Perception of Binaural Cues Develops in Children Who Are Deaf through Bilateral Cochlear Implantation

Gordon, Karen A.; Deighton, Michael; Abbasalipour, Parvaneh; Papsin, Blake C.

doi:10.1371/journal.pone.0114841

Cited by 61 publications

(65 citation statements)

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“…Moreover, children increasingly lateralized these sounds to one side of their head as BD amplitude increased. In later work, Gordon and colleagues found that perception of ILDs was established at very early stages of bilateral implant use even for children who were older and heard through one implant for most of their lives [34]. This was consistent with findings that most children are able to discriminate stimuli containing ILD cues when tested after longer periods of bilateral implant use [26, 35].…”

Section: Direct Stimulation Of Binaural Hearingsupporting

confidence: 56%

Bilateral cochlear implants in children: Effects of auditory experience and deprivation on auditory perception

Litovsky

Gordon

2016

Hearing Research

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Spatial hearing skills are essential for children as they grow, learn and play. They provide critical cues for determining the locations of sources in the environment, and enable segregation of important sources, such as speech, from background maskers or interferers. Spatial hearing depends on availability of monaural cues and binaural cues. The latter result from integration of inputs arriving at the two ears from sounds that vary in location. The binaural system has exquisite mechanisms for capturing differences between the ears in both time of arrival and intensity. The major cues that are thus referred to as being vital for binaural hearing are: interaural differences in time (ITDs) and interaural differences in levels (ILDs). In children with normal hearing (NH), spatial hearing abilities are fairly well developed by age 4–5 years. In contrast, children who are deaf and hear through cochlear implants (CIs) do not have an opportunity to experience normal, binaural acoustic hearing early in life. These children may function by having to utilize auditory cues that are degraded with regard to numerous stimulus features. In recent years there has been a notable increase in the number of children receiving bilateral CIs, and evidence suggests that while having two CIs helps them function better than when listening through a single CI, they generally perform worse than their NH peers. This paper reviews some of the recent work on bilaterally implanted children. The focus is on measures of spatial hearing, including sound localization, release from masking for speech understanding in noise and binaural sensitivity using research processors. Data from behavioral and electrophysiological studies are included, with a focus on the recent work of the authors and their collaborators. The effects of auditory plasticity and deprivation on the emergence of binaural and spatial hearing are discussed along with evidence for reorganized processing from both behavioral and electrophysiological studies. The consequences of both unilateral and bilateral auditory deprivation during development suggest that the relevant set of issues is highly complex with regard to successes and the limitations experienced by children receiving bilateral cochlear implants.

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Section: Direct Stimulation Of Binaural Hearingsupporting

confidence: 56%

Bilateral cochlear implants in children: Effects of auditory experience and deprivation on auditory perception

Litovsky

Gordon

2016

Hearing Research

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“…Future investigations focus on whether we can compensate for these large asymmetries in stimulation and neural conduction, and whether children using a CI and a hearing aid can develop a fused binaural image or obtain true binaural hearing. It may be that children require greater lengths of experience to use ITD and ILD cues, as we have seen in bilaterally deafened children with a long delay between receiving their two CI [Gordon et al, 2014]. These children were able to detect some ITD cues only after several years of using bilateral CI, although sensitivity remained abnormal.…”

Section: Discussionmentioning

confidence: 76%

The Effects of Asymmetric Hearing on Bilateral Brainstem Function: Findings in Children with Bimodal (Electric and Acoustic) Hearing

Polonenko

Papsin²,

Gordon³

2015

Audiol Neurotol

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As implantation criteria are broadening to include children with asymmetric hearing loss, it is important to determine the degree of residual hearing needed to protect the bilateral auditory pathways for binaural hearing and whether there is a sensitive period in development for implantation in these children. We have been studying these questions in a growing cohort of children. In the present study, auditory brainstem responses were recorded in 21 children who had 2.2 ± 2.2 years of bimodal hearing. Responses were evoked by 11-Hz acoustic clicks presented to the non-implanted ear and with biphasic electric pulses presented to the implanted ear. Twelve of these children also completed a behavioural task in which they were asked to which side of their heads bilaterally presented clicks/pulses that varied in interaural level or timing lateralized. All children experienced a delay in the non-implanted ear that resulted in 2.0 ± 0.35 ms longer peak latencies. These were further prolonged in 7 children as measured by longer interwave latencies from this ear than from the implanted ear. Despite large asymmetries in timing of brainstem activity between the two ears, all children perceived changes in interaural level differences. They were unable to detect differences in interaural timing cues. Symmetric brainstem function suggests bilateral development was preserved in some children. Future work will explore whether these children have better potential for developing binaural hearing using bimodal input.

