Cochlear implantation and quality of life in postlingually deaf adults: Long-term follow-up

[Adaptation and Validation for European Portuguese of the Auditory Performance Categories-II and Infant-Toddler Meaningful Auditory Integration Scale for Children with Cochlear Implant]

INTRODUCTION

The Categories of Auditory Performance II (CAP-II) scale and the Infant-Toddler Meaningful Audit Integration Scale (IT-MAIS) are simple and quick questionnaires that allow assessment of the auditory performance of children with cochlear implant (CI). The aim of this study was to translate, adapt and validate the European Portuguese version of the CAP-II and IT-MAIS scales.

METHODS

A total of 85 participants completed the European Portuguese version of the CAP-II and IT-MAIS questionnaires, of which 45 were parents of children with pediatric cochlear implants (9.84 ± 4.22 years) and another 40 were parents of children with normal hearing (8.35 ± 3.56 years). Inter-rater reproducibility, test-retest reproducibility, comparison of study group versus control group results, internal consistency and correlation of the new scales were evaluated.

RESULTS

The CAP-II and IT-MAIS scales showed high reliability and reproducibility, respectively, with an intraclass correlation coefficient (ICC) of 0.979 (p < 0.001) and a Spearman's correlation of 0.924 for the CAP-II scale, and an ICC of 0.932 (p < 0.001) and Spearman's correlation coefficient of 0.732 for the IT-MAIS scale. The IT-MAIS and CAP-II versions showed strong internal consistency (Cronbach's α coefficient value of 0.887 for the CAP-II scale and Spearman's positive correlation of 0.677 for the IT-MAIS scale, respectively) and allowed for the differentiation between children with normal hearing and post-implantation children (p = 0.001 and p < 0.001 respectively for each of the scales). There was no association between parental education and the results on the scales (p > 0.05).

CONCLUSION

The findings demonstrated that the European Portuguese version of these scales is a valid and reliable tool for assessing auditory performance in European Portuguese-speaking children with hearing loss.

Cochlear Implant Insertion Routes and Intra-operative Electrophysiological Measurements: A Retrospective Analysis at a Tertiary Care Centre

BACKGROUND

Cochlear implant surgeries are performed by different surgical routes, Round window (RW), Extended round window (Ext RW) and Cochleostomy (C). Optimum intracochlear electrode placement is important to achieve a successful outcome. Intra-operative electrophysiological testing (Impedance and ECAP) is crucial to assess the device function and appropriate electrode placement. The variability of portal of electrode insertion might affect the neural response and its characteristics.

OBJECTIVE

To compare the intraoperative electrophysiological measurements (Impedance and ECAP) for possible differences on auditory nerve stimulation across the three electrode insertion routes.

MATERIALS AND METHODS

This is a retrospective data analysis of 47 cochlear implant recipients at a tertiary care centre in Central India over a period of 4 years. They were broadly divided into two groups depending on the electrode design as full banded and half banded. Intraoperative impedances were recorded for different modes of stimulation and ECAP measured at E5, E10, E15, E20 electrodes in both the groups across the three insertion routes.

RESULTS

In the half-banded group, the impedance values in different modes CG, MP1, MP2, MP1 + 2 did not differ significantly among the surgical routes at all four electrodes. While in the full banded group, for CG mode impedance values at E5 differ significantly. Rest for other modes in full banded group, there was no statistically significant difference across the three routes.

CONCLUSION

The present study supports that there is no statistically significant difference in the intraoperative impedance and ECAP measurements in both, the full-banded and half- banded electrodes across the three surgical routes implying that, all the three surgical approaches provide equal stimulation of the auditory nerve. The CI surgeon can select the electrode insertion portal based on the surgical anatomy, the implant type and individual preferences.

Analysis of aided thresholds in children who have undergone cochlear reimplantation: a ten-year follow-up

PURPOSE

To characterize hearing thresholds at frequencies of 500, 1000, 2000 and 4000 Hz in children undergoing reimplantation with a follow-up of at least 10 years.

METHODS

Retrospective review of medical records of children who underwent reimplantation surgery for at least 10 years. The auditory thresholds obtained in free-field pure tone audiometry with the cochlear implant were evaluated at frequencies of 500, 1000, 2000 and 4000 Hz at four different times: 1 (before failure), 2 (activation), 3 (five years after reimplantation) and 4 (ten years after reimplantation, regardless of the time of use of the 2nd CI) in patients with a follow-up of at least 10 years.

RESULTS

Evaluating patients who underwent reimplantation, it was observed that the thresholds of 500, 1000, 2000, 4000 Hz were similar in the long term to those obtained in patients who were implanted only once, thus not presenting damage in the detection of sounds.

CONCLUSION

Reimplantation had no long-term effect on the hearing thresholds obtained in children who underwent this surgery due to internal component failure.

Nanocatalysts as fast and powerful medical intervention: Bridging cochlear implant therapies and advanced modelling using Hidden Markov Models (HMMs) for effective treatment of infections

As human population growth and waste from technologically advanced industries threaten to destabilise our delicate ecological equilibrium, the global spotlight intensifies on environmental contamination and climate-related changes. These challenges extend beyond our external environment and have significant effects on our internal ecosystems. The inner ear, which is responsible for balance and auditory perception, is a prime example. When these sensory mechanisms are impaired, disorders such as deafness can develop. Traditional treatment methods, including systemic antibiotics, are frequently ineffective due to inadequate inner ear penetration. Conventional techniques for administering substances to the inner ear fail to obtain adequate concentrations as well. In this context, cochlear implants laden with nanocatalysts emerge as a promising strategy for the targeted treatment of inner ear infections. Coated with biocompatible nanoparticles containing specific nanocatalysts, these implants can degrade or neutralise contaminants linked to inner ear infections. This method enables the controlled release of nanocatalysts directly at the infection site, thereby maximising therapeutic efficacy and minimising adverse effects. In vivo and in vitro studies have demonstrated that these implants are effective at eliminating infections, reducing inflammation, and fostering tissue regeneration in the ear. This study investigates the application of hidden Markov models (HMMs) to nanocatalyst-loaded cochlear implants. The HMM is trained on surgical phases in order to accurately identify the various phases associated with implant utilisation. This facilitates the precision placement of surgical instruments within the ear, with a location accuracy between 91% and 95% and a standard deviation between 1% and 5% for both sites. In conclusion, nanocatalysts serve as potent medicinal instruments, bridging cochlear implant therapies and advanced modelling utilising hidden Markov models for the effective treatment of inner ear infections. Cochlear implants loaded with nanocatalysts offer a promising method to combat inner ear infections and enhance patient outcomes by addressing the limitations of conventional treatments.

Knowledge, Beliefs, and Practices Towards Cochlear Implantations Among Otorhinolaryngologists in India

The outcome of the cochlear implant is dependent highly on the knowledge, belief and practice of cochlear implant in otolaryngologists who are among the important team members. The study explored the knowledge, beliefs, and practices towards cochlear implantations among otorhinolaryngologists in India. An online cross-sectional survey study was carried out using convenient sampling among otorhinolaryngologists in India. Phase-I involved developing and validating of a questionnaire to study the knowledge, beliefs, and practices towards cochlear implants among otorhinolaryngologists in India while phase II involved administration of the questionnaire and analysis. Data collection was conducted using Google Forms. A total of 106 otorhinolaryngologists participated across 24-65 years of age and with experience ranging from 1 to 42 years. The participating otorhinolaryngologists reported having good knowledge about the candidacy for a cochlear implant but having limited knowledge of the recent developments and governmental schemes. The otorhinolaryngologists displayed positive beliefs regarding cochlear implantation. Most recommended a battery of tests to determine the candidacy and gave a lot of importance to rehabilitation (96.2%) and surgery for implantation (83%). The respondents also practiced giving importance to a team approach involving multiple team members. High costs and financial burden emerged to be the major challenges for cochlear implantation in India. The findings of the survey indicate an overall positive belief and practices towards cochlear implantation by otorhinolaryngologists in India. However, there is a need to spread more awareness among them about the recent advances and schemes that would further improve their service delivery.

