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Vohra V, Andresen NS, Carver C, Dunham R, Marsiglia D, Yeagle J, Della Santina CC, Creighton FX, Bowditch SP, Sun DQ. Cochlear Implant Electrode Array Design and Speech Understanding. Otol Neurotol 2024; 45:136-142. [PMID: 38152035 DOI: 10.1097/mao.0000000000004083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE Cochlear implant electrode arrays are categorized based on their design as lateral wall (LW) and perimodiolar (PM) electrode arrays. The objective of this study was to investigate the effect of LW versus PM designs on postoperative speech perception across multiple manufacturers and over long follow-up durations. DESIGN Retrospective cohort study. SETTING Single academic medical center. PARTICIPANTS A total of 478 adult cochlear implant recipients, implanted between the years 1992 and 2017. INTERVENTIONSS PM versus LW cochlear implants. MAIN OUTCOMES AND MEASURES Postoperative Consonant-Nucleus-Consonant Word (CNC-w) and Hearing in Noise Test (HINT) scores between 6 months and 5 years. RESULTS Across 478 patients, approximately one-third received LW (n = 176, 36.8%), whereas 302 patients received a PM array (63.2%). The PM group had higher CNC-w scores from 6 months to 2 years (52 [interquartile range, 38-68] versus 48 [31-62], p = 0.036) and from 2 to 5 years (58 [43-72] versus 48 [33-66], p < 0.001). Multivariable analysis of patient-averaged scores indicated that the PM group had greater improvement from preoperative scores at all time points after the initial 6 months for both CNC-w ( β = 4.4 [95% confidence interval, 0.6-8.3], p = 0.023) and HINT testing ( β = 4.5 [95% confidence interval, 0.3-8.7], p = 0.038). CONCLUSIONS This study indicates that PM electrode arrays are associated with small increases in postoperative speech perception scores, relative to LW arrays, when assessed across manufacturers, over long time durations, and using multiple outcome instruments. These findings may help guide surgeon selection and patient counseling of cochlear implant arrays.
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Affiliation(s)
| | - Nicholas S Andresen
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Carver
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Dunham
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dawn Marsiglia
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenifer Yeagle
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles C Della Santina
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Francis X Creighton
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen P Bowditch
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Q Sun
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Nourski KV, Steinschneider M, Rhone AE, Berger JI, Dappen ER, Kawasaki H, Howard III MA. Intracranial electrophysiology of spectrally degraded speech in the human cortex. Front Hum Neurosci 2024; 17:1334742. [PMID: 38318272 PMCID: PMC10839784 DOI: 10.3389/fnhum.2023.1334742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Cochlear implants (CIs) are the treatment of choice for severe to profound hearing loss. Variability in CI outcomes remains despite advances in technology and is attributed in part to differences in cortical processing. Studying these differences in CI users is technically challenging. Spectrally degraded stimuli presented to normal-hearing individuals approximate input to the central auditory system in CI users. This study used intracranial electroencephalography (iEEG) to investigate cortical processing of spectrally degraded speech. Methods Participants were adult neurosurgical epilepsy patients. Stimuli were utterances /aba/ and /ada/, spectrally degraded using a noise vocoder (1-4 bands) or presented without vocoding. The stimuli were presented in a two-alternative forced choice task. Cortical activity was recorded using depth and subdural iEEG electrodes. Electrode coverage included auditory core in posteromedial Heschl's gyrus (HGPM), superior temporal gyrus (STG), ventral and dorsal auditory-related areas, and prefrontal and sensorimotor cortex. Analysis focused on high gamma (70-150 Hz) power augmentation and alpha (8-14 Hz) suppression. Results Chance task performance occurred with 1-2 spectral bands and was near-ceiling for clear stimuli. Performance was variable with 3-4 bands, permitting identification of good and poor performers. There was no relationship between task performance and participants demographic, audiometric, neuropsychological, or clinical profiles. Several response patterns were identified based on magnitude and differences between stimulus conditions. HGPM responded strongly to all stimuli. A preference for clear speech emerged within non-core auditory cortex. Good performers typically had strong responses to all stimuli along the dorsal stream, including posterior STG, supramarginal, and precentral gyrus; a minority of sites in STG and supramarginal gyrus had a preference for vocoded stimuli. In poor performers, responses were typically restricted to clear speech. Alpha suppression was more pronounced in good performers. In contrast, poor performers exhibited a greater involvement of posterior middle temporal gyrus when listening to clear speech. Discussion Responses to noise-vocoded speech provide insights into potential factors underlying CI outcome variability. The results emphasize differences in the balance of neural processing along the dorsal and ventral stream between good and poor performers, identify specific cortical regions that may have diagnostic and prognostic utility, and suggest potential targets for neuromodulation-based CI rehabilitation strategies.
