Comparison of an Electromagnetic Middle Ear Implant and Hearing Aid Word Recognition Performance to Word Recognition Performance Obtained Under Earphones

Role of cochlear reserve in adults with cochlear implants following post-lingual hearing loss

INTRODUCTION

Pre-operative assessments before cochlear implantation (CI) includes the examination of both tone hearing, and the level of the cochlear reserve indicated by speech understanding. The goal of this study was to explore the predictive influence of tone hearing and cochlear reserve in CI.

METHODS

We did a retrospective cohort study, which included adult patients who had undergone CI between January 2012 and December 2019 in a tertiary care center. The pre-operative tone hearing, unaided maximum monosyllabic word recognition score (WRSmax), aided hearing gain, aided monosyllabic word recognition score at 65 dB (WRS65(HA)), and speech perception gap (SPG) were measured. The duration of unaided hearing loss (UHL) was also assessed. These variables were compared with post-operative monosyllabic word recognition score after CI at 65 dB (WRS65(CI)).

RESULTS

103 patients and 128 ears were included in this study. Regardless of tone hearing, patients with better pre-operative WRSmax and WRS65(HA) performed better post-operatively. WRSmax was found to be the most important factor that was statistically significantly associated with WRS65(CI). SPG was statistically significantly associated with WRSmax and SPG ≥ 20% group performed better post-operatively. Any duration of unaided hearing loss was statistically significantly inversely associated with WRSmax above 0%.

CONCLUSION

Cochlear reserve represented by WRSmax may play the most important role as a predictive factor in outcomes after CI. SPG should be considered for indicating CI in patients, when WRS65(HA) does not reach WRSmax. Early rehabilitation with hearing aids and duration of hearing aid usage might play an important role in preserving cochlear reserve in adults.

Results and Quality of Life after Implantation of Active Middle Ear Implants

The provision of implantable hearing aids represents an area with high development and innovation potential. On the one hand, this review article provides an overview of current indication criteria for the treatment with active middle ear implants. On the other hand, outcome parameters as well as functional results after implantation of active middle ear implants are demonstrated and discussed. The focus is mainly placed on audiological results as well as the subjective health status. "Patient Reported Outcome Measures" (PROMs) have become an integral part of the evaluation of hearing implant treatment. Due to low evidence level criteria, the study situation regarding audiological as well as subjective outcome parameters is not satisfactory. The lack of an international consensus on accepted outcome parameters makes a meta-analytical analysis of results immensely difficult. In the studies published to date, patients with sensorineural hearing loss and patients with conductive or mixed hearing loss offered better speech recognition after implantation of an active middle ear implant compared to conventional hearing aids. Current analyses show a significant improvement in general as well as hearing-specific quality of life after implantation of an active middle ear implant. To date, no validated, hearing-specific quality-of-life measurement instruments exist for assessing the success of fitting in children. Especially in children with complex malformations of the outer ear and the middle ear, excellent audiological results were shown. However, these results need to be substantiated by quality-of-life measurements in future.

New Considerations for a Totally Implantable Active Middle Ear Implant

Totally implantable active middle ear implants (AMEI) provide full-time hearing amplification to those with moderate to severe sensorineural hearing loss. While technology in conventional hearing aids (CHA) has advanced greatly, limitations remain for people with active lifestyles, limited vision or dexterity, and hearing aid fit issues. Furthermore, direct-drive properties of AMEI are thought to provide those with inefficient middle ear transfer functions a distinct advantage in delivering prescribed sound to the cochlea, ultimately improving speech understanding with less distortion. AMEI safety, stability, and efficacy outcomes are well documented and fitting strategies continue to improve. Recent studies show how simple aided speech testing can help predict whether a patient struggling with CHA may instead benefit from an AMEI. Totally implantable AMEI continue to be a viable option for patients who cannot or will not utilize traditional hearing aids.

Speech Perception Gap Is Predictive of an Active Middle Ear Implant Advantage

OBJECTIVE

Evaluate whether the difference between word recognition score (WRS) obtained unaided under earphone and with a hearing aid (HA), the speech perception gap (SPgap), is predictive of performance with a totally implantable active middle ear implant (AMEI).