Translation and Adaptation of the Nijmegen Cochlear Implant Questionnaire in Hindi: A Health-Related Quality of Life Questionnaire for Adults with Cochlear Implants

Nijmegen Cochlear Implant Questionnaire is an HRQoL tool that was developed by Dutch researchers to assess the QoL in adult CI users in the English language. It is used to measure the impact of the use of CI on the daily life situations of its users, on the perception of speech sounds, and on the cost-benefit assessment CI in adult CI users. There is no specific instrument available to assess the QoL in adult CI users in India, hence there was a need to take up this study. The primary aim of the study was to adapt and translate NCIQ into Hindi with a secondary aim to describe the effect of CI on quality of life in adult CI users. For translation, permission was taken from the authors of the original tool. The Forward-backward translation method was utilized for translation. The final version of the NCIQ-H was administered to the study participants (25 no.) 25, aged 18-60 years; High School as the minimum level of education; post-lingual hearing impairment, and CI use ≥ 12 months. The Cronbach's α coefficient was calculated for all domains and subdomains in the NCIQ-H showed the overall reliability of the questionnaire (0.82), showing good internal consistency. The CI users reported high scores across all the domains indicating improved quality of life. No significant correlation was found between the CI usage time and NCIQ scores on Spearman's correlation test. Also, there was no significant difference in NCIQ-H scores between genders on the Kruskal-Wallis test. The NCIQ (H) can be used to assess QoL in adults with cochlear implants. The scores suggest improvement in physical, social and psychological domains of life. No correlation was observed between the NCIQ-H scores and duration of CI usage as well as with gender differences.

Predictors of Short-Term Changes in Quality of Life after Cochlear Implantation

OBJECTIVE

This study aimed 1) to measure the effect of cochlear implantation on health-related quality of life (HR-QOL) using the Cochlear Implant Quality of Life (CIQOL) questionnaire and 2) to determine audiologic, demographic, and non-CI/hearing-related QOL factors influencing the CIQOL.

STUDY DESIGN

Prospective observational study.

SETTING

Tertiary referral center.

PATIENTS AND INTERVENTIONS

Thirty-seven adult patients with sensorineural hearing loss undergoing cochlear implantation.

MAIN OUTCOME MEASURES

CIQOL-global score preimplantation and 6 months postimplantation. Physical function score as measured by the short-form survey, audiologic, and demographic variables.

RESULTS

CIQOL showed significant improvement from preimplantation to 6 months postactivation with a mean difference of 14.9 points (95% confidence interval, 11.3 to 18.5, p < 0.0001). Improvement in CIQOL (ΔCIQOL) correlated linearly with age ( r = -0.49, p = 0.001) and improvement in speech perception testing ( r = 0.63, p < 0.0001). Multivariate modeling using age and change in consonant-vowel nucleus-consonant (CNC) score explained 46% of the variability measured by the ΔCIQOL-global score.

CONCLUSIONS

Nearly all CI recipients achieve significant gains for all domains as measured by the CIQOL. However, younger patients and those with a greater improvement in speech perception performance (CNC) are more likely to achieve a greater CIQOL benefit. Results here suggest the importance of considering preoperative CIQOL and speech perception measures when evaluating predictors of HR-QOL.

Health State Utility Values Associated with Cochlear Implants in Adults: A Systematic Review and Network Meta-Analysis

OBJECTIVES

The cost-effectiveness of bilateral cochlear implants in adults remains uncertain despite established clinical benefits. In cost-effectiveness studies, benefit is often measured by change in health state utility value (HSUV), a single number summary of health-related quality of life anchored at 0 (state of being dead) and 1 (perfect health). Small differences in bilateral cochlear implant HSUV change conclusions of published models, and invalid estimates can therefore mislead policy and funding decisions. As such, we aimed to review and synthesize published HSUV estimates associated with cochlear implants.

DESIGN

We included observational or experimental studies reporting HSUV for adult patients (age ≥18 years) with at least moderate-profound sensorineural hearing loss in both ears who received unilateral or bilateral cochlear implants. We searched MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases up to May 1, 2021. Study and participant characteristics and HSUV outcomes were extracted. Narrative synthesis is reported for all studies. A Bayesian network meta-analysis was conducted to generate pooled estimates for the mean difference in HSUV for three comparisons: (1) unilateral cochlear implant versus preimplant, (2) bilateral cochlear implants versus preimplant, (3) bilateral versus unilateral cochlear implants. Our principal measure was pooled mean difference in HSUV.

RESULTS

Thirty-six studies reporting unique patient cohorts were identified. Health Utilities Index, 3 (HUI-3) was the most common HSUV elicitation method. HSUV from 19 preimplant mean estimates (1402 patients), 19 unilateral cochlear implant mean estimates (1701 patients), and 5 bilateral cochlear implants mean estimates (83 patients) were pooled to estimate mean differences in HUI-3 HSUV by network meta-analysis. Compared with preimplant, a unilateral cochlear implant was associated with a mean change in HSUV of +0.17 (95% credible interval [CrI] +0.12 to +0.23) and bilateral cochlear implants were associated with a mean change of +0.25 (95% CrI +0.12 to +0.37). No significant difference in HSUV was detected for bilateral compared with unilateral cochlear implants (+0.08 [95% CrI -0.06 to +0.21]). Overall study quality was moderate.

CONCLUSIONS

The findings of this review and network meta-analysis comprise the best-available resource for parameterization of cost-utility models of cochlear implantation in adults and highlight the need to critically evaluate the validity of available HSUV instruments for bilateral cochlear implant populations.Protocol registration: PROSPERO (CRD42018091838).

5-Year Observation Period of Quality of Life After Cochlear Implantation

BACKGROUND

Only few studies assessed health-related quality of life (HRQoL) in cochlear implant (CI) patients for a period of more than 2 years. Some of these studies indicated that HRQoL might decrease after that period. The goal of our study was to see whether HRQoL indeed decreases or remains stable beyond 2 years after implant activation.

METHODS

Twenty-five adults (11 women, 14 men; mean age at implantation: 60 ± 19 yr) with a unilateral CI for profound hearing loss were administered two questionnaires: the Nimjegen Cochlear Implant Questionnaire and the Health Utility Index 3 (HUI 3). The Nimjegen Cochlear Implant Questionnaire total score and the HUI single-attribute utility score of Hearing are measures of hearing-specific HRQoL, whereas the HUI multiattribute utility score is a measure of generic HRQoL. The questionnaires were administered before cochlear implantation and 1, 2, and 5 years after implant activation.

RESULTS

Hearing-specific HRQoL was significantly improved at 1 year after implant activation and did not significantly change thereafter. Generic HRQoL also showed significant improvement at 1 year after implant activation, but deteriorated to a clinically relevant degree thereafter.

CONCLUSIONS

The significant improvement of hearing-specific HRQoL obtained from cochlear implantation was fully maintained for up to 5 years after implantation. Generic HRQoL of our CI patients, however, fluctuated over time. The decrease of generic HRQoL is supposed to reflect general age-associated health declines.

The Impact of Hearing Loss and Its Treatment on Health-Related Quality of Life Utility: a Systematic Review with Meta-analysis

BACKGROUND

Hearing loss significantly impacts health-related quality of life (QoL), yet the effects of current treatments on QoL utility remain uncertain. Our objective was to describe the impact of untreated and treated hearing loss on QoL utility to inform hearing healthcare policy.

METHODS

We searched databases for articles published through 02/01/2021. Two independent reviewers screened for articles that reported elicitation of general QoL utility values for untreated and treated hearing loss health states. We extracted data and quality indicators from 62 studies that met the inclusion criteria.

RESULTS

Included studies predominately used observational pre/post designs (61%), evaluated unilateral cochlear implantation (65%), administered the Health Utilities Index 3 (HUI3; 71%), and were conducted in Europe and North America (84%). In general, treatment of hearing loss improved post-treatment QoL utility when measured by most methods except the Euro-QoL 5 dimension (EQ-5D). In meta-analysis, hearing aids for adult mild-to-moderate hearing loss compared to no treatment significantly improved HUI3-estimated QoL utility (3 studies; mean change=0.11; 95% confidence interval (CI): 0.07 to 0.14) but did not impact EQ-5D-estimated QoL (3 studies; mean change=0.0; 95% CI: -0.03 to 0.04). Cochlear implants improved adult QoL utility 1-year post-implantation when measured by the HUI3 (7 studies; mean change=0.17; 95% CI: 0.11 to 0.23); however, pediatric VAS-estimated QoL utility was non-significant (4 studies; mean change=0.12; 95% CI: -0.02 to 0.25). The quality of included studies was limited by failure to report missingness of data and low survey response rates. Our study was limited by heterogeneous study populations and designs.

FINDINGS

Treatment of hearing loss significantly improves QoL utility, and the HUI3 and VAS were most sensitive to improvements in hearing. Improved access to hearing healthcare should be prioritized. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42021253314.

Evaluation of self-esteem in hearing aid and cochlear implant users

PURPOSE

We investigated the relationship between hearing aid or cochlear implant use and self-esteem, quality of life, hearing quality, and speech perception.

METHODS

Of the 120 participants studied, 29 were cochlear implant users, 26 were hearing aid users, 33 were non-device users with hearing loss, and 32 had normal hearing. Each individual included in the study WHOQOL-BREF Quality-of-Life Scale, Rosenberg Self-Esteem and Speech, Spatial Perception and Qualities of Hearing Scale was applied.

