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Mertens G, Andries E, Clement C, Cochet E, Hofkens-Van den Brandt A, Jacquemin L, Joossen I, Vermeersch H, Lammers MJW, Van Rompaey V, Vanderveken O. Contralateral hearing aid use in adult cochlear implant recipients: retrospective analysis of auditory outcomes. Int J Audiol 2024; 63:543-550. [PMID: 37229750 DOI: 10.1080/14992027.2023.2209697] [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: 09/10/2022] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate retrospectively the frequency of usage of bimodal stimulation among cochlear implant (CI) users, as well its clinical benefit relative to unilateral use. DESIGN All subjects had been monitored with the clinical Minimal Outcome Measurements test battery. STUDY SAMPLES 103 adults with bilateral postlingual profound sensorineural hearing loss and unilateral CI use were extracted from the local database. These were divided into two groups: those who only used a CI and those who used bimodal stimulation. RESULTS The preoperative contralateral residual hearing in the bimodal group was significantly better than that of the CI-only group. In both groups, speech perception in quiet and in noise improved after CI, with no significant difference between postoperative unimodal conditions. For the bimodal group, an additional significant improvement was found for the bimodal condition compared to the unimodal. CONCLUSION Given the observed auditory benefit of bimodal stimulation in comparison to unimodal stimulation and given the finding that degree of residual hearing is not correlated with bimodal benefits, it is recommended to encourage CI recipients to continue contralateral HA use after CI. As a result of expanding CI criteria worldwide, the population of bimodal users is expected to grow in the near future.
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Affiliation(s)
- Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ellen Andries
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Charis Clement
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Ellen Cochet
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Anouk Hofkens-Van den Brandt
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laure Jacquemin
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Iris Joossen
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Hanne Vermeersch
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Marc Jan-Willem Lammers
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Olivier Vanderveken
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Gu W, Daoudi H, Lahlou G, Sterkers O, Ferrary E, Nguyen Y, Mosnier I, Torres R. Auditory outcomes after scala vestibuli array insertion are similar to those after scala tympani insertion 1 year after cochlear implantation. Eur Arch Otorhinolaryngol 2024; 281:155-162. [PMID: 37516989 DOI: 10.1007/s00405-023-08107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE In cochlear implantation, a scala vestibuli (SV) insertion of an electrode array is a rare occurrence and is reported to be linked to poor hearing outcomes. Using the same electrode array, the auditory performance of patients with a complete SV location was compared with that of patients having a complete scala tympani (ST) location 1 year after implantation. METHODS Thirty-three patients were included in this retrospective case-control study (SV, n = 12; ST, n = 21). The matching criteria were electrode array type, age at implantation, and duration of severe or profound deafness. The array location was analyzed using 3D reconstruction of postoperative CT scans. Postoperative audiological evaluation of the implanted ear was performed using pure-tone audiometry, speech recognition of monosyllabic words in quiet, and words and sentences in noise. RESULTS On the preoperative CT scan, six patients in the SV group presented with both round window (RW) and ST ossification, three with RW ossification alone, and three with no RW ossification. Auditory performance did not differ between SV and ST groups 1 year after cochlear implantation. Speech recognition of words was 49 ± 7.6% and 56 ± 5.0% in quiet and 75 ± 9.5% and 66 ± 6.0% in noise in SV and ST groups, respectively. CONCLUSION ST insertion is the gold standard that allows the three cochlear scalae to preserve scalar cochlear integrity. However, 1 year after implantation, a planned or unexpected SV insertion is not detrimental to hearing outcomes, providing similar auditory performance in quiet and noise to ST insertion.
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Affiliation(s)
- Wenxi Gu
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Key Laboratory of Translational Medicine On Ear and Nose Diseases (14DZ2260300), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hannah Daoudi
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Ghizlene Lahlou
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Olivier Sterkers
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Evelyne Ferrary
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Yann Nguyen
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Isabelle Mosnier
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Renato Torres
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France.
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France.
- Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru.
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Garcia A, Haleem A, Chari DA, Morse-Fortier C, Arenberg JG, Lee DJ. Influence of listening environment on usage patterns in cochlear implant patients with single-sided deafness. Cochlear Implants Int 2023; 24:335-341. [PMID: 36846887 DOI: 10.1080/14670100.2023.2176990] [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] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To compare cochlear implant (CI) data logging of patients with single-sided deafness (SSD) and bilateral sensorineural hearing loss (biSNHL) in various acoustic environments and study the implications of data logging on auditory performance. STUDY DESIGN Retrospective case control study. METHODS Adult CI patients with SSD or biSNHL from 2010 to 2021 with usage data collected at 3-, 6-, and 12-months following device activation were identified. The CI listening environment was defined as speech in noise, speech in quiet, quiet, music or noise. Auditory performance was measured using the CNC word, AzBio sentence tests and the Tinnitus Handicap Index (THI). RESULTS 60 adults with SSD or biSNHL were included. CI patients with biSNHL wore their devices more than those with SSD at 3-months post-activation (11.18 versus 8.97 hours/day, p = 0.04), though there were no significant differences at 6-12 months. Device usage was highest in the speech in quiet environment. In SSD CI users, there was a positive correlation (p = 0.03) between device use and CNC scores at 12-months and an improvement in THI scores at 12-months (p = 0.0004). CONCLUSIONS CI users with SSD and biSNHL have comparable duration of device usage at longer follow-up periods with greatest device usage recorded in speech in quiet environments.
