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Espina González C, Morant Ventura A, Pla Gil I, Aragonés Redó M, Pérez Carbonell T, Marco Algarra J. Variation of electrical impedance over 5 years post-implantation and relationship with the maximum comfort level (MCL) in adults with cochlear implants. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:23-30. [PMID: 38224870 DOI: 10.1016/j.otoeng.2024.01.004] [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: 09/05/2022] [Accepted: 04/29/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION The maximum comfort level (MCL), threshold level (THR) and electrical impedance change in the postoperative period of the cochlear implant for months until they stabilize. The objective of this article is to establish the variation during 5 post-surgical years of impedance, and its relationship with MCL in unilaterally implanted adults. METHODS Retrospective study over 5 years, with 78 adult patients implanted with MED-EL in a tertiary hospital from the year 2000 to 2015. The variation in impedance, MCL and the relationship between them were analyzed in basal (9-12), medial (5-8) and apical electrodes (1-4), performing an inferential ANOVA analysis of repeated measures with comparisons between consecutive times, corrected with Bonferroni criteria. RESULTS 33 men (42.3%) and 45 women (57.7%), with a mean age of 52.7±14.6 years. "Stability" was considered the time of follow-up without statistically significant differences between one visit and the next. Changes in impedance in medial electrodes ceased to be statistically significant at 3 months, and in apicals at 6 months, with mean values of 5.84 and 6.43kΩ. MCL stabilized at 2 years in basal and apical electrodes, and at 3 years in medial, with mean values of 24.9, 22.7, and 25.6qu. There was a correlation between MCL and impedance in medium electrodes up to 3 months and in apical ones up to one year. CONCLUSIONS Electrical impedance drops significantly in medial and apical electrodes up to 3 and 6 months. MCL increases significantly up to two years. Impedance is related to MCL up to 6 months.
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Affiliation(s)
- Clara Espina González
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Servicio de Otorrinolaringología, Hospital del Mar, Barcelona, Spain.
| | - Antonio Morant Ventura
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Ignacio Pla Gil
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - María Aragonés Redó
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Servicio de Otorrinolaringología, Hospital Arnau de Vilanova, Valencia, Spain
| | - Tomás Pérez Carbonell
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Jaime Marco Algarra
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
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Dornhoffer JR, Khandalavala KR, Zwolan TA, Carlson ML. Preliminary Evidence to Support a De-Escalated Cochlear Implant Programming Paradigm for New Adult Recipients: A Systematic Review. J Clin Med 2023; 12:5774. [PMID: 37762717 PMCID: PMC10532146 DOI: 10.3390/jcm12185774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Background: No standard schedule for cochlear implant (CI) programming has been developed, and common practices may have CI recipients seen in excess of what is necessary. The objective of this study was to review evidence for a de-escalated, evidence-based schedule for adult CI programming. Methods: Systematic review was undertaken in March 2023 of PubMed, Scopus, and CINAHL databases using the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if (1) they evaluated an evidence-based programming/follow-up schedule in new adult CI patients or (2) they evaluated programming or outcomes in a longitudinal fashion such that they could inform CI follow-up strategies. Level of evidence was evaluated using the LEGEND evidence assessment tool. Results: Our review identified 940 studies. After screening with a priori inclusion criteria, 18 studies were ultimately included in this review. Of these, 2 demonstrated feasibility of de-escalated approaches to new adult CI programming. The remainder presented longitudinal speech and programming parameter data that demonstrated relative stability of both categories by 3 to 6 months post-activation. Conclusions: Overall, there is a paucity of literature evaluating any form of evidence-based CI programming or follow-up. Most applicable data derive from longitudinal outcomes featured in studies of other CI features, with only a handful of studies directly evaluating CI programming strategies over time. However, stability in outcomes and programming detailed in the available data supports consideration of a de-escalated programming paradigm that could primarily limit programming to the very early post-activation period (before 3 to 6 months) to enhance patient care and reduce operational strains on cochlear implant programs.
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Affiliation(s)
- James R. Dornhoffer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA; (J.R.D.); (K.R.K.)
| | - Karl R. Khandalavala
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA; (J.R.D.); (K.R.K.)
| | - Teresa A. Zwolan
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI 48109, USA;
- Cochlear Americas, Denver, CO 80124, USA
| | - Matthew L. Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA; (J.R.D.); (K.R.K.)
- Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA
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Müller-Deile J, Neben N, Dillier N, Büchner A, Mewes A, Junge F, Lai W, Schuessler M, Hey M. Comparisons of electrophysiological and psychophysical fitting methods for cochlear implants. Int J Audiol 2023; 62:118-128. [PMID: 34964676 DOI: 10.1080/14992027.2021.2015543] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study compared two different versions of an electrophysiology-based software-guided cochlear implant fitting method with a procedure employing standard clinical software. The two versions used electrically evoked compound action potential (ECAP) thresholds for either five or all twenty-two electrodes to determine sound processor stimulation level profiles. Objective and subjective performance results were compared between software-guided and clinical fittings. DESIGN Prospective, double-blind, single-subject repeated-measures with permuted ABCA sequences. STUDY SAMPLE 48 post linguistically deafened adults with ≤15 years of severe-to-profound deafness who were newly unilaterally implanted with a Nucleus device. RESULTS Speech recognition in noise and quiet was not significantly different between software- guided and standard methods, but there was a visit/learning-effect. However, the 5-electrode method gave scores on the SSQ speech subscale 0.5 points lower than the standard method. Clinicians judged usability for all methods as acceptable, as did subjects for comfort. Analysis of stimulation levels and ECAP thresholds suggested that the 5-electrode method could be refined. CONCLUSIONS Speech recognition was not inferior using either version of the electrophysiology-based software-guided fitting method compared with the standard method. Subject-reported speech perception was slightly inferior with the five-electrode method. Software-guided methods saved about 10 min of clinician's time versus standard fittings.
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Affiliation(s)
- Joachim Müller-Deile
- Audiology Consultant, Kiel-Holtenau, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Nicole Neben
- Cochlear Deutschland GmbH & Co. KG, Karl-Wiechert-Allee 76A, Hannover, Germany
| | - Norbert Dillier
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Andreas Büchner
- German Hearing Centre at Hannover Medical School, Hannover, Germany
| | - Alexander Mewes
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Friederike Junge
- Cochlear Deutschland GmbH & Co. KG, Karl-Wiechert-Allee 76A, Hannover, Germany
| | - Waikong Lai
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital and University of Zurich, Zurich, Switzerland.,Next Sense Cochlear Implant Program, Australian Hearing Hub, Macquarie University, Sydney, Australia
| | - Mark Schuessler
- German Hearing Centre at Hannover Medical School, Hannover, Germany
| | - Matthias Hey
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
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Effects of number of maxima and electrical dynamic range on speech-in-noise perception with an “n-of-m” cochlear-implant strategy. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Holder JT, Holcomb MA, Snapp H, Labadie RF, Vroegop J, Rocca C, Elgandy MS, Dunn C, Gifford RH. Guidelines for Best Practice in the Audiological Management of Adults Using Bimodal Hearing Configurations. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e011. [PMID: 36274668 PMCID: PMC9581116 DOI: 10.1097/ono.0000000000000011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Clinics are treating a growing number of patients with greater amounts of residual hearing. These patients often benefit from a bimodal hearing configuration in which acoustic input from a hearing aid on 1 ear is combined with electrical stimulation from a cochlear implant on the other ear. The current guidelines aim to review the literature and provide best practice recommendations for the evaluation and treatment of individuals with bilateral sensorineural hearing loss who may benefit from bimodal hearing configurations. Specifically, the guidelines review: benefits of bimodal listening, preoperative and postoperative cochlear implant evaluation and programming, bimodal hearing aid fitting, contralateral routing of signal considerations, bimodal treatment for tinnitus, and aural rehabilitation recommendations.
