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Weissgerber T, Löschner M, Stöver T, Baumann U. Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures. J Clin Med 2024; 13:994. [PMID: 38398307 PMCID: PMC10889101 DOI: 10.3390/jcm13040994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data and a predictive model for postoperative speech perception in noise (SPiN) after CI provision. (2) Methods: CI candidates with substantial residual hearing (either in hearing threshold or in word recognition scores) were included in a retrospective analysis (n = 87). Speech perception scores in quiet 12 months post-surgery were compared with the predicted scores. A generalized linear model was fitted to speech reception thresholds (SRTs) after CI fitting to identify predictive variables for SPiN. (3) Results: About two-thirds of the recipients achieved the expected outcome in quiet or were better than expected. The mean absolute error of the prediction was 13.5 percentage points. Age at implantation was the only predictive factor for SPiN showing a significant correlation (r = 0.354; p = 0.007). (4) Conclusions: Outcome prediction accuracy for speech in quiet was comparable to previous studies. For CI recipients in the included study population, the SPiN outcome could be predicted only based on the factor age.
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Affiliation(s)
- Tobias Weissgerber
- Audiological Acoustics, ENT Department, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany (U.B.)
| | - Marcel Löschner
- Audiological Acoustics, ENT Department, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany (U.B.)
| | - Timo Stöver
- ENT Department, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Uwe Baumann
- Audiological Acoustics, ENT Department, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany (U.B.)
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Schmidt FH, Hocke T, Zhang L, Großmann W, Mlynski R. Tone Decay Reconsidered: Preliminary Results of a Prospective Study in Hearing-Aid Users with Moderate to Severe Hearing Loss. J Clin Med 2024; 13:500. [PMID: 38256634 PMCID: PMC10816404 DOI: 10.3390/jcm13020500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Among hearing aid (HA) users, there is a considerable variability in word recognition scores (WRSs). This variability is most pronounced among individuals with moderately severe to severe hearing loss. The variability cannot be adequately explained by factors such as pure-tone audiogram, audiogram type or age. This prospective study was designed to investigate the relationship between tone decay (TD) and WRS in a group of HA users with corresponding pure-tone hearing loss. The study population included 22 patients with hearing loss between 50 and 80 dB HL. Aided WRS, unaided WRS and TD were assessed for both ears. TD was found to be frequency-dependent. TD and WRS were correlated, with up to R = -0.66. The TD test was revealed to be a feasible method for explaining variability in WRS among HA users with hearing loss below 80 dB. This may contribute to improved differential diagnostics. The TD test may thus offer a better understanding of the limitations of HA use in the context of cochlear implant candidacy assessment for HA users.
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Affiliation(s)
- Florian Herrmann Schmidt
- Department of Otorhinolaryngology, Head and Neck Surgery, ‘Otto Körner’, Rostock University Medical Center, Doberaner Strasse 137-139, 18057 Rostock, Germany; (L.Z.); (W.G.); (R.M.)
| | - Thomas Hocke
- Cochlear Deutschland GmbH & Co. KG, Karl-Wiechert-Allee 76, 30625 Hannover, Germany;
| | - Lichun Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, ‘Otto Körner’, Rostock University Medical Center, Doberaner Strasse 137-139, 18057 Rostock, Germany; (L.Z.); (W.G.); (R.M.)
| | - Wilma Großmann
- Department of Otorhinolaryngology, Head and Neck Surgery, ‘Otto Körner’, Rostock University Medical Center, Doberaner Strasse 137-139, 18057 Rostock, Germany; (L.Z.); (W.G.); (R.M.)
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, ‘Otto Körner’, Rostock University Medical Center, Doberaner Strasse 137-139, 18057 Rostock, Germany; (L.Z.); (W.G.); (R.M.)