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Affiliation(s)
- Alejandro Garcia
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
| | - Divya A Chari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
| | - Charlotte Morse-Fortier
- Department of Audiology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
| | - Julie G Arenberg
- Department of Audiology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, USA
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Porps SL, Bennett DM, Gilden J, Ravelo K, Buck B, Reinhart P, Hong RS. Effects of an evidence-based model for cochlear implant aftercare delivery on clinical efficiency and patient outcomes. Cochlear Implants Int 2023; 24:325-334. [PMID: 36927486 DOI: 10.1080/14670100.2023.2188007] [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] [Indexed: 03/18/2023]
Abstract
OBJECTIVES To assess an evidence-based model (EBM) approach to cochlear implant (CI) aftercare that includes a modified, reduced treatment schedule for newly-implanted adult CI recipients consisting of four appointments (initial activation, 1-, 3- and 6- months postactivation) in the first year post-surgery. METHOD This prospective multicenter proof-of-concept study was conducted across three clinics in the United States by five experienced CI clinicians. Seventeen newly-implanted adult patients with postlingual hearing loss enrolled in the study. Hearing outcomes were measured using objective speech testing and subjective self-report measures. RESULTS Most recipients (14/17; 82%) were able to follow the four-appointment EBM schedule. The reduced number of visits translated into an average time savings of 3 hours per patient. Significant improvements in speech perception were observed at both 3- and 6-months postactivation, as measured by CNC words in quiet and AzBio sentences at +10 dB SNR, consistent with published results achieved by traditional practices. Recipients were significantly satisfied with telephone, music, small group conversation, and television listening at 6 months postactivation. Recipient satisfaction with overall service was rated as "excellent" by 14/14 (100%) respondents. CONCLUSION The four-appointment EBM approach delivered efficient and effective audiological aftercare to CI recipients in the first year following CI implantation.
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Affiliation(s)
| | | | - Jan Gilden
- Cochlear Hearing Center, Bellaire, TX, USA
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Philpott N, Philips B, Donders R, Mylanus E, Huinck W. Variability in clinicians' prediction accuracy for outcomes of adult cochlear implant users. Int J Audiol 2023:1-9. [PMID: 37782308 DOI: 10.1080/14992027.2023.2256973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The variability in outcomes among adult cochlear implant (CI) users poses challenges for clinicians in accurately predicting the benefits of the implant for individual candidates. This study aimed to investigate the accuracy and confidence of clinicians in predicting speech perception outcomes for adult CI users one-year post-implantation. DESIGN Participants were presented with comprehensive information on pre-implantation, one-month post-implantation, and six-month post-implantation data for 10 case studies. The cases encompassed a range of one-year post-implantation phoneme scores, from low performers (27%) to high performers (92%). Participants were tasked with predicting the speech perception outcomes for these cases one year after implantation. STUDY SAMPLE Forty-one clinicians completed the full outcome prediction survey. RESULTS Our findings revealed a significant over-prediction of low performance by clinicians. Interestingly, clinicians tended to predict average performance (73-76% phoneme score) even when provided with information suggesting lower-than-average performance. Most clinicians expressed confidence in their predictions, irrespective of their accuracy. CONCLUSIONS Identifying signs of low performance, particularly in the early post-implantation period, can enable clinicians to implement early interventions. Further research into accurate outcome prediction is essential for managing expectations, providing counselling, increasing CI adoption, and optimising clinical care for both high and low performers.
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Affiliation(s)
- Nikki Philpott
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- Cochlear Ltd, Mechelen, Belgium
| | | | - Rogier Donders
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Dourado RPB, Caldas FF, Cardoso CC, Santos DCD, Bahmad F. Benefits of Bimodal Stimulation to Speech Perception in Noise and Silence. Int Arch Otorhinolaryngol 2023; 27:e645-e653. [PMID: 37876694 PMCID: PMC10593532 DOI: 10.1055/s-0043-1761169] [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: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Understanding all the benefits of bimodality with self-assessment questionnaires on the effect of hearing on quality of life is still necessary. Objective To present whether bimodality still offers hearing benefits to the population who uses acoustic stimulation associated with electrical stimulation. Methods The present study included 13 participants aged between 16 and 80 years old who were users of cochlear implants from Cochlear Corporation and hearing aids. All patients underwent the Hearing in Noise Test, and their visual analog scale score was obtained. Four-tone means were collected, and the participants answered the Speech, Spatial and Hearing Qualities questionnaire. Results Bimodal users had an average sentence recognition rate of 76.0% in silence and 67.6% in fixed noise, and the signal-to-noise ratio in adaptive noise was +2.89dB. In addition, a lower level of difficulty was observed in the test using the visual analog scale. The domain with the highest average was auditory qualities (6.50), followed by spatial hearing (6.26) and hearing for speech (5.81). Individuals with an average between 50 and 70 dB of hearing level showed better sentence recognition in silence and noise. Conclusion Bimodal stimulation showed benefits for users with different degrees of hearing loss; however, individuals who presented greater hearing residue had better performance in speech recognition with noise and in silence in addition to a good perception of hearing quality.
