1
|
O'Brien CA, Waltzman SB, Chodosh J, Friedmann DR. Cochlear Implants in Veterans: 10-Year Experience at a Single Referral Center. Am J Audiol 2022; 31:698-706. [PMID: 35772174 PMCID: PMC10023142 DOI: 10.1044/2022_aja-22-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Severe hearing loss is particularly prevalent among Veterans. In response, the Veterans Affairs (VA) provides hearing aids and cochlear implants as part of their comprehensive hearing loss treatment. The VA's national health care system and integrated electronic health records offer a unique opportunity to examine patterns and outcomes in the management of severe hearing loss. METHOD We retrospectively reviewed an urban VA center's database for all Veterans who underwent cochlear implantation between 2010 and 2019. We collected preoperative demographic and audiological data including cochlear implant outcomes. RESULTS During the study period, 61 Veterans received a cochlear implant, totaling 70 ears implanted. Median age at implantation was 70.2 years. Over 90% of Veterans reported preoperative hearing aid use, and median preoperative four-frequency pure-tone average and aided word recognition score in the ear to be implanted were 100 dB HL and 7%, respectively. The median onset of severe hearing loss bilaterally was over 4 years prior to cochlear implant evaluation based on available audiometric data. Postoperative word recognition score was negatively correlated with self-reported duration of hearing loss. CONCLUSIONS This study provides unique insights into how Veterans with severe hearing loss are managed at one VA center. Compared to data published on cochlear implant recipients in the civilian population, Veterans in this cohort were older and had higher rates of preoperative hearing aid use. Available VA data suggest most Veterans were appropriate candidates for cochlear implant referral years prior to undergoing an evaluation. Reasons for treatment delays in this population remain to be studied.
Collapse
Affiliation(s)
- Colleen A O'Brien
- Department of Otolaryngology-Head & Neck Surgery, NYU Grossman School of Medicine, New York, NY
| | - Susan B Waltzman
- Department of Otolaryngology-Head & Neck Surgery, NYU Grossman School of Medicine, New York, NY
| | - Joshua Chodosh
- VA New York Harbor Healthcare System, New York.,Department of Medicine, NYU Grossman School of Medicine, New York, NY
| | - David R Friedmann
- Department of Otolaryngology-Head & Neck Surgery, NYU Grossman School of Medicine, New York, NY.,VA New York Harbor Healthcare System, New York
| |
Collapse
|
2
|
Conversations in Cochlear Implantation: The Inner Ear Therapy of Today. Biomolecules 2022; 12:biom12050649. [PMID: 35625577 PMCID: PMC9138212 DOI: 10.3390/biom12050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023] Open
Abstract
As biomolecular approaches for hearing restoration in profound sensorineural hearing loss evolve, they will be applied in conjunction with or instead of cochlear implants. An understanding of the current state-of-the-art of this technology, including its advantages, disadvantages, and its potential for delivering and interacting with biomolecular hearing restoration approaches, is helpful for designing modern hearing-restoration strategies. Cochlear implants (CI) have evolved over the last four decades to restore hearing more effectively, in more people, with diverse indications. This evolution has been driven by advances in technology, surgery, and healthcare delivery. Here, we offer a practical treatise on the state of cochlear implantation directed towards developing the next generation of inner ear therapeutics. We aim to capture and distill conversations ongoing in CI research, development, and clinical management. In this review, we discuss successes and physiological constraints of hearing with an implant, common surgical approaches and electrode arrays, new indications and outcome measures for implantation, and barriers to CI utilization. Additionally, we compare cochlear implantation with biomolecular and pharmacological approaches, consider strategies to combine these approaches, and identify unmet medical needs with cochlear implants. The strengths and weaknesses of modern implantation highlighted here can mark opportunities for continued progress or improvement in the design and delivery of the next generation of inner ear therapeutics.
Collapse
|
3
|
DeVries J, Ren Y, Purdy J, Carvalho D, Kari E. Exploring Factors Responsible for Delay in Pediatric Cochlear Implantation. Otol Neurotol 2021; 42:e1478-e1485. [PMID: 34608001 DOI: 10.1097/mao.0000000000003321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify and characterize demographic and socioeconomic factors associated with delays in cochlear implantation (CI) in children. STUDY DESIGN Retrospective. SETTING Tertiary pediatric CI referral center. PATIENTS All patients under 18 years of age receiving CI between March 2018 and February 2020. INTERVENTIONS CI. MAIN OUTCOME MEASURES Primary outcome measures included age at implantation and time from hearing loss diagnosis and candidacy evaluation to CI. RESULTS Seventy-two patients were identified (44% women, average age at implantation 4.9 yr). Age at implantation was older in patients with public, rather than private, insurance (6.0 ± 0.8 yr versus 3.1 ± 0.7 yr, p = 0.007) and those from low-income areas (8.6 ± 7.6 yr versus 2.4 ± 3.0 yr, p = 0.007). Time between hearing loss diagnosis and implantation was longer in publicly insured patients (4.1 ± 0.6 yr versus 2.2 ± 0.5 yr, p = 0.014). Time between identification as a CI candidate and implantation was longer in publicly insured patients (721 ± 107d versus 291 ± 64 d, p = 0.001). Among children with congenital profound hearing loss, publicly insured patients continued to be older at implantation (1.9 ± 0.2 versus 1.0 ± 0.2 yr, p = 0.008). Latinx children were more often publicly insured whereas white children were more often privately insured (p < 0.05). Publicly insured patients had delays in the pre-CI workup, including, in no particular order, vestibular evaluation (621 ± 132 d versus 197 ± 67 d, p = 0.007), developmental evaluation (517 ± 106 d versus 150 ± 56 d, p = 0.003), speech evaluation (482 ± 107 d versus 163 ± 65 d, p = 0.013), and children's implant profile (ChIP) assessment (572 ± 107d versus 184 ± 59d, p = 0,002). On ChIP evaluation, concerns regarding educational environment and support were higher in Spanish-speaking children (p = 0.024; p = 2.6 × 10-4) and children with public insurance (p = 0.016; p = 0.002). CONCLUSIONS Disparities in access to CI continue to affect timing of pediatric cochlear implantation.
