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«Submitted for the degree of Doctor of Philosophy University of York Department of Psychology March 2010 Abstract Recently, controversy in the care of ...»

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Comparisons of unilateral and bilateral

cochlear implantation for children:

spatial listening skills and quality of life

Rosemary Elizabeth Susan Lovett

Submitted for the degree of Doctor of Philosophy

University of York

Department of Psychology

March 2010

Abstract

Recently, controversy in the care of severely-profoundly deaf children has centred

on whether they should be provided with bilateral cochlear implants (two implants,

one in each ear) rather than a unilateral cochlear implant (one implant in one ear). Potentially, implanting both ears rather than one could improve children’s spatial listening skills, meaning the ability to localise sources of sound (by comparing the intensity and timing of sounds arriving at the two ears) and to perceive speech in noise (by attending to whichever ear gives the better signal-to-noise ratio). The overall aim of the studies reported in this thesis was to assess whether bilateral implantation for children is more effective than unilateral implantation in improving spatial listening skills and quality of life. The first study measured the relationship between spatial listening skills and age in normally-hearing children.

The second study compared the spatial listening skills of unilaterally- and bilaterallyimplanted children. Whilst controlling for confounds, the bilateral group performed significantly better than the unilateral group on tests of sound-source localisation.

Moreover, the bilateral group, but not the unilateral group, displayed improved speech perception when the source of a masking noise was moved from the front to either side of the head. Neither group of implanted children performed as well as normally-hearing children on tests of the ability to localise sources of sound and to perceive speech in noise. The third study measured the spatial listening skills of normally-hearing adults when listening to simulations of unilateral or bilateral implants. The differences in performance between simulations were similar to the differences in performance between groups of implanted children, which provides further evidence that the children’s performance was primarily influenced by the number of implants they used rather than by confounds. The fourth study found that there was no significant difference between bilaterally- and unilaterally-implanted children in parental estimates of quality of life. The fifth study presented informants, who were not the parents of hearing-impaired children, with descriptions of a hypothetical child with unilateral or bilateral implants. The informants judged that the bilaterally-implanted child had a higher quality of life than the unilaterallyimplanted child. These studies indicate that bilateral implantation for children is more effective than unilateral implantation in enabling spatial listening skills,but the extent of any gain in quality of life remains uncertain.

–  –  –

2.1 A schematic diagram of the peripheral auditory system.......... 6

2.2 A schematic cross-section of the cochlea................... 6

2.3 Minimum audible angle............................. 12

2.4 Measuring binaural summation in normally-hearing listeners...... 15

2.5 Measuring binaural squelch in normally-hearing listeners......... 16

2.6 Measuring the head-shadow effect in normally-hearing listeners..... 16

2.7 Listening conditions used to measure spatial release from masking... 17

3.1 A schematic diagram of a cochlear implant.................. 23

3.2 The continuous interleaved sampling sound-processing strategy for a cochlear implant................................. 24

3.3 Measuring spatial release from masking in implanted listeners...... 35

3.4 Measuring binaural squelch in implanted listeners............. 40

3.5 Measuring the head-shadow effect in implanted listeners......... 40

3.6 Summary of literature review.......................... 64

–  –  –

2.1 Spatial release from masking in normally-hearing children........ 20

3.1 Search terms used to identify relevant studies................ 30

3.2 Between-subjects comparisons of unilaterally- and bilaterally-implanted children using a left-right discrimination task................ 32

3.3 Between-subjects comparisons of the spatial release from masking shown by unilaterally- and bilaterally-implanted children......... 37

3.4 Within-subjects comparisons of bilateral and unilateral performance on left-right discrimination tasks.......................... 45

3.5 Within-subjects comparisons of bimodal and unilateral performance on left-right discrimination tasks........................ 47

3.6 Within-subjects comparisons of bilateral and unilateral performance on localisation tasks................................. 50