RESULTS

We found that the self-esteem level of the group with hearing loss, but without a device, was significantly lower than that of the group with a cochlear implant/hearing aid. There was a moderately statistically significant relationship between self-esteem, quality of life, speech perception, and hearing quality.

CONCLUSIONS

Using hearing aid and cochlear implants increases self-esteem among people with hearing impairments. Self-esteem is associated with quality of life, speech perception, and hearing quality.

Longitudinal Speech Recognition Changes After Cochlear Implant: Systematic Review and Meta-analysis

OBJECTIVES

To examine patterns of change and plateau in speech recognition scores in postlingually hearing impaired adult cochlear implant recipients. The study also examines variations in change patterns for different speech materials and testing conditions.

STUDY DESIGN

Used systematic review with meta-analysis.

METHODS

Articles in English reporting speech recognition scores of adults with postlingual hearing loss at pre-implantation and at least two post-implantation time points were included. Statistically significant changes were determined by meta-analysis and the 95% confidence interval.

RESULTS

A total of 22 articles representing 1954 patients were included. Meta-analysis of mean difference demonstrated significant improvements in speech recognition score for words in quiet (37.4%; 95% confidence interval [34.7%, 40.7%]), sentences in quiet (49.4%; 95% confidence interval [44.9%, 53.9%]), and sentences in noise (30.8%; 95% confidence interval [25.2%, 36.4%]) from pre-op to 3 months. Scores continued to increase from 3 to 12 months but did not reach significance. Similarly, significant improvements from pre-op to 3 months were observed for consonant nucleus consonant (CNC) words in quiet (37.1%; 95% confidence interval [33.8%, 40.4%]), hearing in noise test (HINT) sentences in quiet (46.5%; 95% confidence interval [37.0%, 56.0%]), AzBio sentences in quiet (45.9%; 95% confidence interval [44.2%, 47.5%]), and AzBio sentences in noise (26.4%; 95% confidence interval [18.6%, 34.2%]). HINT sentences in noise demonstrated improvement from pre-op to 3 months (35.1%; 95% confidence interval [30.0%, 40.3%]) and from 3 to 12 months (15.5%; 95% confidence interval [7.2%, 23.8%]).

CONCLUSIONS

Mean speech recognition scores demonstrate significant improvement within the first 3 months, with no further statistically significant improvement after 3 months. However, large individual variation should be expected and future research is needed to explain the sources of these individual differences. Laryngoscope, 2022.

The cost-effectiveness of unilateral cochlear implants in UK adults

OBJECTIVE

The National Institute for Health and Care Excellence (NICE) updated its eligibility criteria for unilateral cochlear implants (UCIs) in 2019. NICE claimed this would not impact the cost-effectiveness results used within its 2009 technology appraisal guidance. This claim is uncertain given changed clinical practice and increased healthcare unit costs. Our objective was to estimate the cost-effectiveness estimates of UCIs in UK adults with severe to profound hearing loss within the contemporary NHS environment.

METHODS

A cost-utility analysis employing a Markov model was undertaken to compare UCIs with hearing aids or no hearing aids for people with severe to profound hearing loss. A clinical pathway was developed to estimate resource use. Health-related quality of life, potential adverse events, device upgrades and device failure were captured. Unit costs were derived mostly from the NHS data. Probabilistic sensitivity analysis further assessed the effect of uncertain model inputs.

RESULTS

A UCI is likely to be deemed cost-effective when compared to a hearing aid (£11,946/QALY) or no hearing aid (£10,499/QALY). A UCI has an 93.0% and 98.7% likelihood of being cost-effective within the UK adult population when compared to a hearing aid or no hearing aid, respectively. ICERs were mostly sensitive to the proportion of people eligible for cochlear implant, discount rate, surgery and device costs and processor upgrade cost.

CONCLUSION

UCIs remain cost-effective despite changes to clinical practice and increased healthcare unit costs. Updating the NICE criteria to provide better access UCIs is projected to increase annual implants in adults and children by 70% and expenditure by £28.6 million within three years. This increased access to UCIs will further improve quality of life of recipients and overall social welfare.

Knowledge, attitude and practices regarding cochlear implants among medical doctors other than otolaryngologists: a prospective cross-sectional study

Objective

Cochlear implant is the standard treatment of choice for children and adults with severe to profound sensorineural hearing loss. The main objective of this study was to assess the knowledge, attitude and practices regarding cochlear implant among doctors other than otolaryngologists in a tertiary care academic institution.

Method

A 24-item knowledge, attitude and practices questionnaire was developed based on an extensive literature review and expert opinion and was administered to 100 non-otolaryngologists in a tertiary care academic institution to be completed in about 15 minutes. The data obtained was analysed to assess knowledge, attitude and practices regarding cochlear implant in this group.

Results

The results showed that awareness regarding the option of cochlear implants for elderly and unilateral deafness was deficient. Surgeons and doctors in higher specialties did better when it came to practice related to cochlear implant. The age and experience of doctors also improved knowledge and practice with regards to cochlear implant.

Conclusion

Improving awareness about cochlear implants and their benefits among non-otolaryngology colleagues can ensure that more people who could potentially benefit from cochlear implants will receive appropriate counselling and referral.

Emerging therapies for human hearing loss

INTRODUCTION

More than 5% of the world's population have a disabling hearing loss which can be managed by hearing aids or implanted electrical devices. However, outcomes are highly variable, and the sound perceived by recipients is far from perfect. Sparked by the discovery of progenitor cells in the cochlea and rapid progress in drug delivery to the cochlea, biological and pharmaceutical therapies are currently in development to improve the function of the cochlear implant or eliminate the need for it altogether.

AREAS COVERED

This review highlights progress in emerging regenerative strategies to restore hearing and adjunct therapies to augment the cochlear implant. Novel approaches include the reprogramming of progenitor cells to restore the sensory hair cell population in the cochlea, gene therapy and gene editing to treat hereditary and acquired hearing loss. A detailed review of optogenetics is also presented as a technique that could enable optical stimulation of the spiral ganglion neurons, replacing or complementing electrical stimulation.

EXPERT OPINION

Increasing evidence of substantial reversal of hearing loss in animal models, alongside rapid advances in delivery strategies to the cochlea and learnings from clinical trials will amalgamate into a biological or pharmaceutical therapy to replace or complement the cochlear implant.

Cochlear Implantation Improves Both Speech Perception and Patient-Reported Outcomes: A Prospective Follow-Up Study of Treatment Benefits among Adult Cochlear Implant Recipients

Cochlear implantation is considered the best treatment option for patients with severe-to-profound sensorineural hearing loss for whom conventional hearing aids are insufficient. We used a repeated measures longitudinal approach to evaluate speech recognition and patient-reported outcomes after cochlear implantation in an unbiased cohort of Danish adult patients in a prospective cohort study. We assessed 39 recipients before and two times after implantation using a battery of tests that included Dantale I, the Danish Hearing in Noise Test, the Nijmegen Cochlear Implant Questionnaire, and the Speech, Spatial, and Qualities of Hearing Scale. The study group improved significantly on all outcome measures following implantation. On average, Dantale I scores improved by 29 percentage points and Hearing in Noise Test scores improved by 22 percentage points. Most notably, the average Dantale score improved from 26 to 70% in the CI in quiet condition and from 12 to 42% in the cochlear implantation in noise condition when tested monaurally. Dantale demonstrated a significant positive correlation with Nijmegen Cochlear Implant Questionnaire and Speech, Spatial, and Qualities of Hearing Scale scores, while Hearing in Noise Test had no significant correlation with the patient-reported outcome measures. Patients improved significantly at 4 months and marginally improved further at 14 months, indicating that they were approaching a plateau. Our study’s use of audiometric and patient-reported outcome measures provides evidence of the treatment benefits of cochlear implantation in adults, which may help physicians advise patients on treatment decisions and align treatment benefit expectations, as well as serve as a foundation for the development of new cochlear implantation selection criteria.

Pitch Accuracy of Vocal Singing in Deaf Children With Bimodal Hearing and Bilateral Cochlear Implants

OBJECTIVES

The purpose of the present study was to investigate the pitch accuracy of vocal singing in children with severe to profound hearing loss who use bilateral cochlear implants (CIs) or bimodal devices [CI at one ear and hearing aid (HA) at the other] in comparison to similarly-aged children with normal-hearing (NH).

DESIGN

The participants included four groups: (1) 26 children with NH, (2) 13 children with bimodal devices, (3) 31 children with bilateral CIs that were implanted sequentially, and (4) 10 children with bilateral CIs that were implanted simultaneously. All participants were aged between 7 and 11 years old. Each participant was recorded singing a self-chosen song that was familiar to him or her. The fundamental frequencies (F0) of individual sung notes were extracted and normalized to facilitate cross-subject comparisons. Pitch accuracy was quantified using four pitch-based metrics calculated with reference to the target music notes: mean note deviation, contour direction, mean interval deviation, and F0 variance ratio. A one-way ANOVA was used to compare listener-group difference on each pitch metric. A principal component analysis showed that the mean note deviation best accounted for pitch accuracy in vocal singing. A regression analysis examined potential predictors of CI children's singing proficiency using mean note deviation as the dependent variable and demographic and audiological factors as independent variables.