STUDY DESIGN

Retrospective review of systematically collected data.

SETTING

Private otologic practice.

PATIENTS

One hundred thirty six ears (133 patients) with sensorineural hearing loss implanted with an AMEI. Subjects were 73.5% men, with mean age = 61.3 years.

INTERVENTION

Previous AMEI.

MAIN OUTCOME MEASURES

WRS with earphone at phonetically balanced maximum (PB-MAX), and with HA and AMEI at 50 dB HL. Differences between earphone, HA and AMEI word recognition, grouped as positive or negative speech perception gap (+SPgap/-SPgap) between two devices.

RESULTS

A +SPgap (WRS poorer with device than earphone) occurred in 86.0% of patients with HA and 42.3% with the AMEI. Mean SPgap = 24.7% with HA and 3.0% with AMEI (p ≤ 0.001). With a HA +SPgap, AMEI performance was better than HA by an average difference of 23.2% WRS, with AMEI more than HA in 82.9% of subjects. With HA -SPgap, the mean difference was 1.1% correct and AMEI more than HA in 47.4% of subjects (p ≤ 0.001 and p ≤ 0.002, for mean difference and percent of subjects, respectively). The larger the +SPgap (earphone-HA), the greater the advantage of AMEI over HA (r = 0.62, p ≤ 0.001).

CONCLUSION

A speech perception gap between earphone PB-MAX and aided word recognition score suggests a patient may have better speech perception with an AMEI than with his/her hearing aid. This information is useful for counseling patients who are not performing well or are unsatisfied with their hearing aid.

Earphone and Aided Word Recognition Differences in Cochlear Implant Candidates

OBJECTIVE

Compare word recognition scores for adults undergoing cochlear implant evaluations (CIE) measured using earphones and hearing aids.

STUDY DESIGN

Retrospective review of data obtained during adult CIEs.

SETTING

Tertiary cochlear implant center.

PATIENTS

Two hundred eight ears in 183 subjects with greater than 10% word recognition scores measured with earphones.

INTERVENTIONS/MAIN OUTCOMES MEASURED

Preoperative pure-tone thresholds and word recognition scores measured with earphones and hearing aids.

RESULTS

A review of audiological data obtained from 2012 to 2017 during adult CIEs was conducted. Overall, a weak positive correlation (r = 0.33, 95% confidence interval 0.17-0.40, p < 0.001) was observed between word recognition scores measured with earphones and hearing aids. Earphone to aided differences (EAD) ranged from -38 to +72% (mean 14.3 ± 19.9%). Consistent with EADs, 108 ears (51.9%) had earphone scores that were significantly higher than aided word recognition scores (+EAD), as determined by 95% confidence intervals; for 14 ears (6.7%), earphone scores were significantly lower than aided scores (-EAD). Moreover, of the patients with earphone word recognition scores ≥50%, 82.6% were CI candidates based on aided AzBio+10 dB SNR scores.

CONCLUSION

These results demonstrate the limited diagnostic value of word recognition scores measured under earphones for patients undergoing CIE. Nevertheless, aided word recognition is rarely measured before CIEs, which limits the information available to determine CI candidacy and referral for CIEs. Earlier and routine measurement of aided word recognition may help guide clinical decision making by determining the extent to which patients are achieving maximum benefit with their hearing aids or should consider cochlear implantation.

Ossicle Coupling Active Implantable Auditory Devices: Magnetic Driven System

Active auditory implants, such as the Maxum, provide significantly improved hearing function compared to hearing aids in patients with moderate to severe hearing loss who are not reaching their cochlear hearing potential. The speech perception gap (SPG), defined as PB Max (phonetically balanced maximum) minus word recognition score with hearing aid, is a useful measure of inadequate hearing aid performance. The Maxum middle ear implant provides significantly improved performance over hearing aids in patients with significant SPG because of superior high frequency gain. Patients with PB Max 60% or greater with SPG are possible candidates for the implant.