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Philpott N, Philips B, Donders R, Mylanus E, Huinck W. Variability in clinicians' prediction accuracy for outcomes of adult cochlear implant users. Int J Audiol 2024; 63:613-621. [PMID: 37782308 DOI: 10.1080/14992027.2023.2256973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The variability in outcomes among adult cochlear implant (CI) users poses challenges for clinicians in accurately predicting the benefits of the implant for individual candidates. This study aimed to investigate the accuracy and confidence of clinicians in predicting speech perception outcomes for adult CI users one-year post-implantation. DESIGN Participants were presented with comprehensive information on pre-implantation, one-month post-implantation, and six-month post-implantation data for 10 case studies. The cases encompassed a range of one-year post-implantation phoneme scores, from low performers (27%) to high performers (92%). Participants were tasked with predicting the speech perception outcomes for these cases one year after implantation. STUDY SAMPLE Forty-one clinicians completed the full outcome prediction survey. RESULTS Our findings revealed a significant over-prediction of low performance by clinicians. Interestingly, clinicians tended to predict average performance (73-76% phoneme score) even when provided with information suggesting lower-than-average performance. Most clinicians expressed confidence in their predictions, irrespective of their accuracy. CONCLUSIONS Identifying signs of low performance, particularly in the early post-implantation period, can enable clinicians to implement early interventions. Further research into accurate outcome prediction is essential for managing expectations, providing counselling, increasing CI adoption, and optimising clinical care for both high and low performers.
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Affiliation(s)
- Nikki Philpott
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- Cochlear Ltd, Mechelen, Belgium
| | | | - Rogier Donders
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Hendrikse MME, Dingemanse G, Goedegebure A. On the Feasibility of Using Behavioral Listening Effort Test Methods to Evaluate Auditory Performance in Cochlear Implant Users. Trends Hear 2024; 28:23312165241240572. [PMID: 38676325 PMCID: PMC11055488 DOI: 10.1177/23312165241240572] [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: 05/23/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/28/2024] Open
Abstract
Realistic outcome measures that reflect everyday hearing challenges are needed to assess hearing aid and cochlear implant (CI) fitting. Literature suggests that listening effort measures may be more sensitive to differences between hearing-device settings than established speech intelligibility measures when speech intelligibility is near maximum. Which method provides the most effective measurement of listening effort for this purpose is currently unclear. This study aimed to investigate the feasibility of two tests for measuring changes in listening effort in CI users due to signal-to-noise ratio (SNR) differences, as would arise from different hearing-device settings. By comparing the effect size of SNR differences on listening effort measures with test-retest differences, the study evaluated the suitability of these tests for clinical use. Nineteen CI users underwent two listening effort tests at two SNRs (+4 and +8 dB relative to individuals' 50% speech perception threshold). We employed dual-task paradigms-a sentence-final word identification and recall test (SWIRT) and a sentence verification test (SVT)-to assess listening effort at these two SNRs. Our results show a significant difference in listening effort between the SNRs for both test methods, although the effect size was comparable to the test-retest difference, and the sensitivity was not superior to speech intelligibility measures. Thus, the implementations of SVT and SWIRT used in this study are not suitable for clinical use to measure listening effort differences of this magnitude in individual CI users. However, they can be used in research involving CI users to analyze group data.
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Affiliation(s)
- Maartje M. E. Hendrikse
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Gertjan Dingemanse
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Philips C, Jacquemin L, Lammers MJW, Mertens G, Gilles A, Vanderveken OM, Van Rompaey V. Listening effort and fatigue among cochlear implant users: a scoping review. Front Neurol 2023; 14:1278508. [PMID: 38020642 PMCID: PMC10656682 DOI: 10.3389/fneur.2023.1278508] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction In challenging listening situations, speech perception with a cochlear implant (CI) remains demanding and requires high levels of listening effort, which can lead to increased levels of listening-related fatigue. The body of literature on these topics increases as the number of CI users rises. This scoping review aims to provide an overview of the existing literature on listening effort, fatigue, and listening-related fatigue among CI users and the measurement techniques to evaluate them. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statements were used to conduct the scoping review. The search was performed on PubMed, Scopus, and Web of Science to identify all relevant studies. Results In total, 24 studies were included and suggests that CI users experience higher levels of listening effort when compared to normal hearing controls using scales, questionnaires and electroencephalogram measurements. However, executing dual-task paradigms did not reveal any difference in listening effort between both groups. Uncertainty exists regarding the difference in listening effort between unilateral, bilateral, and bimodal CI users with bilateral hearing loss due to ambiguous results. Only five studies were eligible for the research on fatigue and listening-related fatigue. Additionally, studies using objective measurement methods were lacking. Discussion This scoping review highlights the necessity for additional research on these topics. Moreover, there is a need for guidelines on how listening effort, fatigue, and listening-related fatigue should be measured to allow for study results that are comparable and support optimal rehabilitation strategies.
