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Kirchhoff L, Arweiler-Harbeck D, Meyer M, Buer J, Lang S, Steinmann J, Bertram R, Deuss E, Höing B. Bacterial biofilm formation on headpieces of Cochlear implants. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08835-2. [PMID: 39042175 DOI: 10.1007/s00405-024-08835-2] [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: 04/17/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Bacterial biofilm formation on medical devices, such as Cochlear implants (CI), can lead to chronic infections. Not only the inner parts of the implant but also the externally located headpiece might be associated with prolonged superficial skin eczema resulting in the inability of wearing the headpiece. In this study, the surface of three CI headpieces from different manufacturers were examined for bacterial biofilm formation. MATERIALS AND METHODS Two bacterial species associated with implant-related infections were tested: Pseudomonas aeruginosa (ATCC9027) and Staphylococcus aureus (ATCC6538). Biofilms were formed over 24 h in tryptic soy broth at 36 °C. Biofilm formation was detected in form of biomass measurement by crystal violet staining. CI headpiece dummies of three manufacturers were used. RESULTS Both tested bacterial species formed biofilms on the examined CI headpiece-surfaces in a species-dependent manner with higher biofilm formation of P. aeruginosa. For both, S. aureus and P. aeruginosa, biofilm formation on the CI components was comparable to a polystyrene control surface. Between the three manufacturers, no significant difference in biofilm formation was found. DISCUSSION The tested bacteria displayed biofilm formation on the CI headpieces in a species-specific manner with higher amount of biofilm formed by P. aeruginosa. The biofilm formation was comparable between the manufacturers. In this study, an enhanced biofilm formation on CI headpieces could not be demonstrated. These in vitro tests suggest a minor role of bacterial biofilm on the CI headpiece in skin infections under the CI headpiece.
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Affiliation(s)
- Lisa Kirchhoff
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg- Essen, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany
| | - Moritz Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg- Essen, Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg- Essen, Essen, Germany
- Institute of Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Ralf Bertram
- Institute of Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Eric Deuss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany.
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Issing C, Loth AG, Sakmen KD, Guchlerner L, Helbig S, Baumann U, Pantel J, Stöver T. Cochlear implant therapy improves the quality of life and social participation in the elderly: a prospective long-term evaluation. Eur Arch Otorhinolaryngol 2024; 281:3453-3460. [PMID: 38353767 PMCID: PMC11211127 DOI: 10.1007/s00405-023-08443-6] [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: 09/14/2023] [Accepted: 12/27/2023] [Indexed: 06/29/2024]
Abstract
PURPOSE In recent years, the number of elderly cochlear implant (CI) candidates is continuously rising. In addition to the audiological improvement, other positive effects of CI treatment can also be observed in clinical routine. The "quality of life" as a parameter of success directly experienced by the patient is increasingly becoming the focus of clinical research. Although there are already clear indications of a rapid and significant improvement in quality of life, there is still a lack of systematic, prospectively collected longitudinal long-term data in patients over the age of 65. METHODS This prospective longitudinal observational study included 31 patients between the age of 71 and 92 years who had first been treated unilaterally with a CI 6 years ago. In addition to free-field monosyllable recognition, quality of life was assessed using the World Health Organization Quality-of-Life Scale-old (WHOQL-OLD). The results were compared with the data from our previous study, in which we focused on the short- and medium-term effects on quality of life. In both studies, the same patient population was examined. In addition, these study data were compared with an age-matched average population. RESULTS In speech recognition, there was no significant change from the control 6 months postoperatively compared with the results 6 years postoperatively. No significant changes occurred in the total quality of life score or any of the other six facets of quality of life when comparing the results 6 months postoperatively with the results 6 years postoperatively. In "Social participation", the CI patients even exceed the values of the age-matched average population 6 years after treatment. CONCLUSION Improvement in the quality of life and especially in social participation appears stable over many years in elderly patients after hearing rehabilitation with a CI.
