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Dornhoffer JR, Shannon C, Schvartz-Leyzac KC, Dubno JR, McRackan TR. Computer-based Auditory Training by New Adult Cochlear Implant Recipients Is Associated With Durable Improvements in Cochlear Implant Quality of Life. Ear Hear 2024; 45:905-914. [PMID: 38351509 PMCID: PMC11178477 DOI: 10.1097/aud.0000000000001486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
OBJECTIVE The process of adapting to communicate with a cochlear implant (CI) is complex. The use of auditory training after cochlear implantation may help to facilitate improvements in postoperative speech recognition and quality-of-life outcomes in new adult CI recipients. However, the effectiveness of auditory training remains uncertain and long-term effects have not been examined in a large sample of new adult CI users. As such, the objective of this study was to examine the influence of common forms of auditory training on speech recognition and CI-related quality-of-life (CI-related QOL) outcomes at 1 year after cochlear implantation. We hypothesized that patients who reported use of computer-based auditory training (CBAT) would show improved speech and CIQOL-35 Profile scores at 1 year after activation of their implant, compared with their peers. DESIGN This study was designed as a prospective study and was undertaken at a tertiary academic CI center. Participants included 114 adults undergoing cochlear implantation for bilateral hearing loss. Patients serially self-reported use of the following types of post-CI auditory training over their first-year postactivation: (1) face-to-face training (e.g., speech-language pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) CBAT (e.g., self-directed software). Outcomes measures for this study included change in Consonant-Nucleus-Consonant phoneme (CNCp), CNC word (CNCw), AzBio sentences in quiet, and CIQOL-35 Profile global and domain scores from pre-CI to 12-mo post-CI. RESULTS Of 114 patients, 94 (82.5%) used one or more auditory training resources. Of these, 19.3% used face-to-face training, 67.5% passive home-based training, and 46.5% CBAT. Of 114 patients, 73 had complete CIQOL data. At 12 mo, only CBAT use was associated with significantly greater improvements in global and all domain-specific CIQOL scores ( d -range = 0.72-0.87), compared with those not using CBAT. Controlling for demographics and use of multiple training resources, CBAT remained the strongest positive predictor of CIQOL improvement, with significant associations with global score (ß = 12.019[4.127,19.9]) and all domain scores at 12-mo post-CI: communication (ß = 11.937[2.456,21.318), emotional (ß = 12.293[1.827,22.759), entertainment (ß = 17.014[5.434,28.774), environment (ß = 13.771[1.814,25.727]), listening effort (ß = 12.523[2.798,22.248]), and social (ß = 18.114[7.403,28.826]). No significant benefits were noted with use of CBAT or any other form of auditory training and speech recognition scores at 12-mo post-CI ( d -range = -0.12-0.22). CONCLUSIONS Auditory training with CBAT was associated with improved CI-related QOL outcomes at 12-mo post-CI. Given its availability and low cost, this study provides evidence to support using CBAT to improve real-world functional abilities in new adult CI recipients.
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Affiliation(s)
- James R Dornhoffer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Pantaleo A, Murri A, Cavallaro G, Pontillo V, Auricchio D, Quaranta N. Single-Sided Deafness and Hearing Rehabilitation Modalities: Contralateral Routing of Signal Devices, Bone Conduction Devices, and Cochlear Implants. Brain Sci 2024; 14:99. [PMID: 38275519 PMCID: PMC10814000 DOI: 10.3390/brainsci14010099] [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: 12/09/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Single sided deafness (SSD) is characterized by significant sensorineural hearing loss, severe or profound, in only one ear. SSD adversely affects various aspects of auditory perception, including causing impairment in sound localization, difficulties with speech comprehension in noisy environments, and decreased spatial awareness, resulting in a significant decline in overall quality of life (QoL). Several treatment options are available for SSD, including cochlear implants (CI), contralateral routing of signal (CROS), and bone conduction devices (BCD). The lack of consensus on outcome domains and measurement tools complicates treatment comparisons and decision-making. This narrative overview aims to summarize the treatment options available for SSD in adult and pediatric populations, discussing their respective advantages and disadvantages. Rerouting devices (CROS and BCD) attenuate the effects of head shadow and improve sound awareness and signal-to-noise ratio in the affected ear; however, they cannot restore binaural hearing. CROS devices, being non-implantable, are the least invasive option. Cochlear implantation is the only strategy that can restore binaural hearing, delivering significant improvements in speech perception, spatial localization, tinnitus control, and overall QoL. Comprehensive preoperative counseling, including a discussion of alternative technologies, implications of no treatment, expectations, and auditory training, is critical to optimizing therapeutic outcomes.