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Affiliation(s)
| | | | | | | | | | - Christine Rocca
- Guy’s and St. Thomas’ Hearing Implant Centre, London, United Kingdom
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Maruthurkkara S, Allen A, Cullington H, Muff J, Arora K, Johnson S. Remote check test battery for cochlear implant recipients: proof of concept study. Int J Audiol 2021; 61:443-452. [PMID: 34431430 DOI: 10.1080/14992027.2021.1922767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES (1) To investigate the remote check test battery, designed for self-administration by cochlear implant (CI) recipients, parents/caregivers, to determine if the results give adequate information for clinicians to decide the necessity of an appointment and to capture suggestions for improvement. (2) To gauge acceptance of remote monitoring by CI-recipients and their parents/caregivers. DESIGN Prospective, multicentre, un-blinded, non-randomized, single-subject, repeated-measures evaluation. The test battery includes an implant-site photograph, impedance measurements, datalogs, questionnaires, speech perception and aided threshold tests. Clinicians reviewed test battery results, followed by a clinical appointment with each CI-recipient, and reported if the battery identified all the issues. Study sample: n = 93 CI-recipients (73 adults, 20 children) and 28 clinicians. RESULTS The test battery identified 94% (615/656) of all issues. The test battery and clinician observations agreed in 99% (92/93) of cases on the need for a clinic visit. For 68% (63/93) of cases, the test battery identified all clinician observed issues. The majority (77%, 72/93) of recipients would be satisfied if clinic visits were based on their test battery results. A significantly high proportion agreed that remote monitoring was more convenient than clinic visits and could result in travel, time and cost reductions. CONCLUSION This is the first comprehensive test battery designed for CI-recipient remote monitoring.
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Affiliation(s)
| | - Agnes Allen
- Scottish Cochlear Implant Programme, Kilmarnock, UK
| | - Helen Cullington
- Auditory Implant Service, University of Southampton, Southampton, UK
| | - Joanne Muff
- Emmeline Centre for Hearing Implants, Cambridge, UK
| | | | - Susan Johnson
- Nottingham Auditory Implant Programme, Nottingham, UK
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Buchman CA, Gifford RH, Haynes DS, Lenarz T, O'Donoghue G, Adunka O, Biever A, Briggs RJ, Carlson ML, Dai P, Driscoll CL, Francis HW, Gantz BJ, Gurgel RK, Hansen MR, Holcomb M, Karltorp E, Kirtane M, Larky J, Mylanus EAM, Roland JT, Saeed SR, Skarzynski H, Skarzynski PH, Syms M, Teagle H, Van de Heyning PH, Vincent C, Wu H, Yamasoba T, Zwolan T. Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss: A Systematic Review and Consensus Statements. JAMA Otolaryngol Head Neck Surg 2021; 146:942-953. [PMID: 32857157 DOI: 10.1001/jamaoto.2020.0998] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Cochlear implants are a treatment option for individuals with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss (SNHL) who receive little or no benefit from hearing aids; however, cochlear implantation in adults is still not routine. Objective To develop consensus statements regarding the use of unilateral cochlear implants in adults with severe, profound, or moderate sloping to profound bilateral SNHL. Design, Setting, and Participants This study was a modified Delphi consensus process that was informed by a systematic review of the literature and clinical expertise. Searches were conducted in the following databases: (1) MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE, (2) Embase, and (3) the Cochrane Library. Consensus statements on cochlear implantation were developed using the evidence identified. This consensus process was relevant for the use of unilateral cochlear implantation in adults with severe, profound, or moderate sloping to profound bilateral SNHL. The literature searches were conducted on July 18, 2018, and the 3-step Delphi consensus method took place over the subsequent 9-month period up to March 30, 2019. Main Outcomes and Measures A Delphi consensus panel of 30 international specialists voted on consensus statements about cochlear implantation, informed by an SR of the literature and clinical expertise. This vote resulted in 20 evidence-based consensus statements that are in line with clinical experience. A modified 3-step Delphi consensus method was used to vote on and refine the consensus statements. This method consisted of 2 rounds of email questionnaires and a face-to-face meeting of panel members at the final round. All consensus statements were reviewed, discussed, and finalized at the face-to-face meeting. Results In total, 6492 articles were identified in the searches of the electronic databases. After removal of duplicate articles, 74 articles fulfilled all of the inclusion criteria and were used to create the 20 evidence-based consensus statements. These 20 consensus statements on the use of unilateral cochlear implantation in adults with SNHL were relevant to the following 7 key areas of interest: level of awareness of cochlear implantation (1 consensus statement); best practice clinical pathway from diagnosis to surgery (3 consensus statements); best practice guidelines for surgery (2 consensus statements); clinical effectiveness of cochlear implantation (4 consensus statements); factors associated with postimplantation outcomes (4 consensus statements); association between hearing loss and depression, cognition, and dementia (5 consensus statements); and cost implications of cochlear implantation (1 consensus statement). Conclusions and Relevance These consensus statements represent the first step toward the development of international guidelines on best practices for cochlear implantation in adults with SNHL. Further research to develop consensus statements for unilateral cochlear implantation in children, bilateral cochlear implantation, combined electric-acoustic stimulation, unilateral cochlear implantation for single-sided deafness, and asymmetrical hearing loss in children and adults may be beneficial for optimizing hearing and quality of life for these patients.
