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de Quillettes R, Kaandorp M, Merkus P, Kramer SE, Smits C. Experienced Adult Cochlear Implant Users Show Improved Speech Recognition When Target Fitting Parameters Are Applied. Ear Hear 2024:00003446-990000000-00274. [PMID: 38755742 DOI: 10.1097/aud.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The aim of the present study was to investigate whether prediction models built by de Graaff et al. (2020) can be used to improve speech recognition in experienced adult postlingual implanted Cochlear CI users. de Graaff et al. (2020) found relationships between elevated aided thresholds and a not optimal electrical dynamic range (<50 CL or >60 CL), and poorer speech recognition in quiet and in noise. The primary hypothesis of the present study was that speech recognition improves both in quiet and in noise when the sound processor is refitted to match targets derived from the prediction models from de Graaff et al. (2020). A second hypothesis was that subjectively, most of the CI users would find the new setting too loud because of an increase in C levels, and therefore, prefer the old settings. DESIGN A within-participant repeated measures design with 18 adult Cochlear CI users was used. T- and C-levels were changed to "optimized settings," as predicted by the model of de Graaff et al. (2020). Aided thresholds, speech recognition in quiet, and speech recognition in noise were measured with the old settings and after a 4-week acclimatization period with the optimized settings. Subjective benefit was measured using the Device Oriented Subjective Outcome Scale questionnaire. RESULTS The mean electrical dynamic range changed from 41.1 (SD = 6.6) CL to 48.6 (SD = 3.0) CL. No significant change in aided thresholds was measured. Speech recognition improved for 16 out of 18 participants and remained stable for 2 participants. Average speech recognition scores in quiet significantly improved by 4.9% (SD = 3.8%). No significant change for speech recognition in noise was found. A significant improvement in subjective benefit was found for one of the Device Oriented Subjective Outcome subscales (speech cues) between the old and optimized settings. All participants chose to keep the optimized settings at the end of the study. CONCLUSIONS We were able to improve speech recognition in quiet by optimizing the electrical dynamic range of experienced adult CI users, according to the prediction models built by de Graaff et al. (2020). There was no significant change in aided thresholds nor in speech recognition in noise. The findings of the present study suggest that improved performance for speech recognition in quiet in adult Cochlear CI users can be achieved by setting the dynamic range as close as possible to values between 50 and 60 CL when the volume level is at 10.
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Affiliation(s)
- Richard de Quillettes
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marre Kaandorp
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Paul Merkus
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Sophia E Kramer
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Cas Smits
- Amsterdam UMC, Location University of Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Migliorini E, van Dijk B, Philips B, Mylanus E, Huinck W. The relation between cochlear implant programming levels and speech perception performance in post-lingually deafened adults: a data-driven approach. Eur Arch Otorhinolaryngol 2024; 281:1163-1173. [PMID: 37665345 PMCID: PMC10858098 DOI: 10.1007/s00405-023-08195-3] [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: 02/24/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Programming a cochlear implant (fitting) is an essential part of a user's post-implantation journey, defining how sound will be translated into electrical stimulation and aiming to provide optimal speech perception outcomes. Currently, there are no established, evidence-based guidelines for fitting cochlear implant users, leading to a high degree of variability in fitting practices, users' parameters, and probably outcomes. In this study a data-driven approach is used to retrospectively investigate the relation between cochlear implant fitting parameters and speech perception outcomes in post-lingually deafened adults. METHODS 298 data points corresponding to fitting parameters and speech audiometry test results for the same number of adult, post-lingually deafened, experienced CI users were analyzed. Correlation analysis was performed, after which parameters from the top-scoring and bottom-scoring tertiles were compared via the Mann-Whitney-Wilcoxon u test. RESULTS Weak correlations between dynamic range and speech audiometry outcomes were identified, having p values lower than (albeit close to) 0.05. A significant (p < 0.05) difference in electrical dynamic range (the difference between the minimum and maximum amount of current which may be delivered by each electrode) was found, with top-scoring subjects having on average a wider dynamic range. CONCLUSION The association between dynamic range and speech perception outcomes shown in this retrospective study highlights the need for deeper investigation into evidence-driven fitting. It might be a first step in the direction of evidence-based fitting, minimizing variability in outcomes for cochlear implant users and helping mitigate the issue of unexplained low performance.
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Affiliation(s)
- Enrico Migliorini
- Cochlear Technology Centre Belgium, Mechelen, Belgium.
