Re-training the deaf ear: Auditory training for adult cochlear implant users with singlesided deafness

Reliability of connectivity for the assessment of hearing perception in cochlear implant recipients

OBJECTIVE

The cochlear implant (CI) is the gold standard treatment for profound hearing loss with insufficient hearing aid benefit. Using regular words and sentences as verbal stimuli showed a ceiling effect in patients with optimal perceptual abilities. The objectives of the study were: (1) to evaluate the reliability of auditory perception through connectivity, comparing it to the regular audiometry in soundbooth and (2) to analyse the use of logatomes to better assess the perceptual abilities of high-performing patients.

DESIGN AND STUDY SAMPLE

Cross sectional analytic study.

STUDY SAMPLE

A total of 32 CI patients with high auditory performances underwent pure-tone and speech audiometry in two methods: (1) in an audiometric booth and (2) via direct streaming to the processor using a connectivity system. Correlation and concordance analyses were performed.

RESULTS

Pure-tone audiometry showed a low correlation between the two methods. Speech audiometry revealed a high correlation at 30 dB HL but a low concordance between the two instruments. The evaluation through connectivity showed better results in pure-tone and speech audiometry than those of regular audiometry in soundbooth. The use of logatomes was useful for discriminating patients with better performances.

CONCLUSIONS

Connectivity might be considered a useful additional method to assess the performance of CI recipients.

Investigating the effect of cochlear implant usage metrics on cortical auditory-evoked potential responses in adult recipients post-implantation

Introduction

This study examines the effect of cochlear implant (CI) device usage metrics on post-operative outcomes in unilateral CI recipients. The primary objective is to investigate the relationship between CI usage frequency (average daily CI use) and duration (total years of CI use) on electrically evoked cortical auditory-evoked potential (eCAEP) response peak latency (ms) and amplitude (μV).

Methods

Adult CI users (n = 41) who previously exhibited absent acoustically evoked CAEP responses participated in the study. The peak latency and amplitude of eCAEP P1-N1-P2 responses were recorded, when present for the apical, medial, and basal test electrode contacts. CI duration was defined as the number of years between the date of CI activation and date that eCAEP testing was performed. CI usage frequency was defined as the average number of hours per day of audio processor use, which was recorded using the CI programming software.

Results

Overall, 27 participants (65.85%) exhibited detectable eCAEP responses across one or more electrode contacts. Among these, 18 participants (43.9%) elicited eCAEP responses at all three electrode contacts, while 7 (17.07%) showed responses at two contacts, and 2 (4.88%) at one contact. For the remaining 14 participants (34.15%), eCAEP responses were either absent or undetectable. CI usage frequency (average daily CI use [hours/day]) was captured for 32 (78%) of the participants (median 10.35 h/day, range 0.2-16 h/day). Participants with present eCAEP responses for the basal electrode (n = 14) showed significantly higher CI usage frequency (11.8 h/day, p = 0.026) compared to those with non-detectable responses (6.25 h/day). An association was found between higher CI usage frequency and reduced N1 (p = 0.002), P2 (p = 0.0037) and P1-N1 inter-peak (p = 0.015) response latency (ms). While CI duration (total CI use [years]) did not differ significantly between groups based on the presence of eCAEP responses, an association was found between greater CI duration and increased eCAEP response amplitude (μV) for the P2 (p = 0.008) and N1-P2 peak-peak (p = 0.009) response components.

Discussion

Additionally, most (65.85%) participants who previously exhibited absent acoustic CAEP responses developed eCAEP responses after consistent CI use and increased CI experience. These findings may suggest a potential for cortical plasticity and adaptation with consistent CI use over time. Recognizing the impact of device usage metrics on neural responses post-implantation enhances our understanding of the importance of consistent daily CI use. Overall, these findings contribute to addressing the variability among CI users, improving post-operative outcomes and advancing the standard of personalized care in auditory rehabilitation.

Cochlear implant usage in single sided deafness and factors affecting usage

OBJECTIVES

The primary objective was to examine duration of daily cochlear implant (CI) usage at 12 and 24 months post-operatively in single sided deafness (SSD). The secondary objective was to examine factors that could affect CI usage.

METHODS

Retrospective cohort of patients with SSD who received CI from January 2015 to March 2020. CI usage was evaluated at 12 and 24 months. Hearing loss duration, tinnitus scores and signal-to-noise ratio (SNR) were correlated with CI usage at 12 months.