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Affiliation(s)
- Christian Issing
- Department of Oto-Rhino-Laryngology, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany.
| | - Andreas G Loth
- Department of Oto-Rhino-Laryngology, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Kenan D Sakmen
- Department of Oto-Rhino-Laryngology, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Leon Guchlerner
- Department of Oto-Rhino-Laryngology, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Silke Helbig
- Department of Oto-Rhino-Laryngology, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Uwe Baumann
- Department of Oto-Rhino-Laryngology, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Johannes Pantel
- Working Group On Geriatric Medicine Specializing in Psychogeriatric Medicine and Clinical Gerontology, Institute of General Practice, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Timo Stöver
- Department of Oto-Rhino-Laryngology, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
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Schauwecker N, Patro A, Holder J, Moberly AC, Perkins E. Simultaneous versus Sequential Cochlear Implantation in Adults: Quantitative and Qualitative Outcomes. Otolaryngol Head Neck Surg 2024. [PMID: 38842041 DOI: 10.1002/ohn.848] [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: 12/01/2023] [Revised: 03/06/2024] [Accepted: 04/14/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To compare speech recognition and quality of life outcomes between bilateral sequentially and simultaneously implanted adult cochlear implant (CI) recipients who initially qualify for a CI in both ears. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. METHODS Retrospective chart review identified adults who underwent bilateral CI, either simultaneously or sequentially, at a high-volume center between 2012 and 2022. Sequentially implanted patients were only included if the second ear qualified for CI in quiet (defined as best-aided AzBio quiet testing <60%), at time of initial CI evaluation. RESULTS Of 112 bilateral CI patients who qualified in both ears at initial evaluation, 95 underwent sequential implantation and 17 simultaneous. Age, duration, and etiology of hearing loss, and CI usage were similar between groups. Preoperatively, the sequential group had lower pure-tone average (PTA) in the 1st ear than the simultaneously implanted group (P = <.001) but, no difference in 2nd ear PTA (P = .657). Preoperative speech recognition scores were significantly higher for the sequential group; however, this was not true for postoperative scores. There was no difference in the proportion of patients showing significant CI-only or bilateral performance improvement between the groups. Both groups demonstrated similar benefit in quality of life measures. CONCLUSION Our findings indicate both simultaneous and sequential cochlear implantation are effective in improving hearing performance and quality of life. Thus, bilateral versus simultaneous implantation should be discussed and tailored for each individual patient.
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Affiliation(s)
- Natalie Schauwecker
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jourdan Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Dang S, Kallogjeri D, Dizdar K, Lee D, Bao JW, Varghese J, Walia A, Zhan K, Youssef S, Durakovic N, Wick CC, Herzog JA, Buchman CA, Piccirillo JF, Shew MA. Individual Patient Comorbidities and Effect on Cochlear Implant Performance. Otol Neurotol 2024; 45:e281-e288. [PMID: 38437816 PMCID: PMC10939851 DOI: 10.1097/mao.0000000000004144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To examine the association between preoperative comorbidities and cochlear implant speech outcomes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS A total of 976 patients who underwent cochlear implantation (CI) between January 2015 and May 2022. Adult patients with follow-up, preoperative audiologic data, and a standardized anesthesia preoperative note were included. EXPOSURE Adult Comorbidity Evaluation 27 (ACE-27) based on standardized anesthesia preoperative notes. MAIN OUTCOME MEASURES Postoperative change in consonant-nucleus-consonant (CNC) score, AzBio Sentence score in quiet, and AzBio + 10 dB signal-to-noise ratio (SNR). Sentence score of the implanted ear at 3, 6, and 12 months. RESULTS A total of 560 patients met inclusion criteria; 112 patients (20%) had no comorbidity, 204 patients (36.4%) had mild comorbidities, 161 patients (28.8%) had moderate comorbidities, and 83 patients (14.8%) had severe comorbidities. Mixed model analysis revealed all comorbidity groups achieved a clinically meaningful improvement in all speech outcome measures over time. This improvement was significantly different between comorbidity groups over time for AzBio Quiet ( p = 0.045) and AzBio + 10 dB SNR ( p = 0.0096). Patients with severe comorbidities had worse outcomes. From preop to 12 months, the estimated marginal mean difference values (95% confidence interval) between the no comorbidity group and the severe comorbidity group were 52.3 (45.7-58.9) and 32.5 (24.6-40.5), respectively, for AzBio Quiet; 39.5 (33.8-45.2) and 21.2 (13.6-28.7), respectively, for AzBio + 10 dB SNR; and 43.9 (38.7-49.0) and 31.1 (24.8-37.4), respectively, for CNC. CONCLUSIONS Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.