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Affiliation(s)
- Cato Philips
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Laure Jacquemin
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Marc J. W. Lammers
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Griet Mertens
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Annick Gilles
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Olivier M. Vanderveken
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Vincent Van Rompaey
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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Lansbergen SE, Versfeld N, Dreschler WA. Exploring Factors That Contribute to the Success of Rehabilitation With Hearing Aids. Ear Hear 2023; 44:1514-1525. [PMID: 37792897 PMCID: PMC10583950 DOI: 10.1097/aud.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/10/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES Hearing aids are an essential and important part of hearing rehabilitation. The combination of technical data on hearing aids and individual rehabilitation needs can give insight into the factors that contribute to the success of rehabilitation. This study sets out to investigate if different subgroups of (comparable) hearing aids lead to differences in the success of rehabilitation, and whether these differences vary between different domains of auditory functioning. DESIGN This study explored the advantages of including patient-reported outcome measures (PROMs) in the process of purchasing new hearing aids in a large sample of successful hearing aid users. Subject data were obtained from 64 (commercial) hearing aid dispensers and 10 (noncommercial) audiological centers in the Netherlands. The PROM was a 32-item questionnaire and was used to determine the success of rehabilitation using hearing aids by measuring auditory disability over time. The items were mapped on six domains of auditory functioning: detection, discrimination, localization, speech in quiet, speech in noise, and noise tolerance, encompassing a variety of daily-life listening situations. Hearing aids were grouped by means of cluster analysis, resulting in nine subgroups. In total, 1149 subjects were included in this study. A general linear model was used to model the final PROM results. Model results were analyzed via a multifactor Analysis of Variance. Post hoc analyses provided detailed information on model variables. RESULTS Results showed a strong statistically significant effect of hearing aids on self-perceived auditory functioning in general. Clinically relevant differences were found for auditory domains including detection, speech in quiet, speech in noise, and localization. There was only a small, but significant, effect of the different subgroups of hearing aids on the final PROM results, where no differences were found between the auditory domains. Minor differences were found between results obtained in commercial and noncommercial settings, or between novice and experienced users. Severity of Hearing loss, age, gender, and hearing aid style (i.e., behind-the-ear versus receiver-in-canal type) did not have a clinically relevant effect on the final PROM results. CONCLUSIONS The use of hearing aids has a large positive effect on self-perceived auditory functioning. There was however no salient effect of the different subgroups of hearing aids on the final PROM results, indicating that technical properties of hearing aids only play a limited role in this respect. This study challenges the belief that premium devices outperform basic ones, highlighting the need for personalized rehabilitation strategies and the importance of evaluating factors contributing to successful rehabilitation for clinical practice.
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Affiliation(s)
- Simon E. Lansbergen
- Department(s), Clinical and Experimental Audiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niek Versfeld
- Otolaryngology Head and Neck Surgery, Ear and Hearing, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Boelelaan, The Netherlands
| | - Wouter A. Dreschler
- Department(s), Clinical and Experimental Audiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Hu XJ, Lau CC. Influence of Speech Recognition Ability on Acceptable Noise Level for Mandarin (Chinese) Speakers with Normal Hearing. Audiol Neurootol 2023; 28:371-379. [PMID: 37166311 DOI: 10.1159/000530025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 02/27/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Noise can induce hearing loss and reduce speech understanding. The Acceptable Noise Level (ANL) test has been widely used in audiology. However, strategies used by listeners to determine ANLs are unclear. The current study evaluated the role of speech recognition in selecting ANL and how well ANL could predict speech understanding in a noisy situation. METHODS Forty-five Mandarin speakers with normal hearing were tested in both ears. ANL is defined as Most Comfortable Level (MCL) minus Background Noise Level (BNL). To obtain ANL monaurally with an earphone, the study measured participants' MCL to hear a Mandarin story in quiet and the maximum BNL to tolerate while following the story. Then, based on the participant's ANL, speech recognition in noise was examined using a set of phonemic-balanced Mandarin words. The signal-to-noise ratio (SNR) was adjusted to ANL, ANL - 10 dB ("degraded noise condition"), and ANL + 10 dB ("improved noise condition"). RESULTS The mean ANLs were 2.4 dB and 2.6 dB for the left and right ears, respectively. The mean speech recognition with SNR adjusted to ANL was relatively high for both ears (81-83% correct). Even for those ear samples with very low ANL (<0 dB), speech performance obtained at SNR = ANL was still high. The mean speech recognition obtained at SNR = ANL was 5 percentage points lower than the mean speech recognition at the improved noise condition and 14 percentage points higher than the mean speech recognition at the degraded noise condition. Speech recognition obtained at SNR = ANL and ANL - 10 dB correlated significantly with ANL. CONCLUSION Speech recognition in noise appears to play an important role for listeners with normal hearing in deciding their ANLs. Additionally, ANL can predict speech performance (r-squared = 53-61%) in the degraded noise condition.