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Affiliation(s)
- Alessandra Pantaleo
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
| | - Alessandra Murri
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
| | - Giada Cavallaro
- Otolaryngology Unit, Madonna delle Grazie Hospital, 75100 Matera, Italy;
| | - Vito Pontillo
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
| | - Debora Auricchio
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
| | - Nicola Quaranta
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
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Philpott N, Philips B, Tromp K, Kramer S, Mylanus E, Huinck W. Phoneme Training for Adult Cochlear Implant Users: A Review of the Literature and Study Protocol. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:5071-5086. [PMID: 37889216 DOI: 10.1044/2023_jslhr-23-00335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE This study describes a protocol for a novel individualized phoneme training program for adult cochlear implant (CI) users, based on individual phoneme confusion errors. The protocol is underpinned by a literature review on phoneme training and a focus group with adult CI users. METHOD After a literature search, five studies were included for review and evaluation of quality and level of evidence. A focus group with experienced adult CI users (n = 7) was then conducted to gain insights into their experiences of auditory training post-implantation and recommendations for future training programs. The knowledge gained from the literature review and focus group was used as the foundation for a novel, individualized phoneme training program for adult CI users, for which the protocol is described in this study. RESULTS A review of the literature shows that phoneme training in adult CI users has variable outcomes for on-task and off-task measures. Overall, the concept of individualized training relates to adaptive difficulty within training tasks and not to tailoring training content to participants' individual needs, as indicated by clinical outcomes. The focus group revealed that participants want to be able to track their training progress, have training content tailored to their individual needs, and expressed a preference for shorter training sessions. CONCLUSIONS Using learnings from a literature review and focus group, this study describes a protocol for a novel, individualized phoneme training program for adult CI users. Study findings from this phoneme training program will be disseminated when available. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24392863.
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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
| | | | | | - Sophia Kramer
- Department of Otolaryngology-Head and Neck Surgery, Vrije Universiteit Amsterdam, Amsterdam UMC, 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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Harris MS, Hamel BL, Wichert K, Kozlowski K, Mleziva S, Ray C, Pisoni DB, Kronenberger WG, Moberly AC. Contribution of Verbal Learning & Memory and Spectro-Temporal Discrimination to Speech Recognition in Cochlear Implant Users. Laryngoscope 2023; 133:661-669. [PMID: 35567421 PMCID: PMC9659673 DOI: 10.1002/lary.30210] [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: 11/30/2021] [Revised: 04/01/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Existing cochlear implant (CI) outcomes research demonstrates a high degree of variability in device effectiveness among experienced CI users. Increasing evidence suggests that verbal learning and memory (VL&M) may have an influence on speech recognition with CIs. This study examined the relations in CI users between visual measures of VL&M and speech recognition in a series of models that also incorporated spectro-temporal discrimination. Predictions were that (1) speech recognition would be associated with VL&M abilities and (2) VL&M would contribute to speech recognition outcomes above and beyond spectro-temporal discrimination in multivariable models of speech recognition. METHODS This cross-sectional study included 30 adult postlingually deaf experienced CI users who completed a nonauditory visual version of the California Verbal Learning Test-Second Edition (v-CVLT-II) to assess VL&M, and the Spectral-Temporally Modulated Ripple Test (SMRT), an auditory measure of spectro-temporal processing. Participants also completed a battery of word and sentence recognition tasks. RESULTS CI users showed significant correlations between some v-CVLT-II measures (short-delay free- and cued-recall, retroactive interference, and "subjective" organizational recall strategies) and speech recognition measures. Performance on the SMRT was correlated with all speech recognition measures. Hierarchical multivariable linear regression analyses showed that SMRT performance accounted for a significant degree of speech recognition outcome variance. Moreover, for all speech recognition measures, VL&M scores contributed independently in addition to SMRT. CONCLUSION Measures of spectro-temporal discrimination and VL&M were associated with speech recognition in CI users. After accounting for spectro-temporal discrimination, VL&M contributed independently to performance on measures of speech recognition for words and sentences produced by single and multiple talkers. LEVEL OF EVIDENCE 3 Laryngoscope, 133:661-669, 2023.
