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Long-term Benefit of Unilateral Cochlear Implantation on Quality of Life and Speech Perception in Bilaterally Deafened Patients. Otol Neurotol 2020; 40:e430-e440. [PMID: 30870378 DOI: 10.1097/mao.0000000000002008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cochlear implantation (CI) is a common treatment modality for unilaterally and bilaterally deafened patients as well as patients with severe to profound hearing loss. The aim of our study is the complex evaluation of the improvement and influence of health related quality of life (HRQoL) and auditory performance in cochlear implant patients during a long-term follow-up. METHODS Sixty-one bilaterally, postlingually deafened patients with unilateral CI were included in this prospective study. Assessment tools for auditory performance and HRQoL included the Freiburg Monosyllabic Speech test, Oldenburg Inventory (OI) questionnaire, Nijmegen Cochlear Implant Questionnaire (NCIQ) and 36-item Short Form Survey (SF-36). Data were collected before CI, at 6, 12, and 24 months postoperatively. RESULTS The assessment tools for speech perception yielded a statistically significant improvement in the Freiburg Monosyllabic Speech test scores and of all subdomain scores of the OI during the 6-month follow-up period. The subdomain scores of the NCIQ and the psychological score of the SF-36 also improved significantly during this follow-up period. All results remained stable thereafter during the 12- and 24-month follow-up. There was a statistically significant correlation between subjective speech perception and HRQoL after CI. CONCLUSION This is the first prospective study to show results in regard to speech perception and HRQoL and their correlation during a 2-year follow-up after unilateral CI in bilaterally deafened patients. Our results for speech perception and HRQoL showed a significant improvement during the 6-month follow-up that remained stable thereafter during a 24-month follow-up, even after finishing the hearing rehabilitation program.
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Dingemanse G, Goedegebure A. The relation of hearing-specific patient-reported outcome measures with speech perception measures and acceptable noise levels in cochlear implant users. Int J Audiol 2020; 59:416-426. [PMID: 32091274 DOI: 10.1080/14992027.2020.1727033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To investigate the relation of a hearing-specific patient-reported outcome measure (PROM) with speech perception and noise tolerance measurements. It was hypothesised that speech intelligibility in noise and noise tolerance may explain a larger part of the variance in PROM scores than speech intelligibility in quiet.Design: This cross-sectional study used the Speech, Spatial, Qualities (SSQ) questionnaire as a PROM. Speech recognition in quiet, the Speech Reception Threshold in noise and noise tolerance as measured with the acceptable noise level (ANL) were measured with sentences.Study sample: A group of 48 unilateral post-lingual deafened cochlear implant (CI) users.Results: SSQ scores were moderately correlated with speech scores in quiet and noise, and also with ANLs. Speech scores in quiet and noise were strongly correlated. The combination of speech scores and ANL explained 10-30% of the variances in SSQ scores, with ANLs adding only 0-9%.Conclusions: The variance in the SSQ as hearing-specific PROM in CI users was not better explained by speech intelligibility in noise than by speech intelligibility in quiet, because of the remarkably strong correlation between both measures. ANLs made only a small contribution to explain the variance of the SSQ. ANLs seem to measure other aspects than the SSQ.
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Affiliation(s)
- Gertjan Dingemanse
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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53
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McRackan TR, Hand BN, Velozo CA, Dubno JR. Association of Demographic and Hearing-Related Factors With Cochlear Implant-Related Quality of Life. JAMA Otolaryngol Head Neck Surg 2020; 145:422-430. [PMID: 30896742 DOI: 10.1001/jamaoto.2019.0055] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Only limited evidence is available describing the contribution of patient-related factors to quality of life in adults with cochlear implants. Objective Assess the association between demographic, hearing-related, and cochlear implant-related factors and quality of life by using a new Cochlear Implant Quality of Life (CIQOL) item bank, which was developed to meet rigorous psychometric standards. Design, Setting, and Participants Multicenter cross-sectional study of adults 18 to 89 years of age who had at least 1 year of cochlear implant use and who were recruited through a consortium of 20 cochlear implant centers in the United States. Using an online format, questionnaires were sent to the first 500 participants who contacted the research team. Of these participants, 371 (74.2%) completed the questionnaire. Demographic, hearing-related, and cochlear implant-related data were obtained along with responses to each of the 81 items in the CIQOL item bank. Multivariable linear regression was used to examine demographic, hearing-related, and cochlear implant-related factors associated with scores in each of the 6 CIQOL domains (communication, emotional, entertainment, environment, listening effort, and social). Main Outcomes and Measures Association among demographic, hearing-related, and cochlear implant-related factors and CIQOL scores for each of 6 domains. Results Of the 371 participants who completed the questionnaire, 222 (59.8%) were women, and the mean (SD) age was 59.5 (14.9) years. The CIQOL scores were normally distributed across the 6 domains. Being employed, having higher household income, longer duration of hearing loss prior to cochlear implantation, and having bilateral rather than unilateral cochlear implantation were associated with higher CIQOL scores in 1 or more domains, but the effect size varied widely (β, 0.1-6.9). Better sentence recognition ability (using AzBio to measure speech recognition) was associated with only a small positive effect size for the communication (β, 0.0 [95% CI, 0.0-0.1]), entertainment (β, 0.0 [95% CI, 0.0-0.1]), and environmental (β, 0.0 [95% CI, 0.0-0.0]) domains. Increased age was associated with lower CIQOL in the entertainment domain (β, -0.3 [95% CI, -1.5 to -0.4]). The demographic, hearing-related, and cochlear implant-related factors included in the multivariable regression models accounted for only a small percentage of the variance in CIQOL domain scores (R2, 0.08-0.17). Conclusions and Relevance Several factors were found to predict higher or lower CIQOL scores in specific domains, with speech-recognition ability having only a minimal association. Despite evaluating a large number of demographic, hearing-related, and cochlear implant-related factors, the multivariable models accounted for only a small amount of CIQOL variance. This suggests that patient or other characteristics that contribute to cochlear implant-related quality of life remain largely unknown.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Craig A Velozo
- Division of Occupational Therapy, Medical University of South Carolina, Charleston
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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Abstract
OBJECTIVES Functional outcomes following cochlear implantation have traditionally been focused on word and sentence recognition, which, although important, do not capture the varied communication and other experiences of adult cochlear implant (CI) users. Although the inadequacies of speech recognition to quantify CI user benefits are widely acknowledged, rarely have adult CI user outcomes been comprehensively assessed beyond these conventional measures. An important limitation in addressing this knowledge gap is that patient-reported outcome measures have not been developed and validated in adult CI patients using rigorous scientific methods. The purpose of the present study is to build on our previous work and create an item bank that can be used to develop new patient-reported outcome measures that assess CI quality of life (QOL) in the adult CI population. DESIGN An online questionnaire was made available to 500 adult CI users who represented the adult CI population and were recruited through a consortium of 20 CI centers in the United States. The questionnaire included the 101 question CIQOL item pool and additional questions related to demographics, hearing and CI history, and speech recognition scores. In accordance with the Patient-Reported Outcomes Measurement Information System, responses were psychometrically analyzed using confirmatory factor analysis and item response theory. RESULTS Of the 500 questionnaires sent, 371 (74.2%) subjects completed the questionnaire. Subjects represented the full range of age, durations of CI use, speech recognition abilities, and listening modalities of the adult CI population; subjects were implanted with each of the three CI manufacturers' devices. The initial item pool consisted of the following domain constructs: communication, emotional, entertainment, environment, independence, listening effort, and social. Through psychometric analysis, after removing locally dependent and misfitting items, all of the domains were found to have sound psychometric properties, with the exception of the independence domain. This resulted in a final CIQOL item bank of 81 items in 6 domains with good psychometric properties. CONCLUSIONS Our findings reveal that hypothesis-driven quantitative analyses result in a psychometrically sound CIQOL item bank, organized into unique domains comprised of independent items which measure the full ability range of the adult CI population. The final item bank will now be used to develop new instruments that evaluate and differentiate adult CIQOL across the patient ability spectrum.
