self-report quality-of-life questionnaire that included seven benefit and six problem items, rated on a 5-point Likert scale. RESULTS: Outcomes revealed agreement across studies in overall benefit and problem ratings. Environmental awareness and frustration reduction were the most and least positively rated outcomes, respectively. Items contributing to overall ratings differed across studies. Current CI recipients rated speech production, making new friends, and understanding speech more positively and taking extra care of the device more negatively than previous generations of pediatric CI users. DISCUSSION: Overall, benefits outweigh problems of the device, according to children using CI. Differences in issues motivating self-report ratings reflect changes in CI candidacy, technology, and social participation over the past decade. These findings emphasize the need for clinicians to address not only communication needs, but also quality-of-life issues to optimize outcomes in children using CI.

10 Article Effects of maternal sensitivity and cognitive and linguistic stimulation on cochlear implant users' language development over four years. 2013

Quittner, Alexandra L / Cruz, Ivette / Barker, David H / Tobey, Emily / Eisenberg, Laurie S / Niparko, John K / Anonymous870737. ·Department of Psychology, University of Miami, Miami, FL, USA. aquittner@miami.edu ·J Pediatr · Pubmed #22985723.

ABSTRACT: OBJECTIVES: To examine the effects of observed maternal sensitivity (MS), cognitive stimulation (CS), and linguistic stimulation on the 4-year growth of oral language in young, deaf children receiving a cochlear implant. Previous studies of cochlear implants have not considered the effects of parental behaviors on language outcomes. STUDY DESIGN: In this prospective, multisite study, we evaluated parent-child interactions during structured and unstructured play tasks and their effects on oral language development in 188 deaf children receiving a cochlear implant and 97 normal-hearing children as controls. Parent-child interactions were rated on a 7-point scale using the National Institute of Child Health and Human Development's Early Childcare Study codes, which have well-established psychometric properties. Language was assessed using the MacArthur Bates Communicative Development Inventories, the Reynell Developmental Language Scales, and the Comprehensive Assessment of Spoken Language. RESULTS: We used mixed longitudinal modeling to test our hypotheses. After accounting for early hearing experience and child and family demographics, MS and CS predicted significant increases in the growth of oral language. Linguistic stimulation was related to language growth only in the context of high MS. CONCLUSION: The magnitude of effects of MS and CS on the growth of language was similar to that found for age at cochlear implantation, suggesting that addressing parenting behaviors is a critical target for early language learning after implantation.

11 Article Cochlear implantation updates: the Dallas Cochlear Implant Program. 2012

Tobey, Emily A / Britt, Lana / Geers, Ann / Loizou, Philip / Loy, Betty / Roland, Peter / Warner-Czyz, Andrea / Wright, Charles G. ·Dallas Cochlear Implant Program, Dallas, TX 75235, USA. etobey@utdallas.edu ·J Am Acad Audiol · Pubmed #22668764.

ABSTRACT: This report provides an overview of many research projects conducted by the Dallas Cochlear Implant Program, a joint enterprise between the University of Texas at Dallas, the University of Texas Southwestern Medical Center, and Children's Medical Center. The studies extend our knowledge of factors influencing communication outcomes in users of cochlear implants. Multiple designs and statistical techniques are used in the studies described including both cross sectional and longitudinal analyses. Sample sizes vary across the studies, and many of the samples represent large populations of children from North America. Multiple statistical techniques are used by the team to analyze outcomes. The team has provided critical information regarding electrode placement, signal processing, and communication outcomes in users of cochlear implants.

12 Article Timing of cochlear implantation and parents' global ratings of children's health and development. 2012

Clark, James H / Wang, Nae-Yuh / Riley, Anne W / Carson, Christine M / Meserole, Rachel L / Lin, Frank R / Eisenberg, Laurie S / Tobey, Emily A / Quittner, Alexandra L / Francis, Howard W / Anonymous1690726 / Niparko, John K. ·Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·Otol Neurotol · Pubmed #22588232.