3.7 Within-subjects comparisons of bimodal and unilateral performance on localisation tasks............................... 51





3.8 Estimates of the amount of SRM shown by bilaterally-implanted children 53

3.9 Estimates of the amount of SRM shown by bimodally-aided children.. 55

–  –  –

5.1 Biographical data for the participants..................... 111

5.2 Results of the Toy Discrimination test..................... 121

5.3 Multiple regression analysis of composite localisation score........ 126

5.4 Multiple regression analysis of spatial release from masking........ 126

–  –  –

5.5 Correlations between biographical variables and performance for unilaterallyimplanted children................................ 127

5.6 Correlations between biographical variables and performance for bilaterallyimplanted children................................ 127

5.7 Results of the listening tests for the simultaneous and sequential bilaterally-implanted children......................... 129

5.8 Results of the listening tests for the unilaterally-implanted children... 130

6.1 The centre frequency and frequency range for the channels in the tone vocoder....................................... 149

6.2 Average presentation levels of the stimuli................... 152

6.3 Post-hoc comparisons for the Left-Right Discrimination test....... 157

6.4 Post-hoc comparisons for the Localisation test............... 159

6.5 Post-hoc comparisons for the Toy Discrimination test in pink noise... 163

6.6 The results of contrasts for the interaction between condition and noise location for the Toy Discrimination test in pink noise............ 163

6.7 Statistical comparisons of the performance of adults and children on the Toy Discrimination test in pink noise................... 165

6.8 Post-hoc comparisons for the Toy Discrimination test in pulsatile noise. 166

6.9 The results of contrasts for the interaction between condition and masker type for the Toy Discrimination test in pulsatile noise....... 167

6.10 Statistical comparisons of the performance of adults and children on the Toy Discrimination test in pulsatile noise................. 169

6.11 Summary of statistical comparisons between the CI-CI condition and each of the CI-0440, CI-0880, and CI-1320 conditions............ 170

–  –  –

I am sincerely grateful to my supervisor, Quentin Summerfield, for his support, encouragement, and patient tuition. I would like to thank the members of my research committee, Peter Bailey and Emma Hayiou-Thomas, for their helpful comments and suggestions. Pádraig Kitterick provided invaluable technical and programming support. Paddy Boyle contributed ideas to several of the studies reported in this thesis, as well as knowledge about recording stimuli via cochlearimplant processors. Advanced Bionics loaned the equipment required to make those recordings. Catherine Hewitt gave advice on the statistical analyses used in Chapter 5.

I am grateful to all of the participants who took part in these studies, especially those families who travelled considerable distances to York. Tricia Kemp and Dominic Byrne of the Cochlear Implanted Children’s Support Group worked tirelessly to recruit families into the studies. The participants of the study reported in Chapter 5 were cared for at: Birmingham Children’s Cochlear Implant Programme (Mr D Proops and Ms K Hanvey), Emmeline Centre for Hearing Implants, Cambridge (Mr P Axon and Ms M Adlington), Great Ormond Street Cochlear Implant Programme (Mr M Bailey and Dr K Rajput), Manchester Cochlear Implant Programme (Professor R Ramsden and Ms L Henderson), Nottingham Cochlear Implant Programme (Professor G O’Donoghue and Ms T Twomey), Royal National Throat Nose and Ear Cochlear Implant Programme (Mr J Lavy and Ms W Aleksy), Scottish Cochlear Implant Programme (Miss M Shanks and Miss A Allen), South of England Cochlear Implant Centre (Mr P Ashcroft, Mr M Pringle, Ms J Brinton and Ms J Eyles), St Georges Hospital Cochlear Implant Program (Mr D Selvadurai and Ms E McKendrick), St Thomas’ Hospital Paediatric Cochlear Implant Programme (Mr A Fitzgerald O’Connor and Ms S Driver), and the Yorkshire Cochlear Implant Service (Mr C Raine and Ms J Martin).

