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Hey M, Kogel K, Dambon J, Mewes A, Jürgens T, Hocke T. Factors to Describe the Outcome Characteristics of a CI Recipient. J Clin Med 2024; 13:4436. [PMID: 39124703 PMCID: PMC11313646 DOI: 10.3390/jcm13154436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
Background: In cochlear implant (CI) treatment, there is a large variability in outcome. The aim of our study was to identify the independent audiometric measures that are most directly relevant for describing this variability in outcome characteristics of CI recipients. An extended audiometric test battery was used with selected adult patients in order to characterize the full range of CI outcomes. Methods: CI users were recruited for this study on the basis of their postoperative results and divided into three groups: low (1st quartile), moderate (medium decentile), and high hearing performance (4th quartile). Speech recognition was measured in quiet by using (i) monosyllabic words (40-80 dB SPL), (ii) speech reception threshold (SRT) for numbers, and (iii) the German matrix test in noise. In order to reconstruct demanding everyday listening situations in the clinic, the temporal characteristics of the background noise and the spatial arrangements of the signal sources were varied for tests in noise. In addition, a survey was conducted using the Speech, Spatial, and Qualities (SSQ) questionnaire and the Listening Effort (LE) questionnaire. Results: Fifteen subjects per group were examined (total N = 45), who did not differ significantly in terms of age, time after CI surgery, or CI use behavior. The groups differed mainly in the results of speech audiometry. For speech recognition, significant differences were found between the three groups for the monosyllabic tests in quiet and for the sentences in stationary (S0°N0°) and fluctuating (S0°NCI) noise. Word comprehension and sentence comprehension in quiet were both strongly correlated with the SRT in noise. This observation was also confirmed by a factor analysis. No significant differences were found between the three groups for the SSQ questionnaire and the LE questionnaire results. The results of the factor analysis indicate that speech recognition in noise provides information highly comparable to information from speech intelligibility in quiet. Conclusions: The factor analysis highlighted three components describing the postoperative outcome of CI patients. These were (i) the audiometrically measured supra-threshold speech recognition and (ii) near-threshold audibility, as well as (iii) the subjective assessment of the relationship to real life as determined by the questionnaires. These parameters appear well suited to setting up a framework for a test battery to assess CI outcomes.
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Affiliation(s)
- Matthias Hey
- ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (K.K.); (J.D.); (A.M.)
| | - Kevyn Kogel
- ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (K.K.); (J.D.); (A.M.)
| | - Jan Dambon
- ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (K.K.); (J.D.); (A.M.)
| | - Alexander Mewes
- ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (K.K.); (J.D.); (A.M.)
| | - Tim Jürgens
- Institute of Acoustics, University of Applied Sciences Lübeck, 23562 Lübeck, Germany;
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Poupore NS, Chidarala S, Morris NS, McRackan TR, Schvartz-Leyzac KC. Impact of auditory environments on language outcomes in children with a cochlear implant. Int J Audiol 2024; 63:510-518. [PMID: 37293929 DOI: 10.1080/14992027.2023.2216875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To analyse the effects of auditory environments on receptive and expressive language outcomes in children with a CI. DESIGN A single-institution retrospective review was performed. The auditory environments included Speech-Noise, Speech-Quiet, Quiet, Music, and Noise. Hearing Hour Percentage (HHP) and percent total hours were calculated for each environment. Generalised Linear Mixed Models (GLMM) analyses were used to study the effects of auditory environments on PLS Receptive and Expressive scores. STUDY SAMPLE Thirty-nine children with CI. RESULTS On GLMM, an increase in Quiet HHP and Quiet percent total hours were positively associated with PLS Receptive scores. Speech-Quiet, Quiet, and Music HHP were positively associated with PLS Expressive scores, with only Quiet being significant for percent total hours. In contrast, percent total hours of Speech-Noise and Noise had a significant negative association with PLS Expressive scores. CONCLUSIONS This study suggests that more time spent in a quiet auditory environment positively influences PLS Receptive and Expressive scores and that more time listening to speech in quiet and music positively influences PLS Expressive scores. Time spent in environments recognised as Speech-Noise and Noise might negatively impact a child's expressive language outcomes with a CI. Future research is needed to better understand this association.
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Affiliation(s)
- Nicolas S Poupore
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- School of Medicine, University of South Carolina Greenville, Greenville, SC, USA
| | - Shreya Chidarala
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nevitte S Morris
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Theodore R McRackan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Kara C Schvartz-Leyzac
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Hornsby BWY, Picou EM, Ricketts TA, Gifford R. Listening-Related Fatigue in New and Experienced Adult Cochlear Implant Users. Ear Hear 2024; 45:929-944. [PMID: 38379155 PMCID: PMC11178470 DOI: 10.1097/aud.0000000000001488] [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: 02/22/2024]
Abstract
OBJECTIVES Active listening in everyday settings is challenging and requires substantial mental effort, particularly in noisy settings. In some cases, effortful listening can lead to significant listening-related fatigue and negatively affect quality of life. However, our understanding of factors that affect the severity of fatigue is limited. Hearing aids and cochlear implants (CIs) can improve speech understanding and thus, potentially, reduce listening effort and fatigue. Some research supports this idea for adult hearing aid users with mild-to-moderate hearing loss, but similar work in CI users is very limited. This study examined (1) longitudinal changes in listening-related fatigue in new and established CI users, and (2) relationships between demographic and audiologic factors and preimplantation and postimplantation listening-related fatigue. DESIGN Participants included an experimental group of 48 adult CI candidates receiving either a unilateral implant (n = 46) or simultaneous, bilateral implants (n = 2) and a control group of 96 experienced (>12 months experience) adult CI users (50 unilateral, 46 bilateral). Listening-related fatigue was evaluated using the 40-item version of the Vanderbilt Fatigue Scale for Adults. Experimental group ratings were obtained before implantation and again at 0.5-, 1-, 2-, 3-, 6-, and 12-month(s) postactivation. Control group participants completed the scale twice-upon study entry and approximately 3 months later. Additional measures, including a social isolation and disconnectedness questionnaire, hearing handicap inventory, and the Effort Assessment Scale, were also administered at multiple time points. The role of these measures and select demographic and audiologic factors on preimplant and postimplant fatigue ratings were examined. RESULTS Adult CI candidates reported significantly more fatigue, greater self-perceived hearing handicap, greater listening effort, and more social isolation than experienced adult CI users. However, significant reductions in fatigue and effort were observed within 2 weeks postimplantation. By 3 months, there were no significant differences in fatigue, effort, hearing handicap, or social isolation between new CI recipients and experienced CI users. Secondary analyses revealed that age at onset of hearing loss (before or after 2 years of age) and subjective hearing handicap contributed significantly to the variance of preimplantation fatigue ratings (those with higher handicap reported higher fatigue). In contrast, variance in postimplantation fatigue ratings was not affected by age of hearing loss onset but was affected by gender (females reported more fatigue than males) and subjective ratings of effort, handicap, and isolation (those reporting more effort, handicap, and isolation reported more fatigue). CONCLUSIONS Listening-related fatigue is a significant problem for many CI candidates, as well as for many experienced unilateral and bilateral CI users. Receipt of a CI significantly reduced listening-related fatigue (as well as listening effort, hearing handicap, and social isolation) as soon as 2 weeks post-CI activation. However, the magnitude of fatigue-related issues for both CI candidates and experienced CI users varies widely. Audiologic factors, such as hearing loss severity and aided speech recognition, were not predictive of individual differences in listening-related fatigue. In contrast, strong associations were observed between perceived hearing handicap and listening-related fatigue in all groups suggesting fatigue-related issues may be a component of perceived hearing handicap.