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Affiliation(s)
- Sabina Dang
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | | | - Karmela Dizdar
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - David Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - James W Bao
- Miller School of Medicine, University of Miami, Florida
| | - Jordan Varghese
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Kevin Zhan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Stephanie Youssef
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Nedim Durakovic
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jacques A Herzog
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Matthew A Shew
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
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Song B, Oh S, Kim D, Cho YS, Moon IJ. Changes in Revision Cochlear Implantation and Device Failure Profiles. Clin Exp Otorhinolaryngol 2024; 17:37-45. [PMID: 38228133 PMCID: PMC10933811 DOI: 10.21053/ceo.2023.00010] [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: 10/16/2023] [Revised: 11/10/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES As cochlear implantation (CI) experiences rapid innovations and its indications expand, the characteristics of revision CI (RCI) are evolving. This study investigated changes in the RCI profile and explored their clinical implications. METHODS A retrospective chart review was conducted of all CIs performed at a tertiary medical institution between October 2001 and January 2023. The rates of and reasons for RCI were evaluated in relation to the manufacturer and device model. Kaplan-Meier analysis was employed to examine cumulative and device survival curves. Cumulative and device survival rates were additionally analyzed based on age group, period of primary CI, and manufacturer. A Cox proportional hazards model was employed to evaluate the association between RCI and the device manufacturer. RESULTS Among 1,430 CIs, 73 (5.1%) required RCI. The predominant reason for RCI was device failure (40 of 73 RCIs [54.8%]), with an overall device failure rate of 2.8%. This was followed by flap-associated problems and migration (nine of 73 RCIs each [12.3%]). Flap retention issues emerged as a new cause in three cases (two involving the CI 632 and one involving the SYNCHRONY 2 implant), and six instances of electrode tip fold-over arose (four for the CI 600 series and two for the CI 500 series). The overall 10-year cumulative and device survival rates were 93.4% and 95.8%, respectively. After excluding models with recall issues, significant differences in cumulative (P =0.010) and device (P =0.001) survival rates were observed across manufacturers. CONCLUSION While the overall CI survival rate is stable, device failure persists as the predominant reason for RCI. Moreover, the types of complications leading to revision (including issues with flap retention and electrode tip fold-over) have shifted, particularly for newer implant models. Given the clinical importance of device failure and subsequent reoperation, clinicians should remain informed about and responsive to these trends.
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Affiliation(s)
- Bokhyun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Subi Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doyun Kim
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
| | - Young Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
| | - Il Joon Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
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Young A, Fechtner L, Kim C, Nayak N, Kellermeyer B, Ortega C, Rende S, Rosenberg S, Wazen J. Long-term cognition and speech recognition outcomes after cochlear implantation in the elderly. Am J Otolaryngol 2024; 45:104071. [PMID: 37793300 DOI: 10.1016/j.amjoto.2023.104071] [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: 08/03/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate how cognition, as measured using the Self-Administered Gerocognitive Examination Test (SAGE), and age affect speech recognition scores in older adults (age > 65) at one year and two years after cochlear implantation. STUDY DESIGN This is a prospective study. SETTING This study was conducted at a single institution. METHODS Unilateral cochlear implantation was performed by two surgeons on adult patients (>65 years) with postlingual bilateral sensorineural hearing loss. There were 230 patients who underwent cochlear implantation from January 2016 to June 2023. Fifty-five of these patients completed the SAGE questionnaire before implantation, one year after implantation, and 2 years after implantation. Paired t-test analysis was used to evaluate pre- and post-operative speech recognition scores (CNC, AzBio in Quiet). RESULTS Patients who had normal preoperative cognition on SAGE showed greater improvement in postoperative speech recognition tests at 1 year and 2 years after implantation compared with patients who showed preoperative cognitive impairment. There were no significant differences in postoperative speech outcome between age group 1 (between 65 and 80 years old) and age group 2 (over 80 years old) cochlear implant recipients. There were no changes in cognitive SAGE scores after 2 years implantation. CONCLUSION Cognitive function, as measured by SAGE, is a more reliable predictor than age in determining speech recognition improvement after cochlear implantation. Cochlear implantation did not improve postoperative cognition.