RESULTS

Usage data was available for 54 patients at 12 months and 38 patients at 24 months. The mean usage was 8.2 h/day (SD 4.2) at 12 months, 7.0 h/day (SD 5.1) at 24 months. 5 out of 54 (9.3%) and 7 out of 38 patients (18.4%) were non-users at 12 and 24 months post-operatively. An improved mean SNR score from pre-operative 4.4 dB (SD 2.8) to - 0.70 dB (SD 4.2) at 12 months post-operative was positively correlated with CI usage at 12 and 24 months. Hearing loss duration and tinnitus scores were not associated with CI usage.

CONCLUSIONS

18.4% of our patients were non-users at 24 months. Mean usage at 24 months was 7.0 h/day. Improved hearing in noise at 12 months was correlated with better usage.

Effects of Auditory Training on Speech Recognition in Children with Single-Sided Deafness and Cochlea Implants Using a Direct Streaming Device: A Pilot Study

Treating individuals with single-sided deafness (SSD) with a cochlear implant (CI) offers significant benefits for speech perception in complex spatial listening environments. After implantation, training without involvement of the normal-hearing ear is essential. Therefore, the AudioLink streaming device (MED-EL GmbH, Austria) can be used to connect the externally worn audio processor to media devices; thus, the auditory stimuli are directly streamed to the implanted ear. The aim was to test whether children with SSD, aged 5-12 years, accept this training method and whether auditory training, streamed directly via AudioLink using the Tiptoi device (Ravensburger GmbH., Ravensburg, Germany), improves speech recognition. A total of 12 children with SSD and implanted with a CI received Tiptoi training via AudioLink and were asked to practice daily for 10 min over a period of one month. All participants completed the training. The measurements employed to assess improvement included speech audiometry, speech, spatial, and quality of hearing scale for parents (SSQ P), and specially designed tasks crafted for this study. Daily training of 9.93 min was reported. The word recognition score (WRS) at 65 dB and 80 dB in aided condition significantly improved and the WRS streamed via AudioLink was significantly better after training. The speech, spatial, and qualities of hearing scale for parents (SSQ P questionnaire) showed significant improvement in the dimension of quality of hearing and overall gain. The outcomes of the Tiptoi tasks resulted in a significant benefit in both categories of the "recognition of sounds" and "understanding of sentences". The results are very encouraging and do not only show the positive uptake of daily training at home but also how this resulted in a significant improvement in subjective and objective measures for this rather short training period of one month only.

Postoperative optimization of cochlear implantation for single sided deafness and asymmetric hearing loss: a systematic review

OBJECTIVE

Identify and evaluate the effectiveness of methods for improving postoperative cochlear implant (CI) hearing performance in subjects with single-sided deafness (SSD) and asymmetric hearing loss (AHL).

DATA SOURCES

Embase, PubMed, Scopus.

REVIEW METHODS

Systematic review and narrative synthesis. English language studies of adult CI recipients with SSD and AHL reporting a postoperative intervention and comparative audiometric data pertaining to speech in noise, speech in quiet and sound localization were included.

RESULTS

32 studies met criteria for full text review and 6 (n = 81) met final inclusion criteria. Interventions were categorized as: formal auditory training, programming techniques, or hardware optimization. Formal auditory training (n = 10) found no objective improvement in hearing outcomes. Experimental CI maps did not improve audiologic outcomes (n = 9). Programed CI signal delays to improve synchronization demonstrated improved sound localization (n = 12). Hardware optimization, including multidirectional (n = 29) and remote (n = 11) microphones, improved sound localization and speech in noise, respectively.

CONCLUSION

Few studies meeting inclusion criteria and small sample sizes highlight the need for further study. Formal auditory training did not appear to improve hearing outcomes. Programming techniques, such as CI signal delay, and hardware optimization, such as multidirectional and remote microphones, show promise to improve outcomes for SSD and AHL CI users.