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Ausili SA, Backus B, Agterberg MJH, van Opstal AJ, van Wanrooij MM. Sound Localization in Real-Time Vocoded Cochlear-Implant Simulations With Normal-Hearing Listeners. Trends Hear 2019; 23:2331216519847332. [PMID: 31088265 PMCID: PMC6535744 DOI: 10.1177/2331216519847332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Bilateral cochlear-implant (CI) users and single-sided deaf listeners with a CI are less effective at localizing sounds than normal-hearing (NH) listeners. This performance gap is due to the degradation of binaural and monaural sound localization cues, caused by a combination of device-related and patient-related issues. In this study, we targeted the device-related issues by measuring sound localization performance of 11 NH listeners, listening to free-field stimuli processed by a real-time CI vocoder. The use of a real-time vocoder is a new approach, which enables testing in a free-field environment. For the NH listening condition, all listeners accurately and precisely localized sounds according to a linear stimulus–response relationship with an optimal gain and a minimal bias both in the azimuth and in the elevation directions. In contrast, when listening with bilateral real-time vocoders, listeners tended to orient either to the left or to the right in azimuth and were unable to determine sound source elevation. When listening with an NH ear and a unilateral vocoder, localization was impoverished on the vocoder side but improved toward the NH side. Localization performance was also reflected by systematic variations in reaction times across listening conditions. We conclude that perturbation of interaural temporal cues, reduction of interaural level cues, and removal of spectral pinna cues by the vocoder impairs sound localization. Listeners seem to ignore cues that were made unreliable by the vocoder, leading to acute reweighting of available localization cues. We discuss how current CI processors prevent CI users from localizing sounds in everyday environments.
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Affiliation(s)
- Sebastian A Ausili
- 1 Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | | | - Martijn J H Agterberg
- 1 Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,3 Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, the Netherlands
| | - A John van Opstal
- 1 Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Marc M van Wanrooij
- 1 Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
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Bergman P, Lyxell B, Harder H, Mäki-Torkko E. The Outcome of Unilateral Cochlear Implantation in Adults: Speech Recognition, Health-Related Quality of Life and Level of Anxiety and Depression: a One- and Three-Year Follow-Up Study. Int Arch Otorhinolaryngol 2019; 24:e338-346. [PMID: 32754246 PMCID: PMC7394645 DOI: 10.1055/s-0039-3399540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction
Hearing impairment is a common disease worldwide, with a comprehensive impact, and cochlear implantation (CI) is an intervention for profound hearing impairment.
Objective
To study the outcome one and three years after unilateral CI on hearing, health-related quality of life and level of depression and anxiety, and the correlation between the outcomes. Second, to study whether age, gender, etiology, operated side, residual hearing or cognitive performance can predict the outcome.
Methods
A prospective longitudinal study including adults with profound postlingual hearing impairment, with respect to hearing (speech recognition), health-related quality of life (Health Utilities Index 3) and level of depression and anxiety (Hospital Anxiety and Depression scale), pre-CI, and one and three years post-CI. The total sample was composed of 40 participants (40% of men), with a mean age of 71 years.
Results
Speech recognition and the overall health-related quality of life improved one year post-CI (
p
= 0.000), without correlation (ρ= 0.27), and with no difference three years post-CI. The hearing attribute (in the health-related quality of life instrument) improved one and three years post-CI (
p
= 0.000). The level of anxiety did not change one and three years post-CI. The level of depression improved one year post-CI (
p
= 0.036), and deteriorated three years post-CI (
p
= 0.031). Age, etiology, operated side, residual hearing and cognitive performance did not predict the outcome, but the female gender did significantly improve speech recognition compared with men (
p
= 0.009).
Conclusion
The CI significantly improved speech recognition, health-related quality of life and level of depression one year post-CI without mutual correlation, and women performed significantly better than men. There were no further improvements three years post-CI, apart from the hearing attribute.
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Affiliation(s)
- Pia Bergman
- Department of Otorhinolaryngology, Jönköping County hospital, Jönköping, Sweden.,Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden
| | - Björn Lyxell
- Department of Special Needs Education, Oslo University, Oslo, Norway.,Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Henrik Harder
- Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden
| | - Elina Mäki-Torkko
- Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden.,Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.,Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Erdem BK, Çiprut A. Evaluation of Speech, Spatial Perception and Hearing Quality in Unilateral, Bimodal and Bilateral Cochlear Implant Users. Turk Arch Otorhinolaryngol 2019; 57:149-153. [PMID: 31620697 DOI: 10.5152/tao.2019.4105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/02/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of the study was to conduct a scale-based evaluation of the hearing skills of unilateral, bimodal and bilateral cochlear implant (CI) users, including distinguishing, orientating and locating speech and environmental sounds in their surrounding environment that they are exposed to in different contexts of everyday life. The scale results were compared between groups. Methods A total of 74 cochlear implant users, 30 unilateral, 30 bimodal and 14 bilateral, were included in the study. Their ages ranged from 11 to 64 years. Participants were assessed using the Speech, Spatial and Qualities of Hearing Scale (SSQ). Results Bilateral CI users' subjective ratings of their own hearing skills were found to be significantly better than those of bimodal and unilateral CI users; bimodal users' subjective ratings were also found to be significantly better than those of unilateral CI users. Paired comparisons showed statistically significant differences between the groups in terms of total scores of Speech, Spatial, Qualities of Hearing and General SSQ (p<0.05). Conclusion Our findings show that bilateral use of cochlear implants should be recommended for those presently using bimodal and unilateral devices. Moreover, subjective tests should be used regularly along with objective tests for evaluating CI patients.
