Update On Cochlear Implantation

Medication-Related Experience of Deaf American Sign Language Users

BACKGROUND

Previous studies showed that deaf and hard-of-hearing (DHH) individuals have low health literacy related to prescription labels. This study examined the DHH's experience with understanding prescription labels and how technology can impact that experience.

OBJECTIVES

The purpose of this qualitative study was twofold: (1) gain a more enhanced understanding of DHH experiences in understanding prescription labels with a focus on language needs, expectations, and preferences, and (2) assess the potential role of technology in addressing the communication-related accessibility issues which emerge from the data.

METHODS

In this study, 25 Deaf American Sign Language users who picked up a prescription from a pharmacy within the past year were interviewed. A thematic analysis, which included a systematic coding process, was used to uncover themes about their experiences picking up and using prescription medications.

KEY RESULTS

Thematic analyses identified that medication-related experiences centered around themes: (1) medication information seeking; (2) comfort taking medication; (3) picking up medication; and (4) communication with the pharmacy team. A large contributor to the communication experience was the perception that the pharmacist was not being respectful. Regarding comfort taking medications, 12% of participants expressed a lack of understanding medications while taking medication. This led to participants largely using online resources when seeking medication information. This study also found that technology greatly aided the participants during this experience.

CONCLUSION

This study recorded the experiences within the context of limited health literacy and aversive audism found that the DHH individual repeatedly encountered communication barriers, which may contribute to their poor medication literacy. Thus, future studies should explore how to leverage the potential benefits of technology to improve the pharmacy experience of the DHH, thereby improving medication literacy. [HLRP: Health Literacy Research and Practice. 2023;7(4):e215-e224.].

Cochlear Health and Cochlear-implant Function

The cochlear implant (CI) is widely considered to be one of the most innovative and successful neuroprosthetic treatments developed to date. Although outcomes vary, CIs are able to effectively improve hearing in nearly all recipients and can substantially improve speech understanding and quality of life for patients with significant hearing loss. A wealth of research has focused on underlying factors that contribute to success with a CI, and recent evidence suggests that the overall health of the cochlea could potentially play a larger role than previously recognized. This article defines and reviews attributes of cochlear health and describes procedures to evaluate cochlear health in humans and animal models in order to examine the effects of cochlear health on performance with a CI. Lastly, we describe how future biologic approaches can be used to preserve and/or enhance cochlear health in order to maximize performance for individual CI recipients.

REVIEW ■ : Prospects for a Visual Prosthesis

Diseases of the retina and optic nerve are common causes of irreversible blindness. Given the lack of effective treatments, several laboratories are utilizing microelectronic technology to develop either a cortical or retinal prosthesis. Each strategy offers certain advantages, but both face numerous and formidable chal lenges. Consequently, a clinically useful device of either type is still conceptual. The technological means to build prostheses are available, but the ultimate obstacle is the integration of the technology with the brain. This article reviews achievements of the ongoing efforts and focuses on our project to develop a retinal prosthesis. NEUROSCIENTIST 3:251-262, 1997

Audism

More than 30 years ago, Tom Humphries coined the term “audism” to describe audiocentric (based on hearing and speaking) assumptions and attitudes of supremacy. Only a handful of scholarly articles mention the concept of audism and not one of those is published outside of Deaf Cultural Studies. In this article, audism is broadly defined in the ideological contexts of individual, institutional, metaphysical, and laissez-faire prejudices. Audism is further explained in the context of overt, covert, and aversive practices of discrimination. Examples of the intersections of the theory and practice of audiocentric privilege are explored. Based on critical observations of audism as a stratifying system of oppression, four recommendations are made: increasing public awareness of Deaf American contributions to society (multiculturalism), infusing Deaf-centric curriculum content in education (equity), advocating intergroup dialogues as a transformative pedagogy that further exposes audism as a social injustice (intercultural responsibility), and promoting community service opportunities (ethical citizenship) for students to do volunteer work in the Deaf American Community.