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Affiliation(s)
- Rayssa Pacheco Brito Dourado
- Health Sciences Postgraduate Program in Ciências da Saúde, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Brasília, DF, Brazil
| | | | | | - Danielle Cristovão dos Santos
- Faculdade de Ciências da Saúde, Universidade de Brasília, Brasilia, DF, Brazil
- Centro de Reabilitação da Audição e Fala, Instituto Brasiliense de Otorrino, Asa Norte, Brasília, DF, Brazil
| | - Fayez Bahmad
- Health Science School, Universidade de Brasilia, Brasilia, DF, Brazil
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Hoppe U, Hast A, Hornung J, Hocke T. Evolving a Model for Cochlear Implant Outcome. J Clin Med 2023; 12:6215. [PMID: 37834857 PMCID: PMC10573840 DOI: 10.3390/jcm12196215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Cochlear implantation is an efficient treatment for postlingually deafened adults who do not benefit sufficiently from acoustic amplification. Implantation is indicated when it can be foreseen that speech recognition with a cochlear implant (CI) is superior to that with a hearing aid. Especially for subjects with residual speech recognition, it is desirable to predict CI outcome on the basis of preoperative audiological tests. PURPOSE The purpose of the study was to extend and refine a previously developed model for CI outcome prediction for subjects with preoperative word recognition to include subjects with no residual hearing by incorporating additional results of routine examinations. RESULTS By introducing the duration of unaided hearing loss (DuHL), the median absolute error (MAE) of the prediction was reduced. While for subjects with preoperative speech recognition, the model modification did not change the MAE, for subjects with no residual speech recognition before surgery, the MAE decreased from 23.7% with the previous model to 17.2% with the extended model. CONCLUSIONS Prediction of word recognition with CI is possible within clinically relevant limits. Outcome prediction is particularly important for preoperative counseling and in CI aftercare to support systematic monitoring of CI fitting.
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Affiliation(s)
- Ulrich Hoppe
- Cochlear Implant Center CICERO, Department of Otorhinolaryngology-Head and Neck Surgery, Uniklinikum Erlangen, Waldstr. 1, D-91054 Erlangen, Germany; (A.H.); (J.H.)
| | - Anne Hast
- Cochlear Implant Center CICERO, Department of Otorhinolaryngology-Head and Neck Surgery, Uniklinikum Erlangen, Waldstr. 1, D-91054 Erlangen, Germany; (A.H.); (J.H.)
| | - Joachim Hornung
- Cochlear Implant Center CICERO, Department of Otorhinolaryngology-Head and Neck Surgery, Uniklinikum Erlangen, Waldstr. 1, D-91054 Erlangen, Germany; (A.H.); (J.H.)
| | - Thomas Hocke
- Cochlear Deutschland GmbH & Co. KG, Mailänder Str. 4a, D-30539 Hannover, Germany;
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Dornhoffer JR, Khandalavala KR, Zwolan TA, Carlson ML. Preliminary Evidence to Support a De-Escalated Cochlear Implant Programming Paradigm for New Adult Recipients: A Systematic Review. J Clin Med 2023; 12:5774. [PMID: 37762717 PMCID: PMC10532146 DOI: 10.3390/jcm12185774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Background: No standard schedule for cochlear implant (CI) programming has been developed, and common practices may have CI recipients seen in excess of what is necessary. The objective of this study was to review evidence for a de-escalated, evidence-based schedule for adult CI programming. Methods: Systematic review was undertaken in March 2023 of PubMed, Scopus, and CINAHL databases using the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if (1) they evaluated an evidence-based programming/follow-up schedule in new adult CI patients or (2) they evaluated programming or outcomes in a longitudinal fashion such that they could inform CI follow-up strategies. Level of evidence was evaluated using the LEGEND evidence assessment tool. Results: Our review identified 940 studies. After screening with a priori inclusion criteria, 18 studies were ultimately included in this review. Of these, 2 demonstrated feasibility of de-escalated approaches to new adult CI programming. The remainder presented longitudinal speech and programming parameter data that demonstrated relative stability of both categories by 3 to 6 months post-activation. Conclusions: Overall, there is a paucity of literature evaluating any form of evidence-based CI programming or follow-up. Most applicable data derive from longitudinal outcomes featured in studies of other CI features, with only a handful of studies directly evaluating CI programming strategies over time. However, stability in outcomes and programming detailed in the available data supports consideration of a de-escalated programming paradigm that could primarily limit programming to the very early post-activation period (before 3 to 6 months) to enhance patient care and reduce operational strains on cochlear implant programs.
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Affiliation(s)
- James R. Dornhoffer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA; (J.R.D.); (K.R.K.)
| | - Karl R. Khandalavala
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA; (J.R.D.); (K.R.K.)
| | - Teresa A. Zwolan
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI 48109, USA;
- Cochlear Americas, Denver, CO 80124, USA
| | - Matthew L. Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA; (J.R.D.); (K.R.K.)
- Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA
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Van Bogaert L, Machart L, Gerber S, Lœvenbruck H, Vilain A. Speech rehabilitation in children with cochlear implants using a multisensory (French Cued Speech) or a hearing-focused (Auditory Verbal Therapy) approach. Front Hum Neurosci 2023; 17:1152516. [PMID: 37250702 PMCID: PMC10219235 DOI: 10.3389/fnhum.2023.1152516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/31/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Early exposure to a rich linguistic environment is essential as soon as the diagnosis of deafness is made. Cochlear implantation (CI) allows children to have access to speech perception in their early years. However, it provides only partial acoustic information, which can lead to difficulties in perceiving some phonetic contrasts. This study investigates the contribution of two spoken speech and language rehabilitation approaches to speech perception in children with CI using a lexicality judgment task from the EULALIES battery. Auditory Verbal Therapy (AVT) is an early intervention program that relies on auditory learning to enhance hearing skills in deaf children with CI. French Cued Speech, also called Cued French (CF), is a multisensory communication tool that disambiguates lip reading by adding a manual gesture. Methods In this study, 124 children aged from 60 to 140 months were included: 90 children with typical hearing skills (TH), 9 deaf children with CI who had participated in an AVT program (AVT), 6 deaf children with CI with high Cued French reading skills (CF+), and 19 deaf children with CI with low Cued French reading skills (CF-). Speech perception was assessed using sensitivity (d') using both the hit and false alarm rates, as defined in signal-detection theory. Results The results show that children with cochlear implants from the CF- and CF+ groups have significantly lower performance compared to children with typical hearing (TH) (p < 0.001 and p = 0.033, respectively). Additionally, children in the AVT group also tended to have lower scores compared to TH children (p = 0.07). However, exposition to AVT and CF seems to improve speech perception. The scores of the children in the AVT and CF+ groups are closer to typical scores than those of children in the CF- group, as evidenced by a distance measure. Discussion Overall, the findings of this study provide evidence for the effectiveness of these two speech and language rehabilitation approaches, and highlight the importance of using a specific approach in addition to a cochlear implant to improve speech perception in children with cochlear implants.