ABSTRACT: OBJECTIVE: To assess children's health-related quality of life (HRQL) and development after cochlear implant (CI) surgery and compare improvements between different age of implantation categories. STUDY DESIGN: Prospective, longitudinal study comparing outcomes of deaf children post-CI with hearing controls. SETTING: Six US CI centers. PATIENTS: Deaf children who received CI (n = 188) and hearing children of comparable ages (n = 97). INTERVENTION: CI before 5 years of age. MAIN OUTCOME MEASURE: Parental ratings of global HRQL and development, as assessed over the first 4 years of follow-up using visual analog scales. Development scores assess parental views of children's growth and development, motor skills, ability to express themselves and communicate with others, and learning abilities. Associations of baseline child and family characteristics with post-CI HRQL and development were investigated using multivariable analysis, controlling for factors that influence post-CI language learning. RESULTS: Baseline deficits of CI candidates relative to hearing controls were larger in development than HRQL. Development scores improved significantly by 4 years after CI, particularly in the youngest CI recipients. Developmental deficits of older CI recipients with early, extended hearing aid use were only partially remediated by CI. Overall, no significant health deficits were observed in CI children after 4 years. Cognition and speech recognition were positively associated with both HRQL and development. CONCLUSION: Parental perspectives on quality of their child's life and development provide practical insight into the optimal timing of interventions for early-onset deafness. Validity of parental global assessments is supported by clinical measures of speech perception and language learning and comparison with a well-validated health status instrument.

13 Article Epilogue: factors contributing to long-term outcomes of cochlear implantation in early childhood. 2011

Geers, Ann E / Strube, Michael J / Tobey, Emily A / Pisoni, David B / Moog, Jean S. ·Dallas Cochlear Implant Program, Callier Advanced Hearing Research Center, The University of Texas at Dallas, Dallas, Texas 75235, USA. ageers@earthlink.net ·Ear Hear · Pubmed #21832892.

ABSTRACT: OBJECTIVES: This report focuses on how speech perception, speech production, language, and literacy performance in adolescence are influenced by a common set of predictor variables obtained during elementary school in a large group of teenagers using cochlear implants (CIs). DESIGN: Time-lag analyses incorporating seven common predictor variables associated with the elementary school test period were evaluated. The elementary school-age variables included five contributors across the performance domains: gender, performance intelligence quotient, family size, socioeconomic status, and duration of deafness (operationally defined as the time period between the age of implantation and the onset of deafness). Regression analyses then examined how communication mode in early elementary grades influenced skills exhibited in high school and how this influence was mediated by information capacity of immediate memory. RESULTS: High correlations occurred between outcome measures collected at CI-E session and similar measures collected at CI-HS (values ranging from 0.75 to 0.83), indicating that the relative standing of individuals on these outcomes is highly stable over time. The best performers in elementary grades exhibit the best outcomes in high school, and early difficulties tend to persist throughout the elementary and high school years. The most highly related outcome areas were language and reading/literacy (values ranging from 0.74 to 0.88). These skills seem closely linked, and CI children who demonstrate the best vocabulary and syntax skills in elementary grades achieved the highest literacy performance in high school. Speech perception and speech production skills are also highly correlated with one another (r = 0.69 to 0.87), suggesting that the most direct result of improved auditory input from a CI is the child's ability to produce intelligible speech. The lowest correlations are observed between reading/literacy and speech perception (r = 0.30 to 0.54) or speech production (values ranging from 0.31 to 0.58). CI-E verbal rehearsal speed is an independent and powerful predictor of each early performance outcome, accounting for between 13% and 30% of the variance in early outcomes above and beyond that accounted for by gender, family size, socioeconomic status, performance intelligence quotient, duration of deafness, and the CI-E sign enhancement ratio. Group mean scores for language, reading, and social adjustment were generally within an SD of normative samples of typically developing age-mates with normal hearing. CONCLUSIONS: Use of sign to enhance spoken communication negatively influenced verbal rehearsal speed, which was a strong predictor of all early outcomes, which in turn strongly influenced later outcomes. These analyses suggest that early communication mode exerts a powerful influence on early outcomes that persist into later years. Speech perception, speech intelligibility, language, literacy, and psychosocial adjustment far exceeded that reported for similar groups before the advent of CI technology.