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“…75,94 Thus, even in the worst condition (early onset, long duration of single-sided deafness), there is some hope for stimulating hearing in the deaf ear and establishing binaural hearing, with demonstrable benefits already realized. 64-66,68-70, [131][132][133][134] On the other hand, these skills remain abnormal, reflecting persistent reorganization after single-sided hearing. Without focused training, 3 to 4 years of bilateral implant use was not sufficient to reduce the preference of the first-implanted ear…”

Section: Important Factors For a New Treatment Of Asymmetric Hearing mentioning

confidence: 99%

“…122 Although these children learned to detect large changes in binaural timing cues after long periods of bilateral implant experience, they continued to judge input as coming from the side of their first implant more often than children receiving bilateral implants simultaneously. 134 Furthermore, although speech perception was gained in the weaker ear, the progress was slow and did not match the stronger ear even after 5 to 9 years of implant use. 58 Poor speech perception 55 together with absent cortical binaural interaction 135 in children receiving the second implant as adolescents suggest that there are continued difficulties in processing input from the second-treated ear.…”

Section: Figurementioning

confidence: 99%

Asymmetric Hearing During Development: The Aural Preference Syndrome and Treatment Options

2015

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Deafness affects ∼2 in 1000 children and is one of the most common congenital impairments. Permanent hearing loss can be treated by fitting hearing aids. More severe to profound deafness is an indication for cochlear implantation. Although newborn hearing screening programs have increased the identification of asymmetric hearing loss, parents and caregivers of children with single-sided deafness are often hesitant to pursue therapy for the deaf ear. Delayed intervention has consequences for recovery of hearing. It has long been reported that asymmetric hearing loss/single-sided deafness compromises speech and language development and educational outcomes in children. Recent studies in animal models of deafness and in children consistently show evidence of an "aural preference syndrome" in which singlesided deafness in early childhood reorganizes the developing auditory pathways toward the hearing ear, with weaker central representation of the deaf ear. Delayed therapy consequently compromises benefit for the deaf ear, with slow rates of improvement measured over time. Therefore, asymmetric hearing needs early identification and intervention. Providing early effective stimulation in both ears through appropriate fitting of auditory prostheses, including hearing aids and cochlear implants, within a sensitive period in development has a cardinal role for securing the function of the impaired ear and for restoring binaural/spatial hearing. The impacts of asymmetric hearing loss on the developing auditory system and on spoken language development have often been underestimated. Thus, the traditional minimalist approach to clinical management aimed at 1 functional ear should be modified on the basis of current evidence.Deafness is one of the most common congenital impairments. 1,2 Newborn hearing screening programs, implemented in many countries, have decreased the age at diagnosis of hearing loss. When hearing loss occurs in only 1 ear, the screening result may be overlooked or dismissed as unimportant, particularly when hearing in the opposite ear is normal (unilateral or single-sided deafness). The consequence will be a failure to intervene until long after major developmental effects have set in, which causes significant negative clinical implications. Screening programs will also miss children who acquire deafness in 1 ear from infection, trauma, or worsening of preexisting hearing loss. 3-6 Acquired unilateral deafness can go unidentified until educational, social, or other impairments push families and caregivers to seek medical consult. Because the prevalence of permanent unilateral hearing loss in neonates is reported to vary from 0.45 to 2.7 in 1000 7,8 In this State-of-the-Art Review, we present evidence from basic and applied neuroscience, audiology, and otology that points to the existence of an impairment of the central representation of the poorer hearing ear if developmental asymmetric hearing is left untreated for years. First, we review the current state of the problem as viewed in the clin...

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Perception of Binaural Cues Develops in Children Who Are Deaf through Bilateral Cochlear Implantation

Cited by 61 publications

References 50 publications

Bilateral cochlear implants in children: Effects of auditory experience and deprivation on auditory perception

Bilateral cochlear implants in children: Effects of auditory experience and deprivation on auditory perception

The Effects of Asymmetric Hearing on Bilateral Brainstem Function: Findings in Children with Bimodal (Electric and Acoustic) Hearing

Asymmetric Hearing During Development: The Aural Preference Syndrome and Treatment Options

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