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Lailach S, Lenz A, Zahnert T, Neudert M. Value of patient-reported outcome measures for evaluating the benefit of speech processor upgrading in patients with cochlear implants. HNO 2024; 72:25-32. [PMID: 37656221 PMCID: PMC10799117 DOI: 10.1007/s00106-023-01342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Patients with a cochlear implant (CI) should be evaluated for a new speech processor every 6 years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades. METHODS Speech understanding and subjective benefit were analyzed in 99 patients with the old and the new speech processor after 4 weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction. RESULTS The speech processor upgrade resulted in a significant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9 percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7 percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dB signal-to-noise ratio [S/N], p = 0.006). Using the APHAB, a significant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006). A comparative assessment of the benefit based on subjective and speech audiometric results identified a proportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry. CONCLUSION There was a significant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only a small improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.
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Affiliation(s)
- Susen Lailach
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Alexander Lenz
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Thomas Zahnert
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Marcus Neudert
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Jones M, Warren C, Mashal M, Greenham P, Wyss J. Speech understanding in noise for cochlear implant recipients using a spatial noise reduction setting in an off the ear sound processor with directional microphones. Cochlear Implants Int 2023; 24:311-324. [PMID: 37566646 DOI: 10.1080/14670100.2023.2233203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
PURPOSE Cochlear implant (CI) recipients struggle to hear in competing background noise. ForwardFocus is a spatial noise reduction setting from Cochlear Ltd. (Sydney) that can simultaneously attenuate noise from multiple sources behind the listener. This study assessed hearing performance with ForwardFocus in an off-the-ear (OTE) sound processor. METHOD Twenty-two experienced adult CI recipients participated. Speech reception data was collected in fixed noise acutely in the clinic. After three to five weeks take home experience, subjective impressions were recorded, and evaluations were conducted for speech reception in quiet and roving noise. RESULTS Group mean speech reception thresholds (SRT) were below 0 dB in two spatially-separated noise test conditions when using ForwardFocus in the OTE sound processor. SRT were -8.5 dB (SD 2.9) in 4-talker babble roving in a rear hemi-field (S0Nrearhemi) and -3.9 dB (SD 3.3) in 12-talker babble presented laterally and behind (S0N3). Results in S0N3 were significantly better with ForwardFocus On (p = 0.0018). Subjective ratings with the OTE were comparable to, or better than, with their walk-in BTE or OTE sound processor. CONCLUSIONS ForwardFocus provides significant benefits for speech recognition in competing background noise in an OTE sound processor. These results support clinicians in counselling CI recipients on potential sound processor options to consider.
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Lailach S, Lenz A, Zahnert T, Neudert M. [Value of patient-reported outcome measures for evaluating the benefit of speech processor upgrading in patients with cochlear implants. German version]. HNO 2023; 71:583-591. [PMID: 37540233 PMCID: PMC10462568 DOI: 10.1007/s00106-023-01341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Patients with a cochlear implant (CI) should be evaluated for a new speech processor every 6 years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades. METHODS Speech understanding and subjective benefit were analyzed in 99 patients with the old and the new speech processor after 4 weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction. RESULTS The speech processor upgrade resulted in a significant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9 percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7 percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dB signal-to-noise ratio [S/N], p = 0.006). Using the APHAB, a significant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006). A comparative assessment of the benefit based on subjective and speech audiometric results identified a proportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry. CONCLUSION There was a significant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only a small improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.
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Affiliation(s)
- Susen Lailach
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Sächsisches Cochlear Implant Centrum, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Alexander Lenz
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Sächsisches Cochlear Implant Centrum, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Thomas Zahnert
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Sächsisches Cochlear Implant Centrum, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Marcus Neudert
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Sächsisches Cochlear Implant Centrum, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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Obrycka A, Lorens A, Walkowiak A, Wlodarczyk E, Dziendziel B, Skarzynski PH, Skarzynski H. The COVID-19 pandemic and upgrades of CI speech processors for children: part II-hearing outcomes. Eur Arch Otorhinolaryngol 2022; 279:4815-4823. [PMID: 35286441 PMCID: PMC8919915 DOI: 10.1007/s00405-022-07324-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
Purpose To gauge the benefits to children of upgrading speech processors during the COVID-19 pandemic. Methods The study involved 297 children, aged from 7.3 to 18.0 years, whose processors were upgraded to either Nucleus 7 or Kanso 2, or to Sonnet 2 or Rondo 3. To document the benefits of the upgrades, a speech-in-noise discrimination test and Patient Reported Outcome Measures (PROMs) were used. Results There was a significant benefit from the newer processors in terms of speech discrimination in noise. Patient Reported Outcome Measures (PROMs) indicated less hearing disability, a higher level of functioning in everyday life situations, and more satisfaction with the new speech processor in social situations. Conclusion There is a measurable improvement in performance when the devices are upgraded to the new technology.