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Affiliation(s)
- Benjamin W Y Hornsby
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville Tennessee, USA
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Bartholomew RA, Hoffman SE, Juliano AF, Wu PZ, Zhao Y, de Gruttola V, Liberman MC, Maison SF. On the Difficulty Predicting Word Recognition Performance After Cochlear Implantation. Otol Neurotol 2024; 45:e393-e399. [PMID: 38573598 PMCID: PMC11087198 DOI: 10.1097/mao.0000000000004176] [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: 04/05/2024]
Abstract
HYPOTHESIS Preimplantation word scores cannot reliably predict postimplantation outcomes. BACKGROUND To date, there is no model based on preoperative data that can reliably predict the postoperative outcomes of cochlear implantation in the postlingually deafened adult patient. METHODS In a group of 228 patients who received a cochlear implant between 2002 and 2021, we tested the predictive power of nine variables (age, etiology, sex, laterality of implantation, preimplantation thresholds and word scores, as well as the design, insertion approach, and angular insertion depth of the electrode array) on postimplantation outcomes. Results of multivariable linear regression analyses were then interpreted in light of data obtained from histopathological analyses of human temporal bones. RESULTS Age and etiology were the only significant predictors of postimplantation outcomes. In agreement with many investigations, preimplantation word scores failed to significantly predict postimplantation outcomes. Analysis of temporal bone histopathology suggests that neuronal survival must fall below 40% before word scores in quiet begin to drop. Scores fall steeply with further neurodegeneration, such that only 20% survival can support acoustically driven word scores of 50%. Because almost all cochlear implant implantees have at least 20% of their spiral ganglion neurons (SGNs) surviving, it is expected that most cochlear implant users on average should improve to at least 50% word recognition score, as we observed, even if their preimplantation score was near zero as a result of widespread hair cell damage and the fact that ~50% of their SGNs have likely lost their peripheral axons. These "disconnected" SGNs would not contribute to acoustic hearing but likely remain electrically excitable. CONCLUSION The relationship between preimplantation word scores and data describing the survival of SGNs in humans can explain why preimplantation word scores obtained in unaided conditions fail to predict postimplantation outcomes.
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Affiliation(s)
| | | | - Amy F Juliano
- Department of Radiology, Massachusetts Eye & Ear, Harvard Medical School
| | | | - Yan Zhao
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear
| | - Victor de Gruttola
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Collins A, Foghsgaard S, Druce E, Margani V, Mejia O, O'Leary S. The Effect of Electrode Position on Behavioral and Electrophysiologic Measurements in Perimodiolar Cochlear Implants. Otol Neurotol 2024; 45:238-244. [PMID: 38238914 DOI: 10.1097/mao.0000000000004080] [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: 02/17/2024]
Abstract
BACKGROUND The shape and position of cochlear implant electrodes could potentially influence speech perception, as this determines the proximity of implant electrodes to the spiral ganglion. However, the literature to date reveals no consistent association between speech perception and either the proximity of electrode to the medial cochlear wall or the depth of insertion. These relationships were explored in a group of implant recipients receiving the same precurved electrode. METHODS This was a retrospective study of adults who underwent cochlear implantation with Cochlear Ltd.'s Slim Perimodiolar electrode at the Royal Victorian Eye and Ear Hospital between 2015 and 2018 (n = 52). Postoperative images were obtained using cone beam computed tomography (CBCT) and analyzed by multi-planar reconstruction to identify the position of the electrode contacts within the cochlea, including estimates of the proximity of the electrodes to the medial cochlear wall or modiolus and the angular depth of insertion. Consonant-vowel-consonant (CVC) monosyllabic phonemes were determined preoperatively, and at 3 and 12 months postoperatively. Electrically evoked compound action potential (ECAP) thresholds and impedance were measured from the implant array immediately after implantation. The relationships between electrode position and speech perception, electrode impedance, and ECAP threshold were an analyzed by Pearson correlation. RESULTS Age had a negative impact on speech perception at 3 months but not 12 months. None of the electrode-wide measures of proximity between electrode contacts and the modiolus, nor measures of proximity to the medial cochlear wall, nor the angular depth of insertion of the most apical electrode correlated with speech perception. However, there was a moderate correlation between speech perception and the position of the most basal electrode contacts; poorer speech perception was associated with a greater distance to the modiolus. ECAP thresholds were inversely related to the distance between electrode contacts and the modiolus, but there was no clear association between this distance and impedance. CONCLUSIONS Speech perception was significantly affected by the proximity of the most basal electrodes to the modiolus, suggesting that positioning of these electrodes may be important for optimizing speech perception. ECAP thresholds might provide an indication of this proximity, allowing for its optimization during surgery.
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Affiliation(s)
- Aaron Collins
- Department of Otolaryngology, The University of Melbourne, Melbourne, Australia
| | - Søren Foghsgaard
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Edgar Druce
- Department of Otolaryngology, The University of Melbourne, Melbourne, Australia
| | - Valerio Margani
- Department of Neuroscience, Mental Health, and Sense Organs (NEMOS), Sant' Andrea University Hospital, Sapienza University, Rome, Italy
| | - Olivia Mejia
- sENTro Head and Neck Clinic, Manila, Philippines
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Fabie JE, Shannon CM, Schvartz-Leyzac K, Dubno JR, McRackan TR. Discrepancies Between Expected and Actual Cochlear Implant-Related Functional Outcomes. Otol Neurotol 2023; 44:997-1003. [PMID: 37733999 PMCID: PMC10841233 DOI: 10.1097/mao.0000000000004018] [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: 09/23/2023]
Abstract
OBJECTIVE Previous research has demonstrated that realistic patient expectations are a critical factor in determining cochlear implant (CI) candidacy. The current study uses the validated Cochlear Implant Quality of Life-Expectations (CIQOL-Expectations) instrument to determine expectations of potential CI users and the degree to which their pre-CI expectations are met after implantation. STUDY DESIGN Prospective cohort study. SETTING Tertiary medical center. PATIENTS Sixty adult CI patients. INTERVENTIONS/MAIN OUTCOME MEASURES Pre-CI aided and post-CI consonant-nucleus-consonant word and AzBio sentence scores, pre-CI CIQOL-Expectations, and pre-CI and 3/6/12-month post-CI CIQOL-35 Profile scores. RESULTS Mean pre-CI CIQOL-Expectations exceeded 12-month mean CIQOL-35 Profile scores for the global measure and the communication, environment, and listening effort domains ( d = 0.65-0.97). The communication and listening effort domain scores had the largest discrepancy between expected and actual post-CI improvement (actual scores, 15.1 and 16.3 points lower than expected [ d = 0.93-0.97], respectively). For 42% of patients, pre-CI global expectations exceeded 12-month post-CI CIQOL-35 Profile global scores, 49% met their expectations, and actual scores exceeded expectations for only 10% of patients. Similar patterns were seen for all CIQOL domains except emotional. CONCLUSIONS Post-CI functional abilities seem to fall short of pre-CI expectations for a substantial percentage of CI users, which was most apparent for the communication and listening effort CIQOL domains. These results may help clinicians direct personalized counseling toward common misconceptions, which can aid shared decision making and potentially minimize the mismatch between expected and realized outcomes.Level of Evidence: III.IRB Pro00073019, approved December 20, 2017 (Medical University of South Carolina).
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Affiliation(s)
- Joshua E Fabie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Tropitzsch A, Schade-Mann T, Gamerdinger P, Dofek S, Schulte B, Schulze M, Fehr S, Biskup S, Haack TB, Stöbe P, Heyd A, Harre J, Lesinski-Schiedat A, Büchner A, Lenarz T, Warnecke A, Müller M, Vona B, Dahlhoff E, Löwenheim H, Holderried M. Variability in Cochlear Implantation Outcomes in a Large German Cohort With a Genetic Etiology of Hearing Loss. Ear Hear 2023; 44:1464-1484. [PMID: 37438890 PMCID: PMC10583923 DOI: 10.1097/aud.0000000000001386] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES The variability in outcomes of cochlear implantation is largely unexplained, and clinical factors are not sufficient for predicting performance. Genetic factors have been suggested to impact outcomes, but the clinical and genetic heterogeneity of hereditary hearing loss makes it difficult to determine and interpret postoperative performance. It is hypothesized that genetic mutations that affect the neuronal components of the cochlea and auditory pathway, targeted by the cochlear implant (CI), may lead to poor performance. A large cohort of CI recipients was studied to verify this hypothesis. DESIGN This study included a large German cohort of CI recipients (n = 123 implanted ears; n = 76 probands) with a definitive genetic etiology of hearing loss according to the American College of Medical Genetics (ACMG)/Association for Molecular Pathology (AMP) guidelines and documented postoperative audiological outcomes. All patients underwent preoperative clinical and audiological examinations. Postoperative CI outcome measures were based on at least 1 year of postoperative audiological follow-up for patients with postlingual hearing loss onset (>6 years) and 5 years for children with congenital or pre/perilingual hearing loss onset (≤6 years). Genetic analysis was performed based on three different methods that included single-gene screening, custom-designed hearing loss gene panel sequencing, targeting known syndromic and nonsyndromic hearing loss genes, and whole-genome sequencing. RESULTS The genetic diagnosis of the 76 probands in the genetic cohort involved 35 genes and 61 different clinically relevant (pathogenic, likely pathogenic) variants. With regard to implanted ears (n = 123), the six most frequently affected genes affecting nearly one-half of implanted ears were GJB2 (21%; n = 26), TMPRSS3 (7%; n = 9), MYO15A (7%; n = 8), SLC26A4 (5%; n = 6), and LOXHD1 and USH2A (each 4%; n = 5). CI recipients with pathogenic variants that influence the sensory nonneural structures performed at or above the median level of speech performance of all ears at 70% [monosyllable word recognition score in quiet at 65 decibels sound pressure level (SPL)]. When gene expression categories were compared to demographic and clinical categories (total number of compared categories: n = 30), mutations in genes expressed in the spiral ganglion emerged as a significant factor more negatively affecting cochlear implantation outcomes than all clinical parameters. An ANOVA of a reduced set of genetic and clinical categories (n = 10) identified five detrimental factors leading to poorer performance with highly significant effects ( p < 0.001), accounting for a total of 11.8% of the observed variance. The single strongest category was neural gene expression accounting for 3.1% of the variance. CONCLUSIONS The analysis of the relationship between the molecular genetic diagnoses of a hereditary etiology of hearing loss and cochlear implantation outcomes in a large German cohort of CI recipients revealed significant variabilities. Poor performance was observed with genetic mutations that affected the neural components of the cochlea, supporting the "spiral ganglion hypothesis."