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Affiliation(s)
- Michael S. Harris
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Kristin Wichert
- Department of Communication Sciences & Disorders, University of Wisconsin - Eau Claire, Eau Claire, WI
| | - Kristin Kozlowski
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Sarah Mleziva
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Christin Ray
- Department of Otolaryngology – Head & Neck Surgery, The Ohio State Wexner Medical Center, Columbus, OH
| | - David B. Pisoni
- Speech Research Laboratory, Department of Psychology, Indiana University, Bloomington, IN
| | | | - Aaron C. Moberly
- Department of Otolaryngology – Head & Neck Surgery, The Ohio State Wexner Medical Center, Columbus, OH
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Lee YH, Ho PH, Chen PY, Chen XX, Sun YC, Chu CH, Lin HC. Long-term auditory performance and psychosocial benefits of cochlear implantation in Mandarin-speaking older adults. Am J Otolaryngol 2023; 44:103876. [PMID: 37084611 DOI: 10.1016/j.amjoto.2023.103876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE Although previous studies have shown the efficacy of cochlear implants (CIs) in older adults, no study written in English has focused on Mandarin-speaking older recipients. Mandarin is a tonal language, it is hard to lip-read and tone recognition for CI users. This study aimed to evaluate the long-term post-CI outcomes in Mandarin-speaking older adults and the difference between them and younger recipients. MATERIALS AND METHODS Forty-six post-lingually deafened adults were included. Speech perception tests (vowel, consonant, disyllable words, Mandarin monosyllable recognition test, and categories of audiology performance were evaluated) and psychosocial scale were evaluated. RESULTS There were no significant differences between older and younger recipients in post-CI open-set speech perception. However, older recipients had significantly lower social and total scores in the subjective questionnaire than younger recipients. In both duration of deafness less than seven years and hearing years in life over 92.6 %, older recipients had no less capable speech perception than in younger. CONCLUSION Mandarin-speaking older recipients can improve not only speech perception but also psychosocial benefits. Well hearing experience may confer an advantage to older recipients, despite their older implanted age. These results can help provide pre-CI consultation guidelines for older Mandarin-speaking recipients.
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Bako P, Lippai B, Nagy J, Kramer S, Kaszas B, Tornoczki T, Bock-Marquette I. Thymosin beta-4 - A potential tool in healing middle ear lesions in adult mammals. Int Immunopharmacol 2023; 116:109830. [PMID: 38706788 PMCID: PMC11068331 DOI: 10.1016/j.intimp.2023.109830] [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: 02/16/2023]
Abstract
Acute tympanic membrane perforations primarily occur due to injury or infection in humans. In acute cases, nearly 80-94 % of the perforations heal spontaneously. In chronic cases, non-surgical treatment becomes significantly limited, and the perforation can be restored only by myringoplasty. In addition to classical grafts such as the fascia or cartilage, promising results have been reported with various biological materials including silk or acellular collagen. However, despite of all the efforts, healing remains insufficient. Consequentially, a need for substances which actively promote tympanic cell migration and proliferation is deemed essential. In our study, we utilized Thymosin beta-4 (TB4), a 43aa peptide possessing many regenerative properties in various organ systems. Our aim was to reveal the impact of externally administered TB4 regarding impairments of the middle ear, particularly the tympanic membrane. We harvested tympanic membranes from adult mice and treated these with TB4 or PBS on both collagen gel matrixes and in the form of floating, ex vivo explants. Cell migration and proliferation was measured, while immunocytochemical analyses were performed to determine cell type and the nature of the targeted molecules. We discovered the peptide affects the behavior of epidermal and epithelial cells of the tympanic membrane in vitro. Moreover, as our initial results imply, it is not the differentiated, yet most likely the local epidermal progenitor cells which are the primary targets of the molecule. Our present results unveil a new, thus far undiscovered field regarding clinical utilization for TB4 in the future.