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Friedmann DR, Nicholson A, O'Brien-Russo C, Sherman S, Chodosh J. Prevalence and Characteristics of Veterans with Severe Hearing Loss: A Descriptive Study. Trends Hear 2024; 28:23312165241273393. [PMID: 39113646 PMCID: PMC11311185 DOI: 10.1177/23312165241273393] [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] [Received: 02/16/2024] [Revised: 06/14/2024] [Accepted: 07/08/2024] [Indexed: 08/11/2024] Open
Abstract
Hearing loss is common among Veterans, and extensive hearing care resources are prioritized within the Veterans Administration (VA). Severe hearing loss poses unique communication challenges with speech understanding that may not be overcome with amplification. We analyzed data from the VA Audiometric Repository between 2005 and 2017 and the relationship between hearing loss severity with speech recognition scores. We hypothesized that a significant subset of Veterans with severe or worse hearing loss would have poor unaided speech perception outcomes even with adequate audibility. Sociodemographic characteristics and comorbidities were compiled using electronic medical records as was self-report measures of hearing disability. We identified a cohort of 137,500 unique Veterans with 232,789 audiograms demonstrating bilateral severe or worse hearing loss (four-frequency PTA > 70 dB HL). The median (IQR; range) age of Veterans at their first audiogram with severe or worse hearing loss was 81 years (74 to 87; 21-90+), and a majority were male (136,087 [99%]) and non-Hispanic white (107,798 [78.4%]). Among those with bilateral severe or worse hearing loss, 41,901 (30.5%) also had poor speech recognition scores (<50% words), with greater hearing loss severity correlating with worse speech perception. We observed variability in speech perception abilities in those with moderate-severe and greater levels of hearing loss who may derive limited benefit from amplification. Veterans with communication challenges may warrant alternative approaches and treatment strategies such as cochlear implants to support communication needs.
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Affiliation(s)
- David R Friedmann
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Otolaryngology-Head & Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Andrew Nicholson
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Colleen O'Brien-Russo
- Department of Otolaryngology-Head & Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Scott Sherman
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Joshua Chodosh
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
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Franke-Trieger A, Lailach S, Shetty J, Murrmann K, Zahnert T, Neudert M. Word Recognition with a Cochlear Implant in Relation to Prediction and Electrode Position. J Clin Med 2023; 13:183. [PMID: 38202190 PMCID: PMC10780042 DOI: 10.3390/jcm13010183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND the word recognition score (WRS) achieved with cochlear implants (CIs) varies widely. To account for this, a predictive model was developed based on patients' age and their pre-operative WRS. This retrospective study aimed to find out whether the insertion depth of the nucleus lateral-wall electrode arrays contributes to the deviation of the CI-achieved WRS from the predicted WRS. MATERIALS AND METHODS patients with a pre-operative maximum WRS > 0 or a pure-tone audiogram ≥80 dB were included. The insertion depth was determined via digital volume tomography. RESULTS fifty-three patients met the inclusion criteria. The median WRS achieved with the CI was 70%. The comparison of pre- and post-operative scores achieved with a hearing aid and a CI respectively in the aided condition showed a median improvement of 65 percentage points (pp). A total of 90% of the patients improved by at least 20 pp. The majority of patients reached or exceeded the prediction, with a median absolute error of 11 pp. No significant correlation was found between the deviation from the predicted WRS and the insertion depth. CONCLUSIONS our data support a previously published model for the prediction of the WRS after cochlear implantation. For the lateral-wall electrode arrays evaluated, the insertion depth did not influence the WRS with a CI.
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Affiliation(s)
- Annett Franke-Trieger
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany (T.Z.)
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Hoppe U, Hast A, Hornung J, Hocke T. Evolving a Model for Cochlear Implant Outcome. J Clin Med 2023; 12:6215. [PMID: 37834857 PMCID: PMC10573840 DOI: 10.3390/jcm12196215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Cochlear implantation is an efficient treatment for postlingually deafened adults who do not benefit sufficiently from acoustic amplification. Implantation is indicated when it can be foreseen that speech recognition with a cochlear implant (CI) is superior to that with a hearing aid. Especially for subjects with residual speech recognition, it is desirable to predict CI outcome on the basis of preoperative audiological tests. PURPOSE The purpose of the study was to extend and refine a previously developed model for CI outcome prediction for subjects with preoperative word recognition to include subjects with no residual hearing by incorporating additional results of routine examinations. RESULTS By introducing the duration of unaided hearing loss (DuHL), the median absolute error (MAE) of the prediction was reduced. While for subjects with preoperative speech recognition, the model modification did not change the MAE, for subjects with no residual speech recognition before surgery, the MAE decreased from 23.7% with the previous model to 17.2% with the extended model. CONCLUSIONS Prediction of word recognition with CI is possible within clinically relevant limits. Outcome prediction is particularly important for preoperative counseling and in CI aftercare to support systematic monitoring of CI fitting.