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Affiliation(s)
- Anke Tropitzsch
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Hearing Center, Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Center for Rare Hearing Disorders, Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Thore Schade-Mann
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Hearing Center, Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Philipp Gamerdinger
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Hearing Center, Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Saskia Dofek
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Björn Schulte
- CeGaT GmbH und Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Martin Schulze
- CeGaT GmbH und Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Sarah Fehr
- CeGaT GmbH und Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Saskia Biskup
- CeGaT GmbH und Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Tobias B. Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Petra Stöbe
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Andreas Heyd
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Jennifer Harre
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Anke Lesinski-Schiedat
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Athanasia Warnecke
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Marcus Müller
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Barbara Vona
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Ernst Dahlhoff
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Hubert Löwenheim
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Martin Holderried
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Department of Medical Development and Quality Management, University Hospital Tübingen, Tübingen, Germany
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Dornhoffer JR, Lawlor SK, Saoji AA, Driscoll CLW. Initial Experiences with the Envoy Acclaim ® Fully Implanted Cochlear Implant. J Clin Med 2023; 12:5875. [PMID: 37762817 PMCID: PMC10532076 DOI: 10.3390/jcm12185875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction: Cochlear implantation has become the standard of care for the treatment of moderate-to-profound bilateral sensorineural hearing loss. However, current technologies, all of which rely on an external sound processor, have intrinsic limitations that prevent certain activities and diagnostics, thus hampering full integration into a patient's lifestyle. The Envoy Medical (White Bear Lake, MN, USA) Acclaim® fully implanted cochlear implant is a new device currently undergoing testing that has been designed to alleviate many of the current constraints by housing all components within the patient, thus allowing for near-constant use in many environments that are not conducive to a traditional cochlear implant. Methods: As part of an Early Feasibility Study, three adult implant candidates were implanted with the Acclaim® cochlear implant. Surgical video and photography were taken, and initial observations were recorded. Implantation with the Acclaim® device is largely similar to a traditional cochlear implant, with modifications to allow room for the implanted sensor as well as the implantation of a battery in the subcutaneous tissues of the chest. Results: This study demonstrates a step-by-step overview of implanting the Acclaim® and discusses initial insight and experiences with the first three implantations with this new device. Conclusions: All three surgeries proceeded without complication, and at activation, all three patients were hearing through their devices. Surgery is more technically challenging compared to a standard cochlear implant, but the skills needed can all be mastered by a dedicated otologic surgeon.
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Affiliation(s)
| | | | | | - Colin L. W. Driscoll
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA; (J.R.D.); (S.K.L.); (A.A.S.)
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Lindquist NR, Holder JT, Patro A, Cass ND, Tawfik KO, O'Malley MR, Bennett ML, Haynes DS, Gifford RH, Perkins EL. Cochlear Implants for Single-Sided Deafness: Quality of Life, Daily Usage, and Duration of Deafness. Laryngoscope 2023; 133:2362-2370. [PMID: 36254870 DOI: 10.1002/lary.30452] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To report our experience for adults undergoing cochlear implantation (CI) for single-sided deafness (SSD). METHODS This is a retrospective case series for adults with SSD who underwent CI between January 2013 and May 2021 at our institution. CNC and AzBio speech recognition scores, Tinnitus Handicap Inventory (THI), Speech, Spatial, and Qualities of Hearing Scale (SSQ12), datalogging, and the Cochlear Implant Quality of Life (CIQOL)-10 Global measure were utilized. RESULTS Sixty-six adults underwent CI for SSD (median 51.3 years, range 20.0-74.3 years), and 57 (86.4%) remained device users at last follow-up. Compared to pre-operative performance, device users demonstrated significant improvement in speech recognition scores and achieved peak performance at six months post-activation for CNC (8.0% increased to 45.6%, p < 0.0001) and AzBio in quiet (12.2% increased to 59.5%, p < 0.0001). THI was decreased at 6 months post-implantation (58.1-14.6, p < 0.0001), with 77% of patients reporting improved or resolved tinnitus. Patients demonstrated improved SSQ12 scores as well as the disease-specific CIQOL-10 Global questionnaire. Duration of deafness was not associated with significant differences in speech recognition performance. Average daily wear time was positively associated with CNC and AzBio scores as well as post-operative CIQOL-10 scores. CONCLUSIONS Herein we present the largest cohort of adult CI recipients with SSD with data on speech recognition scores, tinnitus measures, and SSQ12. Novel insights regarding the correlation of datalogging, duration of deafness, and CI-specific quality of life (CIQOL-10) metrics are discussed. Data continue to support CI as an efficacious treatment option for SSD. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2362-2370, 2023.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nathan D Cass
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - René H Gifford
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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DeFreese AJ, Lindquist NR, Shi L, Holder JT, Berg KA, Haynes DS, Gifford RH. The Impact of Daily Processor Use on Adult Cochlear Implant Outcomes: Reexamining the Roles of Duration of Deafness and Age at Implantation. Otol Neurotol 2023; 44:672-678. [PMID: 37367733 PMCID: PMC10524754 DOI: 10.1097/mao.0000000000003920] [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: 06/28/2023]
Abstract
OBJECTIVE To quantify the roles and relationships between age at implantation, duration of deafness (DoD), and daily processor use via data logging on speech recognition outcomes for postlingually deafened adults with cochlear implants. STUDY DESIGN Retrospective case review. SETTING Cochlear implant (CI) program at a tertiary medical center. PATIENTS Six-hundred fourteen postlingually deafened adult ears with CIs (mean age, 63 yr; 44% female) were included. MAIN OUTCOME MEASURES A stepwise multiple regression analysis was completed to investigate the combined effects of age, DoD, and daily processor use on CI-aided speech recognition (Consonant-Nucleus-Consonant monosyllables and AzBio sentences). RESULTS Results indicated that only daily processor use was significantly related to Consonant-Nucleus-Consonant word scores ( R2 = 0.194, p < 0.001) and AzBio in quiet scores ( R2 = 0.198, p < 0.001), whereas neither age nor DoD was significantly related. In addition, there was no significant relationship between daily processor use, age at implantation, or DoD and AzBio sentences in noise ( R2 = 0.026, p = 0.005). CONCLUSIONS Considering the clinical factors of age at implantation, DoD, and daily processor use, only daily processor use significantly predicted the ~20% of variance in postoperative outcomes (CI-aided speech recognition) accounted for by these clinical factors.