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Affiliation(s)
- Peter Bako
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pecs, Medical School, H-7624 Pecs, Hungary
- Szentagothai Research Centre, University of Pecs, H-7624 Pecs, Hungary
| | - Balint Lippai
- Department of Biochemistry and Medical Chemistry University of Pecs, Medical School, H-7624 Pecs, Hungary
- Szentagothai Research Centre, University of Pecs, H-7624 Pecs, Hungary
| | - Jazmin Nagy
- Szentagothai Research Centre, University of Pecs, H-7624 Pecs, Hungary
| | - Sofie Kramer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pecs, Medical School, H-7624 Pecs, Hungary
- Szentagothai Research Centre, University of Pecs, H-7624 Pecs, Hungary
| | - Balint Kaszas
- Department of Pathology, University of Pecs, Medical School, H-7624 Pecs, Hungary
| | - Tamas Tornoczki
- Department of Pathology, University of Pecs, Medical School, H-7624 Pecs, Hungary
| | - Ildiko Bock-Marquette
- Department of Biochemistry and Medical Chemistry University of Pecs, Medical School, H-7624 Pecs, Hungary
- Szentagothai Research Centre, University of Pecs, H-7624 Pecs, Hungary
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Beckers L, Tromp N, Philips B, Mylanus E, Huinck W. Exploring neurocognitive factors and brain activation in adult cochlear implant recipients associated with speech perception outcomes-A scoping review. Front Neurosci 2023; 17:1046669. [PMID: 36816114 PMCID: PMC9932917 DOI: 10.3389/fnins.2023.1046669] [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: 09/16/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
Background Cochlear implants (CIs) are considered an effective treatment for severe-to-profound sensorineural hearing loss. However, speech perception outcomes are highly variable among adult CI recipients. Top-down neurocognitive factors have been hypothesized to contribute to this variation that is currently only partly explained by biological and audiological factors. Studies investigating this, use varying methods and observe varying outcomes, and their relevance has yet to be evaluated in a review. Gathering and structuring this evidence in this scoping review provides a clear overview of where this research line currently stands, with the aim of guiding future research. Objective To understand to which extent different neurocognitive factors influence speech perception in adult CI users with a postlingual onset of hearing loss, by systematically reviewing the literature. Methods A systematic scoping review was performed according to the PRISMA guidelines. Studies investigating the influence of one or more neurocognitive factors on speech perception post-implantation were included. Word and sentence perception in quiet and noise were included as speech perception outcome metrics and six key neurocognitive domains, as defined by the DSM-5, were covered during the literature search (Protocol in open science registries: 10.17605/OSF.IO/Z3G7W of searches in June 2020, April 2022). Results From 5,668 retrieved articles, 54 articles were included and grouped into three categories using different measures to relate to speech perception outcomes: (1) Nineteen studies investigating brain activation, (2) Thirty-one investigating performance on cognitive tests, and (3) Eighteen investigating linguistic skills. Conclusion The use of cognitive functions, recruiting the frontal cortex, the use of visual cues, recruiting the occipital cortex, and the temporal cortex still available for language processing, are beneficial for adult CI users. Cognitive assessments indicate that performance on non-verbal intelligence tasks positively correlated with speech perception outcomes. Performance on auditory or visual working memory, learning, memory and vocabulary tasks were unrelated to speech perception outcomes and performance on the Stroop task not to word perception in quiet. However, there are still many uncertainties regarding the explanation of inconsistent results between papers and more comprehensive studies are needed e.g., including different assessment times, or combining neuroimaging and behavioral measures. Systematic review registration https://doi.org/10.17605/OSF.IO/Z3G7W.