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Affiliation(s)
- Kirill V. Nourski
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, United States
| | - Mitchell Steinschneider
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
- Departments of Neurology and Neuroscience, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ariane E. Rhone
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Joel I. Berger
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Emily R. Dappen
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, United States
| | - Hiroto Kawasaki
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Matthew A. Howard III
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, United States
- Pappajohn Biomedical Institute, The University of Iowa, Iowa City, IA, United States
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Amini AE, Naples JG, Hwa T, Larrow DC, Campbell FM, Qiu M, Castellanos I, Moberly AC. Emerging Relations among Cognitive Constructs and Cochlear Implant Outcomes: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 169:792-810. [PMID: 37365967 DOI: 10.1002/ohn.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/07/2023] [Accepted: 03/25/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Hearing loss has a detrimental impact on cognitive function. However, there is a lack of consensus on the impact of cochlear implants on cognition. This review systematically evaluates whether cochlear implants in adult patients lead to cognitive improvements and investigates the relations of cognition with speech recognition outcomes. DATA SOURCES A literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies evaluating cognition and cochlear implant outcomes in postlingual, adult patients from January 1996 to December 2021 were included. Of 2510 total references, 52 studies were included in qualitative analysis and 11 in meta-analyses. REVIEW METHODS Proportions were extracted from studies of (1) the significant impacts of cochlear implantation on 6 cognitive domains and (2) associations between cognition and speech recognition outcomes. Meta-analyses were performed using random effects models on mean differences between pre- and postoperative performance on 4 cognitive assessments. RESULTS Only half of the outcomes reported suggested cochlear implantation had a significant impact on cognition (50.8%), with the highest proportion in assessments of memory & learning and inhibition-concentration. Meta-analyses revealed significant improvements in global cognition and inhibition-concentration. Finally, 40.4% of associations between cognition and speech recognition outcomes were significant. CONCLUSION Findings relating to cochlear implantation and cognition vary depending on the cognitive domain assessed and the study goal. Nonetheless, assessments of memory & learning, global cognition, and inhibition-concentration may represent tools to assess cognitive benefit after implantation and help explain variability in speech recognition outcomes. Enhanced selectivity in assessments of cognition is needed for clinical applicability.
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Affiliation(s)
- Andrew E Amini
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James G Naples
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tiffany Hwa
- Division of Otology, Neurotology, and Lateral Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle C Larrow
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank M Campbell
- Biotech Commons, Johnson Pavilion, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maylene Qiu
- Biotech Commons, Johnson Pavilion, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irina Castellanos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Kallioinen P, Olofsson JK, von Mentzer CN. Semantic processing in children with Cochlear Implants: A review of current N400 studies and recommendations for future research. Biol Psychol 2023; 182:108655. [PMID: 37541539 DOI: 10.1016/j.biopsycho.2023.108655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
Deaf and hard of hearing children with cochlear implants (CI) often display impaired spoken language skills. While a large number of studies investigated brain responses to sounds in this population, relatively few focused on semantic processing. Here we summarize and discuss findings in four studies of the N400, a cortical response that reflects semantic processing, in children with CI. A study with auditory target stimuli found N400 effects at delayed latencies at 12 months after implantation, but at 18 and 24 months after implantation effects had typical latencies. In studies with visual target stimuli N400 effects were larger than or similar to controls in children with CI, despite lower semantic abilities. We propose that in children with CI, the observed large N400 effect reflects a stronger reliance on top-down predictions, relative to bottom-up language processing. Recent behavioral studies of children and adults with CI suggest that top-down processing is a common compensatory strategy, but with distinct limitations such as being effortful. A majority of the studies have small sample sizes (N < 20), and only responses to image targets were studied repeatedly in similar paradigms. This precludes strong conclusions. We give suggestions for future research and ways to overcome the scarcity of participants, including extending research to children with conventional hearing aids, an understudied group.
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Affiliation(s)
- Petter Kallioinen
- Department of Linguistics, Stockholm University, Stockholm, Sweden; Lund University Cognitive Science, Lund University, Lund, Sweden.
| | - Jonas K Olofsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Lindquist NR, Dietrich MS, Patro A, Henry MR, DeFreese AJ, Freeman MH, Perkins EL, Gifford RH, Haynes DS, Holder JT. Early Datalogging Predicts Cochlear Implant Performance: Building a Recommendation for Daily Device Usage. Otol Neurotol 2023; 44:e479-e485. [PMID: 37442607 PMCID: PMC10361622 DOI: 10.1097/mao.0000000000003917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To quantify the effect of datalogging on speech recognition scores and time to achievement for a "benchmark" level of performance within the first year, and to provide a data-driven recommendation for minimum daily cochlear implant (CI) device usage to better guide patient counseling and future outcomes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS Three hundred thirty-seven adult CI patients with data logging and speech recognition outcome data who were implanted between August 2015 and August 2020. MAIN OUTCOME MEASURES Processor datalogging, speech recognition scores, achievement of "benchmark speech recognition performance" defined as 80% of the median score for speech recognition outcomes at our institution. RESULTS The 1-month datalogging measure correlated positively with word and sentences scores at 1, 3, 6, and 12 months postactivation. Compared with age, sex, and preoperative performance, datalogging was the largest predictive factor of benchmark achievement on multivariate analysis. Each hour/day increase of device usage at 1 month resulted in a higher likelihood of achieving benchmark consonant-nucleus-consonant and AzBio scores within the first year (odds ratio = 1.21, p < 0.001) as well as earlier benchmark achievement. Receiver operating characteristic curve analysis identified the optimal data logging threshold at an average of 12 hours/day. CONCLUSIONS Early CI device usage, as measured by 1-month datalogging, predicts benchmark speech recognition achievement in adults. Datalogging is an important predictor of CI performance within the first year postimplantation. These data support the recommended daily CI processor utilization of at least 12 hours/day to achieve optimal speech recognition performance for most patients.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary S Dietrich
- Vanderbilt University Schools of Medicine (Biostatistics, VICC, Psychiatry) and Nursing, Nashville, Tennessee
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R Henry
- Division of Audiology, Henry Ford Health, Dearborn, Michigan
| | - Andrea J DeFreese
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael H Freeman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jourdan T Holder
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
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