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Chen SL, Zhang BY, Lee YC, Lin CC, Sun YS, Chan KC, Wu CM. Importance of age at 2nd implantation and interimplant interval to the outcome of bilateral prelingually deafened pediatric cochlear implantation. J Chin Med Assoc 2024; 87:434-441. [PMID: 38349155 DOI: 10.1097/jcma.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND In Taiwan, the number of cases of sequential bilateral pediatric cochlear implantation (CI) is increasing but data regarding its effectiveness and impact of the reimbursement policy are lacking. We examined the speech perception and quality of life (QOL) of bilateral prelingually deaf children who underwent sequential CI, considering the effects of age at the time of second implantation and interimplant interval. METHODS We enrolled 124 Mandarin-speaking participants who underwent initial cochlear implant (CI1) in 2001-2019 and a second CI (CI2) in 2015-2020. Patients were followed up for ≥2 years and were categorized into groups based on age at the time of CI2 implantation (<3.5, 3.6-7, 7.1-10, 10.1-13, and 13.1-18 years) and interimplant interval (0.5-3, 3.1-5, 5.1-7, 7.1-10, and >10 years). We evaluated speech perception, device usage rates, and QOL using subjective questionnaires (Speech, Spatial, and Qualities of Hearing and Comprehension Cochlear Implant Questionnaire). RESULTS Speech perception scores of CI2 were negatively correlated with ages at the time of CI1 and CI2 implantation and interimplant interval. Older age and a longer interimplant interval were associated with higher nonuse rates for CI2 and worse auditory performance and QOL. Among individuals aged >13 years with interimplant intervals >10 years, up to 44% did not use their second ear. Patients aged 7.1 to 10 years had better speech perception and higher questionnaire scores than those aged 10.1 to 13 and 13.1 to 18 years. Furthermore, patients aged 10.1 to 13 years had a lower rate of continuous CI2 usage compared to those aged 7.1 to 10 years. CONCLUSION Timely implantation of CI2 is essential to achieve optimal outcomes, particularly among sequentially implanted patients with long-term deafness in the second ear and no improvement with hearing aids following CI1 implantation. For CI2 implantation, an upper limit of age of 10 years and interimplant interval of 7 years are essential to prevent suboptimal outcomes. These data can provide useful information to implant recipients, their families, and medical and audiological professionals, enabling a comprehensive understanding of the benefits and potential impacts of the timing of CI2 implantation.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Bang-Yan Zhang
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan, ROC
| | - Yi-Chieh Lee
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan, ROC
| | - Chia-Chen Lin
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan, ROC
| | - Yu-Sheng Sun
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Kai-Chieh Chan
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Che-Ming Wu
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan, ROC
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Maheo C, Marie A, Torres R, Archutick J, Leclère JC, Marianowski R. Robot-Assisted and Manual Cochlear Implantation: An Intra-Individual Study of Speech Recognition. J Clin Med 2023; 12:6580. [PMID: 37892718 PMCID: PMC10607818 DOI: 10.3390/jcm12206580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Cochlear implantation (CI) allows rehabilitation for patients with severe to profound hearing impairment. Although the use of a robotic assistant provides technical assistance to the surgeon, the assessment of the impact of its use on auditory outcomes remains uncertain. We aim to compare the hearing results of patients who underwent bilateral cochlear implantation; one side was performed with manual insertion and the other side with robot-assisted insertion. The electrode array intrascalar positioning and the surgery duration were also studied. This retrospective intra-individual study involved 10 patients who underwent bilateral cochlear implantation. The study included two infants and eight adults. The unique composition of this cohort enabled us to utilize each patient as their own control. Regarding speech disyllabic recognition, pure tone average, ECAP, ratio of array translocation, basilar membrane rupture, and percentage of translocated electrodes, there was no difference between manual and robot-assisted CI groups. This study is the first to compare intra-individual hearing performance after cochlear implantation, either manually or robot-assisted. The number of patients and the time delay between manual and robotic implantation may have led to a lack of power, but there was no apparent difference in hearing performance between manual and robotic implantation.