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Affiliation(s)
- Loes Beckers
- Cochlear Ltd., Mechelen, Belgium,Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands,*Correspondence: Loes Beckers,
| | - Nikki Tromp
- Cochlear Ltd., Mechelen, Belgium,Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Ma C, Fried J, Nguyen SA, Schvartz-Leyzac KC, Camposeo EL, Meyer TA, Dubno JR, McRackan TR. Longitudinal Speech Recognition Changes After Cochlear Implant: Systematic Review and Meta-analysis. Laryngoscope 2022; 133:1014-1024. [PMID: 36004817 DOI: 10.1002/lary.30354] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To examine patterns of change and plateau in speech recognition scores in postlingually hearing impaired adult cochlear implant recipients. The study also examines variations in change patterns for different speech materials and testing conditions. STUDY DESIGN Used systematic review with meta-analysis. METHODS Articles in English reporting speech recognition scores of adults with postlingual hearing loss at pre-implantation and at least two post-implantation time points were included. Statistically significant changes were determined by meta-analysis and the 95% confidence interval. RESULTS A total of 22 articles representing 1954 patients were included. Meta-analysis of mean difference demonstrated significant improvements in speech recognition score for words in quiet (37.4%; 95% confidence interval [34.7%, 40.7%]), sentences in quiet (49.4%; 95% confidence interval [44.9%, 53.9%]), and sentences in noise (30.8%; 95% confidence interval [25.2%, 36.4%]) from pre-op to 3 months. Scores continued to increase from 3 to 12 months but did not reach significance. Similarly, significant improvements from pre-op to 3 months were observed for consonant nucleus consonant (CNC) words in quiet (37.1%; 95% confidence interval [33.8%, 40.4%]), hearing in noise test (HINT) sentences in quiet (46.5%; 95% confidence interval [37.0%, 56.0%]), AzBio sentences in quiet (45.9%; 95% confidence interval [44.2%, 47.5%]), and AzBio sentences in noise (26.4%; 95% confidence interval [18.6%, 34.2%]). HINT sentences in noise demonstrated improvement from pre-op to 3 months (35.1%; 95% confidence interval [30.0%, 40.3%]) and from 3 to 12 months (15.5%; 95% confidence interval [7.2%, 23.8%]). CONCLUSIONS Mean speech recognition scores demonstrate significant improvement within the first 3 months, with no further statistically significant improvement after 3 months. However, large individual variation should be expected and future research is needed to explain the sources of these individual differences. Laryngoscope, 2022.
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Affiliation(s)
- Cheng Ma
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Jacob Fried
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Kara C Schvartz-Leyzac
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Elizabeth L Camposeo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness. Ear Hear 2022; 43:1605-1619. [PMID: 35994570 PMCID: PMC9592177 DOI: 10.1097/aud.0000000000001260] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The indications for cochlear implantation have expanded to include individuals with profound sensorineural hearing loss in the impaired ear and normal hearing (NH) in the contralateral ear, known as single-sided deafness (SSD). There are additional considerations for the clinical assessment and management of adult cochlear implant candidates and recipients with SSD as compared to conventional cochlear implant candidates with bilateral moderate to profound sensorineural hearing loss. The present report reviews the current evidence relevant to the assessment and management of adults with SSD. A systematic review was also conducted on published studies that investigated outcomes of cochlear implant use on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population. Expert consensus and systematic review of the current literature were combined to provide guidance for the clinical assessment and management of adults with SSD.
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Kucuk Ceyhan A, Dere HH, Mujdeci B. Evaluating the Effectiveness of a New Auditory Training Program on the Speech Recognition Skills and Auditory Event-Related Potentials in Elderly Hearing Aid Users. Audiol Neurootol 2022; 27:368-376. [DOI: 10.1159/000523807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/20/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> The objective of this study was to evaluate the effectiveness of a new auditory training (AT) program on the speech recognition in the noise and on the auditory event-related potentials in elderly hearing aid users. <b><i>Methods:</i></b> Thirty-three elderly individuals using hearing aids aged from 60 to 80 years participated. A new AT program was developed for the study. AT program lasts for 8 weeks and includes sound discrimination exercises and cognitive exercises. Seventeen individuals (mean age 72.17 ± 6.94) received AT and 16 individuals (mean age 71.75 ± 6.81) did not receive AT. The mismatch negativity (MMN) test and matrix test were used to evaluate the effectiveness of AT. Tests were conducted for the study group before and after the AT. The tests were carried out for the control group at the same times with the study group and the results were compared. <b><i>Results:</i></b> In comparison with the first evaluation, the last evaluation of the study group demonstrated a significant difference regarding the decrease of mean latency in the MMN wave (<i>p</i> = 0.038), and regarding the improving score of matrix test (<i>p</i> = 0.004), there was no difference in the control group. <b><i>Conclusion:</i></b> The AT program prepared for the study was effective in improving speech recognition in noise in the elderly, and the efficiency of AT could be demonstrated with MMN and matrix test.
