Perceived improvements and challenges following sequential bilateral cochlear implantation in children and adults

Familial psychosocial impact of cochlear implantation

BACKGROUND

Adult cochlear implantation rates are increasing, and the resulting change in hearing capabilities has vast impacts in the psychosocial domain of life for the cochlear implant users and their families. However, there is currently no published evidence synthesis of the ways in which adult cochlear implantation affects the psychosocial sphere of the family unit.

OBJECTIVE

(1) Describe the existing literature on the psychosocial impact of cochlear implantation on adults. (2) Assess the range of impacts on the family unit and highlight areas warranting further investigation.

DATA SOURCES

Ovid, CINAHL, and Scopus.

REVIEW METHODS

Databases were systematically searched from January 1, 2007 to May 1, 2022. Eligibility assessment was performed via two independent investigators. Disagreements in selection were discussed and consulted on with a third investigator as needed.

RESULTS

Of the 875 unique articles identified, 13 remained in the final review. The most frequently noted psychosocial impacts on the family was quality of life (100 %), family relations (85 %), conversational access (85 %), everyday hearing (77 %), and less feelings of isolation (77 %). 6 of the studies only considered the viewpoint of the CI user and did not have a congruent survey response from an individual from their family unit.

CONCLUSION

This study describes the existing literature on the familial psychosocial impact of adult cochlear implantation, focusing on the general well-being, social integration, and psychological aspects noted post-implantation. This review identifies gaps in this research, with large numbers of studies on CI user benefits and little insight into the impact on the family unit. We recommend shifting research on CI impact toward a focus on the family unit, rather than individual, and an evaluation of familial influence in electing to receive a CI.

Voice Discrimination in Quiet and in Background Noise by Simulated and Real Cochlear Implant Users

PURPOSE

Cochlear implant (CI) users demonstrate poor voice discrimination (VD) in quiet conditions based on the speaker's fundamental frequency (fo) and formant frequencies (i.e., vocal-tract length [VTL]). Our purpose was to examine the effect of background noise at levels that allow good speech recognition thresholds (SRTs) on VD via acoustic CI simulations and CI hearing.

METHOD

Forty-eight normal-hearing (NH) listeners who listened via noise-excited (n = 20) or sinewave (n = 28) vocoders and 10 prelingually deaf CI users (i.e., whose hearing loss began before language acquisition) participated in the study. First, the signal-to-noise ratio (SNR) that yields 70.7% correct SRT was assessed using an adaptive sentence-in-noise test. Next, the CI simulation listeners performed 12 adaptive VDs: six in quiet conditions, two with each cue (fo, VTL, fo + VTL), and six amid speech-shaped noise. The CI participants performed six VDs: one with each cue, in quiet and amid noise. SNR at VD testing was 5 dB higher than the individual's SRT in noise (SRTn +5 dB).

RESULTS

Results showed the following: (a) Better VD was achieved via the noise-excited than the sinewave vocoder, with the noise-excited vocoder better mimicking CI VD; (b) background noise had a limited negative effect on VD, only for the CI simulation listeners; and (c) there was a significant association between SNR at testing and VTL VD only for the CI simulation listeners.

CONCLUSIONS

For NH listeners who listen to CI simulations, noise that allows good SRT can nevertheless impede VD, probably because VD depends more on bottom-up sensory processing. Conversely, for prelingually deaf CI users, noise that allows good SRT hardly affects VD, suggesting that they rely strongly on bottom-up processing for both VD and speech recognition.

Vestibular Function After Cochlear Implantation in Partial Deafness Treatment

Introduction: Cochlear implantation is a fully accepted method of treating individuals with profound hearing loss. Since the indications for cochlear implantation have broadened and include patients with low-frequency residual hearing, single-sided deafness, or an already implanted ear (meaning bilateral cochlear implantation), the emphasis now needs to be on vestibular protection.

Materials and Methods: The research group was made up of 107 patients operated on in the otorhinolaryngosurgery department: 59 females and 48 males, aged 10.4–80.2 years (M = 44.4; SD = 18.4) with hearing loss lasting from 1.4 to 56 years (M = 22.7; SD = 13.5). The patients underwent cVEMP, oVEMP, a caloric test, and vHIT assessment preoperatively, and, postoperatively, cVEMP and oVEMP at 1–3 months and a caloric test and vHIT at 4–6 months.

Results: After cochlear implantation, there was postoperative loss of cVEMP in 19.2% of the patients, oVEMP in 17.4%, reduction of caloric response in 11.6%, and postoperative destruction of the lateral, anterior, and posterior semicircular canal as measured with vHIT in 7.1, 3.9, and 4% respectively.

Conclusions: Hearing preservation techniques in cochlear implantation are connected with vestibular protection, but the risk of vestibular damage in never totally eliminated. The vestibular preservation is associated with hearing preservation and the relation is statistically significant. Informed consent for cochlear implantation must include information about possible vestibular damage. Since the risk of vestibular damage is appreciable, preoperative otoneurological diagnostics need to be conducted in the following situations: qualification for a second implant, after otosurgery (especially if the opposite ear is to be implanted), having a history of vestibular complaints, and when there are no strict audiological or anatomical indications on which side to operate.

Health-Related Quality of Life Changes Associated With Hearing Loss

Importance

Utility is a single-value, preference-based measure of health-related quality of life that represents the desirability of a health state relative to being dead or in perfect health. Clinical, funding, and policy decisions rely on measured changes in utility. The benefit of hearing loss treatments may be underestimated because existing utility measures fail to capture important changes in quality of life associated with hearing loss.

Objective

To develop a comprehensive profile of items that describe how quality of life is associated with hearing loss and its treatments that can be used to generate hearing-related quality of life measures, including a novel utility measure.

Design, Setting, and Participants

This qualitative study, performed from August 1, 2018, to August 1, 2019, in tertiary referral centers, comprised a systematic literature review, focus groups, and semistructured interviews. The systematic review evaluated studies published from 1982 to August 1, 2018. Focus groups included 8 clinical experts experienced in the measurement, diagnosis, treatment, and rehabilitation of hearing loss. Semistructured interviews included 26 adults with hearing loss recruited from an institutional data set and outpatient hearing aid and otology clinics using stratified convenience sampling to include individuals of diverse ages, urban and rural residency, causes of hearing loss, severity of hearing loss, and treatment experience.

Main Outcomes and Measures

A set of items and subdomains that collectively describe the association of hearing loss with health-related quality of life.

Results

The literature search yielded 2779 articles from the MEDLINE, Embase, Cochrane, PsycINFO, and CINAHL databases. Forty-five studies including 1036 individuals (age range, 18-84 years) were included. The focus group included 4 audiologists and 4 otologists. Hour-long semistructured interviews were conducted with 26 individuals (13 women; median age, 54 years; range, 25-83 years) with a broad range of hearing loss causes, configurations, and severities. From all 3 sources, a total of 125 items were generated and organized into 29 subdomains derived from the World Health Organization's International Classification of Functioning, Disability and Health.

Conclusions and Relevance

The association of hearing loss with quality of life is multidimensional and includes subdomains that are not considered in the estimation of health utility by existing utility measures. The presented comprehensive profile of items can be used to generate or evaluate measures of hearing-related quality of life, including utility measures.