CC
research presentations. >>And what I'm going to do isew
begin by telling you a little bit about what we think of as
some of the recent advances in
there are future possibilities. I always like to think of the
work that we're doing in the
community, I mean the field of community, and when I say
worldwide. cochlear implants which spans
we're doing as representing the glass being both half full and
half empty in the sense that
We've learned so much about how to provide hearing to people who
are either born deaf or acquire deafness later in life, and yet
there are remaining challenges. You'll hear me talk both about,
look, this is what we're
fantastic progress, and you'll finding, and this is really
where these children or these adults aren't functioning as
well as normal hearing people.
about that bar. As Dr. Heatley described through
the history of cochlear implants, initially the goal was
to provide access to sound. I know there's sound there.
Or access to some speech and
The field, we always compared people to people who have
hearing aids but who have severe
So the question was whether cochlear implants are doing a
better job than hearing aids for
Today we've changed the bar, that same population of people.
changed the goals, and we talk we've raised the bar, we've
being equalizing, people who about the desired outcomes as
people who have normal acoustic have cochlhearing.ants with
We hope down the road this is what the devices will be
able to do. We talk about possibilities for
future development, this is what
So you've heard from Dr. Heatley we're aiming for.
cochlear implants, which is that about some of the history of
could provide access to sound. we wanted to create devices that
communicate with verbal/oral So that the user could
be necessarily, although some cusers are bilingual, in theto
sense that they use sign
You've seen that the age of implantations that decreased.
When I was first working in the field most of the children I met
were receiving their implants no
today we see many children younger than age 3 or 4, and
And the criteria for receive them during infancy.
sense that people used to be implantation has changed in the
today we see people who have severe to profound, whereas
Sometimes in the ear that gets quite a bit of residual hearing.
devices out there that are implanted, but there's new
provide a short array, so a partial cochlear implant in an
ear that is also receiving
Some people have very good acoustic hearing.
frequency area, and to preserve hearing in that area, there's a
new short array that is being tried on quite a few patients to
preserve hearing in the lower frequencies, and to combine
acoustic with electric hearing
That is a hybrid device, and we also have people who are
bimodal.
profound hearing loss in one If you have serious, severe to
with useable acoustic hearing ethrough a hearing aid in theg
opposite ear, you're a candidate
You can be bilateral, for bbut bimodal.ning.
There's a very small number of
under serious debate, who have patients worldwide, and this is
but deafness the opposite excellent heaear. in one ear,
These are single-sided deafness people.
Especially in Europe, they've implanted quite a few dozen
people, and it's off the FDA
patients in the United States lwith single-sided deafness who
would like to have hearing in the deaf ear.
Often it's to relieve tinnitus. But there are a few people who
don't have tinnitus who are interested in getting that
device as well. I'm giving these examples to
highlight this very important point which is that the criteria
for implantation is changing, and it's continuing to change.
I'm always surprised at what I
to. see aA new candidate, a newI go
population of people who seem to
devices. be benefiting from these
didn't really get into, but I think is important to mention,
is that when people are not candidates for cochlear implants
because we cannot stimulate the auditory nerve, there are
devices that can be implanted more centrally in the brainstem.
There are auditory brainstem
slightly higher devices that are devices, and there are now
All of these are experimental, going into the mid-brain.
patients, always more in Europe butthan in the United States,of
little bit looser criteria
more aggressive at trying out some of these procedures, but
they end up coming back to the
see a growing number of those as states at some stage, and we'll
The other thing that is very well.
I show a picture of this family interesting there.e've seen, and
This is a wonderful family who
far away from the west coast have traveled to Madison from
program a number of times. that participate in our research
interesting is that both of the parents who are congenitally
deaf grew up speech reading and using sign language, and both of
their children were born deaf.
should have cochlear implants right away as soon as they weren
able to do that, and in fact
bilaterally, and in fact each parent ended up getting a single
cochlear implant as well. So six implants in that
household, which is very
management. intThey do beautifully.ul
The children both speak and sign.
