[Subjective improvement of hearing through cochlear implantation]

Associations between illness perceptions, word recognition, and perceived sound quality in cochlear implant users

OBJECTIVE

Illness perceptions refer to thoughts and ideas an individual has about an illness. The aim was to understand how cochlear implant (CI) users' illness perceptions, in addition to their monosyllabic word recognition abilities, are associated with their self-perceived sound quality.

DESIGN

Data were collected during routine CI check-up appointments. Participants completed the Brief Illness Perception Questionnaire (assessing their illness perceptions) and the Hearing Implant Sound Quality Index (assessing their subjective sound quality). Additionally, monosyllabic word recognition abilities were measured with the Freiburg Monosyllable Word Test. Hierarchical regression analysis were utilised to model users' sound quality ratings. Participants' age was entered first as a control variable. In the next step, monosyllabic word recognition was entered. Finally, participants' illness perceptions were entered.

STUDY SAMPLE

Fifty-five participants with unilateral CI provision.

RESULTS

Monosyllabic word recognition was significant in the second step. When illness perceptions and monosyllabic word recognition were both included in the third step, illness perceptions, but not monosyllabic word recognition, were significant. The model explained 22% of the variance of subjective sound quality.

CONCLUSIONS

Monosyllabic word recognition abilities and illness perceptions of CI users are important for their self-reported sound quality, but illness perceptions appear to be potentially more relevant.

Speech comprehension in noise-considerations for ecologically valid assessment of communication skills ability with cochlear implants

BACKGROUND

Nowadays, cochlear implant (CI) patients mostly show good to very good speech comprehension in quiet, but there are known problems with communication in everyday noisy situations. There is thus a need for ecologically valid measurements of speech comprehension in real-life listening situations for hearing-impaired patients. The additional methodological effort must be balanced with clinical human and spatial resources. This study investigates possible simplifications of a complex measurement setup.

METHODS

The study included 20 adults from long-term follow-up after CI fitting with postlingual onset of hearing impairment. The complexity of the investigated listening situations was influenced by changing the spatiality of the noise sources and the temporal characteristics of the noise. To compare different measurement setups, speech reception thresholds (SRT) were measured unilaterally with different CI processors and settings. Ten normal-hearing subjects served as reference.

RESULTS

In a complex listening situation with four loudspeakers, differences in SRT from CI subjects to the control group of up to 8 dB were found. For CI subjects, this SRT correlated with the situation with frontal speech signal and fluctuating interference signal from the side with R2 = 0.69. For conditions with stationary interfering signals, R2 values <0.2 were found.

CONCLUSION

There is no universal solution for all audiometric questions with respect to the spatiality and temporal characteristics of noise sources. In the investigated context, simplification of the complex spatial audiometric setting while using fluctuating competing signals was possible.

[Speech comprehension in noise-considerations for ecologically valid assessment of communication skills ability with cochlear implants. German version]

BACKGROUND

Nowadays, cochlear implant (CI) patients mostly show good to very good speech comprehension in quiet, but there are known problems with communication in everyday noisy situations. There is thus a need for ecologically valid measurements of speech comprehension in real-life listening situations for hearing-impaired patients. The additional methodological effort must be balanced with clinical human and spatial resources. This study investigates possible simplifications of a complex measurement setup.

METHODS

The study included 20 adults from long-term follow-up after CI fitting with postlingual onset of hearing impairment. The complexity of the investigated listening situations was influenced by changing the spatiality of the noise sources and the temporal characteristics of the noise. To compare different measurement setups, speech reception thresholds (SRT) were measured unilaterally with different CI processors and settings. Ten normal-hearing subjects served as reference.

RESULTS

In a complex listening situation with four loudspeakers, differences in SRT from CI subjects to the control group of up to 8 dB were found. For CI subjects, this SRT correlated with the situation with frontal speech signal and fluctuating interference signal from the side with R2 = 0.69. For conditions with stationary interfering signals, R2 values <0.2 were found.

