Benefits of Bilateral Hearing on the Telephone for Cochlear Implant Recipients

BACKGROUND

 Cochlear implant (CI) recipients frequently experience difficulty understanding speech over the telephone and rely on hearing assistive technology (HAT) to improve performance. Bilateral inter-processor audio streaming technology using nearfield magnetic induction is an advanced technology incorporated within a hearing aid or CI processor that can deliver telephone audio signals captured at one sound processor to the sound processor at the opposite ear. To date, limited data exist examining the efficacy of this technology in CI users to improve speech understanding on the telephone.

PURPOSE

 The primary objective of this study was to examine telephone speech recognition outcomes in bilateral CI recipients in a bilateral inter-processor audio streaming condition (DuoPhone) compared with a monaural condition (i.e., telephone listening with one sound processor) in quiet and in background noise. Outcomes in the monaural and bilateral conditions using either a telecoil or T-Mic2 technology were also assessed. The secondary aim was to examine how deactivating microphone input in the contralateral processor in the bilateral wireless streaming conditions, and thereby modifying the signal-to-noise ratio, affected speech recognition in noise.

RESEARCH DESIGN

 A repeated-measures design was used to evaluate speech recognition performance in quiet and competing noise with the telephone signal transmitted acoustically or via the telecoil to the ipsilateral sound processor microphone in monaural and bilateral wireless streaming listening conditions.

STUDY SAMPLE

 Nine bilateral CI users with Advanced Bionics HiRes 90K and/or CII devices were included in the study.

DATA COLLECTION AND ANALYSIS

 The effects of phone input (monaural [DuoPhone Off] vs. bilateral [DuoPhone on]) and processor input (T-Mic2 vs. telecoil) on word recognition in quiet and noise were assessed using separate repeated-measures analysis of variance. Effect of the contralateral device mic deactivation on speech recognition outcomes for the T-Mic2 DuoPhone conditions was assessed using paired Student's t-tests.

RESULTS

 Telephone speech recognition was significantly better in the bilateral inter-processor streaming conditions relative to the monaural conditions in both quiet and noise. Speech recognition outcomes were similar in quiet and noise when using the T-Mic2 and telecoil in the monaural and bilateral conditions. For the acoustic DuoPhone conditions using the T-Mic2, speech recognition in noise was significantly better when the microphone of the contralateral processor was disabled.

CONCLUSION

 Inter-processor audio streaming allows for bilateral listening on the telephone and produces better speech recognition in quiet and in noise compared with monaural listening conditions for adult CI recipients.

Meta-analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation

OBJECTIVE

Postoperative vertigo is a common complaint after cochlear implantation, but published incidence rates differ vastly. The aim of the present study was to investigate both subjective complaints of vertigo before and after cochlear implantation and related vestibular diagnostic tests on cochlear implant candidates.

DATA SOURCES

We performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Cochrane Register, and EMBASE.

REVIEW METHODS

We presented 116 eligible studies investigating subjective complaints of vertigo after cochlear implantation and/or related vestibular diagnostic tests. We conducted three meta-analyses of 46 eligible studies with matched pre- and postoperative data to calculate the odds ratio of new vertigo onset, as well as the impairment of vestibular receptors measured by nystagmography and cervical vestibular evoked myogenic potentials (cVEMP). Postoperative vertigo was calculated from 95 studies and further subdivided by mean age with pooled data.

RESULTS

We observed a significant increase in postoperative vertigo and significant impairment of nystagmography and cVEMP detection. Vertigo after cochlear implantation was reported in 9.3% of the patients with a continuous increase in patient age at surgery. In a subgroup of studies, new onset of vertigo was found in 17.4% of the patients. In addition, 7.2% of the patients had persisting vertigo complaints, whereas 11.6% described an altered vertigo quality and 7.7% had their preoperative complaints resolved. A comparison of round window approach and cochleostomy revealed significantly increased vertigo after cochleostomy. Both insertion methods showed similar effects in nystagmography and cVEMP testing.

CONCLUSION

Cochlear implantation has a significant impact on subjective vertigo and vestibular receptor function. This is affected by the patient's age at the time of surgery. The surgical technique (round window or cochleostomy) may influence the outcome, but this requires further investigation. Younger patients may compensate better following vestibular dysfunction. Perioperative testing is required to correlate vestibular impairment and subjective complaints. Laryngoscope, 2018 Laryngoscope, 128:2110-2123, 2018.