What's interesting is that
household where the parents' they're growing up in a
well-articulated. They grew up deaf, and they do
very well being mainstreamed, but their speech production is
not what I would say, very clear.
Yet the children's speech is
I think it's a testament to the speech therapy that these
children are receiving and have received since the day that they
could benefit from it.
Very supportive of the cochlear implant as a means of providing
oral, verbal communication. I think this transition in the
field of seeing more and more adults who is decided later in
life to choose to get a cochlear
didn't see 10, 15, 20 years implant ago either.g that we
So I'd like to tell you a little
shown, and then move into some bit about what the field has
here at the Waisman Center at ofthe University of Wisconsin.ng
In general in adults who receive
differences between people who cochlear implants, we see
congenitally or early in life. have onset of deafness, either
questions a few minutes ago. This came up a little bit in the
deafness during childhood, and People who have onset of
during adulthood. pIt seems, moving up from the
bottom of the slide, that the best outcomes in the sense that
immediate recognition of voices at the turn-on of the devices
are people whose onset of deafness is during adulthood.
Sometimes people report that at turn-on they can understand
their spouse's voice, or at turn
and recognize music. on, they can understand speech
but not that long. Sometimes it takes a few months,
people with onset of deafness Acongenitally or early in life,f
this is where it takes longer to
the benefits don't get as high see the benefits, and sometimes
deafness during adulthood. as for people with onset of
with what happens to the This has almost everything to do
deprived of stimulation. auditory system when it's
children, we talk about early Thisstimulation being verybout
important.
years, as we think of them being Adults who have spent many
degeneration in the neural out of sound, have experienced
What that means is that neurons lose the ability to send
information to the brain. That is not something we can
recover.
use whatever information we have, but when the neurons can't
stimulate anymore, or there are fewer of them, this is when
getting information through the cochlear implant becomes more
challenging.
through hundreds of labs and So through the fields,
out, this has been a consistent story between the age of onset
of deafness and the amount of time being out of sound is
important factor in outcomes. In children we see a similar
story, but there's more opportunity for plasticity in
children. We see with children born
congenitally or early in life,
greater success, which is why the age of implantation has come
down. Children with onset of deafness
during early childhood also see excellent success.
Sometimes they need more speech therapy.
Sometimes it takes a little bit longer, but there are other
factors that add to the variability that we don't
understand yet. So today's standards, we implant
early and/or soon after we see
from the hearing aid. thI want to get into the nittyit
gritty of the research that we
One of the first questions is how do we test these kids.
How do we know what they're hearing or what they're
understanding.
video in which I can give you an I wanted to show you a little
domain, but it's not that different from what we do in
the clinic in how we test language abilities in very young
children. You're seeing a video of a young
toddler.
body-worn devices. Actually, he was wearing
from behind his ears. THe then got the ear levelng
devices about a year later. This in particular experiment,
which was done by Tina Grieco-Calub, who was a
post-doctoral fellow here,
child can look at pictures of wwords that the parents tell us
they know.
baby, which is pictured here, or So the child knows the word
here. But the question is when they
see these pictures in the real
information and match that world can they hear the auditory
object. So how good are they at in the
real world or in the lab real world scenario can they do that
task. How accurate are they, and how
fast are they.
for you. So let me play this little movie
the baby's eyes. What I want you to do is watch
30 frames per second where the In the data analysis we score
He's darting around the room. baI'll play it twice.g.
Before the sound comes on he's
After the sound comes on his just looking around.
room. eyes So watch his eyes.n the
Look at the doggy.
Oh-oh, the sound didn't Whcome on.t?
Should we turn it up a little bit?
Look at the doggy.
I'm going to turn it up Wheagain.it?
Here we go. >> Look at the doggy.
Where is it?
said, look at the, but after >> Hopefully, what you saw, she
eyes settled on this part of she said the word doggy, his
picture of the dog is. the room which is where the
many times. We alternate sides and pictures,
and then we score the data for
We also do this in the presence all of noise.ren.
So they're listening to the woman, but there's a male voice
in the background.
the too loud. [indistinguishable male voice]
Female voice: Look at the doggy.