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Affiliation(s)
- Allen Young
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA.
| | - Linnea Fechtner
- Grand Valley ENT and Facial Plastics Surgeon, 2373 G Road, Suite 270, Grand Junction, CO 81505, USA
| | - Christine Kim
- AMC Otolaryngology, 50 New Scotland Avenue, Albany, NY 12208, USA
| | - Neil Nayak
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Brian Kellermeyer
- West Virginia University Hospitals, 1 Medical Center DR, Morganton, WV 26505, USA
| | - Carmelo Ortega
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Sharon Rende
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Seth Rosenberg
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
| | - Jack Wazen
- Silverstein Institute-First Physicians Group of Sarasota, 1901 Floyd Street, Sarasota, FL 34239, USA
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Shen S, Sayyid Z, Andresen N, Carver C, Dunham R, Marsiglia D, Yeagle J, Della Santina CC, Bowditch S, Sun DQ. Longitudinal Auditory Benefit for Elderly Patients After Cochlear Implant for Bilateral Hearing Loss, Including Those Meeting Expanded Centers for Medicare & Medicaid Services Criteria. Otol Neurotol 2023; 44:866-872. [PMID: 37621128 PMCID: PMC10527933 DOI: 10.1097/mao.0000000000003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To examine the effect of patient age on longitudinal speech understanding outcomes after cochlear implantation (CI) in bilateral hearing loss. STUDY DESIGN Retrospective cohort study. SETTING Tertiary academic center. PATIENTS One thousand one hundred five adult patients with bilateral hearing loss receiving a unilateral CI between 1987 and 2022InterventionsNone. MAIN OUTCOME MEASURES Postoperative speech recognition outcomes, including AzBio sentences, consonant-nucleus-consonant word, and Hearing in Noise Test in quiet were analyzed at short-term (<2 yr), medium-term (2-8 y), and long-term (>8 yr) term postoperative intervals. RESULTS Eighty-six very elderly (>80 yr), 409 elderly (65-80 yr), and 709 nonelderly (18-65 yr) patients were included. Short-term postoperative AzBio scores demonstrated similar magnitude of improvement relative to preoperative scores in the very elderly (47.6, 95% confidence interval [CI], 28.9-66.4), elderly (49.0; 95% CI, 39.2-58.8), and nonelderly (47.9; 95% CI, 35.4-60.4). Scores for those older than 80 years remained stable after 2 years after implant, but in those 80 years or younger, scores continued to improve for up to 8 years (elderly: 6.2 [95% CI, 1.5-12.4]; nonelderly: 9.9 [95% CI, 2.1-17.7]) after implantation. Similar patterns were observed for consonant-nucleus-consonant word scores. Across all age cohorts, patients with preoperative Hearing in Noise Test scores between 40 and 60% had similar scores to those with preoperative scores of less than 40%, at short-term (82.4, 78.9; 95% CI, -23.1 to 10.0), medium-term (77.2, 83.9; 95% CI, -15.4 to 8.2), or long-term (73.4, 71.2; 95% CI, -18.2 to 12.2) follow-up. CONCLUSIONS Patients older than 80 years gain significant and sustained auditory benefit after CI, including those meeting expanded Centers for Medicare & Medicaid Service criteria for implantation. Patients younger than 80 years demonstrated continued improvement over longer periods than older patients, suggesting a role of central plasticity in mediating CI outcomes as a function of age.
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Affiliation(s)
- Sarek Shen
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery. Baltimore, Maryland. USA
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Petito GT, Tripathi SH, Dhanda Patil R. Outcomes of Cochlear Implantation in Age Subgroups of Veterans Over 50 Years Old. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e037. [PMID: 38515639 PMCID: PMC10950163 DOI: 10.1097/ono.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/13/2023] [Indexed: 03/23/2024]
Abstract
Objective This study aimed to determine whether there was a difference in postoperative Arizona Biomedical (AzBio) speech recognition scores in 2 differently aged subgroups of veterans 50 years and older after cochlear implantation (CI). Study Design Retrospective chart review. Setting Tertiary referral center. Patients Seventy-one patients aged 50 to 74 years (younger cohort) were compared with 56 patients aged 75 years and older (older cohort) at the time of CI. Interventions Patients underwent therapeutic CI. Main Outcome Measures Comparison of AzBio speech recognition test scores in a quiet environment between the 2 differently aged cohorts of veterans 50 years and older. Results Despite no significant differences in preoperative AzBio score between the younger (mean 22.2%) and older cohorts (mean, 17.3%; P > 0.05), when examining the 6- and 12-month postoperative time points, the older cohort had significantly lower mean AzBio scores (50%, 55.8%; P < 0.05) than the younger cohort (69.8%, 71.9%; P < 0.05). Conclusions All patients aged >50 years experienced significant improvement in speech recognition scores following CI, although the cohort of ages 50 to 74 years scored significantly higher in later follow-up visits. These findings suggest that CI should be offered to appropriate candidates, regardless of age, although earlier intervention may be more advantageous.