Collapse
Affiliation(s)
- Jacquelyn DeVries
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California
| | - Yin Ren
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California
| | - Julie Purdy
- Division of Otolaryngology, Rady Children's Hospital, San Diego, California
| | - Daniela Carvalho
- Division of Otolaryngology, Rady Children's Hospital, San Diego, California
| | - Elina Kari
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California
| |
Collapse
|
4
|
Steinhardt CR, Fridman GY. A Machine Learning-based Neural Implant Front End for Inducing Naturalistic Firing. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5713-5718. [PMID: 34892418 DOI: 10.1109/embc46164.2021.9630548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite being able to restore speech perception with 99% success rate, cochlear implants cannot successfully restore pitch perception or music appreciation. Studies suggest that if auditory neurons were activated with fine timing closer to that of natural responses pitch would be restored. Predicting the timing of cochlear responses requires detailed biophysical models of sound transmission, inner hair cell responses, and outer hair cell responses. Performing these calculations is computationally costly for real time cochlear implant stimulation. Instead, implants typically modulate pulse amplitude of fixed pulse rate stimulation with the band-limited envelopes of incoming sound. This method is known to produce unrealistic responses, even to simple step inputs. Here we investigate using a machine learning algorithm to optimize the prediction of the desired firing patterns of the auditory afferents in response to sinusoidal and step modulation of pure tones. We conclude that a trained network that consists of 25 GRU nodes can reproduce fine timing with 4.4 percent error on a test set of sines and steps. This trained network can also transfer learn and capture features of natural sounds that are not captured by standard CI algorithms. Additionally, for 0.5 second test inputs, the ML algorithm completed the sound to spike rate conversion in 300x less time than the phenomenological model. This calculation occurs at a real-time compatible rate of 1 ms for 1 second of spike timing prediction on an i9 microprocessor. This suggests that this is a feasible approach to pursue for real-time CI implementation.
Collapse
|
5
|
Nassiri AM, Marinelli JP, Sorkin DL, Carlson ML. Barriers to Adult Cochlear Implant Care in the United States: An Analysis of Health Care Delivery. Semin Hear 2021; 42:311-320. [PMID: 34912159 PMCID: PMC8660164 DOI: 10.1055/s-0041-1739281] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Persistent underutilization of cochlear implants (CIs) in the United States is in part a reflection of a lack of hearing health knowledge and the complexities of care delivery in the treatment of sensorineural hearing loss. An evaluation of the patient experience through the CI health care delivery process systematically exposes barriers that must be overcome to undergo treatment for moderate-to-severe hearing loss. This review analyzes patient-facing obstacles including diagnosis of hearing loss, CI candidate identification and referral to surgeon, CI evaluation and candidacy criteria interpretation, and lastly CI surgery and rehabilitation. Pervasive throughout the process are several themes which demand attention in addressing inequities in hearing health disparities in the United States.
Collapse
Affiliation(s)
- Ashley M. Nassiri
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - John P. Marinelli
- Department of Otolaryngology - Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | | | - Matthew L. Carlson
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
6
|
Marinelli JP, Carlson ML. Barriers to Access and Health Care Disparities Associated With Cochlear Implantation Among Adults in the United States. Mayo Clin Proc 2021; 96:547-549. [PMID: 33673908 DOI: 10.1016/j.mayocp.2020.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/25/2020] [Indexed: 10/22/2022]
Affiliation(s)
- John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, TX
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery and Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
7
|
Barnes JH, Yin LX, Marinelli JP, Carlson ML. Audiometric Profile of Cochlear Implant Recipients Demonstrates Need for Revising Insurance Coverage. Laryngoscope 2020; 131:E2007-E. [PMID: 33347621 DOI: 10.1002/lary.29334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the pre-implant audiometric profile of adult cochlear implant (CI) recipients to investigate whether current binaural candidacy requirements prevent access to patients who could benefit from CI. STUDY DESIGN Retrospective case series. METHODS Retrospective review from 2016 to 2018 evaluating preoperative pure-tone thresholds and speech perception scores in the ipsilateral and contralateral ear. RESULTS A total of 252 adult CI recipients undergoing 270 implants were identified. Median age at time of implantation was 70.5 years (IQR 61.3-78.3) for those undergoing unilateral implantation and 59.0 (IQR 48.0-72.3) for those undergoing bilateral implantation (P < .01). For unilateral implantation, median pre-implantation speech perception performance in the ear to be implanted was 8.0% (IQR 0%-26.0%) for CNC word scores, and 9.0% (IQR 0%-34.0%) for AzBio sentence scores in quiet. Median speech perception performance in the contralateral ear was 36.0% (IQR 14.0%-60.0%) on CNC word scores, and 48.5% (IQR 17.5%-76.0%) on AzBio sentence tests. Speech perception scores were significantly different between ears for word and sentence tests (P < .01). Patients older than age 65 were significantly less likely to undergo bilateral implantation (P = .03). CONCLUSIONS Adult CI recipients exhibit substantially poorer pre-implant speech perception scores than the commonly utilized ipsilateral qualifying threshold of 50% on sentence testing. Yet, existing insurance paradigms limit patients by excessively stringent binaural best-aided requirements. This limitation likely leads to worse device performance as patients often wait years for their binaural hearing to qualify while their ear to be implanted potentially experiences an unnecessarily extended duration of deafness. Older patients also experience a unique delay in referral for cochlear implantation. LEVEL OF EVIDENCE 3- Retrospective review Laryngoscope, 131:E2007-E2012, 2021.
Collapse
Affiliation(s)
- Jason H Barnes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| |
Collapse
|
8
|
West NC, Kressner AA, Baungaard LH, Sandvej MG, Bille M, Cayé-Thomasen P. Nordic results of cochlear implantation in adults: speech perception and patient reported outcomes. Acta Otolaryngol 2020; 140:939-947. [PMID: 32957807 DOI: 10.1080/00016489.2020.1816656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although cochlear implantation (CI) is widely performed in postlingually hearing-impaired adults in the Nordic countries, the literature on hearing outcomes remains scarce. Aims/objectives: To evaluate and correlate hearing outcomes after implantation. METHODS Prospective evaluation of 40 adult first-implantation recipients pre- and post-implantation with Dantale, the Danish Hearing in Noise Test (HINT), the Nijmegen Cochlear Implant Questionnaire (NCIQ) and the Speech, Spatial and Qualities of Hearing Scale (SSQ12). RESULTS Dantalemean increased from 50% (95% CI [41.7,58.4])) to 73% (95% CI [66.6,80.1]) and 19% (95% CI [13.3,25.1]) to 40%(95% CI [32.1,46.7]) (quiet/noise). HINTwords increased from 71% (95% CI [58.8,83.8]) to 83% (95% CI [69.8,95.4]) and 59% (95% CI [46.2,70.6]) to 73% (95% CI [63.3,82.8]) (quiet/noise). NCIQmean changed from 277 (95% CI [252.4,301.6]) to 396 (95% CI [366.7,424.7]) and SSQ12mean from 27 (95% CI [21.3,31.8]) to 48 (95% CI [39.4,55.6]). Correlations coefficients were r s = 0.39-0.74 (p < .01) between Dantale/HINT, rs = 0.78 (p < .0001) between NCIQ/SSQ12, r s = 0.41-0.59 (p < .01) between NCIQ/SSQ12 and Dantale and r s = 0.24-0.41 (ns) between NCIQ/SSQ12 and HINT. CONCLUSION The study documents a high auditory performance and patient-perceived improvement after implantation and advocate broader awareness of implantation as treatment option in the growing population of severe-to-profound hearing-impaired adults. Correlations between hearing measures may influence future evaluation practices.