The Impact of Patient Factors on Objective Cochlear Implant Verification Using Acoustic Cortical Auditory-Evoked Potentials

INTRODUCTION

Hearing loss is a major global public health issue that negatively impacts quality of life, communication, cognition, social participation, and mental health. The cochlear implant (CI) is the most efficacious treatment for severe-to-profound sensorineural hearing loss. However, variability in outcomes remains high among CI users. Our previous research demonstrated that the existing subjective methodology of CI programming does not consistently produce optimal stimulation for speech perception, thereby limiting the potential for CI users to derive the maximum device benefit to achieve their peak potential. We demonstrated the benefit of utilising the objective method of measuring auditory-evoked cortical responses to speech stimuli as a reliable tool to guide and verify CI programming and, in turn, significantly improve speech perception performance. The present study was designed to investigate the impact of patient- and device-specific factors on the application of acoustically-evoked cortical auditory-evoked potential (aCAEP) measures as an objective clinical tool to verify CI mapping in adult CI users with bilateral deafness (BD).

METHODS

aCAEP responses were elicited using binaural peripheral auditory stimulation for four speech tokens (/m/, /g/, /t/, and /s/) and recorded by HEARLab™ software in adult BD CI users. Participants were classified into groups according to subjective or objective CI mapping procedures to elicit present aCAEP responses to all four speech tokens. The impact of patient- and device-specific factors on the presence of aCAEP responses and speech perception was investigated between participant groups.

RESULTS

Participants were categorised based on the presence or absence of the P1-N1-P2 aCAEP response to speech tokens. Out of the total cohort of adult CI users (n = 132), 63 participants demonstrated present responses pre-optimisation, 37 participants exhibited present responses post-optimisation, and the remaining 32 participants either showed an absent response for at least one speech token post-optimisation or did not accept the optimised CI map adjustments. Overall, no significant correlation was shown between patient and device-specific factors and the presence of aCAEP responses or speech perception scores.

CONCLUSION

This study reinforces that aCAEP measures offer an objective, non-invasive approach to verify CI mapping, irrespective of patient or device factors. These findings further our understanding of the importance of personalised CI rehabilitation through CI mapping to minimise the degree of speech perception variation post-CI and allow all CI users to achieve maximum device benefit.

Towards a Consensus on an ICF-Based Classification System for Horizontal Sound-Source Localization

The study aimed to develop a consensus classification system for the reporting of sound localization testing results, especially in the field of cochlear implantation. Against the background of an overview of the wide variations present in localization testing procedures and reporting metrics, a novel classification system was proposed to report localization errors according to the widely accepted International Classification of Functioning, Disability and Health (ICF) framework. The obtained HEARRING_LOC_ICF scale includes the ICF graded scale: 0 (no impairment), 1 (mild impairment), 2 (moderate impairment), 3 (severe impairment), and 4 (complete impairment). Improvement of comparability of localization results across institutes, localization testing setups, and listeners was demonstrated by applying the classification system retrospectively to data obtained from cohorts of normal-hearing and cochlear implant listeners at our institutes. The application of our classification system will help to facilitate multi-center studies, as well as allowing better meta-analyses of data, resulting in improved evidence-based practice in the field.

American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness

The indications for cochlear implantation have expanded to include individuals with profound sensorineural hearing loss in the impaired ear and normal hearing (NH) in the contralateral ear, known as single-sided deafness (SSD). There are additional considerations for the clinical assessment and management of adult cochlear implant candidates and recipients with SSD as compared to conventional cochlear implant candidates with bilateral moderate to profound sensorineural hearing loss. The present report reviews the current evidence relevant to the assessment and management of adults with SSD. A systematic review was also conducted on published studies that investigated outcomes of cochlear implant use on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population. Expert consensus and systematic review of the current literature were combined to provide guidance for the clinical assessment and management of adults with SSD.

Longitudinal auditory data of children with prelingual single-sided deafness managed with early cochlear implantation

Individuals with single-sided deafness (SSD) have no access to binaural hearing, which limits their ability to localize sounds and understand speech in noisy environments. In addition, children with prelingual SSD are at risk for neurocognitive and academic difficulties. Early cochlear implantation may lead to improved hearing outcomes by restoring bilateral hearing. However, its longitudinal impact on the development of children with SSD remains unclear. In the current study, a group of young children with prelingual SSD received a cochlear implant at an early age. From the age of four, the children’s spatial hearing skills could be assessed using a spatial speech perception in noise test and a sound localization test. The results are compared to those of two control groups: children with SSD without a cochlear implant and children with bilateral normal hearing. Overall, the implanted group exhibited improved speech perception in noise abilities and better sound localization skills, compared to their non-implanted peers. On average, the children wore their device approximately nine hours a day. Given the large contribution of maturation to the development of spatial hearing skills, further follow-up is important to understand the long-term benefit of a cochlear implant for children with prelingual SSD.