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Affiliation(s)
- Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
| | - Gerard O'Donoghue
- Department of Otology and Neurotology, University of Nottingham, Nottingham, United Kingdom.,Nottingham Biomedical Research Center, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, United Kingdom
| | - Oliver Adunka
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus
| | | | - Robert J Briggs
- Department of Otolaryngology, The University of Melbourne, Melbourne, Victoria, Australia.,Otology and Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Matthew L Carlson
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Pu Dai
- Department of Otolaryngology, General Hospital of People's Liberation Army, Beijing, China
| | - Colin L Driscoll
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Howard W Francis
- Division of Head and Neck Surgery and Communication Sciences, Duke Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Bruce J Gantz
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City
| | - Richard K Gurgel
- Division of Otolaryngology-Head & Neck Surgery, School of Medicine, University of Utah Hospital, Salt Lake City
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City
| | - Meredith Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,now with Department of Otolaryngology, University of Miami, Miami, Florida
| | - Eva Karltorp
- Cochlear Implant Department, Karolinska University Hospital, Stockholm, Sweden
| | - Milind Kirtane
- Department of ENT and Head Neck Surgery, Seth Gordhandas Sunderdas Medical College, King Edward Memorial Hospital, Mumbai, India
| | - Jannine Larky
- Cochlear Implant Center, Stanford University School of Medicine, Stanford, California
| | - Emmanuel A M Mylanus
- Department of Ear Nose Throat, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Thomas Roland
- NYU Langone Health, New York University School of Medicine, New York
| | - Shakeel R Saeed
- Royal National Throat, Nose and Ear Hospital and University College London Ear Institute, London, United Kingdom
| | - Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Nadarzyn, Poland
| | - Piotr H Skarzynski
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Nadarzyn, Poland.,Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Institute of Sensory Organs, Kajetany, Nadarzyn, Poland
| | | | - Holly Teagle
- School of Population Health-Audiology, The University of Auckland, Auckland, New Zealand
| | - Paul H Van de Heyning
- Department NKO & Head-Neck Surgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Christophe Vincent
- Service d'Otologie et Oto-Neurologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Hao Wu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tatsuya Yamasoba
- Department of Otorhinolaryngology and Auditory and Voice Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Terry Zwolan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
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Carlyon RP, Guérit F, Billig AJ, Tam YC, Harris F, Deeks JM. Effect of Chronic Stimulation and Stimulus Level on Temporal Processing by Cochlear Implant Listeners. J Assoc Res Otolaryngol 2019; 20:169-185. [PMID: 30543016 PMCID: PMC6453997 DOI: 10.1007/s10162-018-00706-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/29/2018] [Indexed: 01/26/2023] Open
Abstract
A series of experiments investigated potential changes in temporal processing during the months following activation of a cochlear implant (CI) and as a function of stimulus level. Experiment 1 tested patients on the day of implant activation and 2 and 6 months later. All stimuli were presented using direct stimulation of a single apical electrode. The dependent variables were rate discrimination ratios (RDRs) for pulse trains with rates centred on 120 pulses per second (pps), obtained using an adaptive procedure, and a measure of the upper limit of temporal pitch, obtained using a pitch-ranking procedure. All stimuli were presented at their most comfortable level (MCL). RDRs decreased from 1.23 to 1.16 and the upper limit increased from 357 to 485 pps from 0 to 2 months post-activation, with no overall change from 2 to 6 months. Because MCLs and hence the testing level increased across sessions, two further experiments investigated whether the performance changes observed across sessions could be due to level differences. Experiment 2 re-tested a subset of subjects at 9 months post-activation, using current levels similar to those used at 0 months. Although the stimuli sounded softer, some subjects showed lower RDRs and/or higher upper limits at this re-test. Experiment 3 measured RDRs and the upper limit for a separate group of subjects at levels equal to 60 %, 80 % and 100 % of the dynamic range. RDRs decreased with increasing level. The upper limit increased with increasing level for most subjects, with two notable exceptions. Implications of the results for temporal plasticity are discussed, along with possible influences of the effects of level and of across-session learning.
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Affiliation(s)
- Robert P Carlyon
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK.
| | - François Guérit
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - Alexander J Billig
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | | | | | - John M Deeks
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
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