RESULTS

The results revealed significantly poorer performance on all four pitch-based metrics in the three groups of children with CIs in comparison to children with NH. No significant differences were found among the three CI groups. Among the children with CIs, variability in the vocal singing proficiency was large. Within the group of 13 bimodal users, the mean note deviation was significantly correlated with their unaided pure-tone average thresholds (r = 0.582, p = 0.037). The regression analysis for all children with CIs, however, revealed no significant demographic or audiological predictor for their vocal singing performance.

CONCLUSION

Vocal singing performance in children with bilateral CIs or bimodal devices is not significantly different from each other on a group level. Compared to children with NH, the pediatric bimodal and bilateral CI users, in general, demonstrated significant deficits in vocal singing ability. Demographic and audiological factors, known from previous studies to be associated with good speech and language development in prelingually-deafened children with CIs, were not associated with singing accuracy for these children.

Cross-cultural adaptation of the Nijmegen cochlear implant questionnaire into Turkish language: validity, reliability and effects of demographic variables

Purpose

The purpose of this study was to evaluate the validity and reliability of the Turkish version of the Nijmegen Cochlear Implant Questionnaire (Tr-NCIQ) and reveal the demographic factors contributing to the outcomes.

Methods

A group of 118 cochlear implant users aged between 18 and 70 years filled the Tr-NCIQ and the Turkish Hearing Handicapped Inventory for Adults (the Tr-HHI-Adult) via electronic survey. Cross-cultural adaptation of the Tr-NCIQ was performed. The reliability and validity of the questionnaire were evaluated utilizing internal consistency coefficient, split-half method, and predictive validity.

Results

The overall Cronbach’s alpha coefficient of the scale was 0.91, and the Spearman-Brown coefficient was 0.91. A moderately significant and negative correlation was present between the basic sound perception, speech production, self-esteem, activity, and social interactions subdomain scores and the HHI-Adult scores. Patients with post-lingual onset of hearing loss had significantly better results than those with pre-lingual onset, in the advanced sound perception subdomain. In addition, bilateral cochlear implant users had better results than the unilateral and bimodal users in the speech production subdomain and then the bimodal users in the self-esteem subdomain. There was no effect of age, duration of implant use, age at implantation, and the daily usage of cochlear implant (CI) on the quality-of-life outcomes.

Conclusion

The Tr-NCIQ is a reliable and valid tool to evaluate the subjective quality of life in CI users. In addition, as a standardized instrument, it can be easily self-administered both in clinical practice and for research purposes.

Use of Functional Near-Infrared Spectroscopy to Predict and Measure Cochlear Implant Outcomes: A Scoping Review

Outcomes following cochlear implantation vary widely for both adults and children, and behavioral tests are currently relied upon to assess this. However, these behavioral tests rely on subjective judgements that can be unreliable, particularly for infants and young children. The addition of an objective test of outcome following cochlear implantation is therefore desirable. The aim of this scoping review was to comprehensively catalogue the evidence for the potential of functional near infrared spectroscopy (fNIRS) to be used as a tool to objectively predict and measure cochlear implant outcomes. A scoping review of the literature was conducted following the PRISMA extension for scoping review framework. Searches were conducted in the MEDLINE, EMBASE, PubMed, CINAHL, SCOPUS, and Web of Science electronic databases, with a hand search conducted in Google Scholar. Key terms relating to near infrared spectroscopy and cochlear implants were used to identify relevant publications. Eight records met the criteria for inclusion. Seven records reported on adult populations, with five records only including post-lingually deaf individuals and two including both pre- and post-lingually deaf individuals. Studies were either longitudinal or cross-sectional, and all studies compared fNIRS measurements with receptive speech outcomes. This review identified and collated key work in this field. The homogeneity of the populations studied so far identifies key gaps for future research, including the use of fNIRS in infants. By mapping the literature on this important topic, this review contributes knowledge towards the improvement of outcomes following cochlear implantation.

[Validity and reliability of the Nijmegen Cochlear Implant Questionnaire in German]

Hintergrund

Der Nijmegen Cochlear Implant Questionnaire (NCIQ) ist ein krankheitsspezifischer Fragebogen zur Erhebung der gesundheitsbezogenen Lebensqualität von Patienten vor und nach Cochleaimplantation.

Ziel der Arbeit

Validierung und Reliabilitätsprüfung der deutschen Übersetzung des NCIQ.

Material und Methoden

Es wurde eine prospektive Studie an 100 postlingual ertaubten oder hochgradig schwerhörigen Patienten durchgeführt, welche präoperativ sowie 3 und 6 Monate nach einer Cochleaimplantation mittels NCIQ, Abbreviated Profile of Hearing Aid Benefit (APHAB) und Hearing Participation Scale (HPS) untersucht wurden. Als Kontrolle fungierte ein postlingual ertaubtes oder hochgradig schwerhöriges, unbehandeltes Patientenkollektiv (n = 54). Cronbach‑α und Test-Retest-Reliabilität dienten der Reliabilitätsüberprüfung. Es wurde auf Inhalts‑, Übereinstimmungs- und auf diskriminative Validität getestet. Die Konstruktvaliditätsprüfung basiert auf kürzlich veröffentlichen Daten. Als Gütekriterien wurden die Sensitivität und eine ROC(„Receiver Operating Characteristic“)-Analyse, inklusive AUC(„Area Under the ROC Curve“)-Betrachtung, eingesetzt.

Ergebnisse

Das Test-Retesting ergab nach 3 und 6 Monaten postoperativ stabile NCIQ-Werte. Die Cronbach-α-Werte wiesen auf eine gute interne Konsistenz hin. Der NCIQ diskriminierte valide zwischen behandelten und unbehandelten Patientengruppen. Es ergaben sich statistisch signifikante, wenn auch schwache, Korrelationen zwischen dem NCIQ und dem APHAB (r = −0,22; p = 0,04) und dem HPS (r = 0,30; p = 0,01). Sensitivitäts- und ROC-Analysen zeigten eine gute Messqualität des deutschsprachigen NCIQ.

Schlussfolgerung

Die deutsche Übersetzung des NCIQ misst zuverlässig und valide die Lebensqualität vor und nach Cochleaimplantation und kann zur klinischen Erfolgskontrolle nach Cochleaimplantationen verwendet werden.

Feasibility of Day Surgery for Cochlear Implantation under Conscious Sedation with Same-Day Fitting

OBJECTIVES

To evaluate the feasibility of performing cochlear implantation under conscious sedation (CS) as day surgery with same-day fitting.

MATERIALS AND METHODS

All patients underwent cochlear implantation under CS between November 2017 and April 2018. The data collected included demographic information, preoperative clinical characteristics, surgical details, postoperative fitting information, and side effects, if any.

RESULTS

Nine patients had 11 cochlear implants (CIs) placed under CS (2 patients received bilateral CIs). One patient's data were excluded from the audiological results because conversion to general anesthesia (GA) was necessary. One patient (11%) vomited just before the end of the procedure. Seven patients had uneventful procedures. Eight (88%) patients were discharged home the same day. There was a statistically significant difference in recovery time between the CS group and the GA group (t=-2.26, df=12, p<0.05). In the CS group, there was no statistically significant change in the maximum comfortable loudness level for all electrodes from the day of the surgery to the following day. However, there was a statistically significant difference in the threshold levels of all electrodes from the day of the surgery to the following day (Z=-2.04, N=120, p<0.05). Further analysis revealed a statistically significant difference in the four most apical electrodes (Z=-3.496, N=40, p<0.0001), but not in the middle or basal electrodes.

CONCLUSION

Cochlear implantation can be performed under CS with careful patient selection. This approach facilitates same-day fitting and day surgery by minimizing comorbidity.

Validity and reliability of the Cochlear Implant Quality of Life (CIQOL)-35 Profile and CIQOL-10 Global instruments in comparison to legacy instruments

OBJECTIVE

Validated and reliable patient-reported outcome measures (PROMs) may provide a comprehensive and accurate assessment of the real-world experiences of cochlear implant (CI) users and complement information obtained from speech recognition outcomes. To address this unmet clinical need, the Cochlear Implant Quality of Life (CIQOL)-35 Profile instrument and CIQOL-10 Global measure were developed according to the Patient-Reported Outcomes Information System (PROMIS) and COnsensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) guidelines. The CIQOL-35 Profile consists of 35 items in six domain constructs (communication, emotional, entertainment, environment, listening effort, and social) and the CIQOL-10 Global contains 10 items that provide an overall CIQOL score. The present study compares psychometric properties of the newly developed CIQOL instruments to two legacy PROMs commonly used in adult CI users.