14 Article Factors influencing speech production in elementary and high school-aged cochlear implant users. 2011

Tobey, Emily A / Geers, Ann E / Sundarrajan, Madhu / Shin, Sujin. ·Dallas Cochlear Implant Program, Callier Advanced Hearing Research Center, The University of Texas at Dallas, Dallas, Texas 75235, USA. etobey@utdallas.edu ·Ear Hear · Pubmed #21832888.

ABSTRACT: OBJECTIVES: The objectives of this study were to (a) evaluate changes in speech intelligibility in a group of 110 adolescent users of cochlear implants who were first assessed in elementary school (CI-E) and later in high school (CI-HS) and (b) examine factors influencing speech intelligibility performance at the CI-E and CI-HS sessions. DESIGN: Participants were 110 adolescents who participated in an earlier study examining 181 young elementary school-aged children. Primary outcome measures included speech intelligibility under quiet and multispeaker background conditions and consonants correct produced in the sentences. Multiple linear regressions were used to evaluate how participant, family, and performance measures influenced their speech production during adolescence. Performance measures included estimates of speech perception, working memory, sign enhancement, and duration of seven-syllable sentences. Participant and family measures included duration of deafness, performance intelligence quotients, gender, family size, and socioeconomic status. Principal component analyses were used to construct common variables across highly intercorrelated measures. Three sets of multiple linear regressions evaluated the contributions of the variables to the variance associated with adolescent speech intelligibility. RESULTS: Speech intelligibility and consonants correct significantly increased nearly 22% between the two test sessions. Speech intelligibility significantly decreased by approximately 20% in the multispeaker babble condition relative to the quiet condition. Duration of seven-syllable sentences significantly decreased during the two test sessions. Data revealed that 65.8% of the variance in adolescent speech intelligibility was predicted from participant, family, and performance measures observed in elementary school. Forty-nine percent of the variance at adolescence was accounted for by the participant, family, and performance measures observed during the high school test session. Evaluation of variance including participant and family measures at both time periods, in conjunction with the adolescent performance measures, accounted for 49% of the variance in adolescence performance. After contributions from participant and family variables at the elementary and adolescent test sessions were removed, 21% of the variance in adolescent speech intelligibility was due to the performance measures at adolescence. Independent predictors of performance at adolescence included negative effects of sign enhancement and duration of seven-syllable sentences. CONCLUSIONS: Substantial improvements were made in consonant accuracy, sentence duration, and speech intelligibility between elementary and high school test sessions. Reductions in speech intelligibility performance suggest that allophonic variations, distortions, or use of speech sounds in a nonambient language may contribute to the reductions observed in multispeaker background conditions. Although a significant amount of variance in adolescent performance is accounted for by participant and family characteristics, elementary school speech production and an early reliance on speaking and listening independently account for variance in adolescence speech intelligibility. Over and beyond all the contributions made by participant, family and performance measures, greater reliance on oral communication, and shorter sentence durations independently account for variance at adolescence.

15 Article Factors contributing to speech perception scores in long-term pediatric cochlear implant users. 2011

Davidson, Lisa S / Geers, Ann E / Blamey, Peter J / Tobey, Emily A / Brenner, Christine A. ·Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. davidsonl@ent.wustl.edu ·Ear Hear · Pubmed #21832887.