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Affiliation(s)
- Lucie Van Bogaert
- Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble, France
| | - Laura Machart
- Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble, France
| | - Silvain Gerber
- Université Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble, France
| | - Hélène Lœvenbruck
- Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Anne Vilain
- Université Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble, France
| | - Consortium EULALIESCostaMaudGillet-PerretEstelleMacLeodAndrea A. N.MeloniGenevièvePuissantClarisseRoseYvanUniversité Grenoble Alpes, France; CRTLA, Centre Hospitalier Universitaire Grenoble Alpes, France; University of Alberta, Edmonton, Canada; Université Grenoble Alpes, France and Université de Montréal, Montréal, Canada; Université Grenoble Alpes, France; Memorial University, Newfoundland, Canada
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Lambriks L, van Hoof M, Debruyne J, Janssen M, Chalupper J, van der Heijden K, Hof J, Hellingman K, Devocht E, George E. Imaging-based frequency mapping for cochlear implants - Evaluated using a daily randomized controlled trial. Front Neurosci 2023; 17:1119933. [PMID: 37123376 PMCID: PMC10133468 DOI: 10.3389/fnins.2023.1119933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/03/2023] [Indexed: 05/02/2023] Open
Abstract
Background Due to variation in electrode design, insertion depth and cochlear morphology, patients with a cochlear implant (CI) often have to adapt to a substantial mismatch between the characteristic response frequencies of cochlear neurons and the stimulus frequencies assigned to electrode contacts. We introduce an imaging-based fitting intervention, which aimed to reduce frequency-to-place mismatch by aligning frequency mapping with the tonotopic position of electrodes. Results were evaluated in a novel trial set-up where subjects crossed over between intervention and control using a daily within-patient randomized approach, immediately from the start of CI rehabilitation. Methods Fourteen adult participants were included in this single-blinded, daily randomized clinical trial. Based on a fusion of pre-operative imaging and a post-operative cone beam CT scan (CBCT), mapping of electrical input was aligned to natural place-pitch arrangement in the individual cochlea. That is, adjustments to the CI's frequency allocation table were made so electrical stimulation of frequencies matched as closely as possible with corresponding acoustic locations in the cochlea. For a period of three months, starting at first fit, a scheme was implemented whereby the blinded subject crossed over between the experimental and standard fitting program using a daily randomized wearing schedule, and thus effectively acted as their own control. Speech outcomes (such as speech intelligibility in quiet and noise, sound quality and listening effort) were measured with both settings throughout the study period. Results On a group level, standard fitting obtained subject preference and showed superior results in all outcome measures. In contrast, two out of fourteen subjects preferred the imaging-based fitting and correspondingly had better speech understanding with this setting compared to standard fitting. Conclusion On average, cochlear implant fitting based on individual tonotopy did not elicit higher speech intelligibility but variability in individual results strengthen the potential for individualized frequency fitting. The novel trial design proved to be a suitable method for evaluation of experimental interventions in a prospective trial setup with cochlear implants.
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Affiliation(s)
- Lars Lambriks
- Department of ENT/Audiology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marc van Hoof
- Department of ENT/Audiology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Joke Debruyne
- Department of ENT/Audiology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Miranda Janssen
- Department of ENT/Audiology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Josef Chalupper
- Advanced Bionics European Research Centre, Hannover, Germany
| | - Kiki van der Heijden
- Department of ENT/Audiology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Janny Hof
- Department of ENT/Audiology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Katja Hellingman
- Department of ENT/Audiology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Elke Devocht
- Department of ENT/Audiology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Erwin George
- Department of ENT/Audiology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
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11
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Dixon PR, Shapiro J, Tomlinson G, Cottrell J, Lui JT, Falk L, Chen JM. Health State Utility Values Associated with Cochlear Implants in Adults: A Systematic Review and Network Meta-Analysis. Ear Hear 2023; 44:244-253. [PMID: 36303282 DOI: 10.1097/aud.0000000000001287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The cost-effectiveness of bilateral cochlear implants in adults remains uncertain despite established clinical benefits. In cost-effectiveness studies, benefit is often measured by change in health state utility value (HSUV), a single number summary of health-related quality of life anchored at 0 (state of being dead) and 1 (perfect health). Small differences in bilateral cochlear implant HSUV change conclusions of published models, and invalid estimates can therefore mislead policy and funding decisions. As such, we aimed to review and synthesize published HSUV estimates associated with cochlear implants. DESIGN We included observational or experimental studies reporting HSUV for adult patients (age ≥18 years) with at least moderate-profound sensorineural hearing loss in both ears who received unilateral or bilateral cochlear implants. We searched MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases up to May 1, 2021. Study and participant characteristics and HSUV outcomes were extracted. Narrative synthesis is reported for all studies. A Bayesian network meta-analysis was conducted to generate pooled estimates for the mean difference in HSUV for three comparisons: (1) unilateral cochlear implant versus preimplant, (2) bilateral cochlear implants versus preimplant, (3) bilateral versus unilateral cochlear implants. Our principal measure was pooled mean difference in HSUV. RESULTS Thirty-six studies reporting unique patient cohorts were identified. Health Utilities Index, 3 (HUI-3) was the most common HSUV elicitation method. HSUV from 19 preimplant mean estimates (1402 patients), 19 unilateral cochlear implant mean estimates (1701 patients), and 5 bilateral cochlear implants mean estimates (83 patients) were pooled to estimate mean differences in HUI-3 HSUV by network meta-analysis. Compared with preimplant, a unilateral cochlear implant was associated with a mean change in HSUV of +0.17 (95% credible interval [CrI] +0.12 to +0.23) and bilateral cochlear implants were associated with a mean change of +0.25 (95% CrI +0.12 to +0.37). No significant difference in HSUV was detected for bilateral compared with unilateral cochlear implants (+0.08 [95% CrI -0.06 to +0.21]). Overall study quality was moderate. CONCLUSIONS The findings of this review and network meta-analysis comprise the best-available resource for parameterization of cost-utility models of cochlear implantation in adults and highlight the need to critically evaluate the validity of available HSUV instruments for bilateral cochlear implant populations.Protocol registration: PROSPERO (CRD42018091838).