Collapse
Affiliation(s)
- Niels Cramer West
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Abigail Anne Kressner
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Hearing Systems, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Line Husted Baungaard
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Matilde Grønborg Sandvej
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Michael Bille
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Askew C, Chien WW. Adeno-associated virus gene replacement for recessive inner ear dysfunction: Progress and challenges. Hear Res 2020; 394:107947. [PMID: 32247629 DOI: 10.1016/j.heares.2020.107947] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 01/08/2023]
Abstract
Approximately 3 in 1000 children in the US under 4 years of age are affected by hearing loss. Currently, cochlear implants represent the only line of treatment for patients with severe to profound hearing loss, and there are no targeted drug or biological based therapies available. Gene replacement is a promising therapeutic approach for hereditary hearing loss, where viral vectors are used to deliver functional cDNA to "replace" defective genes in dysfunctional cells in the inner ear. Proof-of-concept studies have successfully used this approach to improve auditory function in mouse models of hereditary hearing loss, and human clinical trials are on the immediate horizon. The success of this method is ultimately determined by the underlying biology of the defective gene and design of the treatment strategy, relying on intervention before degeneration of the sensory structures occurs. A challenge will be the delivery of a corrective gene to the proper target within the therapeutic window of opportunity, which may be unique for each specific defective gene. Although rescue of pre-lingual forms of recessive deafness have been explored in animal models thus far, future identification of genes with post-lingual onset that are amenable to gene replacement holds even greater promise for treatment, since the therapeutic window is likely open for a much longer period of time. This review summarizes the current state of adeno-associated virus (AAV) gene replacement therapy for recessive hereditary hearing loss and discusses potential challenges and opportunities for translating inner ear gene replacement therapy for patients with hereditary hearing loss.
Collapse
Affiliation(s)
- Charles Askew
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wade W Chien
- Inner Ear Gene Therapy Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health, Bethesda, MD, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
10
|
Andries E, Gilles A, Topsakal V, Vanderveken OM, Van de Heyning P, Van Rompaey V, Mertens G. Systematic Review of Quality of Life Assessments after Cochlear Implantation in Older Adults. Audiol Neurootol 2020; 26:61-75. [PMID: 32653882 DOI: 10.1159/000508433] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022] Open
Abstract
Cochlear implants (CI) have increasingly been adopted in older adults with severe to profound sensorineural hearing loss as a result of the growing and aging world population. Consequently, researchers have recently shown great interest in the cost-effectiveness of cochlear implantation and its effect on quality of life (QoL) in older CI users. Therefore, a systematic review and critical evaluation of the available literature on QoL in older adult CI users was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected by searching MEDLINE (PubMed) and the Cochrane Library and by checking the reference lists of relevant articles. Inclusion criteria were as follows: (1) the study sample were adults aged 50 years and older with postlingual onset of bilateral severe to profound hearing loss, (2) all subjects received a multi-electrode CI, and (3) QoL was assessed before and after implantation. Out of 1,093 records, 18 articles were accepted for review. Several studies demonstrated significant positive effects of cochlear implantation on QoL in older adults, but high-level evidence-based medicine is lacking. An improvement of QoL was generally reported when using disease-specific instruments, which are designed to detect treatment-specific changes, whereas the outcomes of generic QoL questionnaires, assessing general health states, were rather ambiguous. However, only generic questionnaires would be able to provide calculations of the cost-effectiveness of CI and comparisons across patient populations, diseases, or interventions. Hence, generic and disease-specific QoL instruments are complementary rather than contradictory. In general, older CI users' QoL was assessed using a variety of methods and instruments, which complicated comparisons between studies. There is a need for a standardized, multidimensional, and comprehensive QoL study protocol including all relevant generic and disease-specific instruments to measure and compare QoL, utility, and/or daily life performance in CI users.
Collapse
Affiliation(s)
- Ellen Andries
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium, .,Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium,
| | - Annick Gilles
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium.,Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium.,Department of Education, Health and Social Work, University College Ghent (HoGent), Ghent, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium.,Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Olivier M Vanderveken
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium.,Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium.,Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium.,Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium.,Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| |
Collapse
|
11
|
Kozin ED, Brown MC, Lee DJ, Stankovic KM. Light-Based Neuronal Activation: The Future of Cranial Nerve Stimulation. Otolaryngol Clin North Am 2020; 53:171-183. [PMID: 31739905 DOI: 10.1016/j.otc.2019.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite advances in implant hardware, neuroprosthetic devices in otolaryngology have sustained evolutionary rather than revolutionary changes over the past half century. Although electrical stimulation has the capacity for facile activation of neurons and high temporal resolution, it has limited spatial selectivity. Alternative strategies for neuronal stimulation are being investigated to improve spatial resolution. In particular, light-based neuronal stimulation is a viable alternative and complement to electrical stimulation. This article provides a broad overview of light-based neuronal stimulation technologies. Specific examples of active research on light-based prostheses, including cochlear implants, auditory brainstem implants, retinal implants, and facial nerve implants, are reviewed.