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Cambridge G, Taylor T, Arnott W, Wilson WJ. Auditory training for adults with cochlear implants: a systematic review. Int J Audiol 2022; 61:896-904. [PMID: 35080191 DOI: 10.1080/14992027.2021.2014075] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To systematically review the peer-reviewed literature on the efficacy of auditory training (AT) on auditory outcomes in post lingually deafened adults with cochlear implants (CIs). DESIGN A systematic review. STUDY SAMPLE Searches of five electronic databases yielded 10 studies published after 2010 that met the inclusion criteria. RESULTS For post lingually deafened adults with CIs, the evidence is suggestive that some AT can improve some auditory outcomes compared to no training. More specifically, the evidence suggests that phonemic training can improve identification of trained phonemes, and nonsense word training can improve sentence recognition in noise in this population. CONCLUSIONS While many AT interventions are currently being used with post lingually deafened adults with CIs, the evidence for AT improving auditory outcomes is suggestive with the best evidence being for nonsense word training improving sentence recognition in noise by an average of 10% with these improvements retained at 26 weeks post-training in this population. There remains a need for high quality studies that have the capacity to demonstrate, clearly and unequivocally, which AT is most effective for improving which auditory outcomes in this population.
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Affiliation(s)
| | | | - Wendy Arnott
- Hear and Say, Brisbane, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Wayne J Wilson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Knickerbocker A, Bourn S, Goldstein MR, Jacob A. Cochlear Implant Outcomes in Elderly Recipients During the COVID-19 Pandemic. Otol Neurotol 2021; 42:e1256-e1262. [PMID: 34267095 PMCID: PMC8443422 DOI: 10.1097/mao.0000000000003291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the potential significance of social distancing and quarantine precautions for COVID-19 on speech outcomes, missed appointments, wear time, and exposure to various sound environments in the first 6 months following activation for elderly cochlear implant (CI) recipients. STUDY DESIGN Retrospective cohort. SETTING Tertiary private practice. PATIENTS Fifty cochlear implant recipients ≥65 years were evaluated. A Control Group consisted of 26 patients implanted between November 2, 2018 and February 18, 2019 while the Pandemic Group included 24 patients implanted between November 1, 2019 and February 17, 2020. INTERVENTION Rehabilitative. MAIN OUTCOME MEASURES Preoperative and 6-month postoperative AzBio sentence scores in quiet were compared between groups along with the number of missed appointments as well as datalogged information regarding average CI wear time and average hours in various sound environments such as quiet, speech, and speech-in-noise. RESULTS The Control Group averaged 36.5% improvement for AzBio in quiet scores while the Pandemic Group averaged only 17.2% improvement, a difference that was both statistically and clinically significant (p = 0.04; g = 0.64). Patients in the Pandemic Group were nearly twice as likely to miss CI programming appointments than the Control Group. The Pandemic Group wore their CI 1.2 less hours per day on average, and while the Pandemic Group spent similar times in quiet and speech environments to the Control Group, the Pandemic Group spent less time in speech with presence of background noise. CONCLUSIONS While social distancing and quarantine measures are crucial to limiting spread of COVID-19, these precautions may have negatively impacted early speech performance for elderly cochlear implant recipients. Missed CI programming appointments, decreased sound processor wear time, and reduced exposure to complex listening environments such as speech in the presence of background noise were more common in the Pandemic Group than in the Control Group operated the year prior.