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Affiliation(s)
- Peter R Dixon
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California
| | - Justin Shapiro
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto
| | - George Tomlinson
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada
| | - Justin Cottrell
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Justin T Lui
- Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Lindsey Falk
- Evidence, Development and Standards, Health Quality Ontario
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Joseph M Chen
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
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12
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Cochlear Implant Facilitates the Use of Talker Sex and Spatial Cues to Segregate Competing Speech in Unilaterally Deaf Listeners. Ear Hear 2023; 44:77-91. [PMID: 35733275 DOI: 10.1097/aud.0000000000001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Talker sex and spatial cues can facilitate segregation of competing speech. However, the spectrotemporal degradation associated with cochlear implants (CIs) can limit the benefit of talker sex and spatial cues. Acoustic hearing in the nonimplanted ear can improve access to talker sex cues in CI users. However, it's unclear whether the CI can improve segregation of competing speech when maskers are symmetrically placed around the target (i.e., when spatial cues are available), compared with acoustic hearing alone. The aim of this study was to investigate whether a CI can improve segregation of competing speech by individuals with unilateral hearing loss. DESIGN Speech recognition thresholds (SRTs) for competing speech were measured in 16 normal-hearing (NH) adults and 16 unilaterally deaf CI users. All participants were native speakers of Mandarin Chinese. CI users were divided into two groups according to thresholds in the nonimplanted ear: (1) single-sided deaf (SSD); pure-tone thresholds <25 dB HL at all audiometric frequencies, and (2) Asymmetric hearing loss (AHL; one or more thresholds > 25 dB HL). SRTs were measured for target sentences produced by a male talker in the presence of two masker talkers (different male or female talkers). The target sentence was always presented via loudspeaker directly in front of the listener (0°), and the maskers were either colocated with the target (0°) or spatially separated from the target at ±90°. Three segregation cue conditions were tested to measure masking release (MR) relative to the baseline condition: (1) Talker sex, (2) Spatial, and (3) Talker sex + Spatial. For CI users, SRTs were measured with the CI on or off. RESULTS Binaural MR was significantly better for the NH group than for the AHL or SSD groups ( P < 0.001 in all cases). For the NH group, mean MR was largest with the Talker sex + spatial cues (18.8 dB) and smallest for the Talker sex cues (10.7 dB). In contrast, mean MR for the SSD group was largest with the Talker sex + spatial cues (14.7 dB), and smallest with the Spatial cues (4.8 dB). For the AHL group, mean MR was largest with the Talker sex + spatial cues (7.8 dB) and smallest with the Talker sex (4.8 dB) and the Spatial cues (4.8 dB). MR was significantly better with the CI on than off for both the AHL ( P = 0.014) and SSD groups ( P < 0.001). Across all unilaterally deaf CI users, monaural (acoustic ear alone) and binaural MR were significantly correlated with unaided pure-tone average thresholds in the nonimplanted ear for the Talker sex and Talker sex + spatial conditions ( P < 0.001 in both cases) but not for the Spatial condition. CONCLUSION Although the CI benefitted unilaterally deaf listeners' segregation of competing speech, MR was much poorer than that observed in NH listeners. Different from previous findings with steady noise maskers, the CI benefit for segregation of competing speech from a different talker sex was greater in the SSD group than in the AHL group.
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13
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Chen YS, Cabrera E, Tucker BJ, Shin TJ, Moawad JV, Totten DJ, Booth KT, Nelson RF. TMPRSS3 expression is limited in spiral ganglion neurons: implication for successful cochlear implantation. J Med Genet 2022; 59:1219-1226. [PMID: 35961784 DOI: 10.1136/jmg-2022-108654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND It is well established that biallelic mutations in transmembrane protease, serine 3 (TMPRSS3) cause hearing loss. Currently, there is controversy regarding the audiological outcomes after cochlear implantation (CI) for TMPRSS3-associated hearing loss. This controversy creates confusion among healthcare providers regarding the best treatment options for individuals with TMPRSS3-related hearing loss. METHODS A literature review was performed to identify all published cases of patients with TMPRSS3-associated hearing loss who received a CI. CI outcomes of this cohort were compared with published adult CI cohorts using postoperative consonant-nucleus-consonant (CNC) word performance. TMPRSS3 expression in mouse cochlea and human auditory nerves (HAN) was determined by using hybridisation chain reaction and single-cell RNA-sequencing analysis. RESULTS In aggregate, 27 patients (30 total CI ears) with TMPRSS3-associated hearing loss treated with CI, and 85% of patients reported favourable outcomes. Postoperative CNC word scores in patients with TMPRSS3-associated hearing loss were not significantly different than those seen in adult CI cohorts (8 studies). Robust Tmprss3 expression occurs throughout the mouse organ of Corti, the spindle and root cells of the lateral wall and faint staining within <5% of the HAN, representing type II spiral ganglion neurons. Adult HAN express negligible levels of TMPRSS3. CONCLUSION The clinical features after CI and physiological expression of TMPRSS3 suggest against a major role of TMPRSS3 in auditory neurons.
