1. Localisation and speech perception UK National Paediatric Bilateral Audit. Helen Cullington11 April 2013

2. Results THE RESULTS

3. Results THE RESULTS

4. Notes about results… • This is not a research project • This was not designed to answer questions • This is a real picture of what children in the UK with bilateral CI can do

5. Localisation.

6. Localisation • Judgement about direction and distance of sound • Main method is comparison of signals received at each ear • level difference • time difference

7. vital

8. Can my child localise? Parent report of real life Test in clinic

9. Scoring localisation

10. Scoring localisation Speech

11. Speech

12. Scoring localisation Speech Error = 45 degrees Child answers

13. Localisation error = average error over 25 trials

14. n= 8 230 44 221 41 124 25 30 Lower is better chance

15. What is standard deviation? • A measure of how spread out numbers are … how tightly the results are clustered around the average

17. About 2/3 of the results are in this range

18. n= 8 230 44 221 41 124 25 30 Lower is better chance

19. Bilateral

20. Unilateral

21. Time in sound • Sequential/Unilateral: time from first implant to test • Simultaneous/Bilateral: time from bilateral implants to test

22. n= 44 3 41 8 25 24 n= 44 3 41 8 25 24 Lower is better chance

23. Higher is better seq

24. n= 35 55 13 Higher is better seq

25. Caution • These are average results • Individual results will vary

26. Higher is better seq

27. 14 year old • Age at first CI = 6, age at second CI = 13 • 1 year after 2nd CI, localisation improved from 51 to 13 degrees

29. Speech perception

30. Speech perception in quiet and noise • Automated Toy Test (ATT) • BKB for children with language age of 6 or more

31. Speech perception in quiet • Speech goes quieter and quieter to reach threshold of where child can still understand it • Results is speech level where child can just understand speech (lower is better)

32. n= 7 199 57 249 53 151 37 35 Lower is better

33. n= 23 48 10 Higher is better seq

34. Speech perception in noise • Noise stays at a constant level; speech goes quieter and quieter to reach threshold of where child can still understand it • Result is signal to noise ratio where child can just understand speech (lower is better)

35. BKB sentences in noise

36. Speech perception noise centre Speech and noise in front

37. n= 11 36 8 Higher is better seq

42. Improvement from moving noise to 1st side Speech always in front Noise seq 1st side

43. Improvement from moving noise to non-implanted/new side Speech always in front Noise seq new side

44. n= 40 38 62 65 33 31 7 8 Higher is better seq

45. n= 32 91 19 Higher is better seq

46. Localisation - simultaneous • Children with bilateral CI localise significantly better than children with unilateral CI sim

47. Localisation - sequential • 1 year after receiving the 2nd CI, on average children can localise significantly better • This localisation improvement appears to decrease as the gap between the implants increases seq

48. Speech perception in noise - sequential • After receiving the 2nd CI, children’s listening in noise improves • This improvement appears to decrease as the gap between the implants increases • As time progresses, children begin to use the 2nd ear to help when noise is separated from speech seq