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Ray C, Taylor E, Vasil KJ, Zombek L, Baxter JH, Moberly AC. The Value of Speech-Language Pathologists in Auditory Rehabilitation for Adults With Cochlear Implants. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1909-1911. [PMID: 34043441 DOI: 10.1044/2021_ajslp-20-00189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Standards for auditory rehabilitation are currently lacking for adults who receive cochlear implants. Speech recognition outcomes are highly variable, and many adults with cochlear implants present with suboptimal performance. Functional real-life communication abilities are not routinely measured clinically and are not strongly linked to performance on traditional measures of speech recognition. In fact, even individuals with relatively good speech recognition outcomes often present with persistent communication difficulties. In contrast to pediatric cochlear implant users, speech-language pathologists are not routinely involved in the rehabilitation of adults who receive cochlear implants. Purpose The purpose of this article is to describe the value of including a speech-language pathologist in a comprehensive approach to auditory rehabilitation for adults with cochlear implants. Method The theoretical and clinical foundations of incorporating a speech-language pathologist into an adult auditory rehabilitation program are discussed. A description of the skills and potential roles of the speech-language pathologist for providing adult cochlear implant rehabilitation services is presented, along with potential barriers to implementation. Conclusion Person-centered management of postlingually deafened adults with cochlear implants can be augmented by a more complete approach utilizing the skill set of a speech-language pathologist. Supplemental Material https://doi.org/10.23641/asha.14669652.
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Affiliation(s)
- Christin Ray
- Department of Otolaryngology, The Ohio State University, Columbus
| | - Erin Taylor
- Department of Otolaryngology, The Ohio State University, Columbus
- Nationwide Children's Hospital, Columbus, OH
| | - Kara J Vasil
- Department of Otolaryngology, The Ohio State University, Columbus
| | | | - Jodi H Baxter
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Aaron C Moberly
- Department of Otolaryngology, The Ohio State University, Columbus
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Chow K, Kaul VF, Levine-Madoff J, Wanna GB, Cosetti MK. Does Auditory Environment Predict Speech Perception Outcomes in Elderly Cochlear Implant Patients? Audiol Neurootol 2021; 26:378-386. [PMID: 33951634 DOI: 10.1159/000513637] [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: 07/21/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cochlear implantation (CI) is a reliable and safe means by which sensorineural hearing loss can be ameliorated in the elderly population. However, a high degree of variation exists in postimplantation hearing outcomes for which some modifiable factors of the daily natural auditory environment may be contributory. In this study, we analyze the relationship between cochlear implant patient age, natural auditory environment, and postimplantation speech perception among older adults. METHODS Data log from automatic environment classification enabled sound processors of postlingually deafened CI recipients ≥50 years old (n = 115) were obtained retrospectively and analyzed for time spent (hours per day) in listening environment and loudness (SPL dB). Speech perception testing was assessed in a subset of patients (n = 27) using open-set word recognition in quiet Consonant-Nucleus-Consonant in the short and intermediate postoperative period. RESULTS The mean subject age was 70 years (range, 53-99 years). Average daily implant use was 10.8 h and was not significantly correlated with age (p = 0.23, Spearman's rho). Age was positively correlated with the percentage of hours spent at <40 and 40-50 dB and negatively correlated to proportional CI use at higher volume (60-70, 70-80, and >80 dB; rs = 0.21, 0.20, -0.20, -0.35, -0.43; p = 0.021, 0.036, 0.033, <0.001, <0.001, respectively). Age was positively correlated with CI use in the quiet scene (rs = 0.26, p = 0.006) and negatively correlated with scenes containing speech and noise (rs = -0.19, -0.25; p = 0.046, 0.007). Total hours of device use and time spent at <40, 40-50 dB, and quiet environments were significantly correlated with improved CNC word scores (rs = 0.48, 0.48, 0.51; p = 0.01, 0.01, <0.01, Spearman's rho). While all speech (speech in noise + speech) was not significantly correlated to improvements in speech perception, a medium effect size was observed (rs = 0.37, p = 0.057). DISCUSSION/CONCLUSION This study supports a relationship between auditory environment and age, with older CI recipients spending a greater proportion of time in quiet. Older CI users demonstrated greater improvements in speech perception with longer daily device use. Additional examination of the relationship between auditory environment and speech perception is necessary to conclusively guide future auditory rehabilitation efforts.