Collapse
Affiliation(s)
- Elliott D Kozin
- Massachusetts Eye and Ear Infirmary and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| | - M Christian Brown
- Massachusetts Eye and Ear Infirmary and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Daniel J Lee
- Massachusetts Eye and Ear Infirmary and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Konstantina M Stankovic
- Massachusetts Eye and Ear Infirmary and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| |
Collapse
|
12
|
Kronenberger WG, Xu H, Pisoni DB. Longitudinal Development of Executive Functioning and Spoken Language Skills in Preschool-Aged Children With Cochlear Implants. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1128-1147. [PMID: 32204645 PMCID: PMC7242982 DOI: 10.1044/2019_jslhr-19-00247] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Purpose Auditory deprivation has downstream effects on the development of language and executive functioning (EF) in prelingually deaf children with cochlear implants (CIs), but little is known about the very early development of EF during preschool ages in children with CIs. This study investigated the longitudinal development of EF and spoken language skills in samples of children with normal hearing (NH; N = 40) or CIs (N = 41) during preschool ages. Method Participants were enrolled in the study between ages 3 and 6 years and evaluated annually up to the age of 7 years. Mixed-effects models were used to evaluate and predict growth of spoken language and EF skills over time. Results Children with CIs scored lower than NH peers on language measures but improved significantly over time. On performance-based neurocognitive measures of controlled attention, inhibition, and working memory, children with CIs scored more poorly than the sample of NH peers but comparable to norms, whereas on a parent report behavior checklist, children with CIs scored more poorly than both NH peers and norms on inhibition and working memory. Children with CIs had poorer EF than the sample of NH peers in most domains even after accounting for language effects, and language predicted only the verbal working memory domain of EF. In contrast, EF skills consistently predicted language skills at subsequent visits. Conclusions Findings demonstrate that, despite significant improvement over time, some domains of EF (particularly parent-reported EF) and language skills in children with CIs lag behind those of children with NH during preschool ages. Language delays do not fully explain differences in EF development between children with CIs and NH peers during preschool ages, but EF skills predict subsequent language development in children with CIs.
Collapse
Affiliation(s)
- William G. Kronenberger
- DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis
| | - David B. Pisoni
- DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| |
Collapse
|
13
|
Affiliation(s)
- Matthew L Carlson
- From the Department of Otolaryngology-Head and Neck Surgery and the Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| |
Collapse
|
14
|
Calvino M, Sánchez-Cuadrado I, Gavilán J, Lassaletta L. Does bimodal hearing increase self-assessed abilities and hearing outcomes when compared to unilateral cochlear implantation? Int J Audiol 2020; 59:654-660. [PMID: 32174222 DOI: 10.1080/14992027.2020.1735653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The primary objective of this study was to compare the applicability and benefit of providing unilateral cochlear implant (CI) users with a contralateral hearing aid (HA).Design: This retrospective (case-control) study was conducted in a hospital-based CI centre. Participants self-assessed their hearing via two questionnaires (SSQ12 and HISQUI19). Objective postoperative speech perception was assessed via aided thresholds and speech perception tests (monosyllabic words, disyllabic words, and sentences) in quiet and noise.Study sample: A CI-only group (n = 113, mean age 55.1 ± 14.2 years) and a bimodal group (n = 50, mean age 56.7 ± 15.2) participated in the study.Results: No significant difference in SSQ12 or HISQUI19 scores was observed between groups. The bimodal group had a significantly better aided hearing level (p = 0.020) and speech discrimination score (p = 0.019).Conclusions: Bimodal (CI + HA) users have significantly better speech understanding than unilateral CI-only users, although this benefit may not be reflected in self-assessed outcomes. Counselling about bimodal hearing must cover expectations about potential benefits.
Collapse
Affiliation(s)
- Miryam Calvino
- Department of Otolaryngology, "La Paz" University Hospital. IdiPAZ Research Institute, Madrid, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, (CIBERER-U761), Madrid, Spain
| | - Isabel Sánchez-Cuadrado
- Department of Otolaryngology, "La Paz" University Hospital. IdiPAZ Research Institute, Madrid, Spain
| | - Javier Gavilán
- Department of Otolaryngology, "La Paz" University Hospital. IdiPAZ Research Institute, Madrid, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, "La Paz" University Hospital. IdiPAZ Research Institute, Madrid, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, (CIBERER-U761), Madrid, Spain
| |
Collapse
|
15
|
The speech perception after cochlear implantation: The hearing gain difference according to the implant systems is important? Auris Nasus Larynx 2019; 46:330-334. [DOI: 10.1016/j.anl.2018.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
|
16
|
Byčkova J, Simonavičienė J, Mickevičienė V, Lesinskas E. Evaluation of quality of life after paediatric cochlear implantation. Acta Med Litu 2019; 25:173-184. [PMID: 30842707 PMCID: PMC6392602 DOI: 10.6001/actamedica.v25i3.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background. Cochlear implantation (CI) is the main treatment method for deaf children. CI influences not only communication, but also psychosocial outcomes in children with severe to profound hearing loss. Focusing on issues specific to CI (e.g., self-reliance, social relations, education) may provide a more accurate and relative view of functional status of paediatric cochlear implant users. The objectives of this study were to translate into Lithuanian and adapt an international questionnaire of the quality of life after cochlear implantation and to evaluate parental perspectives regarding CI and the child’s progress after a minimum of two years after surgery. Materials and methods. The parental questionnaire The Children with Cochlear Implants: Parental Perspectives CCIPP was used to evaluate the quality of life following cochlear implantation. The questionnaire includes 74 items covering two main domains: decision-making (26 items) and the outcomes of implantation (48 items). Quality of life is estimated according to the scores of eight sub-domains: communication, general functioning, well-being, self-reliance, social relations, education, effects of implantation, and supporting the child. Results. The paediatric sample consisted of 11 (39%) girls and 17 (61%) boys, whose mean age at the time of cochlear implantation was 2.41 ± 2.25 years, mean duration of the implant use 3.7 ± 1.3 years. All the grand means in the outcomes of implantation domain exceeded 3 on the 5-point scale, meaning that parents viewed the quality of life of their children as either average or better. Parents rated the sub-domains of communication (3.90 ± 0.77 points), social relations (4.05 ± 0.41), and supporting the child (3.89 ± 0.49) most positively. Conclusions. According to parents, the quality of life improves after the cochlear implantation, especially in the fields of communication, social relations and supporting the child.