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Affiliation(s)
- Clémentine Maheo
- Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Morvan, 2 Avenue Foch, 29200 Brest, France; (A.M.); (J.-C.L.); (R.M.)
| | - Antoine Marie
- Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Morvan, 2 Avenue Foch, 29200 Brest, France; (A.M.); (J.-C.L.); (R.M.)
| | - Renato Torres
- Technologies et Theérapie Génique Pour la Surdité, Institut de l’Audition, Institut Pasteur/Université de Paris Cité/INSERM, 63 rue de Charenton, 75012 Paris, France;
| | - Jerrid Archutick
- Medicine Department, School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland;
| | - Jean-Christophe Leclère
- Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Morvan, 2 Avenue Foch, 29200 Brest, France; (A.M.); (J.-C.L.); (R.M.)
| | - Remi Marianowski
- Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Morvan, 2 Avenue Foch, 29200 Brest, France; (A.M.); (J.-C.L.); (R.M.)
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Kurz A, Herrmann D, Hagen R, Rak K. Using Anatomy-Based Fitting to Reduce Frequency-to-Place Mismatch in Experienced Bilateral Cochlear Implant Users: A Promising Concept. J Pers Med 2023; 13:1109. [PMID: 37511722 PMCID: PMC10381201 DOI: 10.3390/jpm13071109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Fitting cochlear implant (CI) users can be challenging. Anatomy-based fitting (ABF) maps may have the potential to lead to better objective and subjective outcomes than conventional clinically based fitting (CBF) methods. ABF maps were created via information derived from exact electrode contact positions, which were determined via post-operative high-resolution flat panel volume computer tomography and clinical fitting software. The outcome measures were speech understanding in quiet and noise and self-perceived sound quality with the CBF map and with the ABF map. Participants were 10 experienced bilateral CI users. The ABF map provided better speech understanding in quiet and noisy environments compared to the CBF map. Additionally, two approaches of reducing the frequency-to-place mismatch revealed that participants are more likely to accept the ABF map if their electrode array is inserted deep enough to stimulate the apical region of their cochlea. This suggests an Angular Insertion Depth of the most apical contact of around 720°-620°. Participants had better speech understanding in quiet and noise with the ABF map. The maps' self-perceived sound quality was similar. ABF mapping may be an effective tool for compensating the frequency-to-place mismatch in experienced bilateral CI users.
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Affiliation(s)
- Anja Kurz
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - David Herrmann
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Kristen Rak
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
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Predictive Ability of First-Side Cochlear Implant Performance in Adult Sequential Bilateral Cochlear Implantation. Otol Neurotol 2023; 44:141-147. [PMID: 36624591 DOI: 10.1097/mao.0000000000003779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Predictors of second-side cochlear implant performance have not been well studied. We sought to assess whether speech recognition scores from first-side cochlear implant (CI1) could predict second-side cochlear implant (CI2) scores in sequential bilaterally implanted adults. STUDY DESIGN Retrospective review using a prospectively collected database. SETTING Academic tertiary care hospital. PATIENTS Fifty-seven adults with postimplantation speech recognition testing performed at least 12 months after CI2. INTERVENTION Sequential bilateral CI. MAIN OUTCOME MEASURES CI2 performance at ≥12 months as measured using consonant-nucleus-consonant (CNC) words and AzBio sentences in quiet and +10 dB signal-to-noise ratio (S/N). RESULTS CI1 performance scores at ≥12 months were independently associated with CI2 performance scores at ≥12 months for CNC words (β = 0.371 [0.136-0.606], p = 0.003), AzBio sentences in quiet (β = 0.614 [0.429-0.80], p < 0.0001), and AzBio +10 dB S/N (β = 0.712 [0.459-0.964], p < 0.0001). CI1 scores on AzBio in quiet at 0 to 6 months were also independently associated with CI2 AzBio in quiet scores at ≥12 months (β = 0.389 [0.004-0.774], p = 0.048). Hearing loss etiology and duration, age at implantation, interval between CI1 and CI2, duration of hearing aid use, and preimplantation speech recognition testing scores were not consistently associated with CI2 scores at ≥12 months. CONCLUSIONS CI1 performance is an independent predictor of second-side performance as measured ≥12 months postimplantation. This may be a clinically useful metric when considering adult sequential bilateral implantation.