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Affiliation(s)
- Kevin Chow
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Vivian F Kaul
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Jillian Levine-Madoff
- Department of Otolaryngology-Head and Neck Surgery, Northwell School of Medicine, New York, New York, USA
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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Moberly AC. A surgeon-scientist's perspective and review of cognitive-linguistic contributions to adult cochlear implant outcomes. Laryngoscope Investig Otolaryngol 2020; 5:1176-1183. [PMID: 33364410 PMCID: PMC7752064 DOI: 10.1002/lio2.494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/29/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Enormous variability in speech recognition outcomes persists in adults who receive cochlear implants (CIs), which leads to a barrier to progress in predicting outcomes before surgery, explaining "poor" outcomes, and determining how to provide tailored rehabilitation therapy for individual CI users. The primary goal of my research program over the past 9 years has been to extend our understanding of the contributions of "top-down" cognitive-linguistic skills to CI outcomes in adults, acknowledging that "bottom-up" sensory processes also contribute substantially. The main objective of this invited narrative review is to provide an overview of this work. A secondary objective is to provide career "guidance points" to budding surgeon-scientists in Otolaryngology. METHODS A narrative, chronological review covers work done by our group to explore top-down and bottom-up processing in adult CI outcomes. A set of ten guidance points is also provided to assist junior Otolaryngology surgeon-scientists. RESULTS Work in our lab has identified substantial contributions of cognitive skills (working memory, inhibition-concentration, speed of lexical access, nonverbal reasoning, verbal learning and memory) as well as linguistic abilities (acoustic cue-weighting, phonological sensitivity) to speech recognition outcomes in adults with CIs. These top-down skills interact with the quality of the bottom-up input. CONCLUSION Although progress has been made in understanding speech recognition variability in adult CI users, future work is needed to predict CI outcomes before surgery, to identify particular patients' strengths and weaknesses, and to tailor rehabilitation approaches for individual CI users. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Aaron C. Moberly
- Department of Otolaryngology Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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Moberly AC, Vasil K, Baxter J, Klamer B, Kline D, Ray C. Comprehensive auditory rehabilitation in adults receiving cochlear implants: A pilot study. Laryngoscope Investig Otolaryngol 2020; 5:911-918. [PMID: 33134539 PMCID: PMC7585234 DOI: 10.1002/lio2.442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE In the United States, most adults who receive cochlear implants (CIs) do not undergo a comprehensive auditory rehabilitation (CAR) approach, which may result in suboptimal outcomes. The objectives of this pilot study were to demonstrate that a CAR approach incorporating auditory training (AT) by a speech-language pathologist (SLP) is feasible in adults receiving CIs and to explore whether this approach results in improved outcomes. METHODS Twenty-four postlingually deaf adult CI candidates were serially assigned to one of three groups: (a) a "CAR group" that received standard of care implantation, programming by an audiologist, an additional preoperative counseling session, and eight one-hour AT sessions; (b) a "passive control" standard-of-care group; and (c) an "active control" group that also received the extra preoperative counseling session. Participants were tested preoperatively and 1, 3, and 6 months after CI using measures of word and sentence recognition in quiet and in babble, as well as measures of quality of life (QOL). RESULTS The CAR approach was feasible, but this pilot study was underpowered to determine efficacy. Differential time courses of speech recognition improvement were seen for sentence and word recognition. All QOL measurements showed improvement from pre-CI to 1 month post-CI activation. Results revealed issues to consider for a larger-scale study of CAR revolving around participant selection, study measures, and sample size. CONCLUSION The CAR approach is feasible in new CI users. A larger trial is needed to investigate whether CAR leads to better outcomes or faster improvement in this clinical population. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Aaron C. Moberly
- Department of Otolaryngology – Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Kara Vasil
- Department of Otolaryngology – Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Jodi Baxter
- Department of Speech and Hearing ScienceThe Ohio State UniversityColumbusOhioUSA
| | - Brett Klamer
- Center for Biostatistics, Department of Biomedical InformaticsThe Ohio State UniversityColumbusOhioUSA
| | - David Kline
- Center for Biostatistics, Department of Biomedical InformaticsThe Ohio State UniversityColumbusOhioUSA
| | - Christin Ray
- Department of Otolaryngology – Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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Favaretto N, Marioni G, Brotto D, Sorrentino F, Gheller F, Castiglione A, Montino S, Giacomelli L, Trevisi P, Martini A, Bovo R. Cochlear implant outcomes in the elderly: a uni- and multivariate analyses of prognostic factors. Eur Arch Otorhinolaryngol 2019; 276:3089-3094. [DOI: 10.1007/s00405-019-05613-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/21/2019] [Indexed: 12/01/2022]
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