Collapse
Affiliation(s)
- Jekaterina Byčkova
- Clinic of Ear, Nose, Throat and Eye Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Paediatric Otolaryngology and Ophthalmology Department, Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Justė Simonavičienė
- Paediatric Otolaryngology and Ophthalmology Department, Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vaiva Mickevičienė
- Paediatric Otolaryngology and Ophthalmology Department, Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Eugenijus Lesinskas
- Clinic of Ear, Nose, Throat and Eye Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| |
Collapse
|
17
|
Vieira SDS, Dupas G, Chiari BM. Effects of cochlear implantation on adulthood. Codas 2018; 30:e20180001. [PMID: 30517268 DOI: 10.1590/2317-1782/20182018001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/16/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To understand the benefits of cochlear implantation in adulthood under the perspective of users. METHODS Qualitative study using Symbolic Interactionism and Straussian Grounded Theory as theoretical and methodological frameworks, respectively. The project was approved by the Research Ethics Committee of the aforementioned Institution (Opinion no. 482,019). Sixteen adult cochlear implant (CI) users aged 28-58 years participated in the study. The data collection instrument was a semi-structured interview with questions about changes caused by CI in the social relations, communication, family system, and personal, academic and professional spheres of life of users. RESULTS The category Cochlear Implant Effects on Adulthood is part of a more comprehensive theoretical study that addresses how adult CI users cope with deafness. Together with its subcategories, it shows that CI intervenes in a revolutionary way in the lives of its users, because it increases their sense of security, enables them to see life from a new perspective, rescues self-confidence and self-esteem, enables them to communicate and interact more effectively, enjoy music and other entertainment, rescue old projects, and make plans for the future; thus assisting with the process of recovering independence in adult life. CONCLUSION Subjective impressions of the users showed that cochlear implants not only improve their auditory performance, but also bring several positive changes to their social insertion and quality of life. Therefore, this intervention is highly beneficial to deaf adults.
Collapse
Affiliation(s)
- Sheila de Souza Vieira
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil
| | - Giselle Dupas
- Departamento de Enfermagem, Universidade Federal de São Carlos - UFSCar - São Carlos (SP), Brasil
| | - Brasilia Maria Chiari
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil
| |
Collapse
|
18
|
Abstract
OBJECTIVE Immunosuppressed individuals who have undergone organ transplants, especially children, pose particular challenges in terms of treatment. The aim of this study was to analyze the postoperative complication rate of organ transplant recipients who have also received a cochlear implant (CI). STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. INTERVENTION The case series includes 13 kidney, liver, lung, and heart transplant patients. Age at treatment ranged from 2 to 71 years, with a total of 17 CIs. MAIN OUTCOME MEASURES Postoperative complications were classified into major and minor, early (within 3 mo postoperatively) and late (>3 mo postoperatively). The results were compared with those for 13 1:1 matched pairs obtained and from our database and a healthy patient collective from our department. RESULTS The global postoperative complication rate was 29.4%. The proportion of patients suffering major complications was 17.6%, with 17.6% having minor complications. Complications that occurred early accounted for 13.3%, and late for 26.7%. No adults, and 33.0% of children, showed any complications after cochlear implantation. The global complication rate (29.4%) was significantly increased compared with the matched pairs (0%, p = 0.013) and department data (13.8%, p = 0.006; Cramers v = 0.102). CONCLUSION This study demonstrates that organ transplant recipients, and especially children, are at increased risk of postoperative complications after cochlear implantation in comparison with healthy CI recipients.
Collapse
|
19
|
Abstract
Hearing loss (HL) is a common sensory impairment in humans, with significant economic and social impacts. With nearly 20% of the world's population, China has focused on economic development and health awareness to improve the care for its hearing-impaired population. Recently, the Chinese government has initiated national programs such as the China Disabled Persons Federation to fund prevention, treatment, and rehabilitation of hearing impairment. Newborn hearing screening and auditory rehabilitation programs in China have expanded exponentially with government support. While facing many challenges and overcoming obstacles, cochlear implantation (CI) programs in China have also experienced considerable growth. This review discusses the implementation of CI programs for HL in China and presents current HL data including epidemiology, newborn hearing screening, and determination of genetic etiologies. Sharing the experience in Chinese auditory rehabilitation and CI programs will shine a light on the developmental pathway of healthcare infrastructure to meet emerging needs of the hearing-impaired population in other developing countries.
Collapse
|
20
|
Crowson MG, Semenov YR, Tucci DL, Niparko JK. Quality of Life and Cost-Effectiveness of Cochlear Implants: A Narrative Review. Audiol Neurootol 2017; 22:236-258. [PMID: 29262414 DOI: 10.1159/000481767] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 09/21/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To review evidence regarding the health-related quality of life (HRQoL) and cost-effectiveness of unilateral and bilateral cochlear implantation (CI) among children and adults with severe-to-profound hearing loss. STUDY DESIGN Narrative review. METHODS Publications related to quality of life (QoL) and costs of care in CI were acquired through searches in English-language databases. Studies were included if they had identified the HRQoL attainment, cost of care, cost-utility, or cost-effectiveness associated with CI. RESULTS 57 studies were critically reviewed. The QoL outcome metrics used in these articles were divided into 2 categories - generic and condition specific. In studies investigating children, many reported no significant difference in QoL attainment between CI recipients and normal-hearing peers. In adults, significant improvements in QoL after implantation and higher QoL than in their nonimplanted (hearing-aided) peers were frequently reported. Studies involving an older adult cohort reported significant improvement in QoL after implantation, which was often independent of audiological performance. Overall, the calculated cost-utility ratios consistently met the threshold of cost acceptance, indicating acceptable values for expenditures on CI. CONCLUSIONS Considerable work has been done on the QoL attainment and health economic implications of CI. Unilateral CI across all age groups leads to reported sustained benefits in the recipients' overall and disease-specific QoL. With increased cost associated with bilateral CI, further study is needed to characterize its costs and benefits with respect to the recipients' health, well-being, and contributions to society.
Collapse
Affiliation(s)
- Matthew G Crowson
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | |
Collapse
|
21
|
Abstract
Cochlear implants treat severe hearing loss by providing direct electrical stimulation to auditory nerve endings. This article reviews the clinical assessment, surgical procedure and outcomes, and looks at newer developments such as preservation of residual hearing and bilateral implantation.