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | | | | | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
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Wasmann JWA, Huinck WJ, Lanting CP. Remote Cochlear Implant Assessments: Validity and Stability in Self-Administered Smartphone-Based Testing. Ear Hear 2024; 45:239-249. [PMID: 37641179 DOI: 10.1097/aud.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES The stability of remote testing in cochlear implant care was studied by testing the influence of time-of-day, listener fatigue, and motivation on the outcomes of the aided threshold test (ATT) and digit triplets test (DTT) in cochlear implant (CI) recipients using self-tests at-home on a smartphone or tablet. DESIGN A single-center repeated measures cohort study design (n = 50 adult CI recipients). The ATT and DTT were tested at-home ten times, with nine of these sessions planned within a period of eight days. Outcomes were modeled as a function of time-of-day, momentary motivation, listeners' task-related fatigue, and chronotype (i.e., someone's preference for morning or evening due to the sleep-wake cycle) using linear mixed models. Additional factors included aided monosyllabic word recognition in quiet, daily-life fatigue, age, and CI experience. RESULTS Out of 500 planned measurements, 407 ATTs and 476 DTTs were completed. The ATT determined thresholds and impedances were stable across sessions. The factors in the DTT model explained 75% of the total variance. Forty-nine percent of the total variance was explained by individual differences in the participants' DTT performance. For each 10% increase in word recognition in quiet, the DTT speech reception threshold improved by an average of 1.6 dB. DTT speech reception threshold improved, on average by 0.1 dB per repeated session and correlated with the number of successful DTTs per participant. There was no significant time-of-day effect on auditory performance in at-home administered tests. CONCLUSIONS This study is one of the first to report on the validity and stability of remote assessments in CI recipients and reveals relevant factors. CI recipients can be self-tested at any waking hour to monitor performance via smartphone or tablet. Motivation, task-related fatigue, and chronotype did not affect the outcomes of ATT or DTT in the studied cohort. Word recognition in quiet is a good predictor for deciding whether the DTT should be included in an individual's remote test battery. At-home testing is reliable for cochlear implant recipients and offers an opportunity to provide care in a virtual hearing clinic setting.
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Affiliation(s)
- Jan-Willem A Wasmann
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, The Netherlands
| | - Wendy J Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, The Netherlands
- These authors share last authorship
| | - Cris P Lanting
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, The Netherlands
- These authors share last authorship
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Eitutis ST, Vickers DA, Tebbutt K, Thomas T, Jiang D, de Klerk A, Clemesha J, Chung M, Bance ML. A Multicenter Comparison of 1-yr Functional Outcomes and Programming Differences Between the Advanced Bionics Mid-Scala and SlimJ Electrode Arrays. Otol Neurotol 2023; 44:e730-e738. [PMID: 37889939 PMCID: PMC10662583 DOI: 10.1097/mao.0000000000004048] [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] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To determine if there is a difference in hearing outcomes or stimulation levels between Advanced Bionics straight and precurved arrays. STUDY DESIGN Retrospective chart review across three implant centers. SETTING Tertiary centers for cochlear and auditory brainstem implantation. PATIENTS One hundred fifteen pediatric and 205 adult cochlear implants (CIs) were reviewed. All patients were implanted under the National Institute for Health and Care Excellence 2009 guidelines with a HiRes Ultra SlimJ or Mid-Scala electrode array. MAIN OUTCOME MEASURES Hearing preservation after implantation, as well as CI-only listening scores for Bamford-Kowal-Bench sentences were compared 1 year after implantation. Stimulation levels for threshold and comfort levels were also compared 1 year after implantation. RESULTS Hearing preservation was significantly better with the SlimJ compared with the Mid-Scala electrode array. Bamford-Kowal-Bench outcomes were not significantly different between the two arrays in any listening condition. Stimulation levels were not different between arrays but did vary across electrode contacts. At least one electrode was deactivated in 33% of implants but was more common for the SlimJ device. CONCLUSION Modern straight and precurved arrays from Advanced Bionics did not differ in hearing performance or current requirements. Although hearing preservation was possible with both devices, the SlimJ array would still be the preferred electrode in cases where hearing preservation was a priority. Unfortunately, the SlimJ device was also prone to poor sound perception on basal electrodes. Further investigation is needed to determine if deactivated electrodes are associated with electrode position/migration, and if programming changes are needed to optimize the use of these high-frequency channels.