CONCLUSION

There is no universal solution for all audiometric questions with respect to the spatiality and temporal characteristics of noise sources. In the investigated context, simplification of the complex spatial audiometric setting while using fluctuating competing signals was possible.

Aligning Hearing Aid and Cochlear Implant Improves Hearing Outcome in Bimodal Cochlear Implant Users

OBJECTIVE

Patients with unilateral deafness and residual hearing on the contralateral ear can benefit from a cochlear implant (CI) on one side and a hearing aid (HA) on the other. However, hearing improvement among these patients is heterogenous. Interindividual differences in bimodal benefit may be caused by a mismatch of CI and HA. The aim of this study was to clinically apply a HA fitting strategy and to evaluate hearing outcome with and without a dedicated bimodal fitting formula.

STUDY DESIGN

Prospective non-randomized study.

SETTING

Tertiary referral center.

PATIENTS

Twelve patients using a CI processor and a conventional HA were enrolled. Before and after the new HA had been adjusted to the patient and linked to the CI, pure-tone audiometry and localization tests were performed. Speech perception was determined in quiet and noise. Tests were repeated after 6 and 12 weeks. To evaluate the subjective listening comfort two questionnaires (Oldenburg Inventory and HISQUI19) were assessed.

INTERVENTION

Therapeutic.

RESULTS MAIN OUTCOME MEASURE

Word recognition in quiet, sentence recognition in noise. Speech perception in noise improved significantly: directed suppression of noise helped to segregate the target speech signal from a mixture of sounds or competing speakers. Evaluation of the questionnaires revealed a positive subjective hearing experience compared with patients' initial settings of the devices.

CONCLUSION

By linking CI and HA hearing and speech perception can be improved. However, good counselling at the outset is essential to obtain enhanced outcome.

Depressive symptoms affect short- and long-term speech recognition outcome in cochlear implant users

Purpose

To investigate the impact of the amount of depressive symptoms in cochlear implant (CI) recipients on the development of speech recognition after CI-activation up to 2 years.

Design

Retrospective data analysis of a German short form of the Beck Depression Inventory given at initial activation of the implant in relation to monosyllabic word recognition score at conversational level at initial activation and at 3 months, 1 and 2-year follow-up measurements.

Study sample

Thirty-one CI-patients (11 female, 20 male) aged between 41 and 83 (M = 64.77, SD = 10.43) who were German native speakers, postlingually deafened, with severe hearing loss in both sides but unilaterally implanted (19 right-sided, 12 left-sided).

Results

The amount of depressive symptoms at initial activation was negatively correlated with the monosyllabic recognition score after 3 months and after 1 year of implant use.

Conclusion

The psychological status in terms of depressive symptoms is an important parameter regarding the rehabilitative outcome of CI-patients. Care staff and CI-users should be sensitized to the link between depressive symptoms and the development of speech recognition with CI.

Does bimodal hearing increase self-assessed abilities and hearing outcomes when compared to unilateral cochlear implantation?

Objective: The primary objective of this study was to compare the applicability and benefit of providing unilateral cochlear implant (CI) users with a contralateral hearing aid (HA).Design: This retrospective (case-control) study was conducted in a hospital-based CI centre. Participants self-assessed their hearing via two questionnaires (SSQ₁₂ and HISQUI₁₉). Objective postoperative speech perception was assessed via aided thresholds and speech perception tests (monosyllabic words, disyllabic words, and sentences) in quiet and noise.Study sample: A CI-only group (n = 113, mean age 55.1 ± 14.2 years) and a bimodal group (n = 50, mean age 56.7 ± 15.2) participated in the study.Results: No significant difference in SSQ₁₂ or HISQUI₁₉ scores was observed between groups. The bimodal group had a significantly better aided hearing level (p = 0.020) and speech discrimination score (p = 0.019).Conclusions: Bimodal (CI + HA) users have significantly better speech understanding than unilateral CI-only users, although this benefit may not be reflected in self-assessed outcomes. Counselling about bimodal hearing must cover expectations about potential benefits.