ABSTRACT: OBJECTIVES: The objectives of this report are to (1) describe the speech perception abilities of long-term pediatric cochlear implant (CI) recipients by comparing scores obtained at elementary school (CI-E, 8 to 9 yrs) with scores obtained at high school (CI-HS, 15 to 18 yrs); (2) evaluate speech perception abilities in demanding listening conditions (i.e., noise and lower intensity levels) at adolescence; and (3) examine the relation of speech perception scores to speech and language development over this longitudinal timeframe. DESIGN: All 112 teenagers were part of a previous nationwide study of 8- and 9-yr-olds (N = 181) who received a CI between 2 and 5 yrs of age. The test battery included (1) the Lexical Neighborhood Test (LNT; hard and easy word lists); (2) the Bamford Kowal Bench sentence test; (3) the Children's Auditory-Visual Enhancement Test; (4) the Test of Auditory Comprehension of Language at CI-E; (5) the Peabody Picture Vocabulary Test at CI-HS; and (6) the McGarr sentences (consonants correct) at CI-E and CI-HS. CI-HS speech perception was measured in both optimal and demanding listening conditions (i.e., background noise and low-intensity level). Speech perception scores were compared based on age at test, lexical difficulty of stimuli, listening environment (optimal and demanding), input mode (visual and auditory-visual), and language age. RESULTS: All group mean scores significantly increased with age across the two test sessions. Scores of adolescents significantly decreased in demanding listening conditions. The effect of lexical difficulty on the LNT scores, as evidenced by the difference in performance between easy versus hard lists, increased with age and decreased for adolescents in challenging listening conditions. Calculated curves for percent correct speech perception scores (LNT and Bamford Kowal Bench) and consonants correct on the McGarr sentences plotted against age-equivalent language scores on the Test of Auditory Comprehension of Language and Peabody Picture Vocabulary Test achieved asymptote at similar ages, around 10 to 11 yrs. CONCLUSIONS: On average, children receiving CIs between 2 and 5 yrs of age exhibited significant improvement on tests of speech perception, lipreading, speech production, and language skills measured between primary grades and adolescence. Evidence suggests that improvement in speech perception scores with age reflects increased spoken language level up to a language age of about 10 yrs. Speech perception performance significantly decreased with softer stimulus intensity level and with introduction of background noise. Upgrades to newer speech processing strategies and greater use of frequency-modulated systems may be beneficial for ameliorating performance under these demanding listening conditions.

16 Article Long-term outcomes of cochlear implantation in early childhood: sample characteristics and data collection methods. 2011

Geers, Ann E / Brenner, Christine A / Tobey, Emily A. ·Dallas Cochlear Implant Program, Callier Advanced Hearing Research Center, University of Texas at Dallas, Dallas, TX 75235, USA. ageers@earthlink.net ·Ear Hear · Pubmed #21832885.

ABSTRACT: OBJECTIVES: This article describes participants in a follow-up study of a nationwide sample of children who had used a cochlear implant (CI) since preschool. The children were originally tested when they were in early elementary grades, and results were published in a monograph supplement of Ear and Hearing. Recently, many of these children returned for follow-up testing when they were in high school with >10 yrs experience with a CI. This introductory article will (1) discuss the extent to which the sample tested is representative of typical populations and (2) describe how sample characteristics changed over time for the 112 students tested in both elementary grades and high school. DESIGN: Over a 4-yr period, 112 teenagers from across North America, accompanied by a parent, attended a research camp that was similar to one in which they had participated 8 yrs earlier. A battery of auditory, speech, language, and reading tests was administered, and responses to questionnaires and written language samples were obtained and are described in the following articles in this issue. This article summarizes child, family, and educational characteristics that were quantified so that their role in outcome levels achieved could be examined statistically. For example, metrics were devised to reflect the extent to which a student's language improved when sign language was added to spoken language (i.e., sign enhancement) based on test results obtained in elementary grades and in high school. RESULTS: Comparisons of early characteristics of the 112 students who returned for follow-up testing with the 72 who did not return indicated comparable Performance Intelligence Quotients, communication mode ratings, family education/income, and age at implant. However, follow-up participants had better speech perception, speech intelligibility, and language skills at 8 or 9 yrs of age. Seventy-five percent of returning teenagers were fully mainstreamed in high school (compared with 63% in elementary grades). Only 5% of adolescents were in full-time special education. Grade placement of the teenagers was appropriate to their chronologic age. Estimates of sign enhancement, family characteristics, and Performance Intelligence Quotient were consistent over the two test sessions. CONCLUSIONS: A large proportion of the original sample returned for follow-up testing in adolescence, but they were a more selective group than nonreturning subjects, and their scores may overestimate long-term CI outcomes for the general population. On the other hand, CI-HS students who participated in this study received their device >10 yrs ago and did not have some of the advantages available to more recently implanted children, so their results may underestimate those outcomes.