Where is it?
actually ten decibels below that >> So the male's voice is
For normal hearing people that of the target female voice.
Plus ten decibel signal to noise is a no brainer.
But let's see what happens with rathese children.y.
So what I'm showing you, the
that they're looking toward the dacorrect target location as ame
function of time. Now over here at the top what
you see are data from children
they're listening and quiet. who are normal hearing when
word doggy comes on or baby, What happens is as soon as the
eyes dart to the correct depending on the target, their
And they're almost one hundred location.
So they're fast and accurate. When we play the stimulus of
noise, these normal hearing children drop.
When we test children with
filled triangles, they look like cochlear implants, that's the
are listening with noise or tmaybe even a little bit worse.
Remember, these are two and a half year old children.
Children with cochlear implants have had less exposure to sound
because they didn't get their cochlear implant until 12 or 18
months of age.
have had a year less of auditory They might be a year behind or
have normal hearing. experience than the children who
well. On the other hand, when they'rey
listening and quiet, they look
listening in noise. To answer that question that
someone asked about, what's it
when you're first turned on. like to hear with an implant
system, and it takes time to get People report that it's a noisy
from the cochlear implant. the clarity of the information
enough, and they need more time, Maybe six months or a year isn't
them early on. which is why it sounds noisy to
I think the glass is half full But they can do the task.
goodness, they can do the task. They sit there, they do it,
they're learning the words. Yes.
Just a clarification
unilateral? >> Good question, the question
was are these children bilateral
The answer is that in this study or unilateral.
implanted and unilateral we tested many bilateral
was no difference on this implantparticular task. there
But one thing, since you asked, is that the target speech and
the noise both came from in front of the child.
One thing we know about from
that they specifically might be hable to help us if we separates
the target from the noise.
experiment, but we're currently doing in our lab in that sound
booth that you've seen down the hall.
So hopefully we'll know the answer to that shortly.
I had that on here. Children with one implant
perform as well as children with
Now as they get older, many children with cochlear implants
catch up with their normal
language abilities, but not all. hearing peers in terms of their
full, and half empty part of the Again this is the glass is half
These are data from a paper published a couple of years ago
from a very, very large project that was managed by Dr. Niparko
and his colleagues from Johns Hopkins.
It's a very extensive paper.
suggest reading it. The basic part of the story is
that the children who have
have a mean trajectory of norlanguage outcomes that'sng
up here.
with cochlear implants is down The mean trajectory of children
And this is what they were like before they got their device.
You can see that they're closing
normal hearing, and that quite a the gap toward the kids with
of the kids with normal hears few are follhearing.e trajectory
Yet there are a number of kids
This continues at other ages and who are staying down here.
You can see that these are the other intervals of testing them.
when they're older. Children with cochlear implants.
Some are closing the gap, and some are staying down here.
And so most of the children in
unilaterally. I'd like to now move into
bilateral cochlear implants, and
research that we're doing here start to get at some of the
think that bilateral implants may be able to help close some
of that gap.
providing implants in two ears As Dr. Heatley also mentioned,
care in many clinics around has now bthe world.andard of
Now the goal initially was to provide hearing and maybe
replace the other ear.
last decade or so, the goal was to try to bring them up to where
normal hearing people are who have normal binaural acoustic
hearing.
access to sound in both ears What do we get from having
Well, the goal for the children with cochlear implants was to be
able to mainstream them, to make hearing easier, but
specifically binaural helps us
sounds are coming from. hMany of the people who havee
bilateral implants report a significant change in the
quality of life.
I see my child is less tired. I have an easier time.
functioning in the real world,
the patient panel as well. and you'll hear about this at
children who have bilateral cochlear implants, and we looked
at language outcome measures, some of them very similar to the
ones in the Niparko study.
What we looked at, and I'm just showing you a little bit of the
data, was a non-language
and some core language measures. measure, a brief non-verbal IQ,
notice is that this bar is the The first thing I want you to
population in the country of the mean, the average, of the normed
What you can see is that the children at that age.
participate in our research are coming with parents who have
very interested in supporting the research, and have the time
and the ability to come here. These are very smart kids.
