Effects of Age and Implanted Ear on Speech Recognition in Adults with Unilateral Cochlear Implants

Role of Preoperative Patient Expectations in Adult Cochlear Implant Outcomes

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.

Age-related hearing loss and tinnitus, dementia risk, and auditory amplification outcomes

Age-related hearing loss (ARHL) or presbycusis, as the third leading cause of chronic disability in older adults, has been shown to be associated with predisposing cognitive impairment and dementia. Tinnitus is also a chronic auditory disorder demonstrating a growth rate with increasing age. Recent evidence stands for the link between bothersome tinnitus and impairments in various aspects of cognitive function. Both ARHL and age-related tinnitus affect mental health and contribute to developing anxiety, stress, and depression. The present review is a comprehensive multidisciplinary study on diverse interactions among ARHL, tinnitus, and cognitive decline in older adults. This review incorporates the latest evidence in prevalence and risk factors of ARHL and tinnitus, the neural substrates of tinnitus-related cognitive impairments, hypothesized mechanisms concerning the association between ARHL and increased risk of dementia, hearing amplification outcomes in cases with ARHL and cognitive decline, and preliminary findings on the link between ARHL and cognitive impairment in animal studies. Given extensive evidence that demonstrates advantages of using auditory amplification in the alleviation of hearing handicap, depression, and tinnitus, and the improvement of cognition, social communication, and quality of life, regular hearing screening programs for identification and management of midlife hearing loss and tinnitus is strongly recommended.

Right Ear Advantage of Speech Audiometry in Single-sided Deafness

BACKGROUND

Postlingual single-sided deafness (SSD) is defined as normal hearing in one ear and severely impaired hearing in the other ear. A right ear advantage and dominance of the left hemisphere are well established findings in individuals with normal hearing and speech processing. Therefore, it seems plausible that a right ear advantage would exist in patients with SSD.

METHODS

The audiometric database was searched to identify patients with SSD. Results from the German monosyllabic Freiburg word test and four-syllabic number test in quiet were evaluated. Results of right-sided SSD were compared with left-sided SSD. Statistical calculations were done with the Mann-Whitney U test.

RESULTS

Four hundred and six patients with SSD were identified, 182 with right-sided and 224 with left-sided SSD. The two groups had similar pure-tone thresholds without significant differences. All test parameters of speech audiometry had better values for right ears (SSD left) when compared with left ears (SSD right). Statistically significant results (p < 0.05) were found for a weighted score (social index, 98.2 ± 4% right and 97.5 ± 4.7% left, p < 0.026), for word understanding at 60 dB SPL (95.2 ± 8.7% right and 93.9 ± 9.1% left, p < 0.035), and for the level at which 100% understanding was reached (61.5 ± 10.1 dB SPL right and 63.8 ± 11.1 dB SPL left, p < 0.022) on a performance-level function.

CONCLUSION

A right ear advantage of speech audiometry was found in patients with SSD in this retrospective study of audiometric test results.

Hearing threshold levels and hearing loss among people in Zhejiang, China: a population-based cross-sectional study

Hearing loss (≥26 dB threshold in the better ear), as a common chronic condition in humans, is increasingly gaining attention. Relevant research in China is relatively scarce, so we conduct a population-based study to investigate the prevalence of hearing loss among age groups, genders and ears in Zhejiang province, China, from September 2016 to June 2018.

STUDY DESIGN

Population-based cross-sectional study PARTICIPANTS: A total of 3754 participants aged 18-98 years and living in Zhejiang province, China.

OUTCOME MEASURES

Pure-tone audiometric thresholds were measured at frequencies of 0.125-8 kHz for each subject. All participants were asked to complete a structured questionnaire, in the presence of a healthcare official.

RESULTS

The prevalence of speech-frequency and high-frequency hearing loss was 27.9% and 42.9%, respectively, in Zhejiang. There were significant differences in auditory thresholds at most frequencies among the age groups, genders (male vs female: 31.6%vs24.1% at speech frequency; 48.9% vs 36.8% at high frequency) and ears. In addition to the common factors affecting both types of hearing loss, a significant correlation was found between personal income and speech-frequency hearing loss (OR=0.69, 95% CI 0.52 to 0.92), and between hyperlipidaemia and high-frequency hearing loss (OR=1.45, 95% CI 1.02 to 2.07).

CONCLUSION

The prevalence of hearing loss was high among people living in Zhejiang, particularly males, and in the left ear. Moreover, hearing thresholds increased with age. Several lifestyle and environment factors, which can be influenced by awareness and education, were significantly associated with hearing loss.

The effect of side of implantation on unilateral cochlear implant performance in patients with prelingual and postlingual sensorineural hearing loss: A systematic review

OBJECTIVE

Cerebral lateralisation of language processing leads to a right ear advantage in normal hearing subjects. The aim of this study was to present a systematic overview of the effect of implantation side on postoperative cochlear implant performance in patients with symmetrical severe to profound sensorineural hearing loss.

DATA SOURCES

PubMed, Embase and The Cochrane Library databases.

RESEARCH METHODS

Databases were searched from database inception up to 9 January 2017 for cochlear implant and side and all synonyms. Title, abstract and full-text of retrieved articles were screened for eligibility. Then, directness of evidence and risk of bias were assessed. For the included articles, study characteristics and outcome data (hearing and language development) were extracted.

RESULTS

2541 unique articles were screened, of which twenty were eligible for critical appraisal. No randomised controlled trials were identified. Twelve studies with a high directness of evidence remained for data extraction. Four of six studies including children with pre-lingual sensorineural hearing loss and four of seven studies investigating adults with postlingual sensorineural hearing loss found a right ear advantage in at least one outcome measurement related to cochlear implant performance.

CONCLUSION

The available evidence on the effect of side of implantation is of low quality, as study populations and outcome measures are heterogeneous. The majority of studies reveals evidence for a right ear advantage in prelingually deafened children as well as postlingually deafened adults. In view of the present evidence and as no left ear advantage was identified, we cautiously advise implanting the cochlear implant in the right ear when other prognostic factors do not favour the left ear and sensorineural hearing loss is symmetrical.