17 Article Spoken word recognition in adolescent cochlear implant users during quiet and multispeaker babble conditions. 2011

Tobey, Emily A / Shin, Sujin / Sundarrajan, Madhu / Geers, Ann E. ·Dallas Cochlear Implant Program, Callier Advanced Hearing Research Program, University of Texas at Dallas, Dallas, Texas 75235, USA. Etobey@utdallas.edu ·Otol Neurotol · Pubmed #21307815.

ABSTRACT: OBJECTIVE: To assess overall speech intelligibility in adolescent cochlear implant speakers during quiet and multispeaker babble conditions. STUDY DESIGN: A cross-sectional assessment of intelligibility incorporating group (auditory-oral versus total communication speakers), sentence context (high versus low contexts), and background conditions (quiet versus multispeaker babble). SETTING: A camp designed to assess adolescents over a concentrated period. PARTICIPANTS: Fifty-seven adolescents who participated in an earlier study when they were 8 to 9 years old examining functional outcomes of speech perception, speech production, and language were asked to participate in follow-up study. METHODS: Speech intelligibility was assessed by asking the adolescents to repeat sentences. Sentences were digitally edited and played to normal hearing listeners who either provided broad transcriptions of sound accuracy or wrote down the words they understood when the sentences were presented in quiet and in multispeaker babble. MAIN OUTCOME VARIABLE: The dependent variables were percent correct consonants, vowels, and total words identified. RESULTS: Very few substitutions or omissions occurred, resulting in high levels of accuracy for consonants and vowels. Speech intelligibility in quiet was significantly greater than in the multispeaker babble condition. Multispeaker babble decreased performance uniformly across sentence context for the 2 groups. CONCLUSION: Accurate consonant production based on measures of substitutions and omissions fails to account for distortions and allophonic variations. Reductions in speech intelligibility relative to the phoneme correct productions suggest that the allophonic variations related to distortions may influence naive listener's ability to understand the speech of profoundly deaf individuals.

18 Article Cross-modal plasticity and speech perception in pre- and postlingually deaf cochlear implant users. 2011

Buckley, Kristi A / Tobey, Emily A. ·Department of Communicative Disorders & Sciences, University at Buffalo, Buffalo, New York, USA. kb78@buffalo.edu ·Ear Hear · Pubmed #20829699.

ABSTRACT: OBJECTIVE: A great amount of variability is observed in speech perception outcomes with cochlear implants. The mechanisms behind the observed variability need to be elucidated. One possible mechanism contributing to the observed variability is the development of cross-modal plasticity. This study examines the association between visual/auditory cross-modal plasticity and speech perception with a cochlear implant in individuals with pre- and postlingual onset of severe to profound hearing loss. DESIGN: The N1 visual evoked potential (VEP) in response to peripheral visual motion stimuli was recorded in individuals with pre- (N = 10) and postlingual (N = 12) onset of severe to profound hearing loss who use a cochlear implant. The association between the amplitude of the N1 VEP response over the right temporal lobe and sentence and word perception scores obtained with the cochlear implant was examined through linear regression analyses. In addition, the association between the duration of auditory deprivation and the amplitude of the N1 VEP response was examined. RESULTS: As the amplitude of the N1 VEP recorded over the right temporal lobe increased, speech perception scores in individuals with prelingual onset of severe to profound hearing loss decreased. However, a clear association between the amplitude of the N1 VEP over the right temporal lobe and speech perception scores was not observed for individuals with postlingual onset of severe to profound hearing loss. Neither group demonstrated an association between the amplitude of the VEP over the right temporal lobe and the duration of auditory deprivation before cochlear implantation. CONCLUSION: The results suggest that cross-modal plasticity accounts for a significant amount of the variability observed in speech perception performance with a cochlear implant in individuals with prelingual onset of severe to profound hearing loss but not in individuals who acquire severe to profound hearing loss later in life. Furthermore, the results suggest that the influence of cross-modal plasticity on speech perception ability is more greatly influenced by when (pre- or postlingually) a person acquires a severe to profound hearing impairment rather than the duration of auditory deprivation before receipt of a cochlear implant.

