Cochlear Implant Remote Assist: Clinical and Real-World Evaluation

OBJECTIVES

To develop and evaluate Cochlear™ Remote Assist (RA), a smartphone-based cochlear implant (CI) teleaudiology solution. The development phase aimed to identify the minimum features needed to remotely address most issues typically experienced by CI recipients. The clinical evaluation phase assessed ease of use, call clarity, system latency, and CI recipient feedback.

DESIGN

The development phase involved mixed methods research with experienced CI clinicians. The clinical evaluation phase involved a prospective single-site clinical study and real-world use across 16 clinics.

STUDY SAMPLE

CI clinicians (N = 23), CI recipients in a clinical study (N = 15 adults) and real-world data (N = 57 CI recipients).

RESULTS

The minimum feature set required for remote programming in RA, combined with sending replacements by post, should enable the clinician to address 80% of the issues typically seen in CI follow-up sessions. Most recipients completed the RA primary tasks without prior training and gave positive ratings for usefulness, ease of use, effectiveness, reliability, and satisfaction on the Telehealth Usability Questionnaire. System latency was reported to be acceptable.

CONCLUSION

RA is designed to help clinicians address a significant proportion of issues typically encountered by CI recipients. Clinical study and real-world evaluation confirm RA's ease of use, call quality, and responsiveness.

Development of Custom Sound® Pro software utilising big data and its clinical evaluation

OBJECTIVES

To inform and optimise a cochlear implant (CI) fitting software design through an analysis of big data to define array-specific comfort (C) level profiles, frequently-used MAP parameters, and the minimum number of Neural Response Telemetry thresholds (tNRT) needed to create an accurate profile. To evaluate the software's ease of use and completion time for AutoNRT®s.

DESIGN

MAPs analysis. Clinical study evaluating software use in creating MAPs, addressing sound-quality issues and setting patient goals.

STUDY SAMPLE

MAPs (N = 39,885); CI recipients (N = 47) and clinicians (N = 19).

RESULTS

Distinct C-level profiles were observed for lateral-wall, contour, and slim-modiolar electrode arrays. Default settings were used for most MAP parameters (13/16) except for Pulse Width, Rate, and Maxima. Nine tNRT measurements were required for an accurate C-level profile. Measurement-time of nine tNRTs via the new algorithm was comparable to five tNRTs using the previous algorithm. Nearly all (99%) clinical tasks were completed by clinicians with the first use of the software. Most CI recipients (79.5%) rated goal-setting as valuable.

CONCLUSION

Custom Sound Pro fitting software developed based on big data analysis incorporates a guided fitting workflow and expected fitting ranges. It helps to improve clinical efficiency, is easy to use and supports patient-centred care.

Guide to the preparation of speech reports for implanted children: opinion of specialists

PURPOSE

To develop a guide for the preparation of speech-language reports of implanted children to be shared among speech-language pathologists of cochlear implant (CI) services and rehabilitation professionals.

METHODS

The Delphi method was used to select the relevant and fundamental items that should be included in the two versions proposed for the guide: Guide 1 - Speech-language reports provided by the CI services to rehabilitators, and Guide 2 - Speech-language reports provided by the rehabilitators to CI services. Twenty-one speech therapists specialized and with experience in cochlear implants and auditory rehabilitation participated in the discussion and judgment of the items during the selection rounds. Consensus was considered when the item reached agreement equal to or greater than 80% among participants, being selected to compose the two guides.

RESULTS

After the two rounds, 21 items from Guide 1 reached consensus among therapists, that is, more than 80% of them agreed that these items should be present in the report sent by the CI service. For Guide 2, 22 items analyzed by speech therapists working in CI services in the postoperative sector were selected in the second round.

CONCLUSION

Based on the analysis of the two rounds, the "Guide for the preparation of speech-language pathology reports: intersection between CI service and rehabilitators" was developed. This material can be applied in the follow-up of implanted children, standardizing the information shared about the electronic device, evaluation results, monitoring of results and therapeutic process of this population.