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Affiliation(s)
- Susan T. Eitutis
- Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust
- Cambridge Hearing Group, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge
| | - Deborah A. Vickers
- Sound Laboratory, Cambridge Hearing Group, Clinical Neurosciences, University of Cambridge, Cambridge
| | | | | | - Dan Jiang
- Guy's and St. Thomas' NHS Foundation Trust
| | | | - Jennifer Clemesha
- Auditory Implant Department, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mark Chung
- Auditory Implant Department, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Manohar L. Bance
- Cambridge Hearing Group, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge
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Wathour J, Govaerts PJ, Lacroix E, Naïma D. Effect of a CI Programming Fitting Tool with Artificial Intelligence in Experienced Cochlear Implant Patients. Otol Neurotol 2023; 44:209-215. [PMID: 36728126 DOI: 10.1097/mao.0000000000003810] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cochlear implants (CIs) are the treatment of choice for patients with severe to profound hearing loss. The hearing results, however, considerably vary across patients. This may partly be due to variability in the CI fitting. We investigated the effect of FOX, a software tool to program CIs using artificial intelligence (AI), on hearing outcomes. METHODS Forty-seven experienced CI patients who came to our tertiary CI center for their annual follow-up between 2017 and 2020 were recruited for this study. They received a new CI map created by the AI software tool. CI parameters and auditory outcomes obtained with this new map were compared with those of the initial manual map after 15 days of take-home experience. Within-patient differences were assessed. At the end of the study, the patients were offered a choice to continue using the AI map or to revert to their old manual map. RESULTS Several auditory outcomes improved with the AI map, namely, pure tone audiometric threshold at 6,000 Hz (median improvement 10 dB, range = -20 to 50 dB, Z = -2.608, p = 0.008), phonemic discrimination scores (median improvement 10%, range = 0% to 30%, Z = -4.061, p = 0.001), and soft-intensity (median improvement of 10%, range = -20% to 90%, Z = -4.412, p < 0.001) to normal-intensity (median improvement of 10%, range = -30% to 60%, Z = -3.35, p < 0.001) speech audiometric scores. CONCLUSION The AI-assisted CI mapping model as a potential assistive tool may improve audiological outcomes for experienced CI patients, including high-frequency pure tone audiometry and audiometric speech scores at low and normal presentation levels.Clinical trial registration: NCT03700268.
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Affiliation(s)
- Justine Wathour
- Cliniques universitaires Saint-Luc, Avenue Hippocrate 100, 1200, Brussels, Belgium
| | | | | | - Deggouj Naïma
- Cliniques universitaires Saint-Luc, Avenue Hippocrate 100, 1200, Brussels, Belgium
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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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7
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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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Lee DS, Herzog JA, Walia A, Firszt JB, Zhan KY, Durakovic N, Wick CC, Buchman CA, Shew MA. External Validation of Cochlear Implant Screening Tools Demonstrates Modest Generalizability. Otol Neurotol 2022; 43:e1000-e1007. [PMID: 36047695 PMCID: PMC9481700 DOI: 10.1097/mao.0000000000003678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the clinical application of five recently published cochlear implant (CI) candidacy evaluation (CICE) referral screening tools through external validation. STUDY DESIGN Retrospective cohort study. SETTING Tertiary otology/neurotology practice. PATIENTS Adults who underwent CICE between December 2020 and September 2021. INTERVENTIONS CICE referral screening tools versus CI candidacy criteria. MAIN OUTCOME MEASURES CICE screening tool performance, based on the ability to identify patients who met the CI candidacy criteria, was evaluated. CI candidacy criteria were defined as best-aided AzBio sentences at +10 signal-to-noise ratio and either 60% or less accuracy to reflect traditional criteria used in clinical settings or 40% or less accuracy (only patients 65 years or older) to reflect Medicare-eligible criteria. RESULTS Screening criteria of proposed CICE referral tools vary widely across pure-tone average and word recognition scores. When screened by traditional criteria, the sensitivities and specificities of these referral tools varied from 40 to 77% and from 22 to 86%, respectively. When screened by Medicare-eligible criteria, sensitivities and specificities varied from 41 to 81% and from 24 to 91%, respectively. The screening tool proposed by Zwolan et al. ( Otol Neurotol 2020;41(7):895-900) demonstrated the best overall performance for traditional (Youden's J , 0.37; sensitivity, 62%; specificity, 75%) and Medicare-eligible patients (Youden's J , 0.44; sensitivity, 66%; specificity, 78%). All screening tools performed worse on the validation cohort compared with their respective development cohorts. CONCLUSIONS Current tools for determining CICE referral have diverse screening criteria. These combinations of pure-tone average and word recognition score are modestly successful at identifying CI candidates.