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Affiliation(s)
- Yuan-Siao Chen
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ernesto Cabrera
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brady J Tucker
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Timothy J Shin
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jasmine V Moawad
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas J Totten
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kevin T Booth
- Neurobiology, Harvard Medical School, Boston, Massachusetts, USA
- Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rick F Nelson
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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14
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Ma C, Fried J, Nguyen SA, Schvartz-Leyzac KC, Camposeo EL, Meyer TA, Dubno JR, McRackan TR. Longitudinal Speech Recognition Changes After Cochlear Implant: Systematic Review and Meta-analysis. Laryngoscope 2022; 133:1014-1024. [PMID: 36004817 DOI: 10.1002/lary.30354] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To examine patterns of change and plateau in speech recognition scores in postlingually hearing impaired adult cochlear implant recipients. The study also examines variations in change patterns for different speech materials and testing conditions. STUDY DESIGN Used systematic review with meta-analysis. METHODS Articles in English reporting speech recognition scores of adults with postlingual hearing loss at pre-implantation and at least two post-implantation time points were included. Statistically significant changes were determined by meta-analysis and the 95% confidence interval. RESULTS A total of 22 articles representing 1954 patients were included. Meta-analysis of mean difference demonstrated significant improvements in speech recognition score for words in quiet (37.4%; 95% confidence interval [34.7%, 40.7%]), sentences in quiet (49.4%; 95% confidence interval [44.9%, 53.9%]), and sentences in noise (30.8%; 95% confidence interval [25.2%, 36.4%]) from pre-op to 3 months. Scores continued to increase from 3 to 12 months but did not reach significance. Similarly, significant improvements from pre-op to 3 months were observed for consonant nucleus consonant (CNC) words in quiet (37.1%; 95% confidence interval [33.8%, 40.4%]), hearing in noise test (HINT) sentences in quiet (46.5%; 95% confidence interval [37.0%, 56.0%]), AzBio sentences in quiet (45.9%; 95% confidence interval [44.2%, 47.5%]), and AzBio sentences in noise (26.4%; 95% confidence interval [18.6%, 34.2%]). HINT sentences in noise demonstrated improvement from pre-op to 3 months (35.1%; 95% confidence interval [30.0%, 40.3%]) and from 3 to 12 months (15.5%; 95% confidence interval [7.2%, 23.8%]). CONCLUSIONS Mean speech recognition scores demonstrate significant improvement within the first 3 months, with no further statistically significant improvement after 3 months. However, large individual variation should be expected and future research is needed to explain the sources of these individual differences. Laryngoscope, 2022.
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Affiliation(s)
- Cheng Ma
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Jacob Fried
- 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
| | - Kara C Schvartz-Leyzac
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Elizabeth L Camposeo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- 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
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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15
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Cochlear Implantation Improves Both Speech Perception and Patient-Reported Outcomes: A Prospective Follow-Up Study of Treatment Benefits among Adult Cochlear Implant Recipients. J Clin Med 2022; 11:jcm11082257. [PMID: 35456353 PMCID: PMC9032498 DOI: 10.3390/jcm11082257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 01/27/2023] Open
Abstract
Cochlear implantation is considered the best treatment option for patients with severe-to-profound sensorineural hearing loss for whom conventional hearing aids are insufficient. We used a repeated measures longitudinal approach to evaluate speech recognition and patient-reported outcomes after cochlear implantation in an unbiased cohort of Danish adult patients in a prospective cohort study. We assessed 39 recipients before and two times after implantation using a battery of tests that included Dantale I, the Danish Hearing in Noise Test, the Nijmegen Cochlear Implant Questionnaire, and the Speech, Spatial, and Qualities of Hearing Scale. The study group improved significantly on all outcome measures following implantation. On average, Dantale I scores improved by 29 percentage points and Hearing in Noise Test scores improved by 22 percentage points. Most notably, the average Dantale score improved from 26 to 70% in the CI in quiet condition and from 12 to 42% in the cochlear implantation in noise condition when tested monaurally. Dantale demonstrated a significant positive correlation with Nijmegen Cochlear Implant Questionnaire and Speech, Spatial, and Qualities of Hearing Scale scores, while Hearing in Noise Test had no significant correlation with the patient-reported outcome measures. Patients improved significantly at 4 months and marginally improved further at 14 months, indicating that they were approaching a plateau. Our study’s use of audiometric and patient-reported outcome measures provides evidence of the treatment benefits of cochlear implantation in adults, which may help physicians advise patients on treatment decisions and align treatment benefit expectations, as well as serve as a foundation for the development of new cochlear implantation selection criteria.