DESIGN

Using a prospective cohort design, a sample of 334 adult CI users recruited from across the United States provided responses to (1) the CIQOL instruments; (2) a CI-specific PROM (Nijmegen Cochlear Implant Questionnaire, NCIQ); and (3) a general-health PROM (Health Utilities Index 3 [HUI-3]). Responses were obtained again after 1 mo. The reliability and validity of the CIQOL-35 Profile and CIQOL-10 Global instruments were compared with the legacy PROMs (NCIQ and HUI-3). Psychometric properties and construct validity of each instrument were analyzed using confirmatory factor analysis, item response theory (IRT), and test-retest reliability (using Pearson's correlations), where appropriate.

RESULTS

All six CIQOL-35 Profile domains and the CIQOL-10 Global instrument demonstrated adequate to strong construct validity. The majority of the NCIQ subdomains and NCIQ total score had substantial confirmatory factor analysis model misfit, representing poor construct validity. Therefore, IRT analysis could only be applied to the basic sound performance and activity limitation subdomains of the NCIQ. IRT results showed strong psychometric properties for all CIQOL-35 Profile domains, the CIQOL-10 Global instrument, and the basic sound performance and activity limitation subdomains of the NCIQ. Test-retest reliability was strong for the CIQOL-35 Profile, CIQOL-10 Global, and NCIQ, but moderate to weak for the HUI-3; the hearing score of the HUI-3 demonstrated the weakest reliability.

CONCLUSION

The CIQOL-35 Profile and CIQOL-10 Global are more psychometrically sound and comprehensive than the NCIQ and the HUI-3 for assessing QOL in adult CI users. Due to poor reliability, we do not recommend using the HUI-3 to measure QOL in this population. With validation and psychometric analyses complete, the CIQOL-35 Profile measure and CIQOL-10 Global instrument are now ready for use in clinical and research settings to measure QOL and real-world functional abilities of adult CI users.

Quality of Life in Older Adults with Cochlear Implantation: Can It Be Equal to That of Healthy Older Adults?

Background and Objectives

This study aimed to evaluate the audiologic results after cochlear implantation (CI) in older patients and the degree of improvement in their quality of life (QoL).

Subjects and Methods

Patients over 65 years old who underwent CI at implant center in Bozyaka Training and Research Hospital were included in this study (n=54; 34 males and 20 females). The control group was patient over 65 years old with normal hearing (n=54; 34 males and 20 females). We administered three questionnaires [World Health Organization Quality of Life-BREF (WHOQOL-BREF), World Health Organization Quality of Life-OLD (WHOQOL-OLD)], and Geriatric Depression Scale (GDS) to evaluate the QoL, CI-related effects on activities of daily life, and social activities in all the subjects. Moreover, correlations between speech recognition and the QoL scores were evaluated. The duration of implant use and comorbidities were also examined as potential factors affecting QoL.

Results

The patients had remarkable improvements (the mean score of postoperative speech perception 75.7%) in speech perception after CI. The scores for the WHOQOL-OLD and WHOQOL-BREF questionnaire responses were similar in both the study and control groups, except those for a two subdomains (social relations and social participation). The patients with longer-term CI had higher scores than those with short-term CI use. In general, the changes in GDS scores were not significant (p<0.05).

Conclusions

The treatment of hearing loss with CI conferred significant improvement in patient’s QoL (p<0.01). The evaluation of QoL can provide multidimensional insights into a geriatric patient’s progress and, therefore, should be considered by audiologists.

Prospective study on health-related quality of life in patients before and after cochlear implantation

Purpose

Assessing cochlear implant (CI)-associated patient outcomes is a focus of implant research. Most studies have analyzed outcomes retrospectively with low patient numbers and few measurement time points. In addition, standardized CI-specific health-related quality of life (HRQoL) instruments have not been used. To address this, we prospectively assessed HRQoL in patients before and after implantation.

Methods

We assessed HRQoL using the Nijmegen Cochlear Implant Questionnaire (NCIQ), Abbreviated Profile of Hearing Aid Benefit (APHAB), Hearing Participation Scale (HPS), and the Visual Analogue Scale (VAS) in 100 deaf or severely hearing-impaired patients (57 unilaterally deaf and 43 bilaterally deaf) before and 3, 6, and 12 months after cochlear implantation. We compared the results of unilaterally and bilaterally hearing-impaired patients and patients with or without a hearing aid. Principal component (PCA) and exploratory factor analyses (EFA) were also conducted.

Results

The NCIQ measured improvements in all 6 domains after CI and correlated well with other QoL instruments. The PCA revealed that the NCIQ can be better explained by physical, physical advanced, and socio-psychological components. The APHAB score ameliorated over time, except for the background noise domain. The overall HPS score improved over time, but the hearing handicap subscore significantly decreased. Sociodemographic influences on the questionnaire scores were relatively weak.

Conclusion

Assessing HRQoL is essential for quantifying the patient outcome after CI. NCIQ scores in our patient cohort showed improved HRQoL in all domains and we recommend that the NCIQ be used as a first-line questionnaire for assessing QoL in hearing-impaired patients after CI.

An evaluation framework for research platforms to advance cochlear implant/hearing aid technology: A case study with CCi-MOBILE

Cochlear implants (CIs) and hearing aids (HAs) are advanced assistive hearing devices that perform sound processing to achieve acoustic to acoustic/electrical stimulation, thus enabling the prospects for hearing restoration and rehabilitation. Since commercial CIs/HAs are typically constrained by manufacturer design/production constraints, it is necessary for researchers to use research platforms (RPs) to advance algorithms and conduct investigational studies with CI/HA subjects. While previous CI/HA research platforms exist, no study has explored establishing a formal evaluation protocol for the operational safety and reliability of RPs. This study proposes a two-phase analysis and evaluation paradigm for RPs. In the acoustic phase 1 step, a signal processing acoustic space is explored in order to present a sampled set of audio input content to explore the safety of the resulting output electric/acoustic stimulation. In the parameter phase 2 step, the configurable space for realizable electrical stimulation pulses is determined, and overall stimulation reliability and safety are evaluated. The proposed protocol is applied and demonstrated using Costakis Cochlear Implant Mobile. Assessment protocol observations, results, and additional best practices for subsampling of the acoustic and parameter test spaces are discussed. The proposed analysis-evaluation protocol establishes a viable framework for assessing RP operational safety and reliability. Guidelines for adapting the proposed protocol to address variability in RP configuration due to experimental factors such as custom algorithms, stimulation techniques, and/or individualization are also considered.

Single-centre experience and practical considerations of the benefit of a second cochlear implant in bilaterally deaf adults

Purpose

Bilateral cochlear implant (CI) implantation is increasingly used in the auditory rehabilitation of bilaterally deafened adults. However, after successful unilateral implantation, objective patient counselling is essential.

Methods

We investigated the extra benefit of a second CI in adults in terms of health-related quality of life, tinnitus, stress, anxiety, depression, quality of hearing, and speech recognition. Hearing ability was assessed by using the Freiburg monosyllable speech discrimination test (FB MS) and the Oldenburg sentence test with azimuth variations. In a prospective patient cohort, we administered validated questionnaires before a CI, after a first CI and after a second CI implantation.

Results

The study included 29 patients, made up of nine women and 20 men. The median time between the first and the second implantation was 23 months. The mean total NCIQ score and TQ before a CI improved significantly after both implantations. Stress, anxiety, and depression were stable over time and were not significantly affected by CI implantations. Speech recognition with noise significantly improved after the first and again after the second CI. Correlation analysis showed a strong connection between auditory performance and HRQoL.

Conclusion

We demonstrated that a unilateral CI benefitted many fields and that the second sequential CI leads again to additional improvement. Bilateral CI implantation should, therefore, be the standard form of auditory rehabilitation in deafened adults.

Systematic Review of Quality of Life Assessments after Cochlear Implantation in Older Adults

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.

Long-term Benefit of Unilateral Cochlear Implantation on Quality of Life and Speech Perception in Bilaterally Deafened Patients

OBJECTIVE

Cochlear implantation (CI) is a common treatment modality for unilaterally and bilaterally deafened patients as well as patients with severe to profound hearing loss. The aim of our study is the complex evaluation of the improvement and influence of health related quality of life (HRQoL) and auditory performance in cochlear implant patients during a long-term follow-up.

METHODS

Sixty-one bilaterally, postlingually deafened patients with unilateral CI were included in this prospective study. Assessment tools for auditory performance and HRQoL included the Freiburg Monosyllabic Speech test, Oldenburg Inventory (OI) questionnaire, Nijmegen Cochlear Implant Questionnaire (NCIQ) and 36-item Short Form Survey (SF-36). Data were collected before CI, at 6, 12, and 24 months postoperatively.