Toward a theory of deaf ethnos: deafnicity -- D/deaf (Homaemon - Homoglosson - Homothreskon)

Should ethnicity be used to interpret relations between the Deaf community and the hearing people? Recent scholarship questioning the merits of Deaf ethnicity suggests a need to reexamine the use of ethnicity when describing Deaf identity and culture. This article provides an overview of key contributions to race and ethnicity discourse in the 20th century, identifies epistemological and ontological errors to avoid, suggests adherence to the classical Greek concept of ethnos as an alternative to ethnie, and argues for the continuing significance of Deaf ethnicity. Specifically, I propose that Deaf ethnicity is a triadic relational nexus that approximates communities of origin, language, and religion. This is expressed as Deafnicity approximately D/deaf (Hómaemon * Homóglosson * Homóthreskon). Deafnicity offers a promising alternative for examining relations between Deaf and hearing communities, exploring variance between nationalized Deaf communities, and expanding our understanding of audism.

Pitch ranking of complex tones by normally hearing subjects and cochlear implant users

The ability of 10 normally hearing (NH) adults and eight cochlear implant (CI) users to pitch-rank pairs of complex tones was assessed. The acoustically presented stimuli differed in fundamental frequency (F0) by either one or six semitones (F0 range: 98 to 740 Hz). The NH group obtained significantly higher mean scores for both experiments: (NH: one semitone - 81.2%, six semitones - 89.0%; CI: one semitone - 49.0%, six semitones - 60.2%; p<0.001). Prior musical experience was found to be associated with higher pitch-ranking scores for the NH subjects. Those with musical experience ratings <3 obtained significantly lower scores for both interval sizes (p<0.001) than those with higher ratings. Nevertheless, the scores obtained by the musically inexperienced, NH adults were significantly higher than those obtained by the CI group for both the one-semitone (p=0.022) and six-semitone (p=0.018) intervals. These results suggest that the pitch information CI users obtain from their implant systems is less accurate than that obtained by NH listeners when listening to the same complex sounds. Furthermore, the relatively poor pitch-ranking ability of at least some CI users may be associated with a more-limited experience of music in general.

Management of Complications in Neurotology

Neurotologic and skull base surgery involves working around important neurovascular and neurotologic structures and can incur unwarranted complications. Knowledge of surgical anatomy, good preoperative planning, intraoperative monitoring, and excellent microsurgical technique contribute to minimizing and avoiding complications. In the event of a complication, however, the neurotologic surgeon should be prepared to manage it. In this article, the authors focus on the management of complications encountered in neurotologic skull base surgery, including hemorrhage, stroke, cerebrospinal fluid leak, extraocular motility deficits, facial paralysis, hearing loss, dizziness, lower cranial nerve palsies, and postoperative headache.

Cochlear implants

Cochlear implants are cost-effective auditory prostheses that safely provide a high-quality sensation of hearing to adults who are severely or profoundly deaf. In the past 5 years, progress has been made in hardware and software design, candidate selection, surgical techniques, device programming, education and rehabilitation,and, most importantly, outcomes. Cochlear implantation in the elderly is well tolerated and provides marked improvement in auditory performance and psychosocial functioning.

Pitch ranking ability of cochlear implant recipients: a comparison of sound-processing strategies

Pitch ranking of sung vowel stimuli, separated in fundamental frequency (F0) by half an octave, was measured with a group of eleven Nucleus 24 cochlear implant recipients using different sound coding strategies. In three consecutive studies, either two or three different sound coding strategies were compared to the Advanced Combinational Encoder (ACE) strategy. These strategies included Continuous Interleaved Sampling (CIS), Peak Derived Timing (PDT), Modulation Depth Enhancement (MDE), F0 Synchronized ACE (FOSync), and Multi-channel Envelope Modulation (MEM), the last four being experimental strategies. While pitch ranking results on average were poor compared to those expected for most normal hearing listeners, significantly higher scores were obtained using the MEM, MDE, and FOSync strategies compared to ACE. These strategies enhanced coding of temporal F0 cues by providing deeper modulation cues to F0 coincidentally in time across all activated electrodes. In the final study, speech recognition tests were also conducted using ACE, CIS, MDE, and MEM. Similar results among all strategies were obtained for word tests in quiet and between ACE and MEM for sentence tests in noise. These findings demonstrate that strategies such as MEM may aid perception of pitch and still adequately code segmental speech features as per existing coding strategies.