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Affiliation(s)
- Ulrich Hoppe
- Cochlear Implant Center CICERO, Department of Otorhinolaryngology-Head and Neck Surgery, Uniklinikum Erlangen, Waldstr. 1, D-91054 Erlangen, Germany; (A.H.); (J.H.)
| | - Anne Hast
- Cochlear Implant Center CICERO, Department of Otorhinolaryngology-Head and Neck Surgery, Uniklinikum Erlangen, Waldstr. 1, D-91054 Erlangen, Germany; (A.H.); (J.H.)
| | - Joachim Hornung
- Cochlear Implant Center CICERO, Department of Otorhinolaryngology-Head and Neck Surgery, Uniklinikum Erlangen, Waldstr. 1, D-91054 Erlangen, Germany; (A.H.); (J.H.)
| | - Thomas Hocke
- Cochlear Deutschland GmbH & Co. KG, Mailänder Str. 4a, D-30539 Hannover, Germany;
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Thangavelu K, Nitzge M, Weiß RM, Mueller-Mazzotta J, Stuck BA, Reimann K. Role of cochlear reserve in adults with cochlear implants following post-lingual hearing loss. Eur Arch Otorhinolaryngol 2023; 280:1063-1071. [PMID: 35947149 PMCID: PMC9899754 DOI: 10.1007/s00405-022-07558-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Pre-operative assessments before cochlear implantation (CI) includes the examination of both tone hearing, and the level of the cochlear reserve indicated by speech understanding. The goal of this study was to explore the predictive influence of tone hearing and cochlear reserve in CI. METHODS We did a retrospective cohort study, which included adult patients who had undergone CI between January 2012 and December 2019 in a tertiary care center. The pre-operative tone hearing, unaided maximum monosyllabic word recognition score (WRSmax), aided hearing gain, aided monosyllabic word recognition score at 65 dB (WRS65(HA)), and speech perception gap (SPG) were measured. The duration of unaided hearing loss (UHL) was also assessed. These variables were compared with post-operative monosyllabic word recognition score after CI at 65 dB (WRS65(CI)). RESULTS 103 patients and 128 ears were included in this study. Regardless of tone hearing, patients with better pre-operative WRSmax and WRS65(HA) performed better post-operatively. WRSmax was found to be the most important factor that was statistically significantly associated with WRS65(CI). SPG was statistically significantly associated with WRSmax and SPG ≥ 20% group performed better post-operatively. Any duration of unaided hearing loss was statistically significantly inversely associated with WRSmax above 0%. CONCLUSION Cochlear reserve represented by WRSmax may play the most important role as a predictive factor in outcomes after CI. SPG should be considered for indicating CI in patients, when WRS65(HA) does not reach WRSmax. Early rehabilitation with hearing aids and duration of hearing aid usage might play an important role in preserving cochlear reserve in adults.
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Affiliation(s)
- Kruthika Thangavelu
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Markus Nitzge
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Rainer M Weiß
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Jochen Mueller-Mazzotta
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Katrin Reimann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
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Hoppe U, Hast A, Hocke T. Speech Perception in Bilateral Hearing Aid Users With Different Grades of Asymmetric Hearing Loss. Front Neurosci 2022; 15:715660. [PMID: 35153651 PMCID: PMC8826244 DOI: 10.3389/fnins.2021.715660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022] Open
Abstract
Hearing loss is associated with decreased speech perception as well as with changes in the auditory pathway. The effects of those changes on binaural speech perception with hearing aids are not yet fully understood. To provide further evidence on the functional changes of the auditory pathway, several speech perception tests (unilateral and bilateral, aided and unaided, in quiet, and in noise) were conducted in a population of 370 bilateral hearing aid users covering the entire range of the World Health Organization’s most recent classification of hearing loss. To characterize the effects of asymmetric hearing thresholds, a generalized linear model was used for regression analysis. The model revealed a detrimental effect of the poorer ears’ thresholds on both the unaided and the aided unilateral word recognition scores that were attained by the better ear. Moreover, aided binaural word recognition (in quiet and in noise) was affected to a degree that cannot be explained on the sole basis of bilateral summation. Thus, this study provides evidence that there is reorganization and altered functioning of the afferent and efferent auditory pathways due to asymmetric hearing loss. Consequently, more attention should be paid to provision with a hearing aid as early as possible, and separately for each ear.