RESULTS

The assessment tools for speech perception yielded a statistically significant improvement in the Freiburg Monosyllabic Speech test scores and of all subdomain scores of the OI during the 6-month follow-up period. The subdomain scores of the NCIQ and the psychological score of the SF-36 also improved significantly during this follow-up period. All results remained stable thereafter during the 12- and 24-month follow-up. There was a statistically significant correlation between subjective speech perception and HRQoL after CI.

CONCLUSION

This is the first prospective study to show results in regard to speech perception and HRQoL and their correlation during a 2-year follow-up after unilateral CI in bilaterally deafened patients. Our results for speech perception and HRQoL showed a significant improvement during the 6-month follow-up that remained stable thereafter during a 24-month follow-up, even after finishing the hearing rehabilitation program.

Development of the Cochlear Implant Quality of Life Item Bank

OBJECTIVES

Functional outcomes following cochlear implantation have traditionally been focused on word and sentence recognition, which, although important, do not capture the varied communication and other experiences of adult cochlear implant (CI) users. Although the inadequacies of speech recognition to quantify CI user benefits are widely acknowledged, rarely have adult CI user outcomes been comprehensively assessed beyond these conventional measures. An important limitation in addressing this knowledge gap is that patient-reported outcome measures have not been developed and validated in adult CI patients using rigorous scientific methods. The purpose of the present study is to build on our previous work and create an item bank that can be used to develop new patient-reported outcome measures that assess CI quality of life (QOL) in the adult CI population.

DESIGN

An online questionnaire was made available to 500 adult CI users who represented the adult CI population and were recruited through a consortium of 20 CI centers in the United States. The questionnaire included the 101 question CIQOL item pool and additional questions related to demographics, hearing and CI history, and speech recognition scores. In accordance with the Patient-Reported Outcomes Measurement Information System, responses were psychometrically analyzed using confirmatory factor analysis and item response theory.

RESULTS

Of the 500 questionnaires sent, 371 (74.2%) subjects completed the questionnaire. Subjects represented the full range of age, durations of CI use, speech recognition abilities, and listening modalities of the adult CI population; subjects were implanted with each of the three CI manufacturers' devices. The initial item pool consisted of the following domain constructs: communication, emotional, entertainment, environment, independence, listening effort, and social. Through psychometric analysis, after removing locally dependent and misfitting items, all of the domains were found to have sound psychometric properties, with the exception of the independence domain. This resulted in a final CIQOL item bank of 81 items in 6 domains with good psychometric properties.

CONCLUSIONS

Our findings reveal that hypothesis-driven quantitative analyses result in a psychometrically sound CIQOL item bank, organized into unique domains comprised of independent items which measure the full ability range of the adult CI population. The final item bank will now be used to develop new instruments that evaluate and differentiate adult CIQOL across the patient ability spectrum.

The Outcome of Unilateral Cochlear Implantation in Adults: Speech Recognition, Health-Related Quality of Life and Level of Anxiety and Depression: a One- and Three-Year Follow-Up Study

Introduction  Hearing impairment is a common disease worldwide, with a comprehensive impact, and cochlear implantation (CI) is an intervention for profound hearing impairment.

Objective  To study the outcome one and three years after unilateral CI on hearing, health-related quality of life and level of depression and anxiety, and the correlation between the outcomes. Second, to study whether age, gender, etiology, operated side, residual hearing or cognitive performance can predict the outcome.

Methods  A prospective longitudinal study including adults with profound postlingual hearing impairment, with respect to hearing (speech recognition), health-related quality of life (Health Utilities Index 3) and level of depression and anxiety (Hospital Anxiety and Depression scale), pre-CI, and one and three years post-CI. The total sample was composed of 40 participants (40% of men), with a mean age of 71 years.

Results  Speech recognition and the overall health-related quality of life improved one year post-CI ( p  = 0.000), without correlation (ρ= 0.27), and with no difference three years post-CI. The hearing attribute (in the health-related quality of life instrument) improved one and three years post-CI ( p  = 0.000). The level of anxiety did not change one and three years post-CI. The level of depression improved one year post-CI ( p  = 0.036), and deteriorated three years post-CI ( p  = 0.031). Age, etiology, operated side, residual hearing and cognitive performance did not predict the outcome, but the female gender did significantly improve speech recognition compared with men ( p  = 0.009).

Conclusion  The CI significantly improved speech recognition, health-related quality of life and level of depression one year post-CI without mutual correlation, and women performed significantly better than men. There were no further improvements three years post-CI, apart from the hearing attribute.

Evaluation of the quality of life in adults with cochlear implants: As good as the healthy adults?

PURPOSE

The aim of this study was to compare the quality of life (QoL) of adult CI users with the QoL of adults in the healthy and normal-hearing population.

MATERIALS AND METHODS

31 patients with CIs were included in the CI group, and 31 normal-hearing subjects were included in the control group. The QoL was evaluated using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) for all subjects.

RESULTS

A comparison of the QoL of the CI group to that of the control group found that the QoL of healthy adults was better than that of the CI users. The results obtained for the subdomains of physical health, psychological health, and social relations showed statistically significant differences between the two groups (p < 0.05). There were no statistically significant differences between the groups in the subdomains of environment and general health (p > 0.05).

CONCLUSIONS

The effect of a hearing disability on daily life continues after the CI. As expected, adults with CIs still face challenges in their daily lives due to the hearing impairment.

The Effect of Cochlear Implants on Cognitive Function in Older Adults: Initial Baseline and 18-Month Follow Up Results for a Prospective International Longitudinal Study

In older adults, hearing loss is independently associated with an increased rate of cognitive decline, and has been identified to be a modifiable risk factor for dementia. The mechanism underlying the cognitive decline associated with hearing loss is not understood, but it is known that the greater the hearing loss, the faster the rate of decline. It is unknown whether remediation of hearing loss with hearing devices can delay cognitive decline. This 5-year international longitudinal study is investigating the impact of cochlear implants on cognitive function in older people with severe-profound hearing loss, and whether remediation of hearing loss could delay the onset of cognitive impairment. This is the first study to examine the major primary risk factors associated with dementia in the same cohort. Participants were assessed before cochlear implantation and 18 months later using an identical battery including a visually presented cognitive assessment tool (Cogstate battery) that is highly sensitive to small changes in cognition and suitable for use with people with hearing loss. Hearing and speech perception ability were assessed in sound-treated conditions by an audiologist, and a range of questionnaire tools was administered to assess self-perceived ease of listening, quality of life, physical activity, diet, social and emotional loneliness, isolation, anxiety, and depression. A detailed medical health history was taken. Pre-operatively, despite the small initial sample size (n = 59), increased hearing loss and age predicted significantly poorer executive function and visual attention, while tertiary education predicted better executive function. Better self-reported quality of life was correlated with better visual learning performance, and engaging in frequent vigorous physical activity was correlated with poorer visual learning performance. At 18 months, for the first 20 participants, significant benefits of cochlear implants were seen in terms of speech perception, communication ability, and quality of life. Multiple linear regression modeling showed executive function improved significantly for non-tertiary educated males, while cognitive function remained stable for other participants. Further follow-up at 18 month intervals with a larger sample will reveal the effects of cochlear implant intervention on all outcomes, and whether this can delay cognitive decline.

Cochlear implantation as a treatment for single-sided deafness and asymmetric hearing loss: a randomized controlled evaluation of cost-utility

BACKGROUND

Single-sided deafness (SSD) and asymmetric hearing loss (AHL) have recently been proposed as a new indication for cochlear implantation. There is still no recommended treatment for these hearing deficits, and most options considered rely on the transfer of sound from the poor ear to the better ear, using Contralateral Routing of the Signal (CROS) hearing aids or bone conduction (BC) devices. In contrast, cochlear implantation allows the poor ear to be stimulated and binaural hearing abilities to be partially restored. Indeed, most recently published studies have reported an improvement in the spatial localisation of an incoming sound and better speech recognition in noisy environments after cochlear implantation in SSD/AHL subjects. It also provides consistent relief of tinnitus when associated. These encouraging hearing outcomes raise the question of the cost-utility of this expensive treatment in an extended indication.

METHODS

The final endpoint of this national multicentre study is to determine the incremental cost-utility ratio (ICUR) of cochlear implantation in comparison to the current standard of care in France through simple observation, using a randomised controlled trial. Firstly, the study comprises a prospective and descriptive part, where 150 SSD/AHL subjects try CROS hearing aids and a BC device for three weeks each. Secondly, the choice is made between CROS hearing aids, BC implanted device and cochlear implantation. Hearing outcomes and quality of life measurements are described after 6 months for the subjects who chose CROS, BC or declined any option. The subjects who opt for cochlear implantation are randomised between one group where the cochlear implant is inserted without delay and one group of simple initial observation. Hearing outcomes and quality of life measurements are compared after 6 months.