Collapse
Affiliation(s)
- Daniel Hajioff
- Consultant Ear, Nose and Throat Surgeon, Department of Otolaryngology, University Hospitals Bristol NHS Trust, St Michael's Hospital, Bristol BS2 8EG
| |
Collapse
|
22
|
Gubbels SP, Gartrell BC, Ploch JL, Hanson KD. Can routine office-based audiometry predict cochlear implant evaluation results? Laryngoscope 2016; 127:216-222. [PMID: 27797418 DOI: 10.1002/lary.26066] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/17/2016] [Accepted: 03/28/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Determining cochlear implant candidacy requires a specific sentence-level testing paradigm in best-aided conditions. Our objective was to determine if findings on routine audiometry could predict the results of a formal cochlear implant candidacy evaluation. We hypothesize that findings on routine audiometry will accurately predict cochlear implant evaluation results in the majority of candidates. STUDY DESIGN Retrospective, observational, diagnostic study. METHODS The charts of all adult patients who were evaluated for implant candidacy at a tertiary care center from June 2008 through June 2013 were included. Routine, unaided audiologic measures (pure-tone hearing thresholds and recorded monosyllabic word recognition testing) were then correlated with best-aided sentence-level discrimination testing (using either the Hearing in Noise Test or AzBio sentences test). RESULTS The degree of hearing loss at 250 to 4,000 Hz and monosyllabic word recognition scores significantly correlated with sentence-level word discrimination test results. Extrapolating from this association, we found that 86% of patients with monosyllabic word recognition scores at or below 32% (or 44% for patients with private insurance) would meet candidacy requirements for cochlear implantation. CONCLUSIONS Routine audiometric findings can be used to identify patients who are likely to meet cochlear implant candidacy upon formal testing. For example, patients with pure-tone thresholds (250, 500, 1,000 Hz) of ≥75 dB and/or a monosyllabic word recognition test score of ≤40% have a high likelihood of meeting candidacy criteria. Utilization of these predictive patterns during routine audiometric evaluation may assist hearing health professionals in deciding when to refer patients for a formal cochlear implant evaluation. LEVEL OF EVIDENCE 4 Laryngoscope, 127:216-222, 2017.
Collapse
Affiliation(s)
- Samuel P Gubbels
- Department of Otolaryngology, University of Colorado, School of Medicine, Aurora, Colorado.,Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin
| | - Brian C Gartrell
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin.,Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jennifer L Ploch
- Department of Surgery, Division of Audiology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin
| | - Kevin D Hanson
- University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| |
Collapse
|
23
|
Thomas Roland J, Buchman C, Eisenberg L, Henderson L, He S, Firszt J, Francis H, Dunn C, Sladen D, Arndt S, May B, Zeitler D, Niparko JK, Emmett S, Tucci D, Chen J, McConkey Robbins A, Schwefler E, Geers A, Lederberg A, Hayes H, Hughes M, Bierer J, Schafer E, Sorkin D, Kozma-Spytek L, Childress T. Proceedings of the Annual Symposium of the American Cochlear Implant Alliance. Cochlear Implants Int 2016; 17:211-237. [PMID: 27635521 PMCID: PMC5062039 DOI: 10.1080/14670100.2016.1225348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
| | | | | | | | - Shuman He
- e Boys Town National Research Hospital (previously University of North Carolina)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle Hughes
- e Boys Town National Research Hospital (previously University of North Carolina)
| | | | | | | | | | | |
Collapse
|
24
|
Zaidman-Zait A, Curle D. Complexity: An interpretative phenomenological analysis of the experiences of mothers of deaf children with cochlear implants and autism. J Health Psychol 2016; 23:1173-1184. [DOI: 10.1177/1359105316646171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to explore the experiences of parenting a child with a dual diagnosis of childhood deafness and autism spectrum disorder who underwent cochlear implantation. Experiences of these parents are rarely discussed within the literature. Interpretive Phenomenological Analysis was used to examine nine mothers of boys (4–9 years old) for understanding their parenting experiences. Three superordinate themes were identified: complexity, personal and family sacrifices and parent–professional partnerships. These themes provide a rich account of mothers’ interpretations of their experiences, and reflect the numerous challenges they face. This study helps expand the literature on cochlear implantation for children with autism spectrum disorder, and discusses implications for clinical and educational practice.
Collapse
|
25
|
Sun DQ, Ward BK, Semenov YR, Carey JP, Della Santina CC. Bilateral Vestibular Deficiency: Quality of Life and Economic Implications. JAMA Otolaryngol Head Neck Surg 2015; 140:527-34. [PMID: 24763518 DOI: 10.1001/jamaoto.2014.490] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Bilateral vestibular deficiency (BVD) causes chronic imbalance and unsteady vision and greatly increases the risk of falls; however, its effects on quality of life and economic impact are not well defined. OBJECTIVE To quantify disease-specific and health-related quality of life, health care utilization, and economic impact on individuals with BVD in comparison with those with unilateral vestibular deficiency (UVD). DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey study of patients with BVD or UVD and healthy controls at an academic medical center. Vestibular dysfunction was diagnosed by means of caloric nystagmography. INTERVENTIONS Survey questionnaire. MAIN OUTCOMES AND MEASURES Health status was measured using the Dizziness Handicap Index (DHI) and Health Utility Index Mark 3 (HUI3). Economic burden was estimated using participant responses to questions on disease-specific health care utilization and lost productivity. RESULTS Fifteen patients with BVD, 22 with UVD, and 23 healthy controls participated. In comparison with patients with UVD and controls, patients with BVD had significantly worse DHI (P < .001) and HUI3 scores. Statistically significant between-group differences were observed for overall HUI3 score (P < .001) and for specific attributes including vision, hearing, ambulation, emotion, and pain (P < .001 for all). Generalized linear model analysis of clinical variables associated with HUI3 scores after adjustment for other variables (including sex, race, education, age, and frequency of dizziness-related outpatient clinic visits) showed that the presence of UVD (P < .001) or BVD (P < .001), increased dizziness-related emergency room visits (P = .002), and increased dizziness-related missed work days (P < .001) were independently associated with worse HUI3 scores. Patients with BVD and UVD incurred estimated mean (range) annual economic burdens of $13,019 ($0-$48,830) and $3531 ($0-$48,442) per patient, respectively. CONCLUSIONS AND RELEVANCE Bilateral vestibular deficiency significantly decreases quality of life and imposes substantial economic burdens on individuals and society. These results underscore the limits of adaptation and compensation in BVD. Furthermore, they quantify the potential benefits of prosthetic restoration of vestibular function both to these individuals and to society.