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Affiliation(s)
- Ulrich Hoppe
- Department of Audiology, ENT-Clinic, University of Erlangen-Nürnberg, Erlangen, Germany
- *Correspondence: Ulrich Hoppe,
| | - Anne Hast
- Department of Audiology, ENT-Clinic, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Hocke
- Cochlear Deutschland GmbH & Co. KG, Hanover, Germany
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Shohet J, Bibee J. New Considerations for a Totally Implantable Active Middle Ear Implant. Front Neurol 2021; 12:747887. [PMID: 34721275 PMCID: PMC8548455 DOI: 10.3389/fneur.2021.747887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Totally implantable active middle ear implants (AMEI) provide full-time hearing amplification to those with moderate to severe sensorineural hearing loss. While technology in conventional hearing aids (CHA) has advanced greatly, limitations remain for people with active lifestyles, limited vision or dexterity, and hearing aid fit issues. Furthermore, direct-drive properties of AMEI are thought to provide those with inefficient middle ear transfer functions a distinct advantage in delivering prescribed sound to the cochlea, ultimately improving speech understanding with less distortion. AMEI safety, stability, and efficacy outcomes are well documented and fitting strategies continue to improve. Recent studies show how simple aided speech testing can help predict whether a patient struggling with CHA may instead benefit from an AMEI. Totally implantable AMEI continue to be a viable option for patients who cannot or will not utilize traditional hearing aids.
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Affiliation(s)
- Jack Shohet
- Shohet Ear Associates, Orange County, CA, United States
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Hoppe U, Hocke T, Hast A, Iro H. Cochlear Implantation in Candidates With Moderate-to-Severe Hearing Loss and Poor Speech Perception. Laryngoscope 2021; 131:E940-E945. [PMID: 32484949 DOI: 10.1002/lary.28771] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the improvement in word recognition score (WRS65 ) after cochlear implant (CI) surgery in hearing aid (HA) users with preoperative hearing threshold ≤80 dB HL and inadequate speech recognition scores with HA. Secondarily, to identify predictive factors for WRS65 with a CI (WRS65 [CI]) 6 months after surgery, derived from the standard German CI preoperative assessment. STUDY DESIGN Retrospective chart review. METHODS Retrospective review of all adult patients who received a Nucleus cochlear implant in the ear, nose, and throat department of the University Hospital of Erlangen between January 2010 and April 2019. The inclusion criteria were a preoperative hearing threshold ≤80 dB HL in the ear to receive the implantation, German as the native language, and at least 6 months postimplantation care at our center. RESULTS The inclusion criteria were met by 128 patients. All but two patients (98.4%) showed a significant improvement, WRS65 (CI) versus WRS65 with an (HA) (WRS65 [HA]), of at least 15 percentage points (pp). The median improvement was 55 pp with a median WRS65 (CI) of 70%. Three preoperative audiometric measures, the maximum word recognition score, age at implantation, and WRS65 (HA) were identified as predictive factors for WRS65 (CI). For three-quarters of the CI recipients, the score was not poorer than 12 pp below the predicted WRS65 (CI). CONCLUSIONS For patients with a hearing loss ≤80 dB HL, cochlear implantation should be considered when speech perception with an HA is insufficient. The prediction model can support counseling in this patient group. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E940-E945, 2021.
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Affiliation(s)
- Ulrich Hoppe
- ENT Department, University Hospital Erlangen, Erlangen, Germany
| | - Thomas Hocke
- Cochlear Deutschland GmbH and Co. KG, Hannover, Germany
| | - Anne Hast
- ENT Department, University Hospital Erlangen, Erlangen, Germany
| | - Heinrich Iro
- ENT Department, University Hospital Erlangen, Erlangen, Germany
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