Fine structure processing improves telephone speech perception in cochlear implant users

The objective of this study was to compare telephone speech perception and subjective preferences in cochlear implant users with two different speech-processing strategies: high-definition continuous interleaved sampling (HDCIS) and fine structure processing (FSP). A randomized double-blind study was designed for intra-individual comparison of HDCIS and FSP. Twenty-five post-lingually deafened patients with either the PulsarCI(100) or SonataTI(100) and Opus2 acoustic processor were tested consecutively with both coding strategies, assigned in a random order. Disyllabic word speech perception was tested 6 weeks after each fitting under the following conditions: landline use with (LWN) and without (LWoN) background noise, mobile use with (MWN), and without (MWoN) background noise and mobile use with a Bluetooth magnetic field transmitter necklace (MB). Changes in health-related quality of life (QoL) were assessed using the Glasgow Benefit Inventory (GBI) and Faber's questionnaire. Personal preferences between strategies were surveyed upon completion of the study. All subjects included in this study performed better with FSP in the landline tests. There was an improvement of 11.5 % in LWN use (p = 0.014; CI 95 % = 3-20 %) and 10 % in LWoN use (p = 0.001; CI 95 % = 5-15 %). MWoN showed an improvement of 6.3 % with FSP (p = 0.03; CI 95 % = 0-13 %). MB tests showed an improvement of 11 % with FSP (p < 0.05; CI 95 % = 1.5-22 %). Quality of life was significantly better using FSP. Eighty-four percent of participants preferred FSP. The FSP speech coding strategy improved the speech recognition of cochlear implant users when using the telephone compared to HDCIS. Cochlear implantation with FSP coding improved QoL.

Benefits from a mobile telephone adapter in Combi40+ cochlear implant users

CONCLUSIONS

Telephone adapters can help cochlear implanted patients to enhance their telephonic conversations. However, these devices should be further developed to be useful for daily life.

OBJECTIVES

To test a mobile telephone adapter to improve speech discrimination by mobile telephone in Combi40+ users. To evaluate the influence of the mobile telephone in communication.

SUBJECTS AND METHODS

Seventeen Combi40+ implantees were tested with bisyllabic words presented through mobile telephones with and without a telephone adapter in quiet and noisy environments. Speech audiometries in open field were obtained for every patient.

RESULTS

Mean speech discrimination without the adapter in a quiet environment was 51.2%. In a noisy environment, mean discrimination increased significantly with the adapter from 30.3% to 42.9%. No statistically significant difference was found between speech discrimination in the quiet environment without the adapter and speech discrimination in the noisy environment with the adapter. When comparing speech discrimination in open field without lip-reading with equivalent telephonic conditions a statistically significant difference was found in favour of the open field.

Comparison of different mobile telephones in Combi40+ users

CONCLUSION

Telephone usage is a difficult challenge for cochlear implanted patients. A significant number of cochlear implanted patients are able to carry on a land-line or mobile telephone conversation. The telephone model may be a critical factor for telephone performance.

OBJECTIVES

The goals of this study were to evaluate speech discrimination through land-line and mobile telephones in Combi40+ users, and to compare different mobile telephone models to find out which could be more advisable for them.

PATIENTS AND METHODS

Eighteen Combi40+ implantees were tested with CID sentences and bisyllabic words presented through land-line and mobile telephones, in both quiet and noisy environments.

RESULTS

Mean scores for telephonic speech discrimination were over 85% for CID sentences and 28-59% for bisyllabic words. The Siemens M55 was superior to the other mobile telephones tested.

Telephone Use and Understanding in Patients with Cochlear Implants

We conducted a mail survey of patients who had received cochlear implants to ascertain their ability to communicate on the telephone. Of 86 patients who responded, 38 (44%) did not use the telephone at all, 36 (42%) were able to use the telephone without assistance (independent users), and 12 (14%) were able to use the telephone with some type of assistance. Factors associated with independent use were male sex, older age at the onset of hearing loss, longer duration of hearing loss, successful use of hearing aids prior to cochlear implantation, implantation with a MED-EL Combi 40+ device, and a shorter duration of implant use. But regardless of circumstances, our findings suggest that many cochlear implant patients can use the telephone during daily activity without the need for assistive devices or relay services.