American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children

This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child’s skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.

What Influences Decision-Making for Cochlear Implantation in Adults? Exploring Barriers and Drivers From a Multistakeholder Perspective

OBJECTIVES

To explore the factors influencing the uptake of cochlear implants in adults, determine the impact of each factor, and to conceptualize the journey to implantation from a multistakeholder perspective.

DESIGN

Concept mapping was used to integrate input from multiple stakeholders, each with their own experience and expertise. This mixed participatory method collects qualitative and quantitative data collection and enables further quantitative analysis. There were two participant cohorts: clients (cochlear implant recipients, candidates, and family members) and professionals (cochlear implant audiologists, ear, nose, and throat surgeons, administration staff, managers. and manufacturer representatives). A total of 93 people participated in the study: client cohort (n = 60, M age = 66.60 years) and professional cohort (n = 33, M age = 45.24 years). Participants brainstormed statements in response to the question "What influences people's decision to get/not get a cochlear implant?" They subsequently grouped the statements and named each group. They rated each statement as to its impact on the decision and prioritized the need for each to be changed/improved using a five-point Likert scale. Multidimensional scaling was used to produce a visual representation of the ideas and their relationship in the form of concepts. Further analysis was conducted to determine the differences between the cohorts, subcohorts, and concepts.

RESULTS

One hundred ten unique statements were generated and grouped into six concepts which either directly affected the client or their environment. These concepts were: external influences (awareness and attitude of non-implant professionals about uptake, cost, logistics, the referral pathway, public awareness); uncertainties, beliefs, and fears (fears, negative effect of word of mouth, unsuccessful previous ear surgery, cosmetics of the device, misunderstanding of how a cochlear implant functions, eligibility for an implant and outcomes after implantation); health problems (mental and physical health); hearing difficulties (social, emotional, and communication impacts of hearing loss, severity of hearing loss, benefit from and experience with hearing aids); implant professionals (implant team's attitude, knowledge and relationship with clients, quality of overall service); and goals and support (clients 'hearing desires and goals, motivation, positive impact of word of mouth, family support, having a cochlear implant mentor. The six concepts fell into two overarching domains: the client-driven domain with four concepts and the external domain with two concepts. The mean rating of concepts in terms of impact on a client's decision to get an implant ranged from 2.24 (external influences, the main barrier) to 4.45 (goals and support, the main driver). Ratings significantly differed between the client and professional cohorts.

CONCLUSIONS

This study increases our understanding of the factors, which influence a client's decision choose a cochlear implant as a hearing treatment. It also provides new information on the influence of the other stakeholders on the client journey. The magnitude of the generated statements in the client-driven domain highlights the pivotal role of individualized care in clinical settings in influencing a client's decision and the need for the professionals to understand a client's needs and expectations. A client's persistent hearing difficulties, goals, and support network were identified as drivers to the uptake of cochlear implants. However, the barriers identified highlight the need for a collaborative multi- and interdisciplinary approach to raise awareness in and educate non-implant hearing professionals about the cochlear implant process, as well as providing information to empower clients to make educated decisions and consider a cochlear implant as a hearing management option.

Predictors of hearing technology use in children

OBJECTIVE

To identify and describe predictors of daily hearing technology (HT) use in children.

DESIGN

Retrospective review of clinical records. Multiple regression analyses were performed to identify predictors.

STUDY SAMPLE

The sample included 505 children (<11 years of age) using hearing aids (HAs), cochlear implants (CIs), and bone conduction hearing devices (BCHDs).