I could not have got this far without the love and encouragement of my parents, Alan and Angela, and the rest of my family. Thank you to Mark for his love and support. I would also like to thank Pádraig, Jo, and Sam for being great friends and a pleasure to work with.

xiiiFinancial support

This PhD was generously supported by a studentship from Deafness Research UK.

The same charity provided the Pauline Ashley Prize, which allowed me to spend 10 weeks in Jay Rubinstein’s laboratory at the Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle. Advanced Bionics funded the travel and accommodation costs for families who participated in the study reported in Chapter 5. Additional funds were provided by the guarantors of Brain, which enabled me to attend the Association for Research in Otolaryngology Midwinter Meeting in Phoenix, Arizona (February 2008) and the Conference on Implantable Auditory Prostheses in Lake Tahoe, California (July 2009). I am grateful to the organisers of the latter conference for an award of student aid.

xivDeclaration

This thesis comprises the candidate’s own original work and has not, whether in the same or different form, been submitted to this or any other University for a degree. All experiments were designed by the candidate with assistance from the supervisor. As part of undergraduate projects that were co-supervised by the candidate, Shan Huang collected the data from adults reported in Chapter 4 and Georgina Batten and Hannah Bellenger collected the data for Experiment 2 in Chapter 7. The remaining testing and all analyses were conducted by the candidate.

Publications & conference presentations Lovett, R.E.S., Kitterick, P.T., Hewitt, C.E., & Summerfield, A.Q. (2010). Bilateral or unilateral cochlear implantation for deaf children: an observational study. Archives of Disease in Childhood, 95, 107-112.

Summerfield, A.Q., Lovett, R.E.S., Batten, G., & Bellenger, H. (in press.) Estimates of the cost-effectiveness of pediatric bilateral cochlear implantation. Ear and Hearing.

Lovett, R.E.S., Huang, S., & Summerfield, A.Q. (2009). Spatial listening with bilateral implants or bimodal devices: a simulation study. Poster presented at the Conference on Implantable Auditory Prostheses, Lake Tahoe, CA.

Lovett, R.E.S., & Summerfield, A.Q. (2008). Children with unilateral or bilateral cochlear implants: listening skills and quality of life. Poster presented at the British Society of Audiology Short Papers Meeting on Experimental Studies of Hearing and Deafness, York, UK.

Lovett, R.E.S., & Summerfield, A.Q. (2008). Bilateral versus unilateral cochlear implantation: spatial listening skills. Oral presentation at the British Cochlear Implant Group Conference, Bradford, UK.

Lovett, R.E.S., & Summerfield, A.Q. (2008). Spatial listening skills: data from children with normal hearing and children who use cochlear implants. Oral presentation at

–  –  –

the Advanced Bionics European Research Group Meeting, Marrakesh, Morocco.

Lovett, R.E.S., & Summerfield, A.Q. (2008). Tests of spatial listening for preschool children. Poster presented at the Association for Research in Otolaryngology Midwinter Meeting, Phoenix, USA.

Lovett, R.E.S., & Summerfield, A.Q. (2007). Tests of spatial listening for preschool children. Poster presented at the British Society of Audiology Short Papers Meeting on Experimental Studies of Hearing and Deafness, London, UK.

–  –  –

Overview of Thesis This chapter provides a brief introduction to the thesis and an overview of the subsequent chapters.

1.1 Introduction A cochlear implant is an electronic device which is implanted surgically into the inner ear of patients who are severely-profoundly deaf (Ramsden, 2002). Cochlear implantation for severely-profoundly deaf children became widespread in the early 1990s (Summerfield & Marshall, 1995), and for over 20 years the policy in the UK and elsewhere was to offer a single cochlear implant in one ear (unilateral implantation).

Compared to amplification using acoustic hearing aids, unilateral implantation is effective in improving children’s speech perception, language skills, and quality of life (Boothroyd & Eran, 1994; Stacey, Fortnum, Barton, & Summerfield, 2006;



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