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Affiliation(s)
- Gabrielle T. Petito
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Siddhant H. Tripathi
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Reena Dhanda Patil
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Otolaryngology, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH
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Nassiri AM, Marinelli JP, Lohse CM, Carlson ML. Incidence of Cochlear Implantation Among Adult Candidates in the United States. Otol Neurotol 2023; 44:549-554. [PMID: 37205861 DOI: 10.1097/mao.0000000000003894] [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: 05/21/2023]
Abstract
OBJECTIVES To investigate the associations of age and year of cochlear implantation (CI) with CI incidence among adults 20 years and older residing in the US. STUDY DESIGN Deidentified cochlear implant data were acquired from prospective patient registries from two cochlear implant manufacturers (Cochlear Americas and Advanced Bionics), which supply an estimated 85% of cochlear implants in the US. Population estimates for severe-to-profound sensorineural hearing loss by age group were extracted from Census and National Health and Nutrition Examination Survey data. SETTING US CI centers. PATIENTS Adults 20 years and older who underwent CI. INTERVENTIONS CI. MAIN OUTCOME MEASURES CI incidence. RESULTS The study cohort included 30,066 adults 20 years and older who underwent CI from 2015 to 2019. When combining actual and estimated data from all three manufacturers, the annual number of cochlear implants increased 5,406 in 2015 to 8,509 in 2019. Overall, the incidence of CI among adult traditional (bilateral severe-to-profound hearing loss) CI candidates increased from 244 per 100,000 person-years in 2015 to 350 in 2019 ( p < 0.001). Although the elderly (80 years and older) population had the lowest incidence of CI, this cohort experienced the largest growth from an incidence of 105 per 100,000 person-years to 202 during the study period. CONCLUSIONS Despite growing incidence among those with qualifying hearing loss, cochlear implants remain widely underutilized. Elderly adults continue to exhibit the lowest relative cochlear implant utilization rates; however, trends over the last half-decade suggest a shift has occurred, resulting in improved access among this underserved subset.
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Affiliation(s)
- Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Spitzer ER, Waltzman SB. Cochlear implants: the effects of age on outcomes. Expert Rev Med Devices 2023; 20:1131-1141. [PMID: 37969071 DOI: 10.1080/17434440.2023.2283619] [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: 07/13/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Cochlear implants (CIs) provide access to sound for children and adults who do not receive adequate benefit from hearing aids. Age at implantation is known to affect outcomes across the lifespan. AREAS COVERED The effects of age on CI outcomes are examined for infants, children, adolescents, and older adults. A variety of outcome measures are considered, including speech perception, language, cognition, and quality of life measures. EXPERT OPINION/COMMENTARY For those meeting candidacy criteria, CIs are beneficial at any age. In general, younger age is related to greater benefit when considering pre-lingual deafness. Other factors such as additional disabilities, may mitigate this effect. Post-lingually deafened adults demonstrate similar benefit regardless of age, though the oldest individuals (80+) may see smaller degrees of improvement from preoperative scores. Benefit can be measured in many ways, and the areas of greatest benefit may vary based on age: young children appear to see the greatest effects of age at implantation on language measures, whereas scores on cognitive measures appear to be most impacted for the oldest population. Future research should consider implantation at extreme ages (5-9 months or > 90 years), unconventional measures of CI benefit including qualitative assessments, and longitudinal designs.