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Affiliation(s)
- Xu Jun Hu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
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Assouly KKS, Arts RAGJ, Graham PL, van Dijk B, James CJ. Influence of tinnitus annoyance on hearing-related quality of life in cochlear implant recipients. Sci Rep 2022; 12:14423. [PMID: 36002556 PMCID: PMC9402917 DOI: 10.1038/s41598-022-18823-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/19/2022] [Indexed: 01/10/2023] Open
Abstract
Tinnitus is a common symptom in cochlear implant (CI) recipients. There is no clear evidence of the influence of tinnitus on hearing-related quality of life (QoL) in this population. The aim of this study was to assess the relationship between hearing-related QoL measured by the Speech, Spatial and Qualities of Hearing scale (SSQ12) and tinnitus annoyance or perceived change in tinnitus annoyance after cochlear implantation. The study sample consisted of 2322 implanted adults across France, Germany, Ireland, Italy, the Netherlands, Sweden and the United Kingdom. Information relating to QoL measured using the SSQ12 and tinnitus annoyance and change in tinnitus annoyance, assessed using single-item questions, were collected one or more years post-implantation. The relationship between SSQ12 score and tinnitus annoyance or change in tinnitus annoyance was analysed using linear models adjusted for age and unilateral versus bilateral implants. Tukey pairwise tests were used to compare mean SSQ12 scores across levels of tinnitus annoyance and changes. Tinnitus prevalence was 33.9% post-implantation. Recipients with tinnitus had a significantly lower SSQ12 score than recipients without tinnitus. SSQ scores varied significantly with tinnitus annoyance, age and unilateral versus bilateral implants. Overall, CI recipients who experienced less bothersome tinnitus reported better hearing-related QoL. Healthcare professionals should be aware of the influence of tinnitus on CI recipients’ hearing to manage patient expectations.
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Affiliation(s)
- Kelly K S Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. .,University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands. .,Cochlear Technology Centre Belgium, Mechelen, Belgium.
| | | | - Petra L Graham
- School of Mathematical and Physical Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Bas van Dijk
- Cochlear Technology Centre Belgium, Mechelen, Belgium
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Cochlear Implantation Improves Both Speech Perception and Patient-Reported Outcomes: A Prospective Follow-Up Study of Treatment Benefits among Adult Cochlear Implant Recipients. J Clin Med 2022; 11:jcm11082257. [PMID: 35456353 PMCID: PMC9032498 DOI: 10.3390/jcm11082257] [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: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 01/27/2023] Open
Abstract
Cochlear implantation is considered the best treatment option for patients with severe-to-profound sensorineural hearing loss for whom conventional hearing aids are insufficient. We used a repeated measures longitudinal approach to evaluate speech recognition and patient-reported outcomes after cochlear implantation in an unbiased cohort of Danish adult patients in a prospective cohort study. We assessed 39 recipients before and two times after implantation using a battery of tests that included Dantale I, the Danish Hearing in Noise Test, the Nijmegen Cochlear Implant Questionnaire, and the Speech, Spatial, and Qualities of Hearing Scale. The study group improved significantly on all outcome measures following implantation. On average, Dantale I scores improved by 29 percentage points and Hearing in Noise Test scores improved by 22 percentage points. Most notably, the average Dantale score improved from 26 to 70% in the CI in quiet condition and from 12 to 42% in the cochlear implantation in noise condition when tested monaurally. Dantale demonstrated a significant positive correlation with Nijmegen Cochlear Implant Questionnaire and Speech, Spatial, and Qualities of Hearing Scale scores, while Hearing in Noise Test had no significant correlation with the patient-reported outcome measures. Patients improved significantly at 4 months and marginally improved further at 14 months, indicating that they were approaching a plateau. Our study’s use of audiometric and patient-reported outcome measures provides evidence of the treatment benefits of cochlear implantation in adults, which may help physicians advise patients on treatment decisions and align treatment benefit expectations, as well as serve as a foundation for the development of new cochlear implantation selection criteria.
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Dingemanse G, Goedegebure A. Listening Effort in Cochlear Implant Users: The Effect of Speech Intelligibility, Noise Reduction Processing, and Working Memory Capacity on the Pupil Dilation Response. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:392-404. [PMID: 34898265 DOI: 10.1044/2021_jslhr-21-00230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of speech recognition performance, working memory capacity (WMC), and a noise reduction algorithm (NRA) on listening effort as measured with pupillometry in cochlear implant (CI) users while listening to speech in noise. METHOD Speech recognition and pupil responses (peak dilation, peak latency, and release of dilation) were measured during a speech recognition task at three speech-to-noise ratios (SNRs) with an NRA in both on and off conditions. WMC was measured with a reading span task. Twenty experienced CI users participated in this study. RESULTS With increasing SNR and speech recognition performance, (a) the peak pupil dilation decreased by only a small amount, (b) the peak latency decreased, and (c) the release of dilation after the sentences increased. The NRA had no effect on speech recognition in noise or on the peak or latency values of the pupil response but caused less release of dilation after the end of the sentences. A lower reading span score was associated with higher peak pupil dilation but was not associated with peak latency, release of dilation, or speech recognition in noise. CONCLUSIONS In CI users, speech perception is effortful, even at higher speech recognition scores and high SNRs, indicating that CI users are in a chronic state of increased effort in communication situations. The application of a clinically used NRA did not improve speech perception, nor did it reduce listening effort. Participants with a relatively low WMC exerted relatively more listening effort but did not have better speech reception thresholds in noise.
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Affiliation(s)
- Gertjan Dingemanse
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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