Influence of EEG monitoring on intraoperative stapedius reflex threshold values in cochlear implantation in children

BACKGROUND

Cochlear implantation is a widely used means of treating deafness and severe hearing disorders. The surgical procedure includes inserting the cochlear implant electrode array into the cochlea and embedding the corresponding signal receiver in the mastoid bone behind the ear. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. For this purpose, electrically elicited stapedius reflex threshold values can be used. However, stapedius reflex threshold values measured intraoperatively are influenced by anaesthetics. The goal of this retrospective study was to find out whether electroencephalogram (EEG) control of anaesthesia produces more reliable reflex threshold values as a basis for the fitting of the speech processor.

METHODS

Three groups of children, after surgery for cochlear implantation, were analysed with regard to the magnitude of intraoperative electrically elicited stapedius reflex threshold values and their deviations from postoperatively determined maximum comfortable levels (group 1: methohexital/remifentanil with EEG monitoring, n = 10; group 2: isoflurane/fentanyl with EEG monitoring, n = 9; group 3: isoflurane/fentanyl without EEG monitoring, n = 11).

RESULTS

Children with EEG monitoring had significantly lower electrically elicited stapedius reflex threshold values and also significantly lower differences between intraoperative stapedius reflex threshold values and postoperatively determined maximum comfortable levels.

CONCLUSIONS

Electroencephalogram monitoring in cochlear implantation is of considerable value in controlling anaesthesia and improving speech processor fitting based on more reliable intraoperative neurophysiological data.

Cochlear implants: response to therapeutic irradiation

PURPOSE

To determine the response of cochlear implants ("bionic ears") to therapeutic irradiation.

METHODS AND MATERIALS

A patient with a cochlear implant was referred for palliative cranial irradiation. As there were no published or manufacturer's data available regarding the response to radiation, implants were tested for functional changes following irradiation. Cochlear implants were supplied by Cochlear Ltd. Two units each of models CI22M, CI22M (with the second generation integrated circuit) and CI24M were irradiated with 4 MV X-rays, and an unirradiated unit of each model was used as a control. The implants were irradiated initially with 25 daily fractions to 50 Gy. To determine the response at higher doses, 10 Gy fractions were delivered to the same implants to 100 Gy, followed by a final fraction of 50 Gy (total dose 150 Gy). The implants were tested after each 10 Gy, up to 1100 Gy, and at 150 Gy. Several indicators of functionality were assessed, including RF (radio frequency) link range, and stimulator output current. The radiation shielding effect of the implants was also assessed.

RESULTS

Within the dose range < or = 50 Gy, the stimulator output current of the CI22M units was the only parameter to change. At higher doses (to 150 Gy), changes in current output continued, and gradual loss of RF link range occurred in the CI22M units. The CI24M units showed changes in output current to 100 Gy, and large changes at 150 Gy. Dose attenuation by the implants was measured at 6% for ipsilateral single field 4 MV X-rays.

CONCLUSION

Our results suggest that patients with these cochlear implants can receive cranial irradiation with a low risk of implant failure. Changes in stimulator output current can be compensated simply by reprogramming the speech map after the course of radiation treatment.

Correlation of acoustic threshold measures and spiral ganglion cell survival in severe to profound sensorineural hearing loss: implications for cochlear implantation

In a temporal bone study of 26 ears from 13 patients who, in life, had severe sensorineural hearing loss, the segmental and total spiral ganglion cell (SGC) counts were correlated with hearing thresholds and with the difference between hearing thresholds in the two ears, the age at death, the duration of deafness, and the duration of hearing loss. A statistically significant correlation was found between the interaural differences in total SGC counts and the interaural difference in pure tone averages for 3, 4, and 5 frequencies. The total SGC count was higher in the ear with the better residual hearing in 11 of 12 cases. Approximately 41% of the variability in interaural difference in pure tone average was explained by the difference in SGC counts. The findings would suggest that in a given individual, selection of the ear with better residual hearing for cochlear implantation is likely to result in accessing a higher number of residual SGCs. This, in turn, may result in better speech recognition with the implant.