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Affiliation(s)
- David S Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
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Thangaraj M, Arunachalam R, Gore M, Uppunda A. Effect of modified programming parameters on sound field thresholds, speech perception and CAEP among children using CP802 processor. Int J Pediatr Otorhinolaryngol 2022; 159:111212. [PMID: 35749954 DOI: 10.1016/j.ijporl.2022.111212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/22/2022] [Accepted: 06/11/2022] [Indexed: 10/18/2022]
Abstract
Optimizing and validating programming parameters of Thresholds(T) and most comfortable levels(C) is very important in young children using a cochlear implant who may not be able provide behavioral responses. The present study attempts to describe the changes in T/C level with behavioral and Cortical Auditory Evoked Potentials (CAEP) responses. Twenty participants using CI24RE (ST) implant with CP802 speech processor participated in the study. Three experimentally 'sham' programs were created by a) decreasing T levels, b) raising T levels or c) decreasing C levels in the 'everyday' program. Sound field thresholds and speech perception at 50dBHL were measured for all experimental and everyday programs. Acoustically evoked CAEP measures, namely thresholds for three different stimuli of/ba/,/da/and/ga/, along with amplitude and latency at 80dBnHL were recorded for all programs. The results indicated that modification of T levels did not have significant effect on CAEP threshold, latency, amplitude as also on behavioral measures of sound field thresholds and speech perception. However, reduction of C levels resulted in significantly poor sound field thresholds, speech perception as well as CAEP thresholds. Furthermore, it was found that there was a significant correlation between behavioral measures of sound field threshold and speech perception with CAEP measures. Thus, from the present study it may be concluded that behavioral and CAEP responses can be used as indicator to reflect changes in C levels resulting changes in behavioral measures in users of CP802 speech processors.
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Affiliation(s)
- Muthuselvi Thangaraj
- Department of Speech Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, 600116, Tamil Nadu, India.
| | | | - Madhuri Gore
- Dr. S.R. Chandrasekhar Institute of Speech and Hearing, Bengauru, India.
| | - AjithKumar Uppunda
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, India.
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Caswell-Midwinter B, Doney EM, Arjmandi MK, Jahn KN, Herrmann BS, Arenberg JG. The Relationship Between Impedance, Programming and Word Recognition in a Large Clinical Dataset of Cochlear Implant Recipients. Trends Hear 2022; 26:23312165211060983. [PMID: 35018875 PMCID: PMC8761885 DOI: 10.1177/23312165211060983] [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] [Indexed: 11/15/2022] Open
Abstract
Cochlear implant programming typically involves measuring electrode impedance, selecting a speech processing strategy and fitting the dynamic range of electrical stimulation. This study retrospectively analyzed a clinical dataset of adult cochlear implant recipients to understand how these variables relate to speech recognition. Data from 425 implanted post-lingually deafened ears with Advanced Bionics devices were analyzed. A linear mixed-effects model was used to infer how impedance, programming and patient factors were associated with monosyllabic word recognition scores measured in quiet. Additional analyses were conducted on subsets of data to examine the role of speech processing strategy on scores, and the time taken for the scores of unilaterally implanted patients to plateau. Variation in basal impedance was negatively associated with word score, suggesting importance in evaluating the profile of impedance. While there were small, negative bivariate correlations between programming level metrics and word scores, these relationships were not clearly supported by the model that accounted for other factors. Age at implantation was negatively associated with word score, and duration of implant experience was positively associated with word score, which could help to inform candidature and guide expectations. Electrode array type was also associated with word score. Word scores measured with traditional continuous interleaved sampling and current steering speech processing strategies were similar. The word scores of unilaterally implanted patients largely plateaued within 6-months of activation. However, there was individual variation which was not related to initially measured impedance and programming levels.
