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Comments by Jane R Madell, PhD on 04 October 2005 at 20:32 IP Logged
In my opinion it is critical that single word speech perception testing be used to measure auditory functioning. Sentence testing can be deceptive. A person with good cognitive skills will appear to hear more than he or she really can hear. Below is a slide demonstrating the results for a young woman who was evaluated for a CI during her Sophmore year at Yale. The fact that she was attending Yale with a profound hearing loss tells you that she has excellent cognitive skills. But she felt that she was struggling to hear in many situations. When she was at dinner in her dorm she felt that she could either eat or talk to her friends. She could not do both. She could not hear if she did not see the person who was talking. She was evaluated at another implant center and was rejected as an implant candidate because of her excellent sentence scores even though her single word scores were very very poor.
At this center, we use single words scores as the critical factor. She was implanted and the results of her post implant testing very clearly indicate the benefit she receives from a cochlear implant.

--------------Right HA : Left HA :B-HA : HA+CI
50 dB words: --12% --- 14% --- 14% --- 68%
phonemes: -----24% --- 24% --- 28% --- 78%
Hint Q:----------------------------- 76% --- 94%
Hint +5 SNR: --------------------- 34% --- 78%

Jane R. Madell, PhD
Director, Hearing and Learning Center
CoDirector, Beth Israel-New York Eye and Ear Cochlear Implant Center
Beth Israel Medical Center
10 Union Square East
New York, NY 10003
212-844-8791 (fax)
United States

Comments by Susan Griffiths on 21 August 2005 at 10:30 IP Logged
I was implanted on 11th February this year and "switchon" 24th March. Prior to this I had had almost no hearing at all for 5 years and deteroiorating hearing for many years before that. I lip read very well which masked the severity of my deafness. However, when I was invited to meet someone who had received an implant 7 years before, another implant candidate was also present. She couldn't lip read at all and needed everything written down, so it is not true to state that only good lip readers are eligible.
During my assessment I underwent various tests including sentence recognition but also including word recognition. I had four lists of different words to listen to in a sound proof booth. One by one I was aware that each word had been spoken but I didn't understand any. On sentence recognition I scored quite well with lip reading but without I had a nil rating. Both tests are indictive of the depth of hearing loss; but together give a much more accurate assessment.
United Kingdom

Comments by Michael Dorman on 23 July 2005 at 15:02 IP Logged
The correlation between sentence scores in quiet and word scores will vary with the test material. Below are the data from a recent project in which we tested 76 implant patients who scored 50% or better on the CNC word test. Because many scored 100 % on the CUNY sentences, the correlation between CNC words and the CUNY test results was .66 – a significant but not terribly high correlation. On the other hand, the correlation between CUNY sentences in noise (at +10 dB signal-to-noise ratio) and CNC words is .73 – a more respectable correlation but still not breath-taking. The correlation between CNC words and our new sentence test (AzBio sentences) was .83 – a correlation worth looking at. So you can make sentence material so unpredictable that the material acts much like words in isolation. However, if you do this, one wonders why go to the trouble? Why not just use word scores?

Pearson Correlations Section (Row-Wise Deletion)

---------CNC------- CUNY----- CUNY10----- AZBIO
CNC --1.000000-- 0.666157-- 0.729794-- 0.86500

A common argument for using sentence scores is that they reflect ‘real world’ abilities, i.e., most of us speak (and listen to) sentences that make sense. (A notable exception is our President …… but that is another story). My most recent adventure with sentence scores is in the context of patients who have hearing at 500 Hz and then extremely poor hearing at 1.0 kHz and above. These patients are candidates for a new procedure termed combined acoustic and electric stimulation (EAS) in which the electrode is inserted only partially into the cochlea – in an effort to preserve the residual hearing. I should have thought these patients would have extreme difficultly understanding speech in sentences. However, sentence scores (the CUNY sentences) were 90 to 100 % correct for several patients. This is an example of sentence scores providing a very misleading index of disability.

At the end of the day, the CNC word test is the single most useful tool in our battery of tests. But it would be silly to use only a single test to evaluate candidacy for implantation. A group of reasonable and experienced professionals who evaluate a wide range of test scores and personal impressions usually can agree on who would benefit from an implant.

Michael Dorman, Professor, Arizona State University

United States

Comments by Christine G. on 28 April 2005 at 17:57 IP Logged
I am an audiologist in the US. Current adult FDA guidelines NEED be reviewed and revised. While sentence testing is a fairly good indication of how well someone can perform in a real world situation, it's not entirely accurate and should NOT be used as the sole criteria. With sentences we are able to use knowledge of and experience with the English language. This enables patients to use contextual cues and info to fill in missing gaps caused by hearing loss. In my experience, pre-linguals tend to fail sentences but post-linguals can do quite well which excludes them from the criteria. Many of these patients CANNOT function well with hearing aids but are denied an implant.
Word testing is a more accurate form of testing b/c it excludes language, and it should be used in the FDA criteria. There must be a way to incorporate both types of testing. Patients shouldnt feel like they have to "cheat" or "bomb" the test to get an implant!
Data needs to be collected so that the FDA can see proof that current criteria methods need to be changed. My guess would be to start w/ some of the leaders in the CI companies. GOOD LUCK!
United States

Comments by Arthur Miller on 10 April 2005 at 13:12 IP Logged
Dear Nicholas,
A friend of mine from California who runs a ci forum made me aware of your campaign. I have forwarded your website
to certain very respected and prestigious audiologists in the field
of ci's in hopes they will become involved with your movement for greater flexibility in defining and refining the criteria for ci candidacy. Meantime, have you considered the possibility of temporarily relocating to another member European Union nation where the current criteria might be less rigid?
A. Miller
New York
United States

Comments by Amanda Mangiardi on 07 April 2005 at 23:10 IP Logged
Actually, what we do in our program is look at the audiogram and see what audiometric benefits the child is getting based on booth testing which includes speech perception and speech recognition tests. If there is a question, if a child seems borderline, we do therapy with them for a time
We don't use sentence tests. We use a speech and language battery, which includes the Peabody for receptive language, and the CELF either preschool or school aged. Also we use speech articulation tests. These, however, are mainly to help us establish goals for the therapy that will begin after the CI has been activated.
Amanda Mangiardi
United States

Comments by Peter Cornish on 06 April 2005 at 23:07 IP Logged
I appreciate the effort the webmaster has made here to highlight the cochlear implants and support the need for them to be opened up to other deaf people who would benfict from the implants.
Who am I? well the answer is a Deaf male who has been Deaf since 7 years of age, and if the implants were avialable at that time I would probable had one, as I had more hearing then.
I at present work closely with the deaf community as I am with disabled people. I wish you and your ambitions every success Nick. I am happy to be contacted if I can be of assistance to you
United Kingdom

Comments by Graham Brickley on 05 April 2005 at 09:53 IP Logged
This is a most valuable spur to the CI community in the UK in particular to review the use of speech test material in candidacy for implantation. You are right to observe that opening up candidacy for implantation would lead to a significant increase in the number of adults being offered a cochlear implant. This could be a good thing for those people however, funding remains the most significant limit at present. It would be good to have a section of your site perhaps dedicated to the issue of equity of access.
United Kingdom

Comments by John Ryder on 29 March 2005 at 19:02 IP Logged
Interesting to see that someone has been motivated enough to create a site like this, for us hearing professionals and presumably for other people in your position. I'm sure this will generate some interesting comments, and I look forward to checking back here to see what people have to say on both sides of this argument, one that seems to have been overlooked until now.
United Kingdom