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Affiliation(s)
- Emily R Spitzer
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Susan B Waltzman
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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Jones M, Kovacevic B, Ionescu CM, Wagle SR, Quintas C, Wong EYM, Mikov M, Mooranian A, Al-Salami H. The applications of Targeted Delivery for Gene Therapies in Hearing Loss. J Drug Target 2023:1-22. [PMID: 37211674 DOI: 10.1080/1061186x.2023.2216900] [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: 10/16/2022] [Revised: 12/07/2022] [Accepted: 04/09/2023] [Indexed: 05/23/2023]
Abstract
Gene therapies are becoming more abundantly researched for use in a multitude of potential treatments, including for hearing loss. Hearing loss is a condition which impacts an increasing number of the population each year, with significant burdens associated. As such, this review will present the concept that delivering a gene effectively to the inner ear may assist in expanding novel treatment options and improving patient outcomes. Historically, several drawbacks have been associated with the use of gene therapies, some of which may be overcome via targeted delivery. Targeted delivery has the potential to alleviate off-target effects and permit a safer delivery profile. Viral vectors have often been described as a delivery method, however, there is an emerging depiction of the potential for nanotechnology to be used. Resulting nanoparticles may also be tuned to allow for targeted delivery. Therefore, this review will focus on hearing loss, gene delivery techniques and inner ear targets, including highlighting promising research. Targeted delivery is a key concept to permitting gene delivery in a safe effective manner, however, further research is required, both in the determination of genes to use in functional hearing recovery and formulating nanoparticles for targeted delivery.
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Affiliation(s)
- Melissa Jones
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics Department, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Bozica Kovacevic
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics Department, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Corina Mihaela Ionescu
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics Department, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Susbin Raj Wagle
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics Department, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Christina Quintas
- School of human sciences, University of Western Australia, Crawley 6009, Perth, Western Australia, Australia
| | - Elaine Y M Wong
- Hearing Therapeutics Department, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
| | - Momir Mikov
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21101 Novi Sad, Serbia
| | - Armin Mooranian
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics Department, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
- School of Pharmacy, University of Otago, Dunedin, Otago, New Zealand
| | - Hani Al-Salami
- The Biotechnology and Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley 6102, Perth, Western Australia, Australia
- Hearing Therapeutics Department, Ear Science Institute Australia, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
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Wichova H, Mills D, Beatty S, Peng K, Miller M. Cochlear implantation performance outcomes in patients over 80 years old. Laryngoscope Investig Otolaryngol 2022; 7:847-853. [PMID: 35734051 PMCID: PMC9194979 DOI: 10.1002/lio2.825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To examine device datalogging characteristics and postoperative performance in the very elderly CI users. Methods Retrospective chart review of postoperative speech recognition outcomes and datalogging characteristics in patients older than 80 years old who underwent cochlear implantation and remain active users with longer than 6 months post‐activation follow‐up. Results(s) The mean age at implantation was 84.8 ± 3.8 years old. Pre‐ and post‐operative AzBio sentences in quiet scores were 12.4 ± 16.4% and 53.0 ± 23.5%, respectively (p < .001). Pre‐ and post‐operative consonant‐nucleus‐consonant (CNC) word scores were 9.4 ± 12.8% and 40.5 ± 20.7%, respectively (p < .001). A nonsignificant negative correlation was noted between the age of implantation and postoperative CNC words and AzBio sentence performance. Significantly decreased performance was noted in the subpopulation with a preoperative diagnosis of dementia. Mean daily use was 10.9 h per day. When available the mean daily usage distribution was 16% speech in noise, 19.1% speech, 51% quiet, 3.8% music, and 9.6% noise. A significant positive correlation was noted between daily use and AzBio sentence and CNC word performance. Conclusions Very elderly patients have significant postoperative auditory performance benefits after CI. Mean daily use is comparable to previously published results in the younger population. Age of implantation does not play a significant role in overall performance. Elderly patients who are medically cleared for implantation receive significant postoperative benefits.
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Affiliation(s)
- Helena Wichova
- Division of Neurotology House Clinic Los Angeles California USA
| | - Dawna Mills
- Department of Audiology University of California Davis Sacramento California USA
| | - Sarah Beatty
- Hearing Services of Santa Barbara Santa Barbara California USA
| | - Kevin Peng
- Division of Neurotology House Clinic Los Angeles California USA
| | - Mia Miller
- Department of Otolaryngology Cedar Sinai Los Angeles California USA
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