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Affiliation(s)
- Benjamin Caswell-Midwinter
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | | | - Meisam K Arjmandi
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | - Kelly N Jahn
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA
| | - Barbara S Herrmann
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | - Julie G Arenberg
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
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11
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Naumova IV, Pashkov AV, Voevodina KI, Fatakhova MT. [Speech perception and the state of sound perception thresholds in patients with cochlear implants]. Vestn Otorinolaringol 2022; 87:11-13. [PMID: 36580503 DOI: 10.17116/otorino20228706111] [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: 12/30/2022]
Abstract
OBJECTIVE To assess the state of the thresholds of sound perception at speech frequencies in users of cochlear implantation (CI) systems with developed speech skills. MATERIAL AND METHODS The study involved 30 patients - users of CI systems, of whom 17 girls, 13 boys aged 6 to 14 years. All patients underwent speech audiometry in a free sound field twice (at the beginning of the study and after adjusting the settings of the speech processor). The ASSR (auditory steady-state responses) thresholds were recorded as the second stage to assess the perception of non-speech stimuli after adjusting the settings of the speech processor. RESULTS Correlation analysis was carried out between the percentage of speech intelligibility and the average ASSR thresholds. There was no statistically significant relationship between lowering the ASSR thresholds and speech intelligibility. The absence of a relationship between speech intelligibility and user satisfaction with the speech processor settings was revealed. Improving the intelligibility of the user's speech by the CI system did not affect the improvement on the response to the addressed speech.
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Affiliation(s)
- I V Naumova
- Petrovsky Russian Scientific Center of Surgery - Research Institute of Pediatrics and Children's Health of the Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - A V Pashkov
- Petrovsky Russian Scientific Center of Surgery - Research Institute of Pediatrics and Children's Health of the Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia.,Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - K I Voevodina
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - M T Fatakhova
- Petrovsky Russian Scientific Center of Surgery - Research Institute of Pediatrics and Children's Health of the Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
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12
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Potts LG, Jang S, Hillis CL. Evaluation of Automatic Directional Processing with Cochlear Implant Recipients. J Am Acad Audiol 2021; 32:478-486. [PMID: 34965594 DOI: 10.1055/s-0041-1733967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND For cochlear implant (CI) recipients, speech recognition in noise is consistently poorer compared with recognition in quiet. Directional processing improves performance in noise and can be automatically activated based on acoustic scene analysis. The use of adaptive directionality with CI recipients is new and has not been investigated thoroughly, especially utilizing the recipients' preferred everyday signal processing, dynamic range, and/or noise reduction. PURPOSE This study utilized CI recipients' preferred everyday signal processing to evaluate four directional microphone options in a noisy environment to determine which option provides the best speech recognition in noise. A greater understanding of automatic directionality could ultimately improve CI recipients' speech-in-noise performance and better guide clinicians in programming. STUDY SAMPLE Twenty-six unilateral and seven bilateral CI recipients with a mean age of 66 years and approximately 4 years of CI experience were included. DATA COLLECTION AND ANALYSIS Speech-in-noise performance was measured using eight loudspeakers in a 360-degree array with HINT sentences presented in restaurant noise. Four directional options were evaluated (automatic [SCAN], adaptive [Beam], fixed [Zoom], and Omni-directional) with participants' everyday use signal processing options active. A mixed-model analysis of variance (ANOVA) and pairwise comparisons were performed. RESULTS Automatic directionality (SCAN) resulted in the best speech-in-noise performance, although not significantly better than Beam. Omni-directional performance was significantly poorer compared with the three other directional options. A varied number of participants performed their best with each of the four-directional options, with 16 performing best with automatic directionality. The majority of participants did not perform best with their everyday directional option. CONCLUSION The individual variability seen in this study suggests that CI recipients try with different directional options to find their ideal program. However, based on a CI recipient's motivation to try different programs, automatic directionality is an appropriate everyday processing option.