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16
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Völter C, Götze L, Bajewski M, Dazert S, Thomas JP. Cognition and Cognitive Reserve in Cochlear Implant Recipients. Front Aging Neurosci 2022; 14:838214. [PMID: 35391751 PMCID: PMC8980358 DOI: 10.3389/fnagi.2022.838214] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
At present, dementia is a hot topic. Hearing loss is considered to be a modifiable risk factor for cognitive decline. The underlying mechanism remains unclear and might be mediated by socioeconomic and psychosocial factors. Cochlear implantation has been shown not only to restore auditory abilities, but also to decrease mental distress and to improve cognitive functions in people with severe hearing impairment. However, the promising results need to be confirmed. In a prospective single-center study, we tested the neurocognitive abilities of a large group of 71 subjects with bilateral severe hearing impairment with a mean age of 66.03 (SD = 9.15) preoperatively and 6, 12, and 24 months after cochlear implantation using a comprehensive non-auditory computer-based test battery, and we also assessed the cognitive reserve (CR) [Cognitive Reserve Index (CRI)], health-related quality of life (QoL) (Nijmegen Cochlear Implant Questionnaire), and depression (Geriatric Depression Scale-15). Cognitive functions significantly increased after 6 months in attention (p = 0.00004), working memory (operation span task; p = 0.002), and inhibition (p = 0.0002); and after 12 months in recall (p = 0.003) and verbal fluency (p = 0.0048), and remained stable up to 24 months (p ≥ 0.06). The CR positively correlated with cognitive functions pre- and post-operatively (both p < 0.005), but postoperative improvement in cognition was better in subjects with poor CR (p = 0.003). Depression had only a slight influence on one subtest. No correlation was found among cognitive skills, quality of life, and speech perception (each p ≥ 0.05). Cochlear implantation creates an enriched environment stimulating the plasticity of the brain with a global positive impact on neurocognitive functions, especially in subjects with poor preoperative cognitive performance and low cognitive reserve.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
- *Correspondence: Christiane Völter,
| | - Lisa Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Marcel Bajewski
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, St.-Johannes-Hospital, Dortmund, Germany
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17
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Shafiro V, Luzum N, Moberly AC, Harris MS. Perception of Environmental Sounds in Cochlear Implant Users: A Systematic Review. Front Neurosci 2022; 15:788899. [PMID: 35082595 PMCID: PMC8785216 DOI: 10.3389/fnins.2021.788899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives: Improved perception of environmental sounds (PES) is one of the primary benefits of cochlear implantation (CI). However, past research contains mixed findings on PES ability in contemporary CI users, which at times contrast with anecdotal clinical reports. The present review examined extant PES research to provide an evidence basis for clinical counseling, identify knowledge gaps, and suggest directions for future work in this area of CI outcome assessment. Methods: Six electronic databases were searched using medical subject headings (MeSH) and keywords broadly identified to reference CI and environmental sounds. Records published between 2000 and 2021 were screened by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to identify studies that met the inclusion criteria. Data were subsequently extracted and evaluated according to synthesis without-meta-analysis (SWiM) guidelines. Results: Nineteen studies met the inclusion criteria. Most examined PES in post-lingually implanted adults, with one study focused on pre/perilingual adults. Environmental sound identification (ESI) in quiet using open- or closed-set response format was most commonly used in PES assessment, included in all selected studies. ESI accuracy in CI children (3 studies) and adults (16 studies), was highly variable but generally mediocre (means range: 31–87%). Only two studies evaluated ESI performance prospectively before and after CI, while most studies were cross-sectional. Overall, CI performance was consistently lower than that of normal-hearing peers. No significant differences in identification accuracy were reported between CI candidates and CI users. Environmental sound identification correlated in CI users with measures of speech perception, music and spectro-temporal processing. Conclusion: The findings of this systematic review indicate considerable limitations in the current knowledge of PES in contemporary CI users, especially in pre/perilingual late-implanted adults and children. Although no overall improvement in PES following implantation was found, large individual variability and existing methodological limitations in PES assessment may potentially obscure potential CI benefits for PES. Further research in this ecologically relevant area of assessment is needed to establish a stronger evidence basis, identify CI users with significant deficits, and improve CI users' safety and satisfaction through targeted PES rehabilitation.
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Affiliation(s)
- Valeriy Shafiro
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL, United States
- *Correspondence: Valeriy Shafiro
| | - Nathan Luzum
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Aaron C. Moberly
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Michael S. Harris
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
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van Wieringen A, Magits S, Francart T, Wouters J. Home-Based Speech Perception Monitoring for Clinical Use With Cochlear Implant Users. Front Neurosci 2021; 15:773427. [PMID: 34916902 PMCID: PMC8669965 DOI: 10.3389/fnins.2021.773427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022] Open
Abstract
Speech-perception testing is essential for monitoring outcomes with a hearing aid or cochlear implant (CI). However, clinical care is time-consuming and often challenging with an increasing number of clients. A potential approach to alleviating some clinical care and possibly making room for other outcome measures is to employ technologies that assess performance in the home environment. In this study, we investigate 3 different speech perception indices in the same 40 CI users: phoneme identification (vowels and consonants), digits in noise (DiN) and sentence recognition in noise (SiN). The first two tasks were implemented on a tablet and performed multiple times by each client in their home environment, while the sentence task was administered at the clinic. Speech perception outcomes in the same forty CI users showed that DiN assessed at home can serve as an alternative to SiN assessed at the clinic. DiN scores are in line with the SiN ones by 3–4 dB improvement and are useful to monitor performance at regular intervals and to detect changes in auditory performance. Phoneme identification in quiet also explains a significant part of speech perception in noise, and provides additional information on the detectability and discriminability of speech cues. The added benefit of the phoneme identification task, which also proved to be easy to administer at home, is the information transmission analysis in addition to the summary score. Performance changes for the different indices can be interpreted by comparing against measurement error and help to target personalized rehabilitation. Altogether, home-based speech testing is reliable and proves powerful to complement care in the clinic for CI users.