The Quality of Life in the Elderly with Acquired Single-Sided Deafness

This study was aimed at assessing the negative impact of an acquired single-sided deafness on quality of life of the elderly. Prospective analysis of outpatient records was carried out to identify elderly patients with single-sided deafness using pure tone audiometry. The main inclusion criteria were age over 60, a 90 dB or higher threshold of an affected ear, a 30 dB or less threshold of an intact ear, and an acquired single-sided hearing loss with sudden onset and a deafness duration of less than 5 years. Taking the inclusion criteria into account, two groups were formed: the main group with single-sided deaf patients (n = 25) and the control group of patients with normal hearing (n = 25). All participants were surveyed with the PSQ, HHIE, and THI questionnaires. Some changes in psychological status in the group of patients with single-sided deafness in comparison with the group of normal hearing participants were revealed. The scores of the questionnaires showed increased stress and anxiety levels and deterioration in their quality of life. Patients with single-sided deafness complained about severe tinnitus in an affected ear, worse intelligibility of speech in a noisy environment and a constant need to adapt to the different acoustic situations that in turn affected psychoemotional homeostasis badly, intensifying the severity of stress, and their quality of life.

Audiologic and patient perceived benefit in cochlear implantation for single-sided deafness

Background

CI in SSD strives to restore binaural hearing. With normal acoustic hearing on one ear, the benefits of rehabilitating the deaf ear with an implant are not well established.

Objectives

We investigate audiologic and quality-of-life measures, and long-term usage patterns of cochlear implantation (CI) in patients with single-sided deafness (SSD)

Methods

Eight patients with idiopathic sudden sensorineural hearing loss of less than 5-year duration were recruited. Pure tone average (PTA), speech discrimination score (SDS), hearing-in-noise test (HINT), tinnitus handicap inventory (THI), quality-of-life speech spatial qualities (SSQ) scale tests were performed before, and one-year after CI. Long-term usage of CI four-years post-operatively was determined.

Results

The median PTA of the deaf ear was 96 dBHL (IQR = 90–120) before, and 30 dBHL (IQR = 27–33) after CI ( p = 0.0156). SDS improved from median of 0% (IQR = 0–3) to 33% (IQR = 24–58) ( p = 0.0360). Median signal-to-noise ratio (SNR), particularly of the S0Nbetter setting of HINT showed improvement from 6.4 dB (IQR = 5.7–7) to 0.9 dB (IQR = −2.25–6.2) ( p = 0.1094). Despite median THI improving from 24 (IQR = 6–47) to 4 (IQR = 2–7) ( p = 0.1563), two patients experienced worsening of tinnitus. SSQ scores in all subscales showed modest improvement not approaching significance. 5 of 8 (62%) patients stopped using their implant four years after surgery.

Conclusion

Despite improved audiologic and tinnitus outcome measures, our patients’ SDS remained in non-serviceable range, while quality-of-life measures showed only modest improvement. Majority of our patients stopped using their implant four years post-surgery. Our study suggests that objective measurable benefits of CI in SSD may not translate to actual patient perceived benefits.

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.

The impact of cochlear implant microphone settings on the binaural hearing of experienced cochlear implant users with single-sided deafness

OBJECTIVE

Cochlear implantation has become a well-accepted treatment option for people with single-sided deafness (SSD) and has become a clinical standard in many countries. A cochlear implant (CI) is the only device which restores binaural hearing. The effect of microphone directionality (MD) settings has been investigated in other CI indication groups, but its impact on speech perception in noise has not been established in CI users with SSD. The focus of this investigation was, therefore, to assess binaural hearing effects using different MD settings in CI users with SSD.

METHODS

Twenty-nine experienced CI users with SSD were recruited to determine speech reception thresholds with varying target and noise sources to define binaural effects (head shadow, squelch, summation, and spatial release from masking), sound localization, and sound quality using the SSQ12 and HISQUI₁₉ questionnaires. Outcome measures included the MD settings "natural", "adaptive", and "omnidirectional".