DISCUSSION

The present study was designed to assess the efficiency of cochlear implantation in SSD/AHL. A favourable cost-utility ratio in this extended indication would strengthen the promising clinical results and justify a reimbursement by the health insurance. The efficiency of other options (CROS, BC) will also be described.

TRIAL REGISTRATION

This research has been registered in ClinicalTrials.gov (http://www.clinicaltrials.gov/), the 29th July 2014 under the n°NCT02204618.

Effects of cochlear implantation on adulthood

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.

Patient Benefit Following Bimodal CI-provision: Self-reported Abilities vs. Hearing Status

Objectives: Patient-reported outcomes gain importance for the assessment of auditory abilities in cochlear implant users and for the evaluation of auditory rehabilitation. Aims of the study were to explore the interrelation of self-reported improvements in auditory ability with improvements in speech comprehension and to identify factors other than audiological improvement that affect self-reported auditory ability.

Study Design: Explorative prospective analysis using a within-subjects repeated measures design.

Setting: Academic tertiary care center.

Participants: Twenty-seven adult participants with bilateral sensorineural hearing loss who received a HiRes 90K CI and continued use of a HA at the non-implanted ear (bimodal hearing).

Intervention: Cochlear implantation.

Main Outcome Measures: Self-reported auditory ability/disability assessed by the comparative version of the Speech, Spatial and Qualities of Hearing Scale (SSQ-B), and monosyllable as well as sentence comprehension in quiet and within speech modulated noise from different directions assessed pre- as well as 3 and 6 months post-implantation.

Results: Data of 17 individuals were analyzed. At the endpoint of the study, improvement of self-reported auditory ability was significant. Regarding audiometric measures, significant improvement was seen for CI-aided pure tone thresholds, for monaural CI-assisted and bimodal sentence comprehension in quiet and in speech-modulated noise that was presented from the same source or at the side of the HA-ear. Correlations between self-reported and audiometric improvements remained weak, with the exception of the improvement seen for monaural CI-aided sentence comprehension in quiet and self-perceived improvement of sound quality. Considerable correlations existed between self-reported improvements and current level of depression and anxiety, and with general self-efficaciousness. Regression analyses substantiated a positive influence of self-efficaciousness on self-reported improvement in speech comprehension and between the improvement of monaural CI-aided sentence comprehension in quiet and perceived sound quality as well as a negative influence of anxiety on self-reported improvement in spatial hearing. Self-reported improvements were significantly better in the subgroup with intensive as compared to regular rehabilitation.

Conclusions: Self-reported auditory ability/disability represents an important measure for the success of bimodal CI-provision. It is influenced by personal and mental health factors that may improve CI-rehabilitation results if addressed during rehabilitation.

[Subjective improvement of hearing through cochlear implantation]

BACKGROUND

During the past few decades various questionnaires have been developed to evaluate quality of life using audiological measures. The Hearing Implant Sound Quality Index (HISQUI) was developed especially for patients with a cochlear implant (CI). The aim of this study was to evaluate subjective hearing improvement after CI surgery and to correlate the results with objective measuring methods such as pure-tone and speech audiometry.

MATERIALS AND METHODS

Pre- and postoperative data of 57 patients who received a cochlear implant (CIs) were retrospectively analyzed. For evaluation of subjective hearing ability the HISQUI questionnaire consisting of 19 questions was used as reference. Pure-tone audiometry and Freiburger monosyllable word tests were used as objective measurements for hearing.

RESULTS

The mean HISQUI score increased on average from 53.0 prior to surgery to 69.0 after surgery. In addition, there were significant improvements in all seven subgroups of the questionnaire divisions. A correlation of r_Sp = 0.53 before surgery and r_Sp = 0.36 after surgery between the HISQUI scores and Freiburg monosyllable word test was recorded. In addition the 4FPTA (four frequency pure tone average) value correlated negatively with r_Sp = -0.48 with the HISQUI total score before surgery.

CONCLUSION

The moderate correlation of both subjective and objective measurement methods underlines the importance of enquiring the patients' subjective perception and satisfaction. Through the combination of subjective statements and measurements of speech comprehension it is possible to obtain a comprehensive picture of the hearing performance of CI recipients.

A Follow-Up Study on Music and Lexical Tone Perception in Adult Mandarin-Speaking Cochlear Implant Users

OBJECTIVE

The aim was to evaluate the development of music and lexical tone perception in Mandarin-speaking adult cochlear implant (CI) users over a period of 1 year.

STUDY DESIGN

Prospective patient series.

SETTING

Tertiary hospital and research institute.

PATIENTS

Twenty five adult CI users, with ages ranging from 19 to 75 years old, participated in a year-long follow-up evaluation. There were also 40 normal hearing adult subjects who participated as a control group to provide the normal value range.

INTERVENTIONS

Musical sounds in cochlear implants (Mu.S.I.C.) test battery was undertaken to evaluate music perception ability. Mandarin Tone Identification in Noise Test (M-TINT) was used to assess lexical tone recognition. The tests for CI users were completed at 1, 3, 6, and 12 months after the CI switch-on.

MAIN OUTCOMES MEASURES

Quantitative and statistical analysis of their results from music and tone perception tests.

RESULTS

The performance of music perception and tone recognition both demonstrated an overall improvement in outcomes during the entire 1-year follow-up process. The increasing trends were obvious in the early period especially in the first 6 months after switch-on. There was a significant improvement in the melody discrimination (p < 0.01), timbre identification (p < 0.001), tone recognition in quiet (p < 0.0001), and in noise (p < 0.0001).

CONCLUSIONS

Adult Mandarin-speaking CI users show an increasingly improved performance on music and tone perception during the 1-year follow-up. The improvement was the most prominent in the first 6 months of CI use. It is essential to strengthen the rehabilitation training within the first 6 months.

Qualitative, multimethod study of behavioural and attitudinal responses to cochlear implantation from the patient and healthcare professional perspective in Australia and the UK: study protocol

INTRODUCTION

The growing prevalence of adults with 'severe or greater' hearing loss globally is of great concern, with hearing loss leading to diminished communication, and impacting on an individual's quality of life (QoL). Cochlear implants (CI) are a recommended device for people with severe or greater, sensorineural hearing loss, who obtain limited benefits from conventional hearing aids (HA), and through improved speech perception, CIs can improve the QoL of recipients. Despite this, utilisation of CIs is low.

METHODS AND ANALYSIS

This qualitative, multiphase and multimethod dual-site study (Australia and the UK) explores patients' and healthcare professionals' behaviours and attitudes to cochlear implantation. Participants include general practitioners, audiologists and older adults with severe or greater hearing loss, who are HA users, CI users and CI candidates. Using purposive time frame sampling, participants will be recruited to take part in focus groups or individual interviews, and will each complete a demographic questionnaire and a qualitative proforma. The study aims to conduct 147 data capture events across a sample of 49 participants, or until data saturation occurs. Schema and thematic analysis with extensive group work will be used to analyse data alongside reporting of demographic and participant characteristics.

ETHICS AND DISSEMINATION

Ethics approval for this study was granted by Macquarie University (HREC: 5201700539), and the study will abide by Australian National Health and Medical Research Council ethical guidelines. Study findings will be published through peer-reviewed journal articles, and disseminated through public and academic conference presentations, participant information sheets and a funders' final report.

Meta-analysis of quality-of-life improvement after cochlear implantation and associations with speech recognition abilities

OBJECTIVES

Determine the impact of cochlear implantation on quality of life (QOL) and determine the correlation between QOL and speech recognition ability.

STUDY DESIGN

Two authors independently searched PubMed, Medline, Scopus, and the Cumulative Index to Nursing and Allied Health Literature to identify studies reporting hearing-specific or cochlear implant (CI)-specific QOL outcomes before and after cochlear implantation, and studies reporting correlations between QOL and speech recognition after cochlear implantation. Data from the included articles were obtained independently by two authors. Standardized mean difference (SMD) for each measure and pooled effects were determined to assess improvement in QOL before and after cochlear implantation.

RESULTS

From 14 articles with 679 CI patients who met the inclusion criteria, pooled analyses of all hearing-specific QOL measures revealed a very strong improvement in QOL after cochlear implantation (SMD = 1.77). Subset analysis of CI-specific QOL measures also showed very strong improvement (SMD = 1.69). Thirteen articles with 715 patients met the criteria to evaluate associations between QOL and speech recognition. Pooled analyses showed a low positive correlation between hearing-specific QOL and word recognition in quiet (r = 0.213), sentence recognition in quiet (r = 0.241), and sentence recognition in noise (r = 0.238). Subset analysis of CI-specific QOL showed similarly low positive correlations with word recognition in quiet (r = 0.213), word recognition in noise (r = 0.241), and sentence recognition in noise (r = 0.255).