Collapse
Affiliation(s)
- Daniel Q Sun
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yevgeniy R Semenov
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John P Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles C Della Santina
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland2Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
26
|
Francis HW, Papel I, Lina I, Koch W, Tunkel D, Fuchs P, Lin S, Kennedy D, Ruben R, Linthicum F, Marsh B, Best S, Carey J, Lane A, Byrne P, Flint P, Eisele DW. Otolaryngology-head and neck surgery at Johns Hopkins: The first 100 years (1914-2014). Laryngoscope 2015; 125 Suppl 9:S1-35. [PMID: 26297867 PMCID: PMC4696071 DOI: 10.1002/lary.25490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Howard W Francis
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Ira Papel
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Ioan Lina
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - David Tunkel
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Paul Fuchs
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Sandra Lin
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - David Kennedy
- the Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Ruben
- the Departments ofOtorhinolaryngology-Head and Neck Surgery and Pediatrics, Albert Einstein College of Medicine Montefiore Medical Center, New York, New York
| | - Fred Linthicum
- the Department of Otolaryngology-Head and Neck Surgery, University of California at Los Angeles, Los Angeles, California
| | - Bernard Marsh
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Simon Best
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - John Carey
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Andrew Lane
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Patrick Byrne
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Paul Flint
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, U.S.A
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
27
|
Calvino M, Gavilán J, Sánchez-Cuadrado I, Pérez-Mora RM, Muñoz E, Díez-Sebastián J, Lassaletta L. Using the HISQUI29 to assess the sound quality levels of Spanish adults with unilateral cochlear implants and no contralateral hearing. Eur Arch Otorhinolaryngol 2015; 273:2343-53. [PMID: 26440105 DOI: 10.1007/s00405-015-3789-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
Abstract
To evaluate cochlear implant (CI) users' self-reported level of sound quality and quality of life (QoL). Sound quality was self-evaluated using the hearing implant sound quality index (HISQUI29). HISQUI29 scores were further examined in three subsets. QoL was self-evaluated using the glasgow benefit inventory (GBI). GBI scores were further examined in three subsets. Possible correlations between the HISQUI29 and GBI were explored. Additional possible correlations between these scores and subjects' pure tone averages, speech perception scores, age at implantation, duration of hearing loss, duration of CI use, gender, and implant type were explored. Subjects derived a "moderate" sound quality level from their CI. Television, radio, and telephone tasks were easier in quiet than in background noise. 89 % of subjects reported their QoL benefited from having a CI. Mean total HISQUI29 score significantly correlated with all subcategories of the GBI. Age at implantation inversely correlated with the total HISQUI29 score and with television and radio understanding. Sentence in noise scores significantly correlated with all sound perception scores. Women had a better mean score in music perception and in telephone use than did men. CI users' self-reported levels of sound quality significantly correlated with their QoL. Cochlear implantation had a beneficial impact on subjects' QoL. Understanding speech is easier in quiet than in noise. Music perception remains a challenge for many CI users. The HISQUI29 and the GBI can provide useful information about the everyday effects of future treatment modalities, rehabilitation strategies, and technical developments.
Collapse
Affiliation(s)
- Miryam Calvino
- Department of Otolaryngology, IdiPAZ Research Institute, La Paz University Hospital, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Javier Gavilán
- Department of Otolaryngology, IdiPAZ Research Institute, La Paz University Hospital, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Isabel Sánchez-Cuadrado
- Department of Otolaryngology, IdiPAZ Research Institute, La Paz University Hospital, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Rosa M Pérez-Mora
- Department of Otolaryngology, IdiPAZ Research Institute, La Paz University Hospital, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Elena Muñoz
- Department of Otolaryngology, IdiPAZ Research Institute, La Paz University Hospital, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Jesús Díez-Sebastián
- Clinical Epidemiology Unit, La Paz University Hospital, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, IdiPAZ Research Institute, La Paz University Hospital, Paseo de La Castellana 261, 28046, Madrid, Spain.
| |
Collapse
|
28
|
Borger D, Lina-Granade G, Verneyre S, Thai-Van H, Saaï S, Hoen M, Gnansia D, Truy E. One-Year Follow Up of Auditory Performance in Post-Lingually Deafened Adults Implanted with the Neurelec Digisonic(®) SP/Saphyr(®) Neo Cochlear Implant System. Audiol Res 2015; 5:139. [PMID: 26779331 PMCID: PMC4698604 DOI: 10.4081/audiores.2015.139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/01/2015] [Indexed: 11/30/2022] Open
Abstract
This study aimed to quantify outcomes in a group of patients who were implanted with an Oticon Medical Neurelec (Vallauris, France) cochlear implant system, the Digisonic® SP/Saphyr® Neo. Ten participants took part in this preliminary study. Their speech perception capacities were evaluated at 3, 6, and 12-months after cochlear implant activation and compared to pre-implantation scores and to scores observed with former versions of the sound processor. Compared to former versions of the sound processor, patients using the Saphyr® Neo processor obtained better speech perception scores for sentences in silence at each tests session (3 months: 79%, 6 months: 82% and 12 months: 94%) compared to Digisonic® users (respectively: 58%, 69% and 75%) and Convex sound processor users (resp. 39%, 59% and 51%). These observations confirm that the technological improvements made in the Saphyr® Neo sound processor coupled with the Digisonic® implant, provided quantifiable benefits in speech perception in Quiet compared to former versions of the processor Convex and Digisonic® SP.
Collapse
Affiliation(s)
| | | | | | | | - Sonia Saaï
- Oticon Medical - Neurelec , Vallauris, France
| | - Michel Hoen
- Oticon Medical - Neurelec , Vallauris, France
| | - Dan Gnansia
- Oticon Medical - Neurelec , Vallauris, France
| | | |
Collapse
|
29
|
Thompson DM, Koppes AN, Hardy JG, Schmidt CE. Electrical stimuli in the central nervous system microenvironment. Annu Rev Biomed Eng 2015; 16:397-430. [PMID: 25014787 DOI: 10.1146/annurev-bioeng-121813-120655] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electrical stimulation to manipulate the central nervous system (CNS) has been applied as early as the 1750s to produce visual sensations of light. Deep brain stimulation (DBS), cochlear implants, visual prosthetics, and functional electrical stimulation (FES) are being applied in the clinic to treat a wide array of neurological diseases, disorders, and injuries. This review describes the history of electrical stimulation of the CNS microenvironment; recent advances in electrical stimulation of the CNS, including DBS to treat essential tremor, Parkinson's disease, and depression; FES for the treatment of spinal cord injuries; and alternative electrical devices to restore vision and hearing via neuroprosthetics (retinal and cochlear implants). It also discusses the role of electrical cues during development and following injury and, importantly, manipulation of these endogenous cues to support regeneration of neural tissue.