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Affiliation(s)
- Andrea J DeFreese
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linjie Shi
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katelyn A Berg
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
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Lindquist NR, Dietrich MS, Patro A, Henry MR, DeFreese AJ, Freeman MH, Perkins EL, Gifford RH, Haynes DS, Holder JT. Early Datalogging Predicts Cochlear Implant Performance: Building a Recommendation for Daily Device Usage. Otol Neurotol 2023; 44:e479-e485. [PMID: 37442607 PMCID: PMC10361622 DOI: 10.1097/mao.0000000000003917] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To quantify the effect of datalogging on speech recognition scores and time to achievement for a "benchmark" level of performance within the first year, and to provide a data-driven recommendation for minimum daily cochlear implant (CI) device usage to better guide patient counseling and future outcomes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS Three hundred thirty-seven adult CI patients with data logging and speech recognition outcome data who were implanted between August 2015 and August 2020. MAIN OUTCOME MEASURES Processor datalogging, speech recognition scores, achievement of "benchmark speech recognition performance" defined as 80% of the median score for speech recognition outcomes at our institution. RESULTS The 1-month datalogging measure correlated positively with word and sentences scores at 1, 3, 6, and 12 months postactivation. Compared with age, sex, and preoperative performance, datalogging was the largest predictive factor of benchmark achievement on multivariate analysis. Each hour/day increase of device usage at 1 month resulted in a higher likelihood of achieving benchmark consonant-nucleus-consonant and AzBio scores within the first year (odds ratio = 1.21, p < 0.001) as well as earlier benchmark achievement. Receiver operating characteristic curve analysis identified the optimal data logging threshold at an average of 12 hours/day. CONCLUSIONS Early CI device usage, as measured by 1-month datalogging, predicts benchmark speech recognition achievement in adults. Datalogging is an important predictor of CI performance within the first year postimplantation. These data support the recommended daily CI processor utilization of at least 12 hours/day to achieve optimal speech recognition performance for most patients.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary S Dietrich
- Vanderbilt University Schools of Medicine (Biostatistics, VICC, Psychiatry) and Nursing, Nashville, Tennessee
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R Henry
- Division of Audiology, Henry Ford Health, Dearborn, Michigan
| | - Andrea J DeFreese
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael H Freeman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jourdan T Holder
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
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Weller T, Timm ME, Lenarz T, Büchner A. Cochlear coverage with lateral wall cochlear implant electrode arrays affects post-operative speech recognition. PLoS One 2023; 18:e0287450. [PMID: 37437046 DOI: 10.1371/journal.pone.0287450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The goal was to investigate the relationship between the insertion angle/cochlear coverage of cochlear implant electrode arrays and post-operative speech recognition scores in a large cohort of patients implanted with lateral wall electrode arrays. METHODS Pre- and post-operative cone beam computed tomography scans of 154 ears implanted with lateral wall electrode arrays were evaluated. Traces of lateral wall and electrode arrays were combined into a virtual reconstruction of the implanted cochlea. This reconstruction was used to measure insertion angles and proportional cochlear coverage. Word recognition scores and sentence recognition scores measured 12 months after implantation using electric-only stimulation were used to examine the relationship between cochlear coverage/insertion angle and implantation outcomes. RESULTS Post-operative word recognition scores and the difference between post- and pre-operative word recognition scores were positively correlated with both cochlear coverage and insertion angle, however sentence recognition scores were not. A group-wise comparison of word recognition scores revealed that patients with cochlear coverage below 70% performed significantly worse than patients with coverage between 79%-82% (p = 0.003). Performance of patients with coverage above 82% was on average poorer than between 79%-82, although this finding was not statistically significant (p = 0.84). Dividing the cohort into groups based on insertion angle quadrants revealed that word recognition scores were highest above 450° insertion angle, sentence recognition scores were highest between 450° and 630° and the difference between pre- and post-operative word recognition scores was largest between 540° and 630°, however none of these differences reached statistical significance. CONCLUSIONS The results of this study show that cochlear coverage has an effect on post-operative word recognition abilities and the benefit patients receive from their implant. Generally, higher coverage led to better outcomes, however there were results indicating that insertion past 82% cochlear coverage may not provide an additional benefit for word recognition. These findings can be useful for choosing the optimal electrode array and thereby improving cochlear implantation outcomes on a patient-individual basis.
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Affiliation(s)
- Tobias Weller
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| | - Max Eike Timm
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
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Schvartz-Leyzac KC, Giordani B, Pfingst BE. Association of Aging and Cognition With Complex Speech Understanding in Cochlear-Implanted Adults: Use of a Modified National Institutes of Health (NIH) Toolbox Cognitive Assessment. JAMA Otolaryngol Head Neck Surg 2023; 149:239-246. [PMID: 36701145 PMCID: PMC9880868 DOI: 10.1001/jamaoto.2022.4806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/01/2022] [Indexed: 01/27/2023]
Abstract
Importance The association between cognitive function and outcomes in cochlear implant (CI) users is not completely understood, partly because some cognitive tests are confounded by auditory status. It is important to determine appropriate cognitive tests to use in a cohort of CI recipients. Objective To provide proof-of-concept for using an adapted version of the National Institutes of Health (NIH) Toolbox Cognition Battery in a cohort of patients with CIs and to explore how hearing in noise with a CI is affected by cognitive status using the adapted test. Design, Setting, and Participants In this prognostic study, participants listened to sentences presented in a speech-shaped background noise. Cognitive tests consisted of 7 subtests of the NIH Toolbox Cognition Battery that were adapted for hearing impaired individuals by including written instructions and visual stimuli. Participants were prospectively recruited from and evaluated at a tertiary medical center. All participants had at least 6 months' experience with their CI. Main Outcomes and Measures The main outcomes were performance on the adapted cognitive test and a speech recognition in noise task. Results Participants were 20 adult perilingually or postlingually deafened CI users (50% male participants; median [range] age, 66 [26-80] years old). Performance on a sentence recognition in noise task was negatively associated with the chronological age of the listener (R2 = 0.29; β = 0.16; standard error, SE = 0.06; t = 2.63; 95% confidence interval, 0.03-0.27). Testing using the adapted version of the NIH Toolbox Cognition Battery revealed that a test of processing speed was also associated with performance, using a standardized score that accounted for contributions of other demographic factors (R2 = 0.28; 95% confidence interval, -0.42 to -0.05). Conclusions and Relevance In this prognostic study, older CI users showed poorer performance on a sentence-in-noise test compared with younger users. This poorer performance was correlated with a cognitive deficit in processing speed when cognitive function was assessed using a test battery adapted for participants with hearing loss. These results provide initial proof-of-concept results for using a standardized and adapted cognitive test battery in CI recipients.
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Affiliation(s)
- Kara C. Schvartz-Leyzac
- Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor
- Hearing Rehabilitation Center, Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor
- Medical University of South Carolina, Charleston
| | - Bruno Giordani
- Department of Psychiatry & Michigan Alzheimer’s Disease Center, University of Michigan Health Systems, Ann Arbor
| | - Bryan E. Pfingst
- Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor
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Patro A, Lindquist NR, Holder JT, Tawfik KO, O’Malley MR, Bennett ML, Haynes DS, Gifford R, Perkins EL. Further Evidence for Individual Ear Consideration in Cochlear Implant Candidacy Evaluation. Otol Neurotol 2022; 43:1033-1040. [PMID: 36075098 PMCID: PMC9481725 DOI: 10.1097/mao.0000000000003677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To report speech outcomes after cochlear implantation (CI) for asymmetric hearing loss (AHL) and assess the influence of contralateral hearing. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS One hundred eighty-eight adults (mean age, 70 yr) undergoing CI for AHL from 2015 to 2020. Candidacy included pure-tone average (PTA) at least 70 dB hearing level and AzBio in quiet 60% or less in the implanted ear and AzBio in quiet greater than 40% in the contralateral ear. MAIN OUTCOME MEASURES PTA; Consonant-Nucleus-Consonant (CNC) word, AzBio sentences scores; Speech, Spatial, and Qualities of Hearing Scale (SSQ). RESULTS Mean preoperative PTA and AzBio in the implanted and contralateral ears were 85.2 and 68.1 dB hearing level and 24.7% and 69.2%, respectively. Mean CNC in the implanted ear increased from 18.3% preoperatively to 44.4% ( p < 0.0001) at 6 months and 49.3% ( p < 0.0001) at 12 months. Mean AzBio in the implanted ear improved from 24.7% preoperatively to 60.3% ( p < 0.0001) at 6 months and 64.3% ( p < 0.0001) at 12 months. Patients demonstrated significant improvement in all SSQ domains at 6 and 12 months. When comparing patients with preoperative contralateral AzBio greater than 60% versus 41% to 60%, no significant differences existed in postoperative CNC scores (6-mo: 47% versus 41%, p = 0.276; 12-mo: 51% versus 47%, p = 0.543). There were no significant differences in 6-month ( p = 0.936) or 12-month ( p = 0.792) CNC scores between patients with AHL (contralateral ear AzBio >40%) and 169 unilateral CI patients meeting the traditional Medicare criteria (contralateral ear AzBio ≤40%). CONCLUSION CI recipients with AHL derive significant speech improvements, supporting individual ear consideration for CI candidacy and patient benefit outside of current Medicare criteria.