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Shafieibavani E, Goudey B, Kiral I, Zhong P, Jimeno-Yepes A, Swan A, Gambhir M, Buechner A, Kludt E, Eikelboom RH, Sucher C, Gifford RH, Rottier R, Plant K, Anjomshoa H. Predictive models for cochlear implant outcomes: Performance, generalizability, and the impact of cohort size. Trends Hear 2021; 25:23312165211066174. [PMID: 34903103 PMCID: PMC8764462 DOI: 10.1177/23312165211066174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
While cochlear implants have helped hundreds of thousands of individuals, it
remains difficult to predict the extent to which an individual’s hearing will
benefit from implantation. Several publications indicate that machine learning
may improve predictive accuracy of cochlear implant outcomes compared to
classical statistical methods. However, existing studies are limited in terms of
model validation and evaluating factors like sample size on predictive
performance. We conduct a thorough examination of machine learning approaches to
predict word recognition scores (WRS) measured approximately 12 months after
implantation in adults with post-lingual hearing loss. This is the largest
retrospective study of cochlear implant outcomes to date, evaluating 2,489
cochlear implant recipients from three clinics. We demonstrate that while
machine learning models significantly outperform linear models in prediction of
WRS, their overall accuracy remains limited (mean absolute error: 17.9-21.8).
The models are robust across clinical cohorts, with predictive error increasing
by at most 16% when evaluated on a clinic excluded from the training set. We
show that predictive improvement is unlikely to be improved by increasing sample
size alone, with doubling of sample size estimated to only increasing
performance by 3% on the combined dataset. Finally, we demonstrate how the
current models could support clinical decision making, highlighting that subsets
of individuals can be identified that have a 94% chance of improving WRS by at
least 10% points after implantation, which is likely to be clinically
meaningful. We discuss several implications of this analysis, focusing on the
need to improve and standardize data collection.
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Affiliation(s)
| | - Benjamin Goudey
- 127113IBM Research Australia, Southbank, Victoria, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Isabell Kiral
- 127113IBM Research Australia, Southbank, Victoria, Australia
| | - Peter Zhong
- 127113IBM Research Australia, Southbank, Victoria, Australia
| | | | - Annalisa Swan
- 127113IBM Research Australia, Southbank, Victoria, Australia
| | - Manoj Gambhir
- 127113IBM Research Australia, Southbank, Victoria, Australia
| | - Andreas Buechner
- 9177Medizinische Hochschule Hannover, Hannover, Niedersachsen, Germany
| | - Eugen Kludt
- 9177Medizinische Hochschule Hannover, Hannover, Niedersachsen, Germany
| | - Robert H Eikelboom
- 104182Ear Science Institute Australia, Subiaco, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, South Africa
| | - Cathy Sucher
- 104182Ear Science Institute Australia, Subiaco, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Rene H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | | | - Kerrie Plant
- 104148Cochlear Limited, New South Wales, Australia
| | - Hamideh Anjomshoa
- 127113IBM Research Australia, Southbank, Victoria, Australia.,School of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
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Abstract
OBJECTIVE Assess relationships between patient, hearing, and cochlear implant (CI)-related factors and second-side CI speech recognition outcomes in adults who are bilaterally implanted. STUDY DESIGN Retrospective review of a prospectively maintained CI database. SETTING Tertiary academic center. PATIENTS One hundred two adults receiving bilateral sequential or simultaneous CIs. OUTCOME MEASURES Postimplantation consonant-nucleus-consonant (CNC) word and AzBio sentence scores at ≥12 months. RESULTS Of patient, hearing and CI-specific, factors examined only postimplantation speech recognition scores of the first CI were independently associated with speech recognition performance of the second CI on multivariable regression analysis (CNC: ß = 0.471[0.298, 0.644]; AzBio: ß = 0.602[0.417, 0.769]). First-side postoperative CNC scores explained 24.3% of variation in second CI postoperative CNC scores, while change in first CI AzBio scores explained 40.3% of variation in second CI AzBio scores. Based on established 95% confidence intervals, 75.2% (CNC) and 65.9% (AzBio) of patients score equivalent or better with their second CI compared to first CI performance. Age at implantation, duration of hearing loss, receiving simultaneous versus sequential CIs, and preoperative residual hearing (measured by pure-tone average and aided speech recognition scores) were not associated with 12 month speech recognition scores at 12 months. CONCLUSIONS The degree of improvement in speech recognition from first CI may predict speech recognition with a second CI. This provides preliminary evidence-based expectations for patients considering a second CI. Counseling should be guarded given the remaining unexplained variability in outcomes. Nonetheless, these data may assist decision making when considering a second CI versus continued use of a hearing aid for an unimplanted ear. LEVEL OF EVIDENCE III.
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