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Affiliation(s)
- Büşra Koçak Erdem
- Department of Audiology, Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Ayça Çiprut
- Department of Audiology, Marmara University School of Medicine, İstanbul, Turkey
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Vasil KJ, Lewis J, Tamati T, Ray C, Moberly AC. How Does Quality of Life Relate to Auditory Abilities? A Subitem Analysis of the Nijmegen Cochlear Implant Questionnaire. J Am Acad Audiol 2019; 31:292-301. [PMID: 31580803 DOI: 10.3766/jaaa.19047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Objective speech recognition tasks are widely used to measure performance of adult cochlear implant (CI) users; however, the relationship of these measures with patient-reported quality of life (QOL) remains unclear. A comprehensive QOL measure, the Nijmegen Cochlear Implant Questionnaire (NCIQ), has historically shown a weak association with speech recognition performance, but closer examination may indicate stronger relations between QOL and objective auditory performance, particularly when examining a broad range of auditory skills. PURPOSE The aim of the present study was to assess the NCIQ for relations to speech and environmental sound recognition measures. Identifying associations with certain QOL domains, subdomains, and subitems would provide evidence that speech and environmental sound recognition measures are relevant to QOL. A lack of relations among QOL and various auditory abilities would suggest potential areas of patient-reported difficulty that could be better measured or targeted. RESEARCH DESIGN A cross-sectional study was performed in adult CI users to examine relations among subjective QOL ratings on NCIQ domains, subdomains, and subitems with auditory outcome measures. STUDY SAMPLE Participants were 44 adult experienced CI users. All participants were postlingually deafened and had met candidacy requirements for traditional cochlear implantation. DATA COLLECTION AND ANALYSIS Participants completed the NCIQ as well as several speech and environmental sound recognition tasks: monosyllabic word recognition, standard and high-variability sentence recognition, audiovisual sentence recognition, and environmental sound identification. Bivariate correlation analyses were performed to investigate relations among patient-reported NCIQ scores and the functional auditory measures. RESULTS The total NCIQ score was not strongly correlated with any objective auditory outcome measures. The physical domain and the advanced sound perception subdomain related to several measures, in particular monosyllabic word recognition and AzBio sentence recognition. Fourteen of the 60 subitems on the NCIQ were correlated with at least one auditory measure. CONCLUSIONS Several subitems demonstrated moderate-to-strong correlations with auditory measures, indicating that these auditory measures are relevant to the QOL. A lack of relations with other subitems suggests a need for the development of objective measures that will better capture patients' hearing-related obstacles. Clinicians may use information obtained through the NCIQ to better estimate real-world performance, which may support improved counseling and development of recommendations for CI patients.
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Affiliation(s)
- Kara J Vasil
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
| | - Jessica Lewis
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
| | - Terrin Tamati
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
| | - Christin Ray
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
| | - Aaron C Moberly
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
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"Product" Versus "Process" Measures in Assessing Speech Recognition Outcomes in Adults With Cochlear Implants. Otol Neurotol 2019; 39:e195-e202. [PMID: 29342056 DOI: 10.1097/mao.0000000000001694] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESES 1) When controlling for age in postlingual adult cochlear implant (CI) users, information-processing functions, as assessed using "process" measures of working memory capacity, inhibitory control, information-processing speed, and fluid reasoning, will predict traditional "product" outcome measures of speech recognition. 2) Demographic/audiologic factors, particularly duration of deafness, duration of CI use, degree of residual hearing, and socioeconomic status, will impact performance on underlying information-processing functions, as assessed using process measures. BACKGROUND Clinicians and researchers rely heavily on endpoint product measures of accuracy in speech recognition to gauge patient outcomes postoperatively. However, these measures are primarily descriptive and were not designed to assess the underlying core information-processing operations that are used during speech recognition. In contrast, process measures reflect the integrity of elementary core subprocesses that are operative during behavioral tests using complex speech signals. METHODS Forty-two experienced adult CI users were tested using three product measures of speech recognition, along with four process measures of working memory capacity, inhibitory control, speed of lexical/phonological access, and nonverbal fluid reasoning. Demographic and audiologic factors were also assessed. RESULTS Scores on product measures were associated with core process measures of speed of lexical/phonological access and nonverbal fluid reasoning. After controlling for participant age, demographic and audiologic factors did not correlate with process measure scores. CONCLUSION Findings provide support for the important foundational roles of information processing operations in speech recognition outcomes of postlingually deaf patients who have received CIs.
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McRackan TR, Hand BN, Velozo CA, Dubno JR. Cochlear Implant Quality of Life (CIQOL): Development of a Profile Instrument (CIQOL-35 Profile) and a Global Measure (CIQOL-10 Global). JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3554-3563. [PMID: 31479616 PMCID: PMC6808347 DOI: 10.1044/2019_jslhr-h-19-0142] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Purpose Valid, reliable, and efficient patient-reported outcome measures are needed to quantify quality of life (QOL) outcomes after cochlear implantation to supplement information obtained from performance-based outcomes. We previously developed the Cochlear Implant Quality of Life (CIQOL) item bank to serve as the source of items for subsequent instruments. This study reports the development and psychometric properties for 2 of these new instruments, the CIQOL-35 Profile and the CIQOL-10 Global. Method Cochlear implant (CI) users referred from the CIQOL Development Consortium (n = 371), consisting of 20 CI centers across the United States, provided responses to the 81-item CIQOL item bank, which are grouped into 6 QOL domains (communication, emotional, entertainment, environment, listening effort, and social). Responses to the 81 CIQOL items were analyzed using item response theory to determine individual item difficulty, discrimination, and model fit to select the set of items for the profile instrument and global measure that would optimize their measurement characteristics. Results The 35-item CIQOL-35 Profile instrument assesses outcomes represented in the 6 domains of the CIQOL final item pool. The 10-item CIQOL-10 Global measure produces a single, overall QOL score. After ensuring the upper and lower ends of the item difficulty continuum were represented (item difficulty range: -2.48 to 2.47), the items with the highest discrimination ability for each domain were selected for the CIQOL-35 Profile instrument (discrimination range: 0.67-1.37). Items were selected for the CIQOL-10 Global measure in a similar manner. Conclusion The CIQOL-35 Profile and CIQOL-10 Global instruments provide psychometrically sound and efficient measures that can be used to assess QOL in adult CI users in both clinical and research settings. Supplemental Material https://doi.org/10.23641/asha.9745010.
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Affiliation(s)
- Theodore R. McRackan
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Brittany N. Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | | | - Craig A. Velozo
- Division of Occupational Therapy, Medical University of South Carolina, Charleston
| | - Judy R. Dubno
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
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61
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McRackan TR, Fabie JE, Bhenswala PN, Nguyen SA, Dubno JR. General Health Quality of Life Instruments Underestimate the Impact of Bilateral Cochlear Implantation. Otol Neurotol 2019; 40:745-753. [PMID: 31192902 PMCID: PMC6578874 DOI: 10.1097/mao.0000000000002225] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the extent to which bilateral cochlear implantation increases patient-reported benefit as compared with unilateral implantation and no implantation. DATA SOURCES PubMed, Scopus, CINAHL, and Cochrane databases searches were performed using the keywords ("Cochlear Implant" or "Cochlear Implantation") and ("bilateral"). STUDY SELECTION Studies assessing hearing/CI-specific (CI) and general-health-related (HR) quality of life (QOL) in adult patients after bilateral cochlear implantation were included. DATA EXTRACTION Of the 31 articles meeting criteria, usable QOL data were available for 16 articles (n = 355 bilateral CI recipients). DATA SYNTHESIS Standardized mean difference (Δ) for each measure and weighted effects were determined. Meta-analysis was performed for all QOL measures and also independently for hearing/CI-specific QOL and HRQOL. CONCLUSION When measured using hearing/CI-specific QOL instruments, patients reported very large improvements in QOL comparing before cochlear implantation to bilateral CI (Δ=2.07 [1.76-2.38]) and medium improvements comparing unilateral CI to bilateral CI (Δ=0.51 [0.32- 0.71]). Utilization of parallel versus crossover study design did not impact QOL outcomes (χ = 0.512, p = 0.47). No detectable improvements were observed in either CI transition when using HRQOL instruments (no CI to bilateral CI: Δ=0.40 [-0.02 to 0.81]; unilateral CI to bilateral CI: Δ=0.22 [-0.02 to 0.46]).The universal nature of HRQOL instruments may render them insensitive to the medium to large QOL improvements reported by patients using hearing/CI-specific QOL instruments. Given that HRQOL instruments are used to determine the economic benefit of health interventions, these measurement differences suggest that the health economic value of bilateral cochlear implantation has been underestimated.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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62
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Hillyer J, Parada JC, Parbery-Clark A. Assessing performance on the Montreal Cognitive Assessment (MoCA) in experienced cochlear implant users: use of alternative scoring guidelines. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:397-411. [DOI: 10.1080/13825585.2019.1624684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jake Hillyer
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer C. Parada
- Auditory Research Laboratory, Swedish Neuroscience Institute, Seattle, WA, USA
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63
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Häußler SM, Köpke V, Knopke S, Gräbel S, Olze H. Multifactorial positive influence of cochlear implantation on patients with single‐sided deafness. Laryngoscope 2019; 130:500-506. [DOI: 10.1002/lary.28007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Sophia M. Häußler
- Department of Otorhinolaryngology, Head and Neck SurgeryCharité–University Medical Center Berlin Berlin Germany
| | - Vanessa Köpke
- Department of Otorhinolaryngology, Head and Neck SurgeryCharité–University Medical Center Berlin Berlin Germany
| | - Steffen Knopke
- Department of Otorhinolaryngology, Head and Neck SurgeryCharité–University Medical Center Berlin Berlin Germany
| | - Stefan Gräbel
- Department of Otorhinolaryngology, Head and Neck SurgeryCharité–University Medical Center Berlin Berlin Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck SurgeryCharité–University Medical Center Berlin Berlin Germany
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64
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Holder JT, Reynolds SM, Sunderhaus LW, Gifford RH. Current Profile of Adults Presenting for Preoperative Cochlear Implant Evaluation. Trends Hear 2019; 22:2331216518755288. [PMID: 29441835 PMCID: PMC6027468 DOI: 10.1177/2331216518755288] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Considerable advancements in cochlear implant technology (e.g., electric acoustic stimulation) and assessment materials have yielded expanded criteria. Despite this, it is unclear whether individuals with better audiometric thresholds and speech understanding are being referred for cochlear implant workup and pursuing cochlear implantation. The purpose of this study was to characterize the mean auditory and demographic profile of adults presenting for preoperative cochlear implant workup. Data were collected prospectively for all adult preoperative workups at Vanderbilt from 2013 to 2015. Subjects included 287 adults (253 postlingually deafened) with a mean age of 62.3 years. Each individual was assessed using the minimum speech test battery, spectral modulation detection, subjective questionnaires, and cognitive screening. Mean consonant-nucleus-consonant word scores, AzBio sentence scores, and pure-tone averages for postlingually deafened adults were 10%, 13%, and 89 dB HL, respectively, for the ear to be implanted. Seventy-three individuals (25.4%) met labeled indications for Hybrid-L and 207 individuals (72.1%) had aidable hearing in the better hearing ear to be used in a bimodal hearing configuration. These results suggest that mean speech understanding evaluated at cochlear implant workup remains very low despite recent advancements. Greater awareness and insurance accessibility may be needed to make cochlear implant technology available to those who qualify for electric acoustic stimulation devices as well as individuals meeting conventional cochlear implant criteria.
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Affiliation(s)
- Jourdan T Holder
- 1 Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan M Reynolds
- 1 Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Linsey W Sunderhaus
- 1 Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - René H Gifford
- 1 Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA.,2 Advanced Bionics, Valencia, CA, USA.,3 Cochlear Americas, Englewood, CO, USA.,4 Frequency Therapeutics, Woburn, MA, USA
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65
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Hillyer J, Elkins E, Hazlewood C, Watson SD, Arenberg JG, Parbery-Clark A. Assessing Cognitive Abilities in High-Performing Cochlear Implant Users. Front Neurosci 2019; 12:1056. [PMID: 30713488 PMCID: PMC6346679 DOI: 10.3389/fnins.2018.01056] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022] Open
Abstract
Despite being considered one of the most successful neural prostheses, cochlear implants (CIs) provide recipients with a wide range of speech perception performance. While some CI users can understand speech in the absence of visual cues, other recipients exhibit more limited speech perception. Cognitive skills have been documented as a contributor to complex auditory processing, such as language understanding; however, there are no normative data for existing standardized clinical tests assessing cognitive abilities in CI users. Here, we assess the impact of modality of presentation (i.e., auditory-visual versus visual) for the administration of working memory tests in high-performing CI users in addition to measuring processing speed, cognitive efficiency and intelligence quotient (IQ). Second, we relate performance on these cognitive measures to clinical CI speech perception outcomes. Methods: Twenty one post-lingually deafened, high-performing, adult CI users [age range: 52–88 years; 3 unilateral CI, 13 bimodal (i.e., CI with contralateral hearing aid), 5 bilateral CI] with clinical speech perception scores (i.e., AzBio sentences in quiet for the first-ear CI) of ≥60% were recruited. A cognitive test battery assessing auditory-visual working memory (AVWM), visual working memory (VWM), processing speed, cognitive efficiency and IQ was administered, in addition to clinical measures of speech perception in quiet (i.e., AzBio sentences in quiet). AzBio sentences were assessed in two conditions: first-ear CI only, and best-aided everyday wearing condition. Subjects also provided self-reported measures of performance and benefit from their CI using standardized materials, including the Glasgow Benefit Inventory (GBI) and the Nijmegen Cochlear Implant questionnaire (NCIQ). Results: High-performing CI users demonstrated greater VWM than AVWM recall. VWM was positively related to AzBio scores when measured in the first-ear CI only. AVWM, processing speed, cognitive efficiency, and IQ did not relate to either measure of speech perception (i.e., first-ear CI or best-aided conditions). Subjects’ self-reported benefit as measured by the GBI predicted best-aided CI speech perception performance. Conclusion: In high-performing CI recipients, visual presentation of working memory tests may improve our assessment of cognitive function.
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Affiliation(s)
- Jake Hillyer
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Elizabeth Elkins
- Auditory Research Laboratory, Center for Hearing and Skull Base Surgery, Swedish Neuroscience Institute, Seattle, WA, Unites States
| | - Chantel Hazlewood
- Auditory Research Laboratory, Center for Hearing and Skull Base Surgery, Swedish Neuroscience Institute, Seattle, WA, Unites States
| | - Stacey D Watson
- Auditory Research Laboratory, Center for Hearing and Skull Base Surgery, Swedish Neuroscience Institute, Seattle, WA, Unites States
| | - Julie G Arenberg
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
| | - Alexandra Parbery-Clark
- Auditory Research Laboratory, Center for Hearing and Skull Base Surgery, Swedish Neuroscience Institute, Seattle, WA, Unites States
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66
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Luo X, Kern A, Pulling KR. Vocal emotion recognition performance predicts the quality of life in adult cochlear implant users. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2018; 144:EL429. [PMID: 30522282 DOI: 10.1121/1.5079575] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
Clinical tests of cochlear implant (CI) outcomes in sentence recognition cannot fully reflect CI users' self-reported quality of life (QoL). Here, vocal emotion recognition scores, speech reception thresholds (SRTs), and demographic factors were tested as predictors of QoL scores assessed with the Nijmegen Cochlear Implant Questionnaire in postlingually deafened adult CI users. After correction for multiple comparisons, vocal emotion recognition scores were significantly correlated with QoL scores in all subdomains (social interaction, self-esteem, etc.), while SRTs and duration of CI use were not. Vocal emotion recognition may thus be used in clinic to accurately and broadly predict QoL with CIs.
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Affiliation(s)
- Xin Luo
- College of Health Solutions, Arizona State University, 975 South Myrtle Avenue, P.O. Box 870102, Tempe, Arizona 85287, USA ; ;
| | - Ashley Kern
- College of Health Solutions, Arizona State University, 975 South Myrtle Avenue, P.O. Box 870102, Tempe, Arizona 85287, USA ; ;
| | - Kathryn R Pulling
- College of Health Solutions, Arizona State University, 975 South Myrtle Avenue, P.O. Box 870102, Tempe, Arizona 85287, USA ; ;
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Moberly AC, Vasil K, Baxter J, Ray C. What to Do When Cochlear Implant Users Plateau in Performance: a Pilot Study of Clinician-guided Aural Rehabilitation. Otol Neurotol 2018; 39:e794-e802. [PMID: 30199497 PMCID: PMC6132264 DOI: 10.1097/mao.0000000000001964] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS For experienced adult cochlear implant (CI) users who have reached a plateau in performance, a clinician-guided aural rehabilitation (CGAR) approach can improve speech recognition and hearing-related quality of life (QOL). BACKGROUND A substantial number of CI users do not reach optimal performance in terms of speech recognition ability and/or personal communication goals. Although self-guided computerized auditory training programs have grown in popularity, compliance and efficacy for these programs are poor. We propose that CGAR can improve speech recognition and hearing-related QOL in experienced CI users. METHODS Twelve adult CI users were enrolled in an 8-week CGAR program guided by a speech-language pathologist and audiologist. Nine patients completed the program along with pre-AR and immediate post-AR testing of speech recognition (AzBio sentences in quiet and in multitalker babble, Consonant-Nucleus-Consonant words in quiet), QOL (Nijmegen Cochlear Implant Questionnaire, Hearing Handicap Inventory for Adults/Elderly, and Speech, Spatial and Qualities of Hearing Scale), and neurocognitive functioning (working memory capacity, information-processing speed, inhibitory control, speed of lexical/phonological access, and nonverbal reasoning). Pilot data for these nine patients are presented. RESULTS From pre-CGAR to post-CGAR, group mean improvements in word recognition were found. Improvements were also demonstrated on some composite and subscale measures of QOL. Patients who demonstrated improvements in word recognition were those who performed most poorly at baseline. CONCLUSIONS CGAR represents a potentially efficacious approach to improving speech recognition and QOL for experienced CI users. Limitations and considerations in implementing and studying aural rehabilitation approaches are discussed.
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Affiliation(s)
- Aaron C. Moberly
- Department of Otolaryngology – Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kara Vasil
- Department of Otolaryngology – Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jodi Baxter
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH
| | - Christin Ray
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH
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Kobosko J, Jedrzejczak WW, Gos E, Geremek-Samsonowicz A, Ludwikowski M, Skarzynski H. Self-esteem in the deaf who have become cochlear implant users as adults. PLoS One 2018; 13:e0203680. [PMID: 30204775 PMCID: PMC6133281 DOI: 10.1371/journal.pone.0203680] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 08/26/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Self-esteem is a good predictor of mental health and is crucial for well-being and psychological functioning. It is especially important in situations where there are potential mental health problems, such as in people suffering from hearing loss or total deafness. This study aims to gauge the level of self-esteem in adults with hearing problems, in particular those who, in adulthood, had received a cochlear implant (CI). The subjects had different onset (pre-lingual/post-lingual) and amount (deafness/partial deafness) of hearing loss, and their current level of self-esteem was compared to that of the general population. The association of self-esteem with other deafness-related variables (e.g. satisfaction with their CI or whether they also used a hearing aid) and sociodemographic factors was also investigated. Methods Data were obtained from questionnaires mailed to patients who, when adult, had received a CI. The subjects were divided into four subgroups: subjects with pre-lingual deafness, post-lingual deafness, pre-lingual partial deafness, and post-lingual partial deafness. To evaluate their self-esteem, the Rosenberg Self-Esteem Scale (RSES) was used. For data on sociodemographic status and information related to deafness and CI, we used our own Information Inquiry form. For statistical analysis of the results, we compared means (t-test, ANOVA), investigated correlations, and applied linear regression. Results The self-esteem of deaf and partially deaf CI users was significantly lower than in the general population, especially for post-lingually deafened subjects. The only factor related to deafness and CIs that explained self-esteem was self-rated satisfaction with the CI–meaning that higher satisfaction was associated with higher self-esteem. The major sociodemographic factor that explained self-esteem was marital/partnership status (being in a relationship was helpful). Also men had higher self-esteem than women. Those with higher levels of education, and those working or studying, had higher self-esteem than those who did not. RSES was found to have a single-factor structure. Conclusion Deafness and partial deafness appear to be risk factors for lower self-esteem, a finding that rehabilitation, medical, educational, and employment communities should be made aware of. Medical intervention in the form of a CI supplies the person with improved hearing, but it is not a panacea: their self-esteem is still vulnerable, and reinforcement of self-esteem is an aspect that professionals should focus on. Psychological, psycho-educational, and psychotherapeutic interventions have important roles to play for CI recipients.
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Affiliation(s)
- Joanna Kobosko
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany Nadarzyn, Poland
| | - W. Wiktor Jedrzejczak
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany Nadarzyn, Poland
- * E-mail:
| | - Elżbieta Gos
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany Nadarzyn, Poland
| | - Anna Geremek-Samsonowicz
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany Nadarzyn, Poland
| | - Maciej Ludwikowski
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany Nadarzyn, Poland
| | - Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany Nadarzyn, Poland
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Wallhäusser-Franke E, Balkenhol T, Hetjens S, Rotter N, Servais JJ. Patient Benefit Following Bimodal CI-provision: Self-reported Abilities vs. Hearing Status. Front Neurol 2018; 9:753. [PMID: 30250450 PMCID: PMC6139334 DOI: 10.3389/fneur.2018.00753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/20/2018] [Indexed: 01/09/2023] Open
Abstract
Objectives: Patient-reported outcomes gain importance for the assessment of auditory abilities in cochlear implant users and for the evaluation of auditory rehabilitation. Aims of the study were to explore the interrelation of self-reported improvements in auditory ability with improvements in speech comprehension and to identify factors other than audiological improvement that affect self-reported auditory ability. Study Design: Explorative prospective analysis using a within-subjects repeated measures design. Setting: Academic tertiary care center. Participants: Twenty-seven adult participants with bilateral sensorineural hearing loss who received a HiRes 90K CI and continued use of a HA at the non-implanted ear (bimodal hearing). Intervention: Cochlear implantation. Main Outcome Measures: Self-reported auditory ability/disability assessed by the comparative version of the Speech, Spatial and Qualities of Hearing Scale (SSQ-B), and monosyllable as well as sentence comprehension in quiet and within speech modulated noise from different directions assessed pre- as well as 3 and 6 months post-implantation. Results: Data of 17 individuals were analyzed. At the endpoint of the study, improvement of self-reported auditory ability was significant. Regarding audiometric measures, significant improvement was seen for CI-aided pure tone thresholds, for monaural CI-assisted and bimodal sentence comprehension in quiet and in speech-modulated noise that was presented from the same source or at the side of the HA-ear. Correlations between self-reported and audiometric improvements remained weak, with the exception of the improvement seen for monaural CI-aided sentence comprehension in quiet and self-perceived improvement of sound quality. Considerable correlations existed between self-reported improvements and current level of depression and anxiety, and with general self-efficaciousness. Regression analyses substantiated a positive influence of self-efficaciousness on self-reported improvement in speech comprehension and between the improvement of monaural CI-aided sentence comprehension in quiet and perceived sound quality as well as a negative influence of anxiety on self-reported improvement in spatial hearing. Self-reported improvements were significantly better in the subgroup with intensive as compared to regular rehabilitation. Conclusions: Self-reported auditory ability/disability represents an important measure for the success of bimodal CI-provision. It is influenced by personal and mental health factors that may improve CI-rehabilitation results if addressed during rehabilitation.
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Affiliation(s)
- Elisabeth Wallhäusser-Franke
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Balkenhol
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Jerome J Servais
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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Claes AJ, Van de Heyning P, Gilles A, Van Rompaey V, Mertens G. Cognitive outcomes after cochlear implantation in older adults: A systematic review. Cochlear Implants Int 2018; 19:239-254. [DOI: 10.1080/14670100.2018.1484328] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Annes J. Claes
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
- Department of Human and Social Welfare, University College Ghent (HoGent), Ghent, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
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Völter C, Götze L, Dazert S, Falkenstein M, Thomas JP. Can cochlear implantation improve neurocognition in the aging population? Clin Interv Aging 2018; 13:701-712. [PMID: 29719382 PMCID: PMC5916259 DOI: 10.2147/cia.s160517] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction The relationship between cognition and the ability to hear is well known. Due to changes in demographics, the number of people with sensorineural hearing loss and cognitive impairment is increasing. The aim of this study was to identify the impact of hearing rehabilitation via cochlear implantation on cognitive decline among the aging population. Patients and methods This prospective study included 60 subjects aged between 50 and 84 years (mean 65.8 years, SD=8.9) with a severe to profound bilateral hearing impairment. A computer-based evaluation of short- and long-term memory, processing speed, attention, working memory and inhibition was performed prior to surgery as well as 6 and 12 months after cochlear implantation. Additionally, speech perception at 65 and 80 dB (Freiburger monosyllabic speech test) as well as disease-related (Nijmegen Cochlear Implant Questionnaire) and general (WHOQOL-OLD) quality of life were assessed. Results Six months postimplantation, speech perception, quality of life and also neurocognitive abilities significantly increased. The most remarkable improvement after 6 months was detected in executive functions such as attention (p<0.001), inhibition (p=0.025) and working memory (n-back: p=0.002; operation span task: p=0.008), followed by delayed recall (p=0.03). In contrast, long-term memory showed a significant change of performance only after 12 months (p=0.021). After 6 months, most cognitive domains remained stable, except working memory assessed by the operation span task, which significantly improved between 6 and 12 months (p<0.001). No correlation was found between cognitive results and duration of deafness, speech perception or quality of life. Conclusion Cochlear implantation does not only lead to better speech perception and quality of life, but has also been shown to improve cognitive skills in hearing impaired adults aged 50 years or more. These effects seem to be independent of each other.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
| | - Lisa Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
| | - Michael Falkenstein
- Institute for Work, Learning and Ageing (ALA), Bochum, Germany.,Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
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McRackan TR, Bauschard M, Hatch JL, Franko-Tobin E, Droghini HR, Nguyen SA, Dubno JR. Meta-analysis of quality-of-life improvement after cochlear implantation and associations with speech recognition abilities. Laryngoscope 2018; 128:982-990. [PMID: 28731538 PMCID: PMC5776066 DOI: 10.1002/lary.26738] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/11/2017] [Accepted: 05/18/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Determine the impact of cochlear implantation on quality of life (QOL) and determine the correlation between QOL and speech recognition ability. STUDY DESIGN Two authors independently searched PubMed, Medline, Scopus, and the Cumulative Index to Nursing and Allied Health Literature to identify studies reporting hearing-specific or cochlear implant (CI)-specific QOL outcomes before and after cochlear implantation, and studies reporting correlations between QOL and speech recognition after cochlear implantation. Data from the included articles were obtained independently by two authors. Standardized mean difference (SMD) for each measure and pooled effects were determined to assess improvement in QOL before and after cochlear implantation. RESULTS From 14 articles with 679 CI patients who met the inclusion criteria, pooled analyses of all hearing-specific QOL measures revealed a very strong improvement in QOL after cochlear implantation (SMD = 1.77). Subset analysis of CI-specific QOL measures also showed very strong improvement (SMD = 1.69). Thirteen articles with 715 patients met the criteria to evaluate associations between QOL and speech recognition. Pooled analyses showed a low positive correlation between hearing-specific QOL and word recognition in quiet (r = 0.213), sentence recognition in quiet (r = 0.241), and sentence recognition in noise (r = 0.238). Subset analysis of CI-specific QOL showed similarly low positive correlations with word recognition in quiet (r = 0.213), word recognition in noise (r = 0.241), and sentence recognition in noise (r = 0.255). CONCLUSIONS Using hearing-specific and CI-specific measures of QOL, patients report significantly improved QOL after cochlear implantation. However, widely used clinical measures of speech recognition are poor predictors of patient-reported QOL with CIs. Laryngoscope, 128:982-990, 2018.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Michael Bauschard
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Jonathan L Hatch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Emily Franko-Tobin
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - H Richard Droghini
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Abdrabbou MF, Tucker DA, Compton MV, Mankoff L. Quality of life and speech perception in two late deafened adults with cochlear implants. Audiol Res 2018; 8:194. [PMID: 29725521 PMCID: PMC5907640 DOI: 10.4081/audiores.2018.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/18/2018] [Indexed: 11/22/2022] Open
Abstract
The aim was to demonstrate the need for a quality of life assessment in biopsychosocial aural rehabilitation (AR) practices with late deafened adults (LDAs) with cochlear implants (CIs). We present a case report of a medical records review of two LDAs enrolled in a biopsychosocial group AR program. A speech perception test Contrasts for Auditory and Speech Training (CAST) and a quality of life (QoL) assessment the Nijmegen Cochlear Implant Questionnaire (NCIQ) were given prior to AR therapy. CAST scores indicated both patients had excellent basic speech perception. However, NCIQ results revealed patients' difficulties in basic and advanced listening settings. NCIQ highlighted patients' self-perceived poor self-esteem and ongoing challenges to their QoL. Speech perception testing results alone are not enough to document the daily challenges of QoL needs of LDAs with CIs. The inclusion of a QoL measure such as the NCIQ is vital in evaluating outcomes of cochlear implantation in LDAs.
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Affiliation(s)
- Marwa F Abdrabbou
- Department of Communication Sciences and Disorders, University of North Carolina, Greensboro, NC, USA
| | - Denise A Tucker
- Department of Communication Sciences and Disorders, University of North Carolina, Greensboro, NC, USA
| | - Mary V Compton
- Department of Communication Sciences and Disorders, University of North Carolina, Greensboro, NC, USA
| | - Lyn Mankoff
- Department of Communication Sciences and Disorders, University of North Carolina, Greensboro, NC, USA
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Ramakers GGJ, Smulders YE, van Zon A, Van Zanten GA, Grolman W, Stegeman I. Correlation between subjective and objective hearing tests after unilateral and bilateral cochlear implantation. BMC EAR, NOSE, AND THROAT DISORDERS 2017; 17:10. [PMID: 29209150 PMCID: PMC5704382 DOI: 10.1186/s12901-017-0043-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/21/2017] [Indexed: 11/10/2022]
Abstract
Background There are many methods for assessing hearing performance after cochlear implantation. Standard evaluations often encompass objective hearing tests only, while patients' subjective experiences gain importance in today's healthcare. The aim of the current study was to analyze the correlation between subjective (self-reported questionnaires) and objective (speech perception and localization) hearing test results in adult cochlear implant (CI) users. Secondary, the correlation between subjective and objective hearing tests was compared between bilateral and unilateral CI patients. Methods Data for this study were prospectively collected as part of a multicentre randomized controlled trial. Thirty-eight postlingually deafened adult patients were randomly allocated to receive either unilateral (n = 19) or bilateral (n = 19) cochlear implantation. We used data gathered after one year of follow-up. We studied the correlation between objectively measured speech perception and localization skills on the one hand and related domains of the Speech, Spatial and Qualities of Hearing Scale (SSQ) and Nijmegen Cochlear Implant Questionnaire (NCIQ) on the other hand. We also compared these correlations between unilateral and bilateral CI users. Results We found significant weak to moderate negative correlations between the subjective test results (speech domain of the SSQ and the advanced speech perception domain of the NCIQ) and the related objective speech perception in noise test results (r = -0.33 to -0.48). A significant moderate correlation was found between the subjective test results (spatial domain of the SSQ) and the related objective localization test results (r = 0.59). The correlations in the group of bilateral CI patients (r = -0.28 to -0.54) did not differ significantly from the correlations in the group of unilateral CI patients (r = 0.15 to -0.40). Conclusions Current objective tests do not fully reflect subjective everyday listening situations. This study elucidates the importance and necessity of questionnaires in the evaluation of cochlear implantation. Therefore, it is advised to evaluate both objective and subjective tests in CI patients on a regular basis. Trial registration This trial was registered on March 11, 2009 in the Dutch Trial Register. Trial registration number: NTR1722.
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Affiliation(s)
- Geerte G J Ramakers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Yvette E Smulders
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Alice van Zon
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Gijsbert A Van Zanten
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
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75
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McRackan TR, Velozo CA, Holcomb MA, Camposeo EL, Hatch JL, Meyer TA, Lambert PR, Melvin CL, Dubno JR. Use of Adult Patient Focus Groups to Develop the Initial Item Bank for a Cochlear Implant Quality-of-Life Instrument. JAMA Otolaryngol Head Neck Surg 2017; 143:975-982. [PMID: 28772297 DOI: 10.1001/jamaoto.2017.1182] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance No instrument exists to assess quality of life (QOL) in adult cochlear implant (CI) users that has been developed and validated using accepted scientific standards. Objective To develop a CI-specific QOL instrument for adults in accordance with the Patient Reported Outcomes Measurement Information System (PROMIS) guidelines. Design, Setting, and Participants As required in the PROMIS guidelines, patient focus groups participated in creation of the initial item bank. Twenty-three adult CI users were divided into 1 of 3 focus groups stratified by word recognition ability. Three moderator-led focus groups were conducted based on grounded theory on December 3, 2016. Two reviewers independently analyzed focus group recordings and transcripts, with a third reviewer available to resolve discrepancies. All data were reviewed and reported according to the Consolidated Criteria for Reporting Qualitative Research. The setting was a tertiary referral center. Main Outcomes and Measures Coded focus group data. Results The 23 focus group participants (10 [43%] female; mean [range] age, 68.1 [46.2-84.2] years) represented a wide range of income levels, education levels, listening modalities, CI device manufacturers, duration of CI use, and age at implantation. Data saturation was determined to be reached before the conclusion of each of the focus groups. After analysis of the transcripts, the central themes identified were communication, emotion, environmental sounds, independence and work function, listening effort, social isolation and ability to socialize, and sound clarity. Cognitive interviews were carried out on 20 adult CI patients who did not participate in the focus groups to ensure item clarity. Based on these results, the initial QOL item bank and prototype were developed. Conclusions and Relevance Patient focus groups drawn from the target population are the preferred method of identifying content areas and domains for developing the item bank for a CI-specific QOL instrument. Compared with previously used methods, the use of patient-centered item development for a CI-specific QOL instrument will more accurately reflect patient experience and increase our understanding of how CI use affects QOL.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Craig A Velozo
- Division of Occupational Therapy, Medical University of South Carolina, Charleston
| | - Meredith A Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Elizabeth L Camposeo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Jonathan L Hatch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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76
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Moberly AC, Harris MS, Boyce L, Vasil K, Wucinich T, Pisoni DB, Baxter J, Ray C, Shafiro V. Relating quality of life to outcomes and predictors in adult cochlear implant users: Are we measuring the right things? Laryngoscope 2017; 128:959-966. [PMID: 28776711 DOI: 10.1002/lary.26791] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Current clinical outcome measures for adults receiving cochlear implants (CIs) consist of word and sentence recognition, primarily under quiet conditions. However, these measures may not adequately reflect patients' CI-specific quality of life (QOL). This study first examined traditional auditory-only speech recognition measures and other potentially relevant auditory measures as correlates of QOL in CI users. Second, scores on nonauditory tasks of language and cognition were examined as potential predictors of QOL. STUDY DESIGN Twenty-five postlingually deafened adults with CIs were assessed. METHODS Participants completed a validated CI-specific QOL measure (the Nijmegen Cochlear Implant Questionnaire) and were tested for word and sentence recognition in quiet, as well as sentence recognition in speech-shaped noise. Participants also completed assessments of audiovisual speech recognition, environmental sound identification, and a task of complex auditory verbal processing. Several nonauditory language and cognitive tasks were examined as potential predictors of QOL. RESULTS Quality-of-life scores significantly correlated with scores for audiovisual speech recognition and recognition of complex sentences in quiet but not sentences in noise or isolated words. No significant correlations were obtained between QOL and environmental sound identification or complex auditory verbal processing. Quality-of-life subdomain scores were predicted by several nonauditory language and cognitive tasks as well as some patient characteristics. CONCLUSION Postoperative measures of recognition of sentences in quiet and audiovisual sentence recognition correlate with CI-related QOL. Findings suggest that sentence recognition tasks are QOL-relevant outcomes but only explain a small fraction of the variability in QOL outcomes for this patient population. LEVEL OF EVIDENCE 4. Laryngoscope, 128:959-966, 2018.
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Affiliation(s)
- Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Michael S Harris
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Lauren Boyce
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Department of Speech and Hearing Science, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kara Vasil
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Taylor Wucinich
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Department of Speech and Hearing Science, The Ohio State University, Columbus, Ohio, U.S.A
| | - David B Pisoni
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, U.S.A
| | - Jodi Baxter
- Department of Speech and Hearing Science, The Ohio State University, Columbus, Ohio, U.S.A
| | - Christin Ray
- Department of Speech and Hearing Science, The Ohio State University, Columbus, Ohio, U.S.A
| | - Valeriy Shafiro
- Department of Communication Disorders and Sciences, Rush University, Chicago, Illinois, U.S.A
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Sladen DP, Peterson A, Schmitt M, Olund A, Teece K, Dowling B, DeJong M, Breneman A, Beatty CW, Carlson ML, Neff BA, Hughes-Borst B, Driscoll CL. Health-related quality of life outcomes following adult cochlear implantation: A prospective cohort study. Cochlear Implants Int 2017; 18:130-135. [DOI: 10.1080/14670100.2017.1293203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Ann Peterson
- Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Matt Schmitt
- Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Amy Olund
- Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Katherine Teece
- Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA
| | | | - Melissa DeJong
- Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Alyce Breneman
- Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Brian A. Neff
- Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA
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le Roux T, Vinck B, Butler I, Louw L, Nauta L, Schlesinger D, Swanepoel DW. Predictors of health-related quality of life in adult cochlear implant recipients in South Africa. Int J Audiol 2016; 56:16-23. [DOI: 10.1080/14992027.2016.1227482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,
| | - Bart Vinck
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,
- Speech-Language Audiology Department, Ghent University, Gent, Belgium,
| | - Iain Butler
- Department of Otorhinolaryngology, University of the Free State, Bloemfontein, South Africa,
| | - Liebie Louw
- Department of Statistics, University of Pretoria, Pretoria, South Africa,
| | - Leone Nauta
- Johannesburg Cochlear Implant Program, Johannesburg, South Africa,
| | - Dani Schlesinger
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa,
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,
- Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia, and
- Ear Science Institute Australia, Subiaco, Australia
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79
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Harris MS, Capretta NR, Henning SC, Feeney L, Pitt MA, Moberly AC. Postoperative Rehabilitation Strategies Used by Adults With Cochlear Implants: A Pilot Study. Laryngoscope Investig Otolaryngol 2016; 1:42-48. [PMID: 28894803 PMCID: PMC5510267 DOI: 10.1002/lio2.20] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/12/2016] [Accepted: 05/07/2016] [Indexed: 11/09/2022] Open
Abstract
Objectives/Hypothesis Aural rehabilitation is not standardized for adults after cochlear implantation. Most cochlear implant (CI) centers in the United States do not routinely enroll adult CI users in focused postoperative rehabilitation programs due to poor reimbursement and lack of data supporting (or refuting) the efficacy of any one specific approach. Consequently, patients generally assume a self‐driven approach toward rehabilitation. This exploratory pilot study examined rehabilitation strategies pursued by adults with CIs and associated these strategies with speech recognition and CI‐specific quality of life (QOL). Study Design Cross‐sectional study of 23 postlingually deafened adults with CIs. Methods Participants responded to an open‐ended questionnaire regarding rehabilitation strategies. A subset underwent in‐depth interviews. Thematic content analysis was applied to the questionnaires and interview transcripts. Participants also underwent word recognition testing and completed a CI‐related QOL measure. Participants were classified as having good or poor performance (upper or lower quartile for speech recognition) and high or low QOL (upper or lower quartile for QOL). Rehabilitation themes were compared and contrasted among groups. Results Five rehabilitation themes were identified: 1) Preimplant expectations of postoperative performance, 2) personal motivation, 3) social support, 4) specific rehabilitation strategies, and 5) patient‐perceived role of the audiologist. Patients with good speech recognition and high QOL tended to pursue more active rehabilitation and had greater social support. Patient expectations and motivation played significant roles in postoperative QOL. Conclusion Postoperative patient‐driven rehabilitation strategies are highly variable but appear to relate to outcomes. Larger‐scale extensions of this pilot study are needed.
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Affiliation(s)
- Michael S Harris
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio
| | - Natalie R Capretta
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio
| | - Shirley C Henning
- DeVault Otologic Research Laboratory Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Laura Feeney
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio
| | - Mark A Pitt
- the Department of Psychology The Ohio State University Columbus Ohio
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio
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