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Affiliation(s)
- Lisa G Potts
- Department of Otolaryngology, Washington University School of Medicine, St Louis, Missouri
| | - Soo Jang
- Program in Audiology and Communication Sciences, Washington University, St Louis, Missouri
| | - Cory L Hillis
- Program in Audiology and Communication Sciences, Washington University, St Louis, Missouri
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van Wieringen A, Magits S, Francart T, Wouters J. Home-Based Speech Perception Monitoring for Clinical Use With Cochlear Implant Users. Front Neurosci 2021; 15:773427. [PMID: 34916902 PMCID: PMC8669965 DOI: 10.3389/fnins.2021.773427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022] Open
Abstract
Speech-perception testing is essential for monitoring outcomes with a hearing aid or cochlear implant (CI). However, clinical care is time-consuming and often challenging with an increasing number of clients. A potential approach to alleviating some clinical care and possibly making room for other outcome measures is to employ technologies that assess performance in the home environment. In this study, we investigate 3 different speech perception indices in the same 40 CI users: phoneme identification (vowels and consonants), digits in noise (DiN) and sentence recognition in noise (SiN). The first two tasks were implemented on a tablet and performed multiple times by each client in their home environment, while the sentence task was administered at the clinic. Speech perception outcomes in the same forty CI users showed that DiN assessed at home can serve as an alternative to SiN assessed at the clinic. DiN scores are in line with the SiN ones by 3–4 dB improvement and are useful to monitor performance at regular intervals and to detect changes in auditory performance. Phoneme identification in quiet also explains a significant part of speech perception in noise, and provides additional information on the detectability and discriminability of speech cues. The added benefit of the phoneme identification task, which also proved to be easy to administer at home, is the information transmission analysis in addition to the summary score. Performance changes for the different indices can be interpreted by comparing against measurement error and help to target personalized rehabilitation. Altogether, home-based speech testing is reliable and proves powerful to complement care in the clinic for CI users.
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Affiliation(s)
| | - Sara Magits
- Experimental ORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Tom Francart
- Experimental ORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Experimental ORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
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Ernst R, Linxweiler M, Rink KA, Rothe H, Lecomte G, Bozzato A, Hecker D. [Neurophysiological parameters for speech recognition in patients with cochlear implants]. Laryngorhinootologie 2021; 101:216-227. [PMID: 33836549 DOI: 10.1055/a-1399-9540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Cochlea Implants (CI) are the preferred treatment for deaf and highly hearing imparied people. While deaf people already profit enormously from any regained hearing perception, it is not as easy to predict a profitable outcome for people with a remaining sense of hearing. To provide patients the best possible outcome in speech understanding, a lot of parameters have to be identified and adjusted. The aim of this study is to show the influence of objective parameters on classified speech understanding using collected data. MATERIAL AND METHODS A total of 52 patients and 65 ears aged between 18 and 80 years were included in this study. ECAP-thresholds from intraoperative measurements and impedance were used as objective parameters. T- and C/M-levels were defined as subjective parameters. To classify the performance the value of speech understanding was used. RESULTS Differences between both groups (age, time after implantation) were not significant. The gained word scores at 500 Hz correlated significantly with the results of the speech perception threshold on two-digit numbers. The electrode impedances correlated on average with speech understanding with constant variability. The distributions of objective and subjective parameters showed partially significant differences. Many distributions showed significant differences to the normal distribution. Accordingly, the overlapping areas of the significance levels are very narrow. CONCLUSION Higher impedances and incorrectly adjusted T-levels resulted in a worse speech understanding. Relation of C/M-levels to ECAP thresholds seem to be crucial for good speech understanding.
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Affiliation(s)
- Robert Ernst
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Maximilian Linxweiler
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Katharina Anna Rink
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Heike Rothe
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Gregory Lecomte
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Alessandro Bozzato
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Dietmar Hecker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
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Correlation between Speech Perception Outcomes after Cochlear Implantation and Postoperative Acoustic and Electric Hearing Thresholds. J Clin Med 2021; 10:jcm10020324. [PMID: 33477270 PMCID: PMC7830395 DOI: 10.3390/jcm10020324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/05/2022] Open
Abstract
The reliable prediction of cochlear implant (CI) speech perception outcomes is highly relevant and can facilitate the monitoring of postoperative hearing performance. To date, multiple audiometric, demographic, and surgical variables have shown some degree of correlation with CI speech perception outcomes. In the present study, postsurgical acoustic and electric hearing thresholds that are routinely assessed in clinical practice were compared to CI speech perception outcomes in order to reveal possible markers of postoperative cochlear health. A total of 237 CI recipients were included in this retrospective monocentric study. An analysis of the correlation of postoperative pure-tone averages (PTAs) and electric CI fitting thresholds (T-/C-levels) with speech perception scores for monosyllabic words in quiet was performed. Additionally, a correlation analysis was performed for postoperative acoustic thresholds in intracochlear electrocochleography (EcochG) and speech recognition scores in a smaller group (n = 14). The results show that neither postoperative acoustic hearing thresholds nor electric thresholds correlate with postoperative speech perception outcomes, and they do not serve as independent predictors of speech perception outcomes. By contrast, the postoperative intracochlear total EcochG response was significantly correlated with speech perception. Since the EcochG recordings were only performed in a small population, a large study is required to clarify the usefulness of this promising predictive parameter.
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