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Affiliation(s)
- Anita Obrycka
- Institute of Physiology and Pathology of Hearing, ul. Mokra 17, 05-830, Kajetany, Nadarzyn, Poland.
| | - Artur Lorens
- Institute of Physiology and Pathology of Hearing, ul. Mokra 17, 05-830, Kajetany, Nadarzyn, Poland
| | - Adam Walkowiak
- Institute of Physiology and Pathology of Hearing, ul. Mokra 17, 05-830, Kajetany, Nadarzyn, Poland
| | - Elzbieta Wlodarczyk
- Institute of Physiology and Pathology of Hearing, ul. Mokra 17, 05-830, Kajetany, Nadarzyn, Poland
| | - Beata Dziendziel
- Institute of Physiology and Pathology of Hearing, ul. Mokra 17, 05-830, Kajetany, Nadarzyn, Poland
| | - Piotr Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, ul. Mokra 17, 05-830, Kajetany, Nadarzyn, Poland.,Heart Failure and Cardiac Rehabilitation, Department of the Medical, University of Warsaw, Warsaw, Poland.,Institute of Sensory Organs, Kajetany, Poland
| | - Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, ul. Mokra 17, 05-830, Kajetany, Nadarzyn, Poland
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Pinheiro MMC, Mancini PC, Soares AD, Ribas Â, Lima DP, Cavadas M, Banhara MR, Carvalho SADS, Buzo BC. Comparison of Speech Recognition in Cochlear Implant Users with Different Speech Processors. J Am Acad Audiol 2021; 32:469-476. [PMID: 34847587 DOI: 10.1055/s-0041-1735252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Speech recognition in noisy environments is a challenge for both cochlear implant (CI) users and device manufacturers. CI manufacturers have been investing in technological innovations for processors and researching strategies to improve signal processing and signal design for better aesthetic acceptance and everyday use. PURPOSE This study aimed to compare speech recognition in CI users using off-the-ear (OTE) and behind-the-ear (BTE) processors. DESIGN A cross-sectional study was conducted with 51 CI recipients, all users of the BTE Nucleus 5 (CP810) sound processor. Speech perception performances were compared in quiet and noisy conditions using the BTE sound processor Nucleus 5 (N5) and OTE sound processor Kanso. Each participant was tested with the Brazilian-Portuguese version of the hearing in noise test using each sound processor in a randomized order. Three test conditions were analyzed with both sound processors: (i) speech level fixed at 65 decibel sound pressure level in a quiet, (ii) speech and noise at fixed levels, and (iii) adaptive speech levels with a fixed noise level. To determine the relative performance of OTE with respect to BTE, paired comparison analyses were performed. RESULTS The paired t-tests showed no significant difference between the N5 and Kanso in quiet conditions. In all noise conditions, the performance of the OTE (Kanso) sound processor was superior to that of the BTE (N5), regardless of the order in which they were used. With the speech and noise at fixed levels, a significant mean 8.1 percentage point difference was seen between Kanso (78.10%) and N5 (70.7%) in the sentence scores. CONCLUSION CI users had a lower signal-to-noise ratio and a higher percentage of sentence recognition with the OTE processor than with the BTE processor.
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Affiliation(s)
| | - Patricia Cotta Mancini
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alexandra Dezani Soares
- Centro do Deficiente Auditivo - Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ângela Ribas
- Centro de Implante Coclear do Hospital Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Danielle Penna Lima
- Centro de Implantes Cocleares do Hospital do Coração de Natal, Natal, Brazil
| | - Marcia Cavadas
- Department of Speech-Language Pathology and Audiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Equipe Sonora, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcos Roberto Banhara
- Centro Especializado de Reabilitação IV do Hospital Santo Antônio/Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil
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Rauch AK, Metzner T, Aschendorff A, Arndt S, Speck I, Laszig R, Beck RL. [Speech processor upgrade increases speech comprehension in patients with cochlear implants]. HNO 2019; 67:778-785. [PMID: 31468082 DOI: 10.1007/s00106-019-00734-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hearing rehabilitation of patients with severe hearing loss by cochlear implant (CI) enhances their opportunities for communication immensely with regard to their normal-hearing social environment. The degree of participation depends decisively on speech discrimination. This study examines whether speech discrimination can be improved by equipping patients with next-generation speech processors (SP). METHODS The changes in speech discrimination of 420 CI patients upon receiving a newer SP from 2003-2012 were retrospectively analyzed. Audiometry comprised the Freiburg number and monosyllable tests and the Oldenburg sentence test in quiet and noise, with a presentation volume of 70 dB. RESULTS In all audiometric tests, the newer SP showed a significant improvement compared to the preceding SP. This improvement was attainable for the majority of patients and was independent of age. CONCLUSION Upgrade of the SP results in improved speech discrimination. This holds true for several test settings. We therefore recommend earlier upgrades and that the costs for new SP be met.
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Affiliation(s)
- A-K Rauch
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - T Metzner
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - A Aschendorff
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - S Arndt
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - I Speck
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - R Laszig
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - R L Beck
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
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Bayard C, Machart L, Strauß A, Gerber S, Aubanel V, Schwartz JL. Cued Speech Enhances Speech-in-Noise Perception. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2019; 24:223-233. [PMID: 30809665 DOI: 10.1093/deafed/enz003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
Speech perception in noise remains challenging for Deaf/Hard of Hearing people (D/HH), even fitted with hearing aids or cochlear implants. The perception of sentences in noise by 20 implanted or aided D/HH subjects mastering Cued Speech (CS), a system of hand gestures complementing lip movements, was compared with the perception of 15 typically hearing (TH) controls in three conditions: audio only, audiovisual, and audiovisual + CS. Similar audiovisual scores were obtained for signal-to-noise ratios (SNRs) 11 dB higher in D/HH participants compared with TH ones. Adding CS information enabled D/HH participants to reach a mean score of 83% in the audiovisual + CS condition at a mean SNR of 0 dB, similar to the usual audio score for TH participants at this SNR. This confirms that the combination of lipreading and Cued Speech system remains extremely important for persons with hearing loss, particularly in adverse hearing conditions.
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Affiliation(s)
| | | | - Antje Strauß
- Zukunftskolleg, FB Sprachwissenschaft, University of Konstanz
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