RESULTS

Average HT use was 9.4 h a day. Bivariate analyses yielded 31 potential predictors from the 42 variables included. The general linear model (p < 0.01, R² = 0.605) identified 10 interacting factors that significantly associated with increased HT use. Intrinsic predictors of increased HT use included older chronological age, more severe degrees of hearing loss and older ages at diagnosis and initial HA fitting. Extrinsic predictors included the child's ability to independently use HT, at least one CI as part of the HT fitting, coordinated onsite audiological management, self-procured batteries, auditory-oral communication mode and regular caregiver intervention attendance.

CONCLUSIONS

Average HT use was high, approximating hearing hours of peers with normal hearing. CI recipients demonstrated higher HT use compared to children using other HT. The newly identified factors can predict and increase HT use in children while contributing to evidence-based intervention services that promote optimal auditory-based outcomes.

Empowering Senior Cochlear Implant Users at Home via a Tablet Computer Application

PURPOSE

The introduction of connectivity technologies in hearing implants allows new ways to support cochlear implant (CI) users remotely. Some functionalities and services that are traditionally only available in an in-clinic care model can now also be accessed at home. This study explores the feasibility of a prototype of a tablet computer application (MyHearingApp [MHA]) in a group of senior experienced CI users at home, evaluating usability and user motivation.

METHOD

Based on user feedback, a tablet computer application (MHA) for the Cochlear Nucleus 6 CP910 sound processor was designed implementing six different functionalities: (a) My Hearing Tests, (b) My Environment, (c) My Hearing Journey, (d) Tip of the Day, (e) Recipient Portal, and (f) Program Use and Events. The clinical evaluation design was a prospective study of the MHA in 16 senior experienced CI users. During 4 weeks, participants could freely explore the functionalities. At the end, the usability and their motivation for uptake and adherence were measured using a baseline and follow-up questionnaire.

RESULTS

Based on the System Usability Score (as part of the follow-up questionnaire), a good level of usability was indicated (M = 75.6, range: 62.5-92.5, SD = 8.6). The ability to perform hearing tests at home is ranked as the most relevant functionality within the MHA. According to the Intrinsic Motivation Inventory (Deci, Eghrari, Patrick, & Leone, 1994) questionnaire (as part of the follow-up questionnaire), participants reported high levels of interest and enjoyment, found themselves competent, and did not experience pressure while working with the app.

CONCLUSIONS

This study evaluated a tablet computer application (MHA) for experienced senior CI users by means of a prospective design, which provided novel insights into delivering CI care into the home of the CI user. The user feedback from this small-scale study suggests that the participants are open to take more responsibility for and to become a more active actor in their own hearing care, if only this is facilitated with the right tools. This may foster the evolution from a clinic-led to a more patient-centered care model, where CI users feel more empowered in the self-management of their hearing implant device.

Perspectives of adults with cochlear implants on current CI services and daily life

This paper reports on a survey and interviews carried out with adults who have gone through the cochlear implantation pathway. It explores their experiences of current services, the assessment process for implantation, and the impact on their daily lives, including views and experiences on communication, independence and confidence. It also explores, in today's financially challenging climate, their awareness of current funding issues and the value of their implant to them.

Multicentre Evaluation of the Naída CI Q70 Sound Processor: Feedback from Cochlear Implant Users and Professionals

The aim of this survey was to gather data from both implant recipients and professionals on the ease of use of the Naída CI Q70 (Naída CI) sound processor from Advanced Bionics and on the usefulness of the new functions and features available. A secondary objective was to investigate fitting practices with the new processor.

A comprehensive user satisfaction survey was conducted in a total of 186 subjects from 24 centres. In parallel, 23 professional questionnaires were collected from 11 centres.

Overall, there was high satisfaction with the Naída CI processor from adults, children, experienced and new CI users as well as from professionals. The Naída CI processor was shown as being easy to use by all ages of recipients and by professionals. The majority of experienced CI users rated the Naída CI processor as being similar or better than their previous processor in all areas surveyed. The Naída CI was recommended by the professionals for fitting in all populations. Features like UltraZoom, ZoomControl and DuoPhone would not be fitