Longitudinal Speech Recognition Changes After Cochlear Implant: Systematic Review and Meta-analysis

Computer-based Auditory Training by New Adult Cochlear Implant Recipients Is Associated With Durable Improvements in Cochlear Implant Quality of Life

OBJECTIVE

The process of adapting to communicate with a cochlear implant (CI) is complex. The use of auditory training after cochlear implantation may help to facilitate improvements in postoperative speech recognition and quality-of-life outcomes in new adult CI recipients. However, the effectiveness of auditory training remains uncertain and long-term effects have not been examined in a large sample of new adult CI users. As such, the objective of this study was to examine the influence of common forms of auditory training on speech recognition and CI-related quality-of-life (CI-related QOL) outcomes at 1 year after cochlear implantation. We hypothesized that patients who reported use of computer-based auditory training (CBAT) would show improved speech and CIQOL-35 Profile scores at 1 year after activation of their implant, compared with their peers.

DESIGN

This study was designed as a prospective study and was undertaken at a tertiary academic CI center. Participants included 114 adults undergoing cochlear implantation for bilateral hearing loss. Patients serially self-reported use of the following types of post-CI auditory training over their first-year postactivation: (1) face-to-face training (e.g., speech-language pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) CBAT (e.g., self-directed software). Outcomes measures for this study included change in Consonant-Nucleus-Consonant phoneme (CNCp), CNC word (CNCw), AzBio sentences in quiet, and CIQOL-35 Profile global and domain scores from pre-CI to 12-mo post-CI.

RESULTS

Of 114 patients, 94 (82.5%) used one or more auditory training resources. Of these, 19.3% used face-to-face training, 67.5% passive home-based training, and 46.5% CBAT. Of 114 patients, 73 had complete CIQOL data. At 12 mo, only CBAT use was associated with significantly greater improvements in global and all domain-specific CIQOL scores ( d -range  =  0.72-0.87), compared with those not using CBAT. Controlling for demographics and use of multiple training resources, CBAT remained the strongest positive predictor of CIQOL improvement, with significant associations with global score (ß  =  12.019[4.127,19.9]) and all domain scores at 12-mo post-CI: communication (ß  =  11.937[2.456,21.318), emotional (ß  =  12.293[1.827,22.759), entertainment (ß  =  17.014[5.434,28.774), environment (ß  =  13.771[1.814,25.727]), listening effort (ß  =  12.523[2.798,22.248]), and social (ß  =  18.114[7.403,28.826]). No significant benefits were noted with use of CBAT or any other form of auditory training and speech recognition scores at 12-mo post-CI ( d -range  =  -0.12-0.22).

CONCLUSIONS

Auditory training with CBAT was associated with improved CI-related QOL outcomes at 12-mo post-CI. Given its availability and low cost, this study provides evidence to support using CBAT to improve real-world functional abilities in new adult CI recipients.

Listening-Related Fatigue in New and Experienced Adult Cochlear Implant Users

OBJECTIVES

Active listening in everyday settings is challenging and requires substantial mental effort, particularly in noisy settings. In some cases, effortful listening can lead to significant listening-related fatigue and negatively affect quality of life. However, our understanding of factors that affect the severity of fatigue is limited. Hearing aids and cochlear implants (CIs) can improve speech understanding and thus, potentially, reduce listening effort and fatigue. Some research supports this idea for adult hearing aid users with mild-to-moderate hearing loss, but similar work in CI users is very limited. This study examined (1) longitudinal changes in listening-related fatigue in new and established CI users, and (2) relationships between demographic and audiologic factors and preimplantation and postimplantation listening-related fatigue.

DESIGN

Participants included an experimental group of 48 adult CI candidates receiving either a unilateral implant (n = 46) or simultaneous, bilateral implants (n = 2) and a control group of 96 experienced (>12 months experience) adult CI users (50 unilateral, 46 bilateral). Listening-related fatigue was evaluated using the 40-item version of the Vanderbilt Fatigue Scale for Adults. Experimental group ratings were obtained before implantation and again at 0.5-, 1-, 2-, 3-, 6-, and 12-month(s) postactivation. Control group participants completed the scale twice-upon study entry and approximately 3 months later. Additional measures, including a social isolation and disconnectedness questionnaire, hearing handicap inventory, and the Effort Assessment Scale, were also administered at multiple time points. The role of these measures and select demographic and audiologic factors on preimplant and postimplant fatigue ratings were examined.

RESULTS

Adult CI candidates reported significantly more fatigue, greater self-perceived hearing handicap, greater listening effort, and more social isolation than experienced adult CI users. However, significant reductions in fatigue and effort were observed within 2 weeks postimplantation. By 3 months, there were no significant differences in fatigue, effort, hearing handicap, or social isolation between new CI recipients and experienced CI users. Secondary analyses revealed that age at onset of hearing loss (before or after 2 years of age) and subjective hearing handicap contributed significantly to the variance of preimplantation fatigue ratings (those with higher handicap reported higher fatigue). In contrast, variance in postimplantation fatigue ratings was not affected by age of hearing loss onset but was affected by gender (females reported more fatigue than males) and subjective ratings of effort, handicap, and isolation (those reporting more effort, handicap, and isolation reported more fatigue).

CONCLUSIONS

Listening-related fatigue is a significant problem for many CI candidates, as well as for many experienced unilateral and bilateral CI users. Receipt of a CI significantly reduced listening-related fatigue (as well as listening effort, hearing handicap, and social isolation) as soon as 2 weeks post-CI activation. However, the magnitude of fatigue-related issues for both CI candidates and experienced CI users varies widely. Audiologic factors, such as hearing loss severity and aided speech recognition, were not predictive of individual differences in listening-related fatigue. In contrast, strong associations were observed between perceived hearing handicap and listening-related fatigue in all groups suggesting fatigue-related issues may be a component of perceived hearing handicap.

Current practices and opinions on auditory training in adult cochlear implant recipients

OBJECTIVE

To examine current practices and opinions of cochlear implant (CI) providers with respect to post-implantation auditory training.

METHODS

A survey was submitted to the American Cochlear Implant Alliance membership that reviewed current practice and opinions with respect to post-implantation auditory training for adult CI recipients.

MAIN OUTCOME MEASURES

Review of respondent practice, center volume, role on CI team, and current usage and opinions surrounding auditory training, including resources used and schedule of use.

RESULTS

Most (79 %) of the 79 CI providers surveyed reported working at academic centers, 34 % at high-volume centers (>150 CIs/year), and 38 % were surgeons. Nearly all (99 %) respondents recommend auditory training for new adult CI recipients. Just over half (52 %) provide auditory training resources to the patient in the form of a broad list of patient-directed exercises from which a patient could select. A specific training resource, generally a computer-based auditory training program (e.g., AngelSound™), is recommended to patients by 30 % of the respondents. Regarding timing of rehabilitation, median preferred start time was 0 months (interquartile range [IQR] 0-1) post-activation. Sessions were preferably performed for a median of 3 h per week (IQR 2-4) and continued for a median of 12 months (IQR 6-12). Recommendations for auditory training were fairly consistent between surgeon and non-surgeon providers and by center volume. Non-surgeons more often had specific recommendations on training resources, benefits of music, and training condition (e.g., contralateral ear plugged).

CONCLUSIONS

Despite a lack of clinical guidelines for adult post-implantation auditory training, a cross-sectional survey of providers' current practices and opinions demonstrates that these services are widely recommended and regarded as valuable. Training is almost universally patient-directed and believed to be most beneficial if started soon after activation. Interestingly, specific recommendations for which training approaches to use are not common, suggesting a gap in provider knowledge of which resources are most efficacious.

Frequency-to-Place Mismatch Impacts Cochlear Implant Quality of Life, But Not Speech Recognition

OBJECTIVE

To retrospectively compare frequency-place mismatch among adult cochlear implant (CI) recipients with lateral wall (LW) and perimodiolar/Mid Scala (PM/MS) arrays, and to quantify the impact of these factors on early post-activation (3 months) speech recognition abilities and CI-specific quality of life.

METHODS

One hundred and twenty-six adult participants were separated into two groups: (1) 83 participants who underwent CI with a PM/MS array and 43 patients who underwent CI with a LW array. All participants completed the Cochlear Implant Quality of Life Profile (CIQOL-35 Profile) instrument. Angular insertion depth and semitone mismatch, which contribute to frequency-place mismatch, were assessed using post-operative CT scans. Word and speech recognition in quiet were determined using the Consonant-Nucleus-Consonant (CNC) and the AzBio tests, respectively (n = 82 patients).

RESULTS

LW arrays were more deeply inserted and exhibited less semitone mismatch compared to PM/MS arrays. No significant relationship was found between semitone mismatch and early post-operative speech perception scores for either PM/MS or LW arrays. However, greater degrees of semitone mismatch were associated with lower CIQOL-35 profile scores for PM/MS arrays.

CONCLUSIONS AND RELEVANCE

The results of this study indicate that both the degree of frequency-place mismatch, and its impact on CI-specific quality of life, vary by CI array design.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:2898-2905, 2024.

Predictors of cochlear implant outcomes in pediatric auditory neuropathy: A matched case-control study

OBJECTIVES

Current evidence supports the benefits of cochlear implants (CIs) in children with hearing loss, including those with auditory neuropathy spectrum disorder (ANSD). However, there is limited evidence regarding factors that hold predictive value for intervention outcomes.

DESIGN

This retrospective case-control study consisted of 66 children with CIs, including 22 with ANSD and 44 with sensorineural hearing loss (SNHL) matched on sex, age, age at CI activation, and the length of follow-up with CIs (1:2 ratio). The case and control groups were compared in the results of five open-set speech perception tests, and a Forward Linear Regression Model was used to identify factors that can predict the post-CI outcomes.

RESULTS

There was no significant difference in average scores between the two groups across five outcome measures, ranging from 88.40% to 95.65%. The correlation matrix revealed that younger ages at hearing aid fitting and CI activation positively influenced improvements in speech perception test scores. Furthermore, among the variables incorporated in the regression model, the duration of follow-up with CIs, age at CI activation, and the utilization of two CIs demonstrated prognostic significance for improved post-CI speech perception outcomes.

CONCLUSIONS

Children with ANSD can achieve similar open-set speech perception outcomes as children with SNHL. A longer CI follow-up, a lower age at CI activation, and the use of two CIs are predictive for optimal CI outcome.

Cochlear Implant Qualification in Noise Versus Quiet: Do Patients Demonstrate Similar Postoperative Benefits?

OBJECTIVE

To assess patient factors, audiometric performance, and patient-reported outcomes in cochlear implant (CI) patients who would not have qualified with in-quiet testing alone.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral center.

METHODS

Adult CI recipients implanted between 2012 and 2022 were identified. Patients with preoperative AzBio Quiet > 60% in the implanted ear, requiring multitalker babble to qualify, comprised the in-noise qualifying (NQ) group. NQ postoperative performance was compared with the in-quiet qualifying (QQ) group using CNC, AzBio Quiet, and AzBio +5 dB signal-to-noise ratio. Speech, Spatial and Qualities of Hearing Scale (SSQ), Cochlear Implant Quality of Life scale (CIQOL-10), and daily device usage were also compared between the groups.

RESULTS

The QQ group (n = 771) and NQ group (n = 67) were similar in age and hearing loss duration. NQ had higher average preoperative and postoperative speech recognition scores. A larger proportion of QQ saw significant improvement in CNC and AzBio Quiet scores in the CI-only listening condition (eg, CI-only AzBio Quiet: 88% QQ vs 51% NQ, P < .001). Improvement in CI-only AzBio +5 dB and in all open set testing in the best-aided binaural listening condition was similar between groups (eg, Binaural AzBio Quiet 73% QQ vs 59% NQ, P = .345). Postoperative SSQ ratings, CIQOL scores, and device usage were also equivalent between both groups.

CONCLUSION

Patients who require in-noise testing to meet CI candidacy demonstrate similar improvements in best-aided speech perception and patient-reported outcomes as in-QQ, supporting the use of in-noise testing to determine CI qualification for borderline CI candidates.

Cochlear Implantation Outcomes in Pediatric Unilateral Hearing Loss: Impact of Device Use and Direct Input

OBJECTIVE

To investigate the impact of daily cochlear implant (CI) use on speech perception outcomes among children with unilateral hearing loss (UHL).

STUDY DESIGN

Multi-institutional retrospective case series of pediatric patients with UHL who underwent CI between 2018 to 2022.

SETTING

Three tertiary children's hospitals.

METHODS

Demographics were obtained including duration of deafness and age at CI. Best consonant-nucleus-consonant (CNC) word scores and data logs describing hours of CI usage were assessed postimplantation. Use of direct audio input (DAI) during rehabilitation was recorded.

RESULTS

Twenty-seven children were included, with a mean age at CI of 7.8 years. Mean datalogging time was 7.8 ± 3.0 hours/day. 40.7% of children utilized daily DAI. The mean CNC score using the best score during the study period was 34.9%. There was no significant correlation between hours of CI usage and CNC score. There was a significant improvement in CNC score associated with whether the child used DAI during rehabilitation (CNC 50.91% [yes] vs 23.81% [no]), which remained significant when adjusting for age at CI, duration of deafness, and data log hours.

CONCLUSION

Unlike children with bilateral hearing loss and CI, children with UHL and CI demonstrate no significant correlation between hours of daily CI usage and CNC scores. However, children who used DAI during postoperative rehabilitation achieved significantly higher CNC scores than those who did not. This suggests that rehabilitation focused on isolated listening with the implanted ear maybe critical in optimizing outcomes with CI in UHL patients.

Audiovisual Processing Skills Before Cochlear Implantation Predict Postoperative Speech Recognition in Adults

OBJECTIVES

Adults with hearing loss (HL) demonstrate greater benefits of adding visual cues to auditory cues (i.e., "visual enhancement" [VE]) during recognition of speech presented in a combined audiovisual (AV) fashion when compared with normal-hearing peers. For patients with moderate-to-profound sensorineural HL who receive cochlear implants (CIs), it is unclear whether the restoration of audibility results in a decrease in the VE provided by visual cues during AV speech recognition. Moreover, it is unclear whether increased VE during the experience of HL before CI is beneficial or maladaptive to ultimate speech recognition abilities after implantation. It is conceivable that greater VE before implantation contributes to the enormous variability in speech recognition outcomes demonstrated among patients with CIs. This study took a longitudinal approach to test two hypotheses: (H1) Adult listeners with HL who receive CIs would demonstrate a decrease in VE after implantation; and (H2) The magnitude of pre-CI VE would predict post-CI auditory-only speech recognition abilities 6 months after implantation, with the direction of that relation supporting a beneficial, redundant, or maladaptive effect on outcomes.

DESIGN

Data were collected from 30 adults at two time points: immediately before CI surgery and 6 months after device activation. Pre-CI speech recognition performance was measured in auditory-only (A-only), visual-only, and combined AV fashion for City University of New York (CUNY) sentences. Scores of VE during AV sentence recognition were computed. At 6 months after CI activation, participants were again tested on CUNY sentence recognition in the same conditions as pre-CI. H1 was tested by comparing post- versus pre-CI VE scores. At 6 months of CI use, additional open-set speech recognition measures were also obtained in the A-only condition, including isolated words, words in meaningful AzBio sentences, and words in AzBio sentences in multitalker babble. To test H2, correlation analyses were performed to assess the relation between post-CI A-only speech recognition scores and pre-CI VE scores.

RESULTS

Inconsistent with H1, after CI, participants did not demonstrate a significant decrease in VE scores. Consistent with H2, preoperative VE scores positively predicted postoperative scores of A-only sentence recognition for both sentences in quiet and in babble (rho = 0.40 to 0.45, p < 0.05), supporting a beneficial effect of pre-CI VE on post-CI auditory outcomes. Pre-CI VE was not significantly related to post-CI isolated word recognition. The raw pre-CI CUNY AV scores also predicted post-CI A-only speech recognition scores to a similar degree as VE scores.

CONCLUSIONS

After implantation, CI users do not demonstrate a decrease in VE from before surgery. The degree of VE during AV speech recognition before CI positively predicts A-only sentence recognition outcomes after implantation, suggesting the potential value of AV testing of CI patients preoperatively to help predict and set expectations for postoperative outcomes.

Holistic assessment of cochlear implant outcomes using the international classification of functioning disability and health model: data analysis of a longitudinal prospective multicenter study

PURPOSE

To study outcome after cochlear implantation using the Cochlear Implant (CI) outcome assessment protocol based on the International Classification of Functioning, Disability and Health (ICF) model (CI-ICF).

METHODS

Raw data of a prospective, longitudinal, multicenter study was analyzed. Seventy-two CI candidates were assessed preoperatively and six months postoperatively using the CI-ICF protocol. Following tools were used: (1) Work Rehabilitation Questionnaire (WORQ), (2) Abbreviated Profile of Hearing Aid Benefit (APHAB), (3) Audio Processor Satisfaction Questionnaire (APSQ), (4) Speech, Spatial, and Qualities of Hearing Scale (SSQ12), (5) Hearing Implant Sound Quality Index (HISQUI19), (6) Nijmegen CI Questionnaire (NCIQ) (7) pure tone audiometry, (8) speech audiometry, (9) sound localization.

RESULTS

There was a significant improvement of speech discrimination in quiet (p = 0.015; p < 0.001) and in noise (p = 0.041; p < 0.001), sound detection (p < 0.001), tinnitus (p = 0.026), listening (p < 0.001), communicating with-receiving-spoken messages (p < 0.001), conversation (p < 0.001), family relationships (p < 0.001), community life (p = 0.019), NCIQ total score and all subdomain scores (p < 0.001). Subjective sound localization significantly improved (p < 0.001), while psychometric sound localization did not. There was no significant subjective deterioration of vestibular functioning and no substantial change in sound aversiveness. CI users reported a high level of implant satisfaction postoperatively.

CONCLUSION

This study highlights the positive impact of cochlear implantation on auditory performance, communication, and subjective well-being. The CI-ICF protocol provides a holistic and comprehensive view of the evolution of CI outcomes.

Influence of depressive disorders, stress, and personality traits on quality of life after cochlear implantation

PURPOSE

This study aimed to determine whether preoperative depressiveness, stress, and personality influence quality of life (QOL) after cochlear implant (CI) surgery.

METHODS

In this prospective study, 79 patients undergoing CI surgery were evaluated preoperatively and 12 months postoperatively. Disease-specific QOL was assessed with the Nijmegen Cochlear Implant Questionnaire (NCIQ) and general QOL with the WHOQOL-BREF. Depressiveness and stress were assessed with the Patient Health Questionnaire (PHQ-D). The Charlson Comorbidity Index (CCI) was used to classify comorbidities. The Big Five Personality Test (B5T) was used to assess the basic personality dimensions. Speech comprehension was evaluated in quiet with the Freiburg monosyllable test and in noise with the Oldenburg sentence test.

RESULTS

After CI surgery, the total NCIQ score improved significantly (Δ 17.1 ± 14.7, p < 0.001). General QOL (WHOQOL-BREF, Δ 0.4 ± 9.9, p = 0.357), stress (Δ 0.25 ± 3.21, p = 0.486), and depressiveness (Δ 0.52 ± 3.21, p = 0.121) were unaffected by CI surgery. Patients without elevated depressiveness (p < 0.01) or stress (p < 0.001) had significantly better total NCIQ scores. The results of the multiple regression analyses show that, after adjusting for the CCI, personality, age, and mental health stress (ß = - 0.495, p < 0.001) was significantly associated with postoperative NCIQ outcome scores. Depressiveness and neuroticism had the strongest influence on the generic QOL (ß = - 0.286 and ß = - 0.277, p < 0.05).

CONCLUSION

Stress symptoms and personality traits are significant predictive factors for disease-specific QOL, as well as hearing status. This should be considered in the preoperative consultation and in optimizing the rehabilitation process.

Teledelivery of Aural Rehabilitation to Improve Cochlear Implant Outcomes

OBJECTIVE(S)

This randomized controlled study evaluated the effectiveness of a Telehealth Aural Rehabilitation (TeleAR) training protocol to improve outcomes for adult cochlear implant (CI) users.

METHODS

This was a multisite clinical study with participants randomized to either an AR treatment or active control group. The AR protocol consisted of auditory training (words, sentences, and speech tracking), informational counseling, and communication strategies. The control group participants engaged in cognitive stimulation activities (crosswords, sudoku, etc.). Each group completed 6 weekly 90-min individual treatment sessions delivered remotely. Twenty postlingually deafened adult CI users participated. Assessments were completed pretreatment and 1 week and 2 months posttreatment.

RESULTS

Repeated-measures ANOVA and planned contrasts were used to compare group performance on AzBio Sentences, Hearing Handicap Inventory (HHI), Client Oriented Scale of Improvement (COSI), and Glasgow Benefit Inventory (GBI). The two groups were statistically equivalent on all outcome measures at pre-assessment. There was a statistically significant main effect of time for all measures. Improvement over time was observed for participants in both groups, with greater improvement seen for the AR than the CT group on all outcome measures. The AR group showed medium to large effect sizes on all measures over time, suggesting clinically significant outcomes.

CONCLUSION

This randomized controlled study provides evidence of improved speech recognition and psychosocial outcomes following 6 weeks of TeleAR intervention. For adult post-lingually deafened CI users, including those >3 months post-activation, AR treatment can leverage neuroplasticity to maximize outcomes.

LEVEL OF EVIDENCE

2 Laryngoscope, 134:1861-1867, 2024.

Influence of cochlear implantation on the working ability of hearing-impaired patients: A prospective study on potential influencing factors

PURPOSE

This study evaluates the effect of cochlear implantation (CI) on work ability. The influences of quality of life (QOL), age, mental health, and hearing were analyzed.

METHODS

Seventy-nine patients undergoing CI surgery were evaluated preoperatively and 12 months postoperatively. Work ability was evaluated using the Work Ability Index (WAI). QOL was assessed with the Nijmegen Cochlear Implant Questionnaire (NCIQ) and the WHOQOL-BREF. Mental health was assessed with the Patient Health Questionnaire.

RESULTS

The WAI was unaffected by CI (Δ 0.8 ± 6.8, p = 0.42). No significant changes in WAI were observed for employees (Δ - 1.1 ± 5.7, p = 0.25) and pensioners (Δ -0.4 ± 7.8, p = 0.73). Patients without elevated depressiveness, stress, or somatoform symptoms had significantly better WAI.The multiple regression analyses show that WHOQOL-BREF (ß = 0.49, p ≤ 0.001), age (ß = -0.34, p ≤ 0.001), and depressiveness (ß = 0.33, p = 0.04) were significantly associated with WAI. In the employee group, the NCIQ (ß = 0.58, p = 0.008) had the strongest association with the WAI.

CONCLUSION

Age, mental health, and QOL are predictive factors for work ability. This should be considered in the consultation and the rehabilitation process.

More than 40 years of cochlear implant research: A bibliometric analysis

OBJECTIVES

Cochlear implantation is the most effective treatment for patients with severe-to-profound sensorineural hearing loss. Much scientific work has been published since their inception. There is a need for a critical reflection on how and what we publish on cochlear implantation.

METHODS

All Science Citation Index Expanded featured articles between 1980 and 2022 with the word 'cochlear implants' or 'cochlear implantation' were collected from the Web of Science database. Separate characteristics, such as the publication dates, the journals, the number of citations, the countries of origin, the authors, the institutions and co-occurring keywords, were assessed.

RESULTS

13,934 articles were included in the data analysis. The journals of of Otology and Neurotology, Ear and Hearing and of Pediatric Otorhinolaryngology represent the top three most publishing journals. Hannover Medical School, the University of Melbourne and the University of Northern Iowa represent the top three most publishing institutions.

DISCUSSION

The amount of scientific publications on cochlear implant technology has increased for the last 40 years. Besides the focus on speech perception, the research landscape on cochlear implantation is broad and diverse. The number of countries and institutions contributing to these publications is limited.

CONCLUSION

This bibliometric analysis serves as a quantitative overview of the research landscape on cochlear implantation.

Meludia platform as a tool to evaluate music perception in pediatric and adult cochlear implant users

PURPOSE

Music perception is one of the greatest challenges for cochlear implant (CI) users. The aims of this study were: (i) to evaluate the music perception of CI users using the online Meludia music training program as music testing platform, (ii) to compare performance among three age groups, and (iii) to compare CI users with their normal hearing (NH) peers.

METHODS

138 individuals participated, divided between children (6-10 y), adolescents (11-16 y), and adults (≥ 17 y). Five music perception tasks were evaluated: Rhythm, Spatialization, Stable/unstable, Melody, and Density. We also administered the music related quality of life (MuRQoL) questionnaire for adults, and a music questionnaire for pediatric population (6-16 y) (MuQPP).

RESULTS

A significantly higher percentage of the adolescent CI users completed the five tasks compared to the other age groups. Both pediatric and adolescent CI users had similar performance to their NH peers in most categories. On the MuRQoL, adult NH listeners reported more music exposure than CI users (3.8 ± 0.6 vs 3.0 ± 0.6, p < 0.01), but both groups reported similar levels of perceived music importance (3.4 ± 0.7 vs 3.2 ± 1.1, p = 0.340). On the MuQPP, pediatric CI users who scored highly on music perception also had higher reported questionnaire scores (54.2 ± 12.9 vs 40.9 ± 12.1, p = 0.009).

CONCLUSIONS

Meludia can be used to evaluate music perception and to use for music training in CI users of all ages. Adolescents had the highest performance in most musical tasks. Pediatric CI users were more similar to their NH peers. The importance of music in adult CI users was comparable to their NH peers.

Investigation of Maximum Monosyllabic Word Recognition as a Predictor of Speech Understanding with Cochlear Implant

Background: The cochlear implant (CI) is an established treatment option for patients with inadequate speech understanding and insufficient aided scores. Nevertheless, reliable predictive models and specific therapy goals regarding achievable speech understanding are still lacking. Method: In this retrospective study, 601 cases of CI fittings between 2005 and 2021 at the University Medical Center Freiburg were analyzed. We investigated the preoperative unaided maximum word recognition score (mWRS) as a minimum predictor for post-interventional scores at 65 dB SPL, WRS65(CI). The WRS65(CI) was compared with the preoperative-aided WRS, and a previously published prediction model for the WRS65(CI) was reviewed. Furthermore, the effect of duration of hearing loss, duration of HA fitting, and etiology on WRS65(CI) were investigated. Results: In 95.5% of the cases, a significant improvement in word recognition was observed after CI. WRS65(CI) achieved or exceeded mWRS in 97% of cases. Etiology had a significant impact on WRS65(CI). The predicted score was missed by more than 20 percentage points in 12.8% of cases. Discussion: Our results confirmed the minimum prediction via mWRS. A more precise prediction of the expected WRS65(CI) is possible. The etiology of hearing loss should be considered in the indication and postoperative care to achieve optimal results.

Features of the speech processing network in post- and prelingually deaf cochlear implant users

The onset of hearing loss can lead to altered brain structure and functions. However, hearing restoration may also result in distinct cortical reorganization. A differential pattern of functional remodeling was observed between post- and prelingual cochlear implant users, but it remains unclear how these speech processing networks are reorganized after cochlear implantation. To explore the impact of language acquisition and hearing restoration on speech perception in cochlear implant users, we conducted assessments of brain activation, functional connectivity, and graph theory-based analysis using functional near-infrared spectroscopy. We examined the effects of speech-in-noise stimuli on three groups: postlingual cochlear implant users (n = 12), prelingual cochlear implant users (n = 10), and age-matched individuals with hearing controls (HC) (n = 22). The activation of auditory-related areas in cochlear implant users showed a lower response compared with the HC group. Wernicke's area and Broca's area demonstrated differences network attributes in speech processing networks in post- and prelingual cochlear implant users. In addition, cochlear implant users maintain a high efficiency of the speech processing network to process speech information. Taken together, our results characterize the speech processing networks, in varying noise environments, in post- and prelingual cochlear implant users and provide new insights for theories of how implantation modes impact remodeling of the speech processing functional networks.

Systematic Review of Auditory Training Outcomes in Adult Cochlear Implant Recipients and Meta-Analysis of Outcomes

Objective: to review evidence on the efficacy of auditory training in adult cochlear implant recipients. Data Sources: PRISMA guidelines for a systematic review of the literature were followed. PubMed, Scopus, and CINAHL databases were queried on 29 June 2023 for terms involving cochlear implantation and auditory training. Studies were limited to the English language and adult patient populations. Study Selection: Three authors independently reviewed publications for inclusion in the review based on a priori inclusion and exclusion criteria. Inclusion criteria encompassed adult cochlear implant populations, an analysis of clinician- or patient-directed auditory training, and an analysis of one or more measures of speech recognition and/or patient-reported outcome. Exclusion criteria included studies with only pediatric implant populations, music or localization training in isolation, and single-sample case studies. Data Extraction: The data were collected regarding study design, patient population, auditory training modality, auditory training timing, speech outcomes, and data on the durability of outcomes. A quality assessment of the literature was performed using a quality metric adapted from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group guidelines. Data Synthesis and Meta-Analysis: Data were qualitatively summarized for 23 studies. All but four studies demonstrated significant improvement in at least one measured or patient-reported outcome measure with training. For 11 studies with sufficient data reporting, pre-intervention and post-intervention pooled means of different outcome measures were compared for 132 patients using meta-analysis. Patient-direct training was associated with significant improvement in vowel-phoneme recognition and speech recognition in noise (p < 0.05 and p < 0.001, respectively), and clinician-directed training showed significant improvement in sentence recognition in noise (p < 0.001). Conclusions: The literature on auditory training for adult cochlear implant recipients is limited and heterogeneous, including a small number of studies with limited levels of evidence and external validity. However, the current evidence suggests that auditory training can improve speech recognition in adult cochlear implant recipients.

Extraordinary Speech and Language Outcomes After Auditory Brainstem Implantation: Guidance From a Case Study

PURPOSE

Large individual differences and poor speech recognition outcomes are routinely observed in most patients who have received auditory brainstem implants (ABIs). A case report of an ABI recipient with exceptionally good speech recognition outcomes presents an opportunity to better understand the core information processing mechanisms that underlie variability and individual differences in outcomes.

METHOD

A case study is reported of an adult ABI recipient (ID-006) with postlingually acquired, Neurofibromatosis Type 2 (NF2)-related hearing loss who displayed exceptional postoperative speech recognition scores. A novel battery of assessment measures was used to evaluate ID-006's auditory, cognitive, and linguistic information processing skills.

RESULTS

Seventeen years following ABI activation, ID-006 scored 77.6% correct on the AzBio Sentences in quiet. On auditory processing tasks, ID-006 scored higher on tasks with meaningful sentences and much lower on tasks that relied exclusively on audibility. ID-006 also demonstrated exceptionally strong abilities on several cognitive and linguistic information processing tasks.

CONCLUSIONS

Results from a novel battery of information processing tests suggest that ID-006 relies extensively on top-down predictive processing and cognitive control strategies to efficiently encode and process auditory information provided by his ABI. Results suggest that current measures of outcomes and benefits should be expanded beyond conventional speech recognition measures to include more sensitive and robust measures of speech recognition as well as neurocognitive measures such as executive function, working memory, and lexical access.

Determinants of Cochlear Implant Satisfaction and Decisional Regret in Adult Cochlear Implant Users

OBJECTIVE

Determine associations expected and actual cochlear implant (CI) outcomes, decisional regret, and satisfaction in experienced adult CI users.

STUDY DESIGN

Cross-sectional cohort study.

SETTING

Tertiary medical center.

PATIENTS

Thirty-nine adult CI users meeting traditional bilateral hearing loss indications with ≥12 months CI experience.

INTERVENTIONS/MAIN OUTCOME MEASURES

Patients completed the validated Satisfaction with Amplification in Daily Living and Decisional Regret instruments. Pre- and post-CI outcomes (CI Quality of Life [CIQOL]-Expectations; CIQOL-35 Profile; CNC words, AzBio Sentences) were obtained from a prospectively maintained clinical database.

RESULTS

Using established cutoff scores, 29% of patients reported a substantial degree of post-CI decisional regret. For each CIQOL domain, patients without decisional regret obtained post-CI outcome scores closer to pre-CI expectations compared with patients with decisional regret ( d = 0.34 to 0.91); similar results were observed with higher CI user satisfaction ( d = 0.17-0.83). Notably, the degree of pre- to post-CI improvement in CNC or AzBio scores did not differ between patients with and without decisional regret or with lower and higher satisfaction. Finally, greater pre-/postimprovement in CIQOL-35 Profile domain scores demonstrated far stronger associations with lower decisional regret and higher satisfaction than changes in speech recognition scores.

CONCLUSIONS

Patients with better alignment of their pre-CI expectations and post-CI outcomes and greater pre-/post-CIQOL improvement had lower decisional regret and higher satisfaction. This emphasizes the importance of evidence-based pre-CI counseling regarding real-world CI benefits and caution against assuming that improvements in speech recognition are related to patient satisfaction.

The Impact of Patient Factors on Objective Cochlear Implant Verification Using Acoustic Cortical Auditory-Evoked Potentials

INTRODUCTION

Hearing loss is a major global public health issue that negatively impacts quality of life, communication, cognition, social participation, and mental health. The cochlear implant (CI) is the most efficacious treatment for severe-to-profound sensorineural hearing loss. However, variability in outcomes remains high among CI users. Our previous research demonstrated that the existing subjective methodology of CI programming does not consistently produce optimal stimulation for speech perception, thereby limiting the potential for CI users to derive the maximum device benefit to achieve their peak potential. We demonstrated the benefit of utilising the objective method of measuring auditory-evoked cortical responses to speech stimuli as a reliable tool to guide and verify CI programming and, in turn, significantly improve speech perception performance. The present study was designed to investigate the impact of patient- and device-specific factors on the application of acoustically-evoked cortical auditory-evoked potential (aCAEP) measures as an objective clinical tool to verify CI mapping in adult CI users with bilateral deafness (BD).

METHODS

aCAEP responses were elicited using binaural peripheral auditory stimulation for four speech tokens (/m/, /g/, /t/, and /s/) and recorded by HEARLab™ software in adult BD CI users. Participants were classified into groups according to subjective or objective CI mapping procedures to elicit present aCAEP responses to all four speech tokens. The impact of patient- and device-specific factors on the presence of aCAEP responses and speech perception was investigated between participant groups.

RESULTS

Participants were categorised based on the presence or absence of the P1-N1-P2 aCAEP response to speech tokens. Out of the total cohort of adult CI users (n = 132), 63 participants demonstrated present responses pre-optimisation, 37 participants exhibited present responses post-optimisation, and the remaining 32 participants either showed an absent response for at least one speech token post-optimisation or did not accept the optimised CI map adjustments. Overall, no significant correlation was shown between patient and device-specific factors and the presence of aCAEP responses or speech perception scores.

CONCLUSION

This study reinforces that aCAEP measures offer an objective, non-invasive approach to verify CI mapping, irrespective of patient or device factors. These findings further our understanding of the importance of personalised CI rehabilitation through CI mapping to minimise the degree of speech perception variation post-CI and allow all CI users to achieve maximum device benefit.

Hearing health care access for adult cochlear implant candidates and recipients: Travel time and socioeconomic status

Objectives

Access to cochlear implantation may be negatively influenced by extended travel time to a cochlear implant (CI) center or lower socioeconomic status (SES) for the individual. There is a critical need to understand the influence of these variables on patient appointment attendance for candidacy evaluations, and CI recipients' adherence to post-activation follow-up recommendations that support optimal outcomes.

Methods

A retrospective chart review of adult patients referred to a CI center in North Carolina for initial cochlear implantation candidacy evaluation between April 2017 and July 2019 was conducted. Demographic and audiologic data were collected for each patient. Travel time was determined using geocoding. SES was proxied using ZCTA-level Social Deprivation Index (SDI) information. Independent samples t tests compared variables between those who did and did not attend the candidacy evaluation. Pearson correlations assessed the association of these variables and the duration of time between initial CI activation and return for first follow-up visit.

Results

Three hundred and ninety patients met the inclusion criteria. There was a statistically significant difference between SDI of those who attended their candidacy evaluation versus those who did not. Age at referral or travel time did not show statistical significance between these two groups. There was no significant correlation with age at referral, travel time, or SDI with the duration of time (days) between initial activation and the 1-month follow-up.

Conclusions

Our findings suggest that SES may influence a patient's ability to attend a cochlear implantation candidacy evaluation appointment and may further impact the decision to pursue cochlear implantation.Level of evidence: 4 - Case Series.