How we do it: patient participation in cochlear implant selection

The Oticon Medical Neuro Zti cochlear implant and the Neuro 2 sound processor: multicentric evaluation of outcomes in adults and children

Objective: This study evaluated the outcomes of the Oticon Medical Neuro Zti cochlear implant and the Neuro 2 sound processor.Design: Neuro One users were upgraded to Neuro 2. Monosyllabic word identification was evaluated in adults with Neuro One after ≥5 months, with Neuro 2 at upgrade, and with Neuro 2 after 3 months. Self-reported listening ability, satisfaction, and usability were measured in adults and children.Study sample: Participants were 44 adults and 26 children.Results: Speech identification scores in quiet and noise were 58% and 45% with Neuro One and 67% and 55% with Neuro 2 after 3 months, respectively. Hearing impairment duration and number of active electrodes significantly predicted speech identification in noise with Neuro 2. Significantly higher questionnaire ratings were obtained for Neuro 2 than Neuro One regarding listening ability in complex listening situations, comfort and music, as well as nine aspects of satisfaction and usability.Conclusion: This study demonstrates the clinical superiority of the Neuro 2 sound processor over Neuro One in terms of speech identification in quiet and in noise and reported patient benefit and satisfaction. Given the study design, sources of improvement may include factors unrelated to the sound processor itself.

What makes someone choose cochlear implantation? An exploration of factors that inform patient decision making

Objective: Our objective was to understand the factors that determine whether an adult who is eligible for cochlear implantation (CI) choose to take up or not take up the implant.Design: We conducted a qualitative in-depth interview study, informed by grounded theory methods of constant comparison to build a theory to describe why and how people decide to opt for CI or not.Study sample: Our samples were patients from an audiology service in England.Results: Our results describe the key factors in weighing up risks and benefits. These are influenced by living context and support, information and social identity. We identify the key features that impact decision making for adults eligible for cochlear implants. The importance of the patient lifeworld view is discussed.Conclusions: This qualitative study provides the first in depth examination of how and why patients do and do not take up the offer of cochlear implants. It highlights the complex and iterative nature of this decision making and the individualised risks that trade off benefits of implantation.

Factors affecting choice of device by cochlear implant candidates

OBJECTIVE

To investigate the ways the various cochlear devices are chosen by candidates/surrogates and analyze the factors that influenced their decisions.

SETTING

University-affiliated tertiary referral center.

METHOD

: A questionnaire that included general items and questions on device's aesthetics, technical considerations, and quality was sent to 429 patients who underwent cochlear implantation between June 1997 and December 2006 in our department.

RESULTS

One hundred eighty-four questionnaires were returned, yielding a response rate of 42.9%. Some patients did not receive the questionnaires because of the postal address changes. In addition, recently implanted patients/their surrogates were more ready to answer on the questionnaire on decision-making process compared with those who received their devices before 2001. The Nucleus users were more influenced by the questions pertaining to the quality/reliability of the device than the aesthetic and technical aspects. The ABC users were more influenced by the aesthetic aspects, and the MED-EL users were generally influenced by all the groups of questions equally. Females used the Internet as the source of information on the devices significantly more than males, and their decisions were more influenced by their families than those of the males. In addition, the females were more influenced by the quality of a device's function compared with males. Pediatric candidates (aged 1-16 yr) were significantly more influenced by the experience of other implant users, the medical staff, and religious considerations than adults. Adults arrived at decisions more easily than children or their surrogates. The adults and older children were more influenced by the ease of the device's functioning compared with the young children.

CONCLUSION

Choosing the type of cochlear implant device is a highly individualized process that depends on various personal, social and cultural factors, and factors linked directly to the device itself.