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Affiliation(s)
| | - Sara Magits
- Experimental ORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Tom Francart
- Experimental ORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Experimental ORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
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Ezeokafor I, Upadhya A, Shetty S. Neurosensory Prosthetics: An Integral Neuromodulation Part of Bioelectronic Device. Front Neurosci 2021; 15:671767. [PMID: 34867141 PMCID: PMC8637173 DOI: 10.3389/fnins.2021.671767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/07/2021] [Indexed: 12/28/2022] Open
Abstract
Bioelectronic medicines (BEMs) constitute a branch of bioelectronic devices (BEDs), which are a class of therapeutics that combine neuroscience with molecular biology, immunology, and engineering technologies. Thus, BEMs are the culmination of thought processes of scientists of varied fields and herald a new era in the treatment of chronic diseases. BEMs work on the principle of neuromodulation of nerve stimulation. Examples of BEMs based on neuromodulation are those that modify neural circuits through deep brain stimulation, vagal nerve stimulation, spinal nerve stimulation, and retinal and auditory implants. BEDs may also serve as diagnostic tools by mimicking human sensory systems. Two examples of in vitro BEDs used as diagnostic agents in biomedical applications based on in vivo neurosensory circuits are the bioelectronic nose and bioelectronic tongue. The review discusses the ever-growing application of BEDs to a wide variety of health conditions and practices to improve the quality of life.
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Affiliation(s)
| | - Archana Upadhya
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, Shri Vile Parle Kelavani Mandal (SVKM) Narsee Monjee Institute of Management Studies (NMiMS) (SVKM’S NMiMS), Mumbai, India
| | - Saritha Shetty
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, Shri Vile Parle Kelavani Mandal (SVKM) Narsee Monjee Institute of Management Studies (NMiMS) (SVKM’S NMiMS), Mumbai, India
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McGuire K, Firestone GM, Zhang N, Zhang F. The Acoustic Change Complex in Response to Frequency Changes and Its Correlation to Cochlear Implant Speech Outcomes. Front Hum Neurosci 2021; 15:757254. [PMID: 34744668 PMCID: PMC8566680 DOI: 10.3389/fnhum.2021.757254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
One of the biggest challenges that face cochlear implant (CI) users is the highly variable hearing outcomes of implantation across patients. Since speech perception requires the detection of various dynamic changes in acoustic features (e.g., frequency, intensity, timing) in speech sounds, it is critical to examine the ability to detect the within-stimulus acoustic changes in CI users. The primary objective of this study was to examine the auditory event-related potential (ERP) evoked by the within-stimulus frequency changes (F-changes), one type of the acoustic change complex (ACC), in adult CI users, and its correlation to speech outcomes. Twenty-one adult CI users (29 individual CI ears) were tested with psychoacoustic frequency change detection tasks, speech tests including the Consonant-Nucleus-Consonant (CNC) word recognition, Arizona Biomedical Sentence Recognition in quiet and noise (AzBio-Q and AzBio-N), and the Digit-in-Noise (DIN) tests, and electroencephalographic (EEG) recordings. The stimuli for the psychoacoustic tests and EEG recordings were pure tones at three different base frequencies (0.25, 1, and 4 kHz) that contained a F-change at the midpoint of the tone. Results showed that the frequency change detection threshold (FCDT), ACC N1' latency, and P2' latency did not differ across frequencies (p > 0.05). ACC N1'-P2 amplitude was significantly larger for 0.25 kHz than for other base frequencies (p < 0.05). The mean N1' latency across three base frequencies was negatively correlated with CNC word recognition (r = -0.40, p < 0.05) and CNC phoneme (r = -0.40, p < 0.05), and positively correlated with mean FCDT (r = 0.46, p < 0.05). The P2' latency was positively correlated with DIN (r = 0.47, p < 0.05) and mean FCDT (r = 0.47, p < 0.05). There was no statistically significant correlation between N1'-P2' amplitude and speech outcomes (all ps > 0.05). Results of this study indicated that variability in CI speech outcomes assessed with the CNC, AzBio-Q, and DIN tests can be partially explained (approximately 16-21%) by the variability of cortical sensory encoding of F-changes reflected by the ACC.
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Affiliation(s)
- Kelli McGuire
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Gabrielle M. Firestone
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
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Willberg T, Sivonen V, Linder P, Dietz A. Comparing the Speech Perception of Cochlear Implant Users with Three Different Finnish Speech Intelligibility Tests in Noise. J Clin Med 2021; 10:jcm10163666. [PMID: 34441961 PMCID: PMC8397150 DOI: 10.3390/jcm10163666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: A large number of different speech-in-noise (SIN) tests are available for testing cochlear implant (CI) recipients, but few studies have compared the different tests in the same patient population to assess how well their results correlate. Methods: A clinically representative group of 80 CI users conducted the Finnish versions of the matrix sentence test, the simplified matrix sentence test, and the digit triplet test. The results were analyzed for correlations between the different tests and for differences among the participants, including age and device modality. Results: Strong and statistically significant correlations were observed between all of the tests. No floor or ceiling effects were observed with any of the tests when using the adaptive test procedure. Age or the length of device use showed no correlation to SIN perception, but bilateral CI users showed slightly better results in comparison to unilateral or bimodal users. Conclusions: Three SIN tests that differ in length and complexity of the test material provided comparable results in a diverse CI user group.
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Affiliation(s)
- Tytti Willberg
- Department of Otorhinolaryngology, Turku University Hospital, 20521 Turku, Finland
- Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland
- Correspondence:
| | - Ville Sivonen
- Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland;
| | - Pia Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, 70029 Kuopio, Finland; (P.L.); (A.D.)
| | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, 70029 Kuopio, Finland; (P.L.); (A.D.)
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