19 Article Spoken language development in children following cochlear implantation. 2010

Niparko, John K / Tobey, Emily A / Thal, Donna J / Eisenberg, Laurie S / Wang, Nae-Yuh / Quittner, Alexandra L / Fink, Nancy E / Anonymous5180658. ·Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jnipark1@jhmi.edu ·JAMA · Pubmed #20407059.

ABSTRACT: CONTEXT: Cochlear implantation is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe to profound sensorineural hearing loss (SNHL). OBJECTIVE: To prospectively assess spoken language acquisition following cochlear implantation in young children. DESIGN, SETTING, AND PARTICIPANTS: Prospective, longitudinal, and multidimensional assessment of spoken language development over a 3-year period in children who underwent cochlear implantation before 5 years of age (n = 188) from 6 US centers and hearing children of similar ages (n = 97) from 2 preschools recruited between November 2002 and December 2004. Follow-up completed between November 2005 and May 2008. MAIN OUTCOME MEASURES: Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales). RESULTS: Children undergoing cochlear implantation showed greater improvement in spoken language performance (10.4; 95% confidence interval [CI], 9.6-11.2 points per year in comprehension; 8.4; 95% CI, 7.8-9.0 in expression) than would be predicted by their preimplantation baseline scores (5.4; 95% CI, 4.1-6.7, comprehension; 5.8; 95% CI, 4.6-7.0, expression), although mean scores were not restored to age-appropriate levels after 3 years. Younger age at cochlear implantation was associated with significantly steeper rate increases in comprehension (1.1; 95% CI, 0.5-1.7 points per year younger) and expression (1.0; 95% CI, 0.6-1.5 points per year younger). Similarly, each 1-year shorter history of hearing deficit was associated with steeper rate increases in comprehension (0.8; 95% CI, 0.2-1.2 points per year shorter) and expression (0.6; 95% CI, 0.2-1.0 points per year shorter). In multivariable analyses, greater residual hearing prior to cochlear implantation, higher ratings of parent-child interactions, and higher socioeconomic status were associated with greater rates of improvement in comprehension and expression. CONCLUSION: The use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their preimplantation scores.

20 Article The children speak: an examination of the quality of life of pediatric cochlear implant users. 2010

Loy, Betty / Warner-Czyz, Andrea D / Tong, Liyue / Tobey, Emily A / Roland, Peter S. ·University of Texas Southwestern Medical Center, Dallas, TX; Dallas Cochlear Implant Program, 5323 Harry Hines Blvd, Dallas, TX 75390-9035, USA. betty.loy@utsouthwestern.edu ·Otolaryngol Head Neck Surg · Pubmed #20115983.

ABSTRACT: OBJECTIVE: To examine the results of health-related quality-of-life questionnaire scores from profoundly deaf children fitted with at least one cochlear implant (CI) and to compare their responses with those of normal-hearing mates of similar age and their parents. STUDY DESIGN: Cross-sectional study utilizing a generic quality-of-life questionnaire designed to be completed by both parents and children independently of each other. SETTING: Questionnaires completed at various summer camps designed for children with CIs in Texas and Colorado. SUBJECTS AND METHODS: Eighty-eight families from 16 states were divided into two subgroups by age of cochlear implantation: an eight- to 11-year-old group and a 12- to 16-year-old group. The KINDL-R Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents was distributed, and CI participants completed the questionnaire independently of their participating family member. RESULTS: CI users in both age groups scored similarly to their normal-hearing peers and their parents. Younger CI users scored their family domain lower compared with their normal-hearing peers. Teen CI users scored the school domain lower compared with their parents. Among CI participants, earlier implantation and longer CI use resulted in higher quality-of-life scores. CONCLUSION: Children with CIs experience quality of life similar to that of normal-hearing peers. Parents are reliable reporters on the status of their child's overall quality of life.