CONCLUSIONS

Using hearing-specific and CI-specific measures of QOL, patients report significantly improved QOL after cochlear implantation. However, widely used clinical measures of speech recognition are poor predictors of patient-reported QOL with CIs. Laryngoscope, 128:982-990, 2018.

Meta-analysis of Cochlear Implantation Outcomes Evaluated With General Health-related Patient-reported Outcome Measures

OBJECTIVE

Determine the change in general health-related quality of life (HRQOL) after cochlear implantation and association with speech recognition.

STUDY DESIGN

Meta-analysis.

METHODS

Search was performed following the PRISMA statement using PubMed, Medline, Scopus, and CINAHL. Studies on adult cochlear implant (CI) patients measuring HRQOL before and after cochlear implantation were included. Standardized mean difference (SMD) for each measure and pooled effects were determined. A meta-analysis of correlations was also performed between all non-disease-specific patient-reported outcome measures (PROMs) and speech recognition after cochlear implantation.

RESULTS

Twenty-two articles met criteria for meta-analysis of HRQOL improvement, but 15 (65%) were excluded due to incomplete statistical reporting. From the seven articles with 274 CI patients that met inclusion criteria, pooled analyses showed a medium positive effect of cochlear implantation on HRQOL (SMD = 0.79). Subset analysis of the HUI-3 measure showed a large effect (SMD = 0.84). Nine articles with 550 CI patients met inclusion criteria for meta-analysis of correlations between non-disease specific PROMs and speech recognition after cochlear implantation. Pooled analysis showed a low correlation between non-disease-specific PROMs and word recognition in quiet (r = 0.35), sentence recognition in quiet (r = 0.40), and sentence recognition in noise (r = 0.32).

CONCLUSION

Although regularly used, HRQOL measures are not intended to measure nor do they accurately reflect the complex difficulties facing CI patients. Only a medium positive effect of cochlear implantation on HRQOL was observed along with a low correlation between non-disease-specific PROMs and speech recognition. The use of such instruments in this population may underestimate the benefit of cochlear implantation.

Quality of Life and Cost-Effectiveness of Cochlear Implants: A Narrative Review

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.

Nijmegen Cochlear Implant Questionnaire (NCIQ): translation, cultural adaptation, and application in adults with cochlear implants

PURPOSE

Cross-cultural adaptation and translation of the Nijmegen Cochlear Implant Questionnaire (NCIQ) into Brazilian Portuguese and analysis of quality of life (QoL) results in adults with cochlear implant (CI).

METHODS

The NCIQ instrument was translated into Brazilian Portuguese and culturally adapted. After that, a cross-sectional and clinical QoL evaluation was conducted with a group of 24 adults with CI.

RESULTS

The questionnaire title in Brazilian Portuguese is 'Questionário Nijmegen de Implantes Cocleares' (NCIQ-P). The version of the NCIQ questionnaire translated into Brazilian Portuguese presented good internal consistency (0.78). The social and physical domains presented the highest scores, with the basic and advanced sound perception subdomains achieving the highest scores. No correlation between gender and time of device use was found for the questionnaire domains and subdomains.

CONCLUSION

The cross-cultural adaptation and translation of the NCIQ into Brazilian Portuguese suggests that this instrument is reliable and useful for clinical and research purposes in Brazilian adults with CI.

Correlation between subjective and objective hearing tests after unilateral and bilateral cochlear implantation

Background

There are many methods for assessing hearing performance after cochlear implantation. Standard evaluations often encompass objective hearing tests only, while patients' subjective experiences gain importance in today's healthcare. The aim of the current study was to analyze the correlation between subjective (self-reported questionnaires) and objective (speech perception and localization) hearing test results in adult cochlear implant (CI) users. Secondary, the correlation between subjective and objective hearing tests was compared between bilateral and unilateral CI patients.

Methods

Data for this study were prospectively collected as part of a multicentre randomized controlled trial. Thirty-eight postlingually deafened adult patients were randomly allocated to receive either unilateral (n = 19) or bilateral (n = 19) cochlear implantation. We used data gathered after one year of follow-up. We studied the correlation between objectively measured speech perception and localization skills on the one hand and related domains of the Speech, Spatial and Qualities of Hearing Scale (SSQ) and Nijmegen Cochlear Implant Questionnaire (NCIQ) on the other hand. We also compared these correlations between unilateral and bilateral CI users.

Results

We found significant weak to moderate negative correlations between the subjective test results (speech domain of the SSQ and the advanced speech perception domain of the NCIQ) and the related objective speech perception in noise test results (r = -0.33 to -0.48). A significant moderate correlation was found between the subjective test results (spatial domain of the SSQ) and the related objective localization test results (r = 0.59). The correlations in the group of bilateral CI patients (r = -0.28 to -0.54) did not differ significantly from the correlations in the group of unilateral CI patients (r = 0.15 to -0.40).

Conclusions

Current objective tests do not fully reflect subjective everyday listening situations. This study elucidates the importance and necessity of questionnaires in the evaluation of cochlear implantation. Therefore, it is advised to evaluate both objective and subjective tests in CI patients on a regular basis.

Trial registration

This trial was registered on March 11, 2009 in the Dutch Trial Register. Trial registration number: NTR1722.

Use of Adult Patient Focus Groups to Develop the Initial Item Bank for a Cochlear Implant Quality-of-Life Instrument

Importance

No instrument exists to assess quality of life (QOL) in adult cochlear implant (CI) users that has been developed and validated using accepted scientific standards.

Objective

To develop a CI-specific QOL instrument for adults in accordance with the Patient Reported Outcomes Measurement Information System (PROMIS) guidelines.

Design, Setting, and Participants

As required in the PROMIS guidelines, patient focus groups participated in creation of the initial item bank. Twenty-three adult CI users were divided into 1 of 3 focus groups stratified by word recognition ability. Three moderator-led focus groups were conducted based on grounded theory on December 3, 2016. Two reviewers independently analyzed focus group recordings and transcripts, with a third reviewer available to resolve discrepancies. All data were reviewed and reported according to the Consolidated Criteria for Reporting Qualitative Research. The setting was a tertiary referral center.

Main Outcomes and Measures

Coded focus group data.

Results

The 23 focus group participants (10 [43%] female; mean [range] age, 68.1 [46.2-84.2] years) represented a wide range of income levels, education levels, listening modalities, CI device manufacturers, duration of CI use, and age at implantation. Data saturation was determined to be reached before the conclusion of each of the focus groups. After analysis of the transcripts, the central themes identified were communication, emotion, environmental sounds, independence and work function, listening effort, social isolation and ability to socialize, and sound clarity. Cognitive interviews were carried out on 20 adult CI patients who did not participate in the focus groups to ensure item clarity. Based on these results, the initial QOL item bank and prototype were developed.

Conclusions and Relevance

Patient focus groups drawn from the target population are the preferred method of identifying content areas and domains for developing the item bank for a CI-specific QOL instrument. Compared with previously used methods, the use of patient-centered item development for a CI-specific QOL instrument will more accurately reflect patient experience and increase our understanding of how CI use affects QOL.

Visually Evoked Visual-Auditory Changes Associated with Auditory Performance in Children with Cochlear Implants

Activation of the auditory cortex by visual stimuli has been reported in deaf children. In cochlear implant (CI) patients, a residual, more intense cortical activation in the frontotemporal areas in response to photo stimuli was found to be positively associated with poor auditory performance. Our study aimed to investigate the mechanism by which visual processing in CI users activates the auditory-associated cortex during the period after cochlear implantation as well as its relation to CI outcomes. Twenty prelingually deaf children with CI were recruited. Ten children were good CI performers (GCP) and ten were poor (PCP). Ten age- and sex- matched normal-hearing children were recruited as controls, and visual evoked potentials (VEPs) were recorded. The characteristics of the right frontotemporal N1 component were analyzed. In the prelingually deaf children, higher N1 amplitude was observed compared to normal controls. While the GCP group showed significant decreases in N1 amplitude, and source analysis showed the most significant decrease in brain activity was observed in the primary visual cortex (PVC), with a downward trend in the primary auditory cortex (PAC) activity, but these did not occur in the PCP group. Meanwhile, higher PVC activation (comparing to controls) before CI use (0M) and a significant decrease in source energy after CI use were found to be related to good CI outcomes. In the GCP group, source energy decreased in the visual-auditory cortex with CI use. However, no significant cerebral hemispheric dominance was found. We supposed that intra- or cross-modal reorganization and higher PVC activation in prelingually deaf children may reflect a stronger potential ability of cortical plasticity. Brain activity evolution appears to be related to CI auditory outcomes.