Collapse
Affiliation(s)
- Deanna M Thompson
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York 12180;
| | | | | | | |
Collapse
|
30
|
Schwab B, Gandolfi M, Lai E, Reilly E, Singer L, Kim AH. The Impact of Age on Cochlear Implant Performance. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ijohns.2015.45056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
31
|
Tao D, Deng R, Jiang Y, Galvin JJ, Fu QJ, Chen B. Contribution of auditory working memory to speech understanding in mandarin-speaking cochlear implant users. PLoS One 2014; 9:e99096. [PMID: 24921934 PMCID: PMC4055598 DOI: 10.1371/journal.pone.0099096] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 05/10/2014] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To investigate how auditory working memory relates to speech perception performance by Mandarin-speaking cochlear implant (CI) users. METHOD Auditory working memory and speech perception was measured in Mandarin-speaking CI and normal-hearing (NH) participants. Working memory capacity was measured using forward digit span and backward digit span; working memory efficiency was measured using articulation rate. Speech perception was assessed with: (a) word-in-sentence recognition in quiet, (b) word-in-sentence recognition in speech-shaped steady noise at +5 dB signal-to-noise ratio, (c) Chinese disyllable recognition in quiet, (d) Chinese lexical tone recognition in quiet. Self-reported school rank was also collected regarding performance in schoolwork. RESULTS There was large inter-subject variability in auditory working memory and speech performance for CI participants. Working memory and speech performance were significantly poorer for CI than for NH participants. All three working memory measures were strongly correlated with each other for both CI and NH participants. Partial correlation analyses were performed on the CI data while controlling for demographic variables. Working memory efficiency was significantly correlated only with sentence recognition in quiet when working memory capacity was partialled out. Working memory capacity was correlated with disyllable recognition and school rank when efficiency was partialled out. There was no correlation between working memory and lexical tone recognition in the present CI participants. CONCLUSIONS Mandarin-speaking CI users experience significant deficits in auditory working memory and speech performance compared with NH listeners. The present data suggest that auditory working memory may contribute to CI users' difficulties in speech understanding. The present pattern of results with Mandarin-speaking CI users is consistent with previous auditory working memory studies with English-speaking CI users, suggesting that the lexical importance of voice pitch cues (albeit poorly coded by the CI) did not influence the relationship between working memory and speech perception.
Collapse
Affiliation(s)
- Duoduo Tao
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China; Division of Communication and Auditory Neuroscience, House Research Institute, Los Angeles, California, United States of America
| | - Rui Deng
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Ye Jiang
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - John J Galvin
- Division of Communication and Auditory Neuroscience, House Research Institute, Los Angeles, California, United States of America; Department of Head and Neck Surgery, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Qian-Jie Fu
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China; Division of Communication and Auditory Neuroscience, House Research Institute, Los Angeles, California, United States of America; Department of Head and Neck Surgery, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Bing Chen
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| |
Collapse
|
32
|
Neuroscience and education: prime time to build the bridge. Nat Neurosci 2014; 17:497-502. [PMID: 24671066 DOI: 10.1038/nn.3672] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 02/05/2014] [Indexed: 02/06/2023]
Abstract
As neuroscience gains social traction and entices media attention, the notion that education has much to benefit from brain research becomes increasingly popular. However, it has been argued that the fundamental bridge toward education is cognitive psychology, not neuroscience. We discuss four specific cases in which neuroscience synergizes with other disciplines to serve education, ranging from very general physiological aspects of human learning such as nutrition, exercise and sleep, to brain architectures that shape the way we acquire language and reading, and neuroscience tools that increasingly allow the early detection of cognitive deficits, especially in preverbal infants. Neuroscience methods, tools and theoretical frameworks have broadened our understanding of the mind in a way that is highly relevant to educational practice. Although the bridge's cement is still fresh, we argue why it is prime time to march over it.
Collapse
|
33
|
Puram SV, Roberts DS, Niesten MEF, Dilger AE, Lee DJ. Cochlear implant outcomes in patients with superior canal dehiscence. Cochlear Implants Int 2013; 16:213-21. [PMID: 24074366 DOI: 10.1179/1754762813y.0000000044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To determine whether adult cochlear implant (CI) users with superior canal dehiscence syndrome (SCDS) or asymptomatic superior semicircular canal dehiscence (SCD) have different surgical, vestibular, and audiologic outcomes when compared to CI users with normal temporal bone anatomy. METHODS A retrospective single institution review of CI users with either superior semicircular canal dehiscence syndrome or asymptomatic superior semicircular canal dehiscence identified eight post-lingually deafened adults with unilateral or bilateral cochlear implantation between 2006 and 2010. Preoperative and postoperative speech perception scores as well as medical and epidemiological data were recorded and analyzed. RESULTS One patient with superior canal dehiscence syndrome and seven patients with asymptomatic superior semicircular canal dehiscence were identified, representing 7% or 8/113 of CI patients that fulfilled selection criteria. Average dehiscence length was 3.3 mm ± 0.79 SEM. Three patients received bilateral implants and five patients received a unilateral implant. Among asymptomatic superior semicircular canal dehiscence patients, subjective rates of post-operative dizziness were similar to those seen in patients with normal temporal bone anatomy (12.5 % vs. 15.9%, respectively). Speech perception abilities after surgery were poorer in SCD patients compared to the non-SCD cohort (Consonant Nucleus Consonant 33.7 ± 7.78 SEM vs. 56.7 ± 2.15 SEM P = 0.011), although both groups improved substantially relative to pre-operative performance. We also completed detailed analyses of auditory and vestibular outcomes in one patient with SCDS who underwent CI surgery in the symptomatic ear, which demonstrated preservation of vestibular function post-operatively, improved quality-of-life measures, and reduced dizziness symptomatology. CONCLUSIONS Our data suggest that patients with asymptomatic superior canal dehiscence at the time of CI surgery have similar albeit decreased speech perception scores compared to non-SCD adult CI users. Subjective rate of dizziness or vertigo following CI surgery was similar in both asymptomatic SCD and non-SCD cohorts, with detailed analyses of a single symptomatic SCD patient revealing improved vestibular function and reduced SCD symptoms following CI.
Collapse
|