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Affiliation(s)
- Ankita Patro
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathan R. Lindquist
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jourdan T. Holder
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kareem O. Tawfik
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew R. O’Malley
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc L. Bennett
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S. Haynes
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - René Gifford
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L. Perkins
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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McRackan TR, Hand BN, Chidarala S, Dubno JR. Understanding Patient Expectations Before Implantation Using the Cochlear Implant Quality of Life-Expectations Instrument. JAMA Otolaryngol Head Neck Surg 2022; 148:870-878. [PMID: 35951334 PMCID: PMC9372907 DOI: 10.1001/jamaoto.2022.2292] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/27/2022] [Indexed: 11/14/2022]
Abstract
Importance Previous research suggests that clinicians view realistic patient expectations as the most important nonaudiological factor in the decision to proceed with a cochlear implant (CI). However, clinicians have few data to determine whether patients' outcome expectations are realistic. Objective To address this unmet clinical need through the development and psychometric analysis of a new patient-reported outcome measure, the CI Quality of Life (CIQOL) Expectations. Design, Setting, and Participants This cross-sectional study was conducted at a tertiary CI center from February 26, 2020, to August 31, 2021. First, a team comprising 2 CI audiologists, a CI surgeon, a hearing scientist, and 2 psychometricians with experience in instrument development converted all items from the CIQOL-35 Profile instrument into statements reflecting expected outcomes. Then, cognitive interviews with 20 potential CI users assessed the clarity and comprehensiveness of the new instrument. Next, responses to the CIQOL-Expectations instrument for 131 potential adult CI candidates were psychometrically analyzed using confirmatory factor analysis and item response theory. Finally, degree to which patient expectations changed from before to after and their CI evaluation appointments was measured. Intervention The CIQOL-Expectations instrument. Results Of 178 participants, 85 (47.8%) were female, and there was 1 (0.6%) Asian, 26 (14.6%) Black or African American, 1 (0.6%) Latinx, and 150 (84.3%) White individuals. No major content or grammar changes were identified during the cognitive interviews. Overall, all CIQOL domains demonstrated adequate to strong psychometric properties. Several domains did not meet all a priori established indicators of model fit or ability to separate CI users based on response patterns, but all met most indicators. Potential CI users demonstrated the highest mean (SD) expectation scores for the environment (70.2 [20.8]) and social (68.4 [18.0]) domains. In addition, the entertainment (20 [15.3%]) and environment (31 [24.4%]) domains had the highest percentage of patients with expectation scores of 100. Yet, normative CIQOL-35 Profile data from experienced CI users suggested few patients obtain this high degree of functional benefit after implant. Conclusions and Relevance The results of this cross-sectional study suggest that the CIQOL-Expectations instrument may provide an opportunity to assess potential CI users' expected outcomes using modification of an established CIQOL instrument and a patient-centered framework. The included items and domains reflect real-world functional abilities valued by CI users and may provide opportunities for an evidence-based shared decision-making approach to the CI evaluation process. With this instrument, clinicians can compare individual patients' pre-CI outcome expectations with established normative data and provide appropriate counseling.
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Affiliation(s)
- Theodore R. McRackan
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Brittany N. Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Shreya Chidarala
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Judy R. Dubno
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
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16
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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: 24] [Impact Index Per Article: 12.0] [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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HiRes Ultra Series Recall: Failure Rates and Revision Speech Recognition Outcomes. Otol Neurotol 2022; 43:e738-e745. [PMID: 35878635 PMCID: PMC9335892 DOI: 10.1097/mao.0000000000003598] [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: 11/26/2022]
Abstract
OBJECTIVE To report Advanced Bionics (AB) Ultra (V1) and Ultra 3D (V1) cochlear implant (CI) electrode failures and revision speech recognition outcomes for patients at a large CI program. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS Patients receiving Ultra (V1) or Ultra 3D (V1) devices as of September 21, 2021. MAIN OUTCOME MEASURES Failure rate, revision surgery, speech recognition scores. RESULTS To data, 65 (21.1%) of the 308 implanted devices are known failures, with 63 (20.5%) associated with the recent voluntary field corrective action (FCA). Average time to failure was 2.2 ± 1.1 years. Fifty-two patients (82.5%) elected for revision surgery. Among adults, immediate prerevision scores demonstrated a significant decrease from best-achieved scores with the faulty implant, with mean difference of -15.2% (p = 0.0115) for consonant-nucleus-consonant (CNC) and -27.3% (p < 0.0001) for AzBio in quiet. By 3 months postactivation of the revised device, CNC (p = 0.9766) and AzBio in quiet (p = 0.9501) scores were not significantly different than best prerevision scores. Overall, 15 of 19 patients regained or improved their best prerevision CNC score. The current trajectory for FCA device failures is approximately 6% per year. CONCLUSION Compared to manufacturer reporting, a high number of patients experienced hard failures of the Ultra (V1) and Ultra 3D (V1) devices. Early identification of failures is possibly because of the diligent use of electrical field imaging testing. Most patients affected by the FCA regain or exceed their prefailure speech recognition score as soon as 3 months after revision surgery.
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18
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Wichova H, Mills D, Beatty S, Peng K, Miller M. Cochlear implantation performance outcomes in patients over 80 years old. Laryngoscope Investig Otolaryngol 2022; 7:847-853. [PMID: 35734051 PMCID: PMC9194979 DOI: 10.1002/lio2.825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To examine device datalogging characteristics and postoperative performance in the very elderly CI users. Methods Retrospective chart review of postoperative speech recognition outcomes and datalogging characteristics in patients older than 80 years old who underwent cochlear implantation and remain active users with longer than 6 months post-activation follow-up. Resultss The mean age at implantation was 84.8 ± 3.8 years old. Pre- and post-operative AzBio sentences in quiet scores were 12.4 ± 16.4% and 53.0 ± 23.5%, respectively (p < .001). Pre- and post-operative consonant-nucleus-consonant (CNC) word scores were 9.4 ± 12.8% and 40.5 ± 20.7%, respectively (p < .001). A nonsignificant negative correlation was noted between the age of implantation and postoperative CNC words and AzBio sentence performance. Significantly decreased performance was noted in the subpopulation with a preoperative diagnosis of dementia. Mean daily use was 10.9 h per day. When available the mean daily usage distribution was 16% speech in noise, 19.1% speech, 51% quiet, 3.8% music, and 9.6% noise. A significant positive correlation was noted between daily use and AzBio sentence and CNC word performance. Conclusions Very elderly patients have significant postoperative auditory performance benefits after CI. Mean daily use is comparable to previously published results in the younger population. Age of implantation does not play a significant role in overall performance. Elderly patients who are medically cleared for implantation receive significant postoperative benefits.
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Affiliation(s)
- Helena Wichova
- Division of NeurotologyHouse ClinicLos AngelesCaliforniaUSA
| | - Dawna Mills
- Department of AudiologyUniversity of California DavisSacramentoCaliforniaUSA
| | - Sarah Beatty
- Hearing Services of Santa BarbaraSanta BarbaraCaliforniaUSA
| | - Kevin Peng
- Division of NeurotologyHouse ClinicLos AngelesCaliforniaUSA
| | - Mia Miller
- Department of OtolaryngologyCedar SinaiLos AngelesCaliforniaUSA
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Rauterkus G, Maxwell AK, Kahane JB, Lentz JJ, Arriaga MA. Conversations in Cochlear Implantation: The Inner Ear Therapy of Today. Biomolecules 2022; 12:649. [PMID: 35625577 PMCID: PMC9138212 DOI: 10.3390/biom12050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023] Open
Abstract
As biomolecular approaches for hearing restoration in profound sensorineural hearing loss evolve, they will be applied in conjunction with or instead of cochlear implants. An understanding of the current state-of-the-art of this technology, including its advantages, disadvantages, and its potential for delivering and interacting with biomolecular hearing restoration approaches, is helpful for designing modern hearing-restoration strategies. Cochlear implants (CI) have evolved over the last four decades to restore hearing more effectively, in more people, with diverse indications. This evolution has been driven by advances in technology, surgery, and healthcare delivery. Here, we offer a practical treatise on the state of cochlear implantation directed towards developing the next generation of inner ear therapeutics. We aim to capture and distill conversations ongoing in CI research, development, and clinical management. In this review, we discuss successes and physiological constraints of hearing with an implant, common surgical approaches and electrode arrays, new indications and outcome measures for implantation, and barriers to CI utilization. Additionally, we compare cochlear implantation with biomolecular and pharmacological approaches, consider strategies to combine these approaches, and identify unmet medical needs with cochlear implants. The strengths and weaknesses of modern implantation highlighted here can mark opportunities for continued progress or improvement in the design and delivery of the next generation of inner ear therapeutics.
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Affiliation(s)
- Grant Rauterkus
- Tulane University School of Medicine, New Orleans, LA 70112, USA;
| | - Anne K. Maxwell
- Department of Otorhinolaryngology and Biocommunications, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (A.K.M.); (J.B.K.)
| | - Jacob B. Kahane
- Department of Otorhinolaryngology and Biocommunications, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (A.K.M.); (J.B.K.)
| | - Jennifer J. Lentz
- Department of Otorhinolaryngology and Biocommunications, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (A.K.M.); (J.B.K.)
- Neuroscience Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Moises A. Arriaga
- Department of Otorhinolaryngology and Biocommunications, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (A.K.M.); (J.B.K.)
- Hearing and Balance Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA 70808, USA
- Hearing Balance Center, Culicchia Neurological Clinic, New Orleans, LA 70112, USA
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Shader MJ, Kwon BJ, Gordon-Salant S, Goupell MJ. Open-Set Phoneme Recognition Performance With Varied Temporal Cues in Younger and Older Cochlear Implant Users. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1196-1211. [PMID: 35133853 PMCID: PMC9150732 DOI: 10.1044/2021_jslhr-21-00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/20/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The goal of this study was to investigate the effect of age on phoneme recognition performance in which the stimuli varied in the amount of temporal information available in the signal. Chronological age is increasingly recognized as a factor that can limit the amount of benefit an individual can receive from a cochlear implant (CI). Central auditory temporal processing deficits in older listeners may contribute to the performance gap between younger and older CI users on recognition of phonemes varying in temporal cues. METHOD Phoneme recognition was measured at three stimulation rates (500, 900, and 1800 pulses per second) and two envelope modulation frequencies (50 Hz and unfiltered) in 20 CI participants ranging in age from 27 to 85 years. Speech stimuli were multiple word pairs differing in temporal contrasts and were presented via direct stimulation of the electrode array using an eight-channel continuous interleaved sampling strategy. Phoneme recognition performance was evaluated at each stimulation rate condition using both envelope modulation frequencies. RESULTS Duration of deafness was the strongest subject-level predictor of phoneme recognition, with participants with longer durations of deafness having poorer performance overall. Chronological age did not predict performance for any stimulus condition. Additionally, duration of deafness interacted with envelope filtering. Participants with shorter durations of deafness were able to take advantage of higher frequency envelope modulations, while participants with longer durations of deafness were not. CONCLUSIONS Age did not significantly predict phoneme recognition performance. In contrast, longer durations of deafness were associated with a reduced ability to utilize available temporal information within the signal to improve phoneme recognition performance.
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Affiliation(s)
- Maureen J. Shader
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | | | | | - Matthew J. Goupell
- Department of Hearing and Speech Sciences, University of Maryland, College Park
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Dornhoffer JR, Reddy P, Ma C, Schvartz-Leyzac KC, Dubno JR, McRackan TR. Use of Auditory Training and Its Influence on Early Cochlear Implant Outcomes in Adults. Otol Neurotol 2022; 43:e165-e173. [PMID: 34772887 PMCID: PMC8752503 DOI: 10.1097/mao.0000000000003417] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Assess associations between postcochlear implant (CI) auditory training and early outcomes related to speech recognition and CI quality of life (CIQOL). STUDY DESIGN Longitudinal, prospective cohort. SETTING Tertiary academic center. PATIENTS Seventy-two adults undergoing cochlear implantation for bilateral severe-to-profound hearing loss. INTERVENTIONS Self-reported use of three categories of auditory training post-CI activation: (1) face-to-face training (e.g., speech pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) computer-based training (e.g., interactive software). MAIN OUTCOME MEASURES 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 3-month post-CI. RESULTS Of 72 patients, 52 (72.2%) used an auditory training resource. Of all patients, 18.4% used face-to-face training, 58.3% passive home-based training, and 33.3% computer-based training. At 3 months post-CI, use of any training was associated with greater improvement in speech recognition (d-range = 0.57-0.85) and global and domain-specific CIQOL scores, except entertainment (d-range = -0.33 to 0.77). Use of computer-based training demonstrated the greatest effect, with larger improvements in speech recognition (CNCp: d = 0.69[0.03,1.35]; CNCw: d = 0.80[0.14,1.46]; AzBio: d = 1.11[0.44,1.77]) and global and all domain-specific CIQOL scores (d-range = 0.05-1.35). Controlling for age, sex, household income, and use of multiple training resources, computer-based training remained the strongest positive predictor of speech recognition and CIQOL improvement, with significant associations with CNCp (ß = 33.07[1,43,64.719]), AzBio (ß = 33.03[5.71,60.35]), and CIQOL-global (ß = 10.92[1.15,20.70]) score improvement. CONCLUSIONS Our findings provide preliminary evidence-based recommendations for use of specific auditory training resources for new adult CI recipients. Auditory training, especially self-directed computer software, resulted in improved speech recognition and CIQOL outcomes after 3 months and are widely available for CI users.
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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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22
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Thai A, Tran E, Swanson A, Fitzgerald MB, Blevins NH, Ma Y, Smith ML, Larky JB, Alyono JC. Outcomes in Patients Meeting Cochlear Implant Criteria in Noise but Not in Quiet. Otol Neurotol 2022; 43:56-63. [PMID: 34889839 DOI: 10.1097/mao.0000000000003351] [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: 11/25/2022]
Abstract
OBJECTIVE Evaluate outcomes in cochlear implant (CI) recipients qualifying in AzBio noise but not quiet, and identify factors associated with postimplantation improvement. STUDY DESIGN Retrospective cohort study. SETTING Tertiary otology/neurotology clinic. PATIENTS This study included 212 implanted ears. The noise group comprised 23 ears with preoperative AzBio more than or equal to 40% in quiet and less than or equal to 40% in +10 signal-to-noise ratio (SNR). The quiet group included 189 ears with preoperative AzBio less than 40% in quiet. The two groups displayed similar demographics and device characteristics. INTERVENTIONS Cochlear implantation. MAIN OUTCOME MEASURES AzBio in quiet and noise. RESULTS Mean AzBio quiet scores improved in both the quiet group (pre-implant: 12.7%, postimplant: 67.2%, p < 0.001) and noise group (pre-implant: 61.6%, postimplant: 73.8%, p = 0.04). Mean AzBio +10 SNR also improved in the quiet group (pre-implant: 15.8%, postimplant: 59.3%, p = 0.001) and noise group (pre-implant: 30.5%, postimplant: 49.1%, p = 0.01). However, compared with the quiet group, fewer ears in the noise group achieved within-subject improvement in AzBio quiet (≥15% improvement; quiet group: 90.3%, noise group: 43.8%, p < 0.001) and AzBio +10 SNR (quiet group: 100.0%, noise group: 45.5%, p < 0.001). Baseline AzBio quiet (p < 0.001) and Consonant-Nucleus-Consonant (CNC) scores (p = 0.004) were associated with within-subject improvement in AzBio quiet and displayed a higher area under the curve than either aided or unaided pure-tone average (PTA) (both p = 0.01). CONCLUSIONS CI patients qualifying in noise display significant mean benefit in speech recognition scores but are less likely to benefit compared with those qualifying in quiet. Patients with lower baseline AzBio quiet scores are more likely to display postimplant improvement.
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Affiliation(s)
- Anthony Thai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Malzanni G, Lerda C, Battista R, Canova C, Gatti O, Bussi M, Piccioni L. Speech recognition, quality of hearing, and data logging statistics over time in adult cochlear implant users. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_51_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Holder JT, Mayberry LS, Gifford R. The Cochlear Implant Use Questionnaire: Assessing Habits and Barriers to Use. Otol Neurotol 2022; 43:e23-e29. [PMID: 34629441 PMCID: PMC8671178 DOI: 10.1097/mao.0000000000003341] [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: 01/03/2023]
Abstract
OBJECTIVE The objective was to design a questionnaire to identify daily cochlear implant (CI) use habits and barriers to daily CI use and to administer this questionnaire to adult CI users. We hypothesized that recipients who reported a greater number of barriers to daily CI use would show lower daily CI use. STUDY DESIGN Questionnaire. SETTING Academic medical center. PATIENTS Hundred adult CI recipients. MAIN OUTCOME MEASURES Questionnaire responses and amount of CI use per day as measured from the CI software. RESULTS The cochlear implant use questionnaire (CIUQ) was created and responses were obtained from 100 participants. The CIUQ yielded an average overall score of 23 (range, 3-54) out of 100; responses were variable, and CI recipients experienced different barriers to using their CI processor. The CIUQ overall score was significantly correlated with recipients' daily CI use (h/d) (rs = -0.561, p < 0.0001, 95% confidence interval [-0.694, -0.391]), which provides evidence of construct validity. Responses were immediately useful for identifying and overcoming barriers to consistent CI use with our study participants. CONCLUSIONS Increasing evidence suggests that daily CI use is correlated with speech recognition outcomes. To optimize outcomes, clinicians should consider implementing this questionnaire to identify and overcome barriers to consistent, full-time CI processor use.
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Affiliation(s)
| | - Lindsay S Mayberry
- Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Brown C, Gifford RH. Expansion of Audiologic Criteria for Pediatric Cochlear Implantation. Otolaryngol Clin North Am 2021; 54:1181-1191. [PMID: 34774230 DOI: 10.1016/j.otc.2021.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In 2020, the lower age limit for pediatric cochlear implant candidacy was lowered from 12 to 9 months of age. However, audiometric-based criteria for pediatric cochlear implant candidacy have remained unchanged for more than 20 years, requiring bilateral profound sensorineural hearing loss for children less than 2 years and bilateral severe-to-profound sensorineural hearing loss for children 2 years and older. Despite the static audiometric criteria, there is an increasing literature base demonstrating significant benefits for pediatric cochlear implant recipients who exceed current Food and Drug Administration-labeled indications for cochlear implantation.
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Affiliation(s)
- Christine Brown
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, 9302 MCE South Tower, Nashville, TN 37232, USA
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, 9302 MCE South Tower, Nashville, TN 37232, USA.
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Holder JT, Gifford RH. Effect of Increased Daily Cochlear Implant Use on Auditory Perception in Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4044-4055. [PMID: 34546763 PMCID: PMC9132064 DOI: 10.1044/2021_jslhr-21-00066] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/27/2021] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
Purpose Despite the recommendation for cochlear implant (CI) processor use during all waking hours, variability in average daily wear time remains high. Previous work has shown that objective wear time is significantly correlated with speech recognition outcomes. We aimed to investigate the causal link between daily wear time and speech recognition outcomes and assess one potential underlying mechanism, spectral processing, driving the causal link. We hypothesized that increased CI use would result in improved speech recognition via improved spectral processing. Method Twenty adult CI recipients completed two study visits. The baseline visit included auditory perception testing (speech recognition and spectral processing measures), questionnaire administration, and documentation of data logging from the CI software. Participants watched an educational video, and they were informed of the compensation schedule. Participants were then asked to increase their daily CI use over a 4-week period during everyday life. Baseline measures were reassessed following the 4-week period. Results Seventeen out of 20 participants increased their daily CI use. On average, participants' speech recognition improved by 3.0, 2.4, and 7.0 percentage points per hour of increased average daily CI use for consonant-nucleus-consonant words, AzBio sentences, and AzBio sentences in noise, respectively. Questionnaire scores were similar between visits. Spectral processing showed significant improvement and accounted for a small amount of variance in the change in speech recognition values. Conclusions Improved consistency of processor use over a 4-week period yielded significant improvements in speech recognition scores. Though a significant factor, spectral processing is likely not the only mechanism driving improvement in speech recognition; further research is warranted.
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Affiliation(s)
- Jourdan T. Holder
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - René H. Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Boss B. Troubleshooting Cochlear Implant Processors via Tele-Audiology. Semin Hear 2021; 42:107-114. [PMID: 34381294 DOI: 10.1055/s-0041-1731691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This case study examines the methods used to troubleshoot a cochlear implant processor via video visit with a nonagenarian (90+ years old) with a bimodal cochlear implant system. This article will discuss the evaluation and management as well as which specific issues could be addressed virtually and how they were resolved. Examples will be provided about how to virtually connect with the patient and how to best facilitate communication during a video visit. Additionally, this article will examine the captioning apps and other hearing assistive technology available for smartphones that can provide further assistance during a cell phone call along with their benefits and limitations.
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Affiliation(s)
- Benjamin Boss
- Department of Audiology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,University of Pittsburgh, Pittsburgh, Pennsylvania
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Perkins E, Dietrich MS, Manzoor N, O'Malley M, Bennett M, Rivas A, Haynes D, Labadie R, Gifford R. Further Evidence for the Expansion of Adult Cochlear Implant Candidacy Criteria. Otol Neurotol 2021; 42:815-823. [PMID: 33606469 PMCID: PMC8627184 DOI: 10.1097/mao.0000000000003068] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE 1) To complete a follow-up investigation of postoperative outcomes for adult cochlear implant (CI) recipients scoring ≥30% Consonant-Nucleus-Consonant (CNC) preoperatively, and 2) to describe the postoperative performance trajectory for this group of higher performing patients. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS One hundred four (105 ears) postlingually deafened adults who scored ≥30% CNC word recognition in the ear to be implanted preoperatively. INTERVENTIONS One hundred four subjects underwent cochlear implantation. MAIN OUTCOME MEASURES Pre- and postoperative CNC word scores and AzBio sentences in quiet and noise in the ear to be implanted as well as the bilateral-aided condition pre-CI and at 1, 3, 6, and 12 months post-CI. RESULTS Statistically significant improvement was demonstrated for CNC and AzBio sentences in quiet and noise for the CI alone and bilateral listening conditions. Most improvement was demonstrated by 6-months postoperatively (p < 0.001) with the exception of AzBio sentences in noise demonstrating improvement within 3 months (p < 0.001). For patients with preop CNC scores up to 40% (n = 57), all recipients demonstrated either equivocal (n = 17) or statistically significant improvement (n = 40) for CNC word recognition in the CI-alone condition and none demonstrated a significant decrement in the bilateral condition. For patients with preop CNC scores >40% (n = 47, 48 ears), 89.3% (42 patients) demonstrated either equivocal (n = 24, 50%) or statistically significant improvement (n = 19, 39.6%) for CNC word recognition in the CI-only condition and none demonstrated a significant decrement in the bilateral condition. CONCLUSIONS CI candidates with preoperative CNC word scores higher than conventional CI recipients derive statistically significant benefit from cochlear implantation for both the CI ear and best-aided condition. These data provide further support for the expansion of adult CI candidacy up to at least 40% CNC word recognition preoperatively with consideration given to further expansion possibly up to 60%.
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Affiliation(s)
- Elizabeth Perkins
- Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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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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Duration of Processor Use Per Day Is Significantly Correlated With Speech Recognition Abilities in Adults With Cochlear Implants. Otol Neurotol 2021; 41:e227-e231. [PMID: 31789794 DOI: 10.1097/mao.0000000000002477] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Quantify the relationship between average hours of processor use per day and measures of speech recognition in post-lingually deafened adults with cochlear implants. SETTING Cochlear implant (CI) program at a tertiary medical center. PATIENTS Three hundred adult (mean age = 64, 130 women) CI users were included. MAIN OUTCOME MEASURES Correlation analyses were completed for CI-aided speech recognition (Consonant-Nucleus-Consonant [CNC] monosyllables and AzBio sentences) at approximately 12 months post-implantation and average hours of processor use per day, which was extracted from the CI programming software. RESULTS Average processor use was 10.2 hours per day (range, 0.1-22.7), and average speech recognition scores were 49.9 and 61.7% for CNC and AzBio sentence recognition, respectively. We found a strong, significant correlation between hours of processor use per day and consonant-nucleus-consonant (CNC) word recognition (rs = 0.61, p < 0.0001) and AzBio sentence recognition (rs = 0.56, p < 0.0001). CONCLUSIONS Results suggest that highest speech recognition outcomes are correlated with greater than 10 hours of CI use per day. Further research is needed to assess the causal link between daily CI use and speech recognition abilities.
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McRackan TR, Reddy P, Costello MS, Dubno JR. Role of Preoperative Patient Expectations in Adult Cochlear Implant Outcomes. Otol Neurotol 2021; 42:e130-e136. [PMID: 33229876 PMCID: PMC8316998 DOI: 10.1097/mao.0000000000002873] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Preoperative expectations affect patient outcomes in many health conditions, but expectations are rarely assessed in adult cochlear implant (CI) users. This study is a first step in assessing the contribution of preoperative expectations to postoperative CI outcomes, including speech recognition, CI quality of life (CIQOL), and CI satisfaction. STUDY DESIGN Cross-sectional study. SETTING Tertiary medical center. PATIENTS Fourty one adult CI patients. INTERVENTIONS/MAIN OUTCOME MEASURES Preoperative expectation questionnaire results, pre- and postoperative speech recognition (CNC and AzBio) scores, postoperative CIQOL domain scores and global scores, and CI satisfaction scores using a visual analog scale (VAS). Cohen's d was used to express effect size. RESULTS Overall, patients with lower preoperative CI performance expectations showed higher postoperative QOL. This effect was large for the emotional, entertainment, and social domains (d = 0.85-1.02) of the CIQOL-35 and medium for the communication, listening effort domains, and the Global score (d = 0.55-0.63). Preoperative performance expectations showed minimal associations with preoperative versus postoperative change in CNC (d = -0.26; -0.69-0.18) or AzBio scores (d = -0.28; -0.72-0.15). Determining the extent to which preoperative expectations played a role in postoperative satisfaction with CIs was limited by the clustering of satisfaction scores in the upper range of the scale (VAS mean 81.1). CONCLUSIONS This study provides preliminary evidence that patients' expectations before cochlear implantation may influence their postoperative quality of life and other outcomes, but not postoperative speech recognition. This suggests that an increased emphasis should be placed on measuring and counseling expectations in CI candidates. This assumption needs to be confirmed with additional research with larger sample sizes, more sensitive satisfaction measures, and a prospective design.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Shader MJ, Gordon-Salant S, Goupell MJ. Impact of Aging and the Electrode-to-Neural Interface on Temporal Processing Ability in Cochlear-Implant Users: Amplitude-Modulation Detection Thresholds. Trends Hear 2020; 24:2331216520936160. [PMID: 32833587 PMCID: PMC7448135 DOI: 10.1177/2331216520936160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although cochlear implants (CIs) are a viable treatment option for severe hearing loss in adults of any age, older adults may be at a disadvantage compared with younger adults. CIs deliver signals that contain limited spectral information, requiring CI users to attend to the temporal information within the signal to recognize speech. Older adults are susceptible to acquiring auditory temporal processing deficits, presenting a potential age-related limitation for recognizing speech signals delivered by CIs. The goal of this study was to measure auditory temporal processing ability via amplitude-modulation (AM) detection as a function of age in CI users. The contribution of the electrode-to-neural interface, in addition to age, was estimated using electrically evoked compound action potential (ECAP) amplitude growth functions. Within each participant, two electrodes were selected: one with the steepest ECAP slope and one with the shallowest ECAP slope, in order to represent electrodes with varied estimates of the electrode-to-neural interface. Single-electrode AM detection thresholds were measured using direct stimulation at these two electrode locations. Results revealed that AM detection ability significantly declined as a function of chronological age. ECAP slope did not significantly impact AM detection, but ECAP slope decreased (became shallower) with increasing age, suggesting that factors influencing the electrode-to-neural interface change with age. Results demonstrated a significant negative impact of chronological age on auditory temporal processing. The locus of the age-related limitation (peripheral vs. central origin), however, is difficult to evaluate because the peripheral influence (ECAPs) was correlated with the central factor (age).
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Affiliation(s)
- Maureen J Shader
- Department of Hearing and Speech Sciences, University of Maryland
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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: 6] [Impact Index Per Article: 1.5] [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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Dillon MT, Buss E, Rooth MA, King ER, McCarthy SA, Bucker AL, Deres EJ, Richter ME, Thompson NJ, Canfarotta MW, O'Connell BP, Pillsbury HC, Brown KD. Cochlear Implantation in Cases of Asymmetric Hearing Loss: Subjective Benefit, Word Recognition, and Spatial Hearing. Trends Hear 2020; 24:2331216520945524. [PMID: 32808881 PMCID: PMC7586262 DOI: 10.1177/2331216520945524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A prospective clinical trial evaluated the effectiveness of cochlear implantation in adults with asymmetric hearing loss (AHL). Twenty subjects with mild-to-moderate hearing loss in the better ear and moderate-to-profound hearing loss in the poorer ear underwent cochlear implantation of the poorer hearing ear. Subjects were evaluated preoperatively and at 1, 3, 6, 9, and 12 months post-activation. Preoperative performance was evaluated unaided, with traditional hearing aids (HAs) or with a bone-conduction HA. Post-activation performance was evaluated with the cochlear implant (CI) alone or in combination with a contralateral HA (bimodal). Test measures included subjective benefit, word recognition, and spatial hearing (i.e., localization and masked sentence recognition). Significant subjective benefit was reported as early as the 1-month interval, indicating better performance with the CI compared with the preferred preoperative condition. Aided word recognition with the CI alone was significantly improved at the 1-month interval compared with preoperative performance with an HA and continued to improve through the 12-month interval. Subjects demonstrated early, significant improvements in the bimodal condition on the spatial hearing tasks compared with baseline preoperative performance tested unaided. The magnitude of the benefit was reduced for subjects with AHL when compared with published data on CI users with normal hearing in the contralateral ear; this finding may reflect significant differences in age at implantation and hearing sensitivity across cohorts.
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Affiliation(s)
- Margaret T Dillon
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - Emily Buss
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - Meredith A Rooth
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - English R King
- Department of Audiology, UNC Health Care, Chapel Hill, North Carolina, United States
| | - Sarah A McCarthy
- Department of Audiology, UNC Health Care, Chapel Hill, North Carolina, United States
| | - Andrea L Bucker
- Department of Audiology, UNC Health Care, Chapel Hill, North Carolina, United States
| | - Ellen J Deres
- Department of Audiology, UNC Health Care, Chapel Hill, North Carolina, United States
| | - Margaret E Richter
- Division of Speech & Hearing Sciences, Department of Allied Health, University of North Carolina at Chapel Hill
| | - Nicholas J Thompson
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - Michael W Canfarotta
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - Brendan P O'Connell
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - Harold C Pillsbury
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - Kevin D Brown
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
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Depressive symptoms affect short- and long-term speech recognition outcome in cochlear implant users. Eur Arch Otorhinolaryngol 2020; 278:345-351. [PMID: 32504200 PMCID: PMC7826306 DOI: 10.1007/s00405-020-06096-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/27/2020] [Indexed: 01/13/2023]
Abstract
Purpose To investigate the impact of the amount of depressive symptoms in cochlear implant (CI) recipients on the development of speech recognition after CI-activation up to 2 years. Design Retrospective data analysis of a German short form of the Beck Depression Inventory given at initial activation of the implant in relation to monosyllabic word recognition score at conversational level at initial activation and at 3 months, 1 and 2-year follow-up measurements. Study sample Thirty-one CI-patients (11 female, 20 male) aged between 41 and 83 (M = 64.77, SD = 10.43) who were German native speakers, postlingually deafened, with severe hearing loss in both sides but unilaterally implanted (19 right-sided, 12 left-sided). Results The amount of depressive symptoms at initial activation was negatively correlated with the monosyllabic recognition score after 3 months and after 1 year of implant use. Conclusion The psychological status in terms of depressive symptoms is an important parameter regarding the rehabilitative outcome of CI-patients. Care staff and CI-users should be sensitized to the link between depressive symptoms and the development of speech recognition with CI.
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