RESULTS

The 29 participants involved in the study were divided into two groups: 11 SONNET users and 18 OPUS 2/RONDO users. In both groups, a significant head shadow effect of 7.4-9.2 dB was achieved with the CI. The MD setting "adaptive" provided a significant head shadow effect of 9.2 dB, a squelch effect of 0.9 dB, and spatial release from masking of 7.6 dB in the SONNET group. No significant summation effect could be determined in either group with CI. Outcomes with the omnidirectional setting were not significantly different between groups. For both groups, localization improved significantly when the CI was activated and was best when the omnidirectional setting was used. The groups' sound quality scores did not significantly differ.

CONCLUSIONS

Adaptive directional microphone settings improve speech perception and binaural hearing abilities in CI users with SSD. Binaural effect measures are valuable to quantify the benefit of CI use, especially in this indication group.

The effect of hearing loss configuration on cochlear implantation uptake rates: an Australian experience

Objective: Recent changes to cochlear implant (CI) candidacy criteria have led to the inclusion of candidates with greater levels of hearing in the contralateral and/or implanted ear. This study assessed the impact of various hearing loss configurations on CI uptake rates (those assessed as eligible for CI, who proceed to CI).Design: Retrospective cohort study.Study sample: Post-lingually deaf adult CI candidates (n = 619) seen at a Western Australian cochlear implant clinic.Results: An overall CI uptake rate of 44% was observed. Hearing loss configuration significantly impacted uptake rates. Uptake rates of 62% for symmetrical hearing loss, 48% for asymmetrical hearing loss (four-frequency average hearing loss (4FAHL) asymmetry ≤60 dB), 25% for highly asymmetrical hearing loss (4FAHL asymmetry >60 dB), 38% for hearing losses eligible for electric-acoustic stimulation, and 22% for individuals with single-sided hearing loss were observed. Hearing loss configuration and age were both significant factors in relation to CI uptake although the impact of age was limited.Conclusion: CI clinics who apply or are considering applying expanded CI candidacy criteria within their practice should be aware that candidates with greater levels of residual hearing in at least the contralateral ear are less likely to proceed to CI.

Therapist-Guided Telerehabilitation for Adult Cochlear Implant Users: Developmental and Feasibility Study

BACKGROUND

Cochlear implants can provide auditory perception to many people with hearing impairment who derive insufficient benefits from hearing aid use. For optimal speech perception with a cochlear implant, postoperative auditory training is necessary to adapt the brain to the new sound transmitted by the implant. Currently, this training is usually conducted via face-to-face sessions in rehabilitation centers. With the aging of society, the prevalence of age-related hearing loss and the number of adults with cochlear implants are expected to increase. Therefore, augmenting face-to-face rehabilitation with alternative forms of auditory training may be highly valuable.

OBJECTIVE

The purpose of this multidisciplinary study was to evaluate the newly developed internet-based teletherapeutic multimodal system Train2hear, which enables adult cochlear implant users to perform well-structured and therapist-guided hearing rehabilitation sessions on their own.

METHODS

The study was conducted in 3 phases: (1) we searched databases from January 2005 to October 2018 for auditory training programs suitable for adult cochlear implant users; (2) we developed a prototype of Train2hear based on speech and language development theories; (3) 18 cochlear implant users (mean age 61, SD 15.4 years) and 10 speech and language therapists (mean age 34, SD 10.9 years) assessed the usability and the feasibility of the prototype. This was achieved via questionnaires, including the System Usability Scale (SUS) and a short version of the intrinsic motivation inventory (KIM) questionnaires.

RESULTS

The key components of the Train2hear training program are an initial analysis according to the International Classification of Functioning, Disability and Health; a range of different hierarchically based exercises; and an automatic and dynamic adaptation of the different tasks according to the cochlear implant user's progress. In addition to motivational mechanisms (such as supportive feedback), the cochlear implant user and therapist receive feedback in the form of comprehensive statistical analysis. In general, cochlear implant users enjoyed their training as assessed by KIM scores (mean 19, SD 2.9, maximum 21). In terms of usability (scale 0-100), the majority of users rated the Train2hear program as excellent (mean 88, SD 10.5). Age (P=.007) and sex (P=.01) had a significant impact on the SUS score with regard to usability of the program. The therapists (SUS score mean 93, SD 9.2) provided slightly more positive feedback than the cochlear implant users (mean 85, SD 10.3).

CONCLUSIONS

Based on this first evaluation, Train2hear was well accepted by both cochlear implant users and therapists. Computer-based auditory training might be a promising cost-effective option that can provide a highly personalized rehabilitation program suited to individual cochlear implant user characteristics.