Their brief non-verbal IQ is
average, but very high, one or hovering not just around
the mean for the majority two standarof them.ions above
In terms of language scores,
that many are within one when we first test them we see
and some are below the mean. standard deviation of the mean,
regraphing the data, but what ThI want to show you is that'm
the brief IQ as we follow them, the blue bar is the first time
we tested them, which I just
A year later is the red bar, and showed you in the last slide.
bar. another year later is the green
hovers above average. TAnother measure that's not,
language related, a memory
What you see with the language screen is also above average.
on average. is As they're getting moretter
experienced with their implants,
ability to listen or speak, is their core language, their
This is where the glass is more cothan half full because these.
kids are getting more experience, and catching up or
surpassing their normal hearing peers, which achieves one of our
goals which is to be able to
oral/verbal communication. mainstream these children with
to my slide? Oh, my goodness, what happened
Okay. Something happened to it.
But I can still talk it through.
interested in is specifically binaural hearing which we know
is important for the what question, can you understand
what I'm telling you, and the where question, can you tell me
where sounds are coming from. We do this because when we have
sound arriving at both ears.
there, the sound reaches the Say we have sound coming from
with differences in intensity or ears at different times, and
And the brain is doing a level.
those differences and being able beautiful job of calculating
noise other where sounds are to help us understand what in
This is an example of something that's been studied over the
years even with normal people,
cocktail party effect. with something called the
people, they are all talking at I'the same time, I'm trying toof
focus on what one person is saying, and ignore what others
are saying. How can I do this?
Binaural hearing helps us do
binaural hearing is what we call this, and the hallmark of
What we're trying to do with is source segregation.
cochlear implants is improve people who have bilateral
segregation. their ability to do source
research environment is that we position somebody in a room with
loud speakers, and we're
environment. simulating a realistic listening
tell us what they hear, so we might present sounds fromr
different locations or where
We do this with noise in the they hear these sounds.
quiet. background or we do this in
data from the work that we were I want to shodoing.a tiny bit of
Here I'm showing you sound
So can you tell me where the localization.
But they're listening either in quiet which is over here or in
noise.
how bad they are. NHow many mistakes-- on average
what's the error in degrees.
there, but you tell me it's over If the sound is coming from over
30-degrees. How good are you at solving this
problem.
quiet adults with bilateral What we'implants rock.that in
They are doing an incredible job
coming from in quiet. This is what they do with a
single cochlear implant.
having two cochlear implants. So these are the unilateral
errors and bilateral errors.
add noise, and make the signal Now normal hearing people, as we
normal hearing people are to nholding out fairly well.se,
Steady rise in error, but not too bad.
What we see with people with
error rates rise dramatically in bilateral implants is that their
Why is this important? noise.
localization with bilateral implants, that sing the praises
of bilateral implants, are done in quiet.
And it's beautiful in quiet,
One implant versus two is a significant improvement in sound
localization. When we put people in noisy
environments, this is where having bilateral implants isn't
as good as we want it to be.
What I'd like to do is take a minute to tell you what we're
looking for in terms of future
What happens with two cochlear progress.
clinically, but we fit them as implants is that we put them on
independently. if we're fitting two ears
Not exactly. Is there anybody to blame?
hard to miniaturize them, make The manufacturers are working
But what they haven't spent time the device better, faster.
the audiologists to map the devices bilaterally or force the
devices to talk to each other.
ears are talking to each other In a normal acoustic system, the
from the cochlea, there's rigintegration of inputs inay
the brainstem.
milliseconds, and the Riinformation is in the brain.of
With the bilateral implants that
haven't done the engineering is not happening because we
So are they doing better than pwith one implant?t.
No question.
and noise showing that We also have data for speech
significantly better with two they're hthan one. noise is
Have we closed the gap? I think there's still work to be
done there. I have a couple of minutes
for questions.
take more questions throughout I'll be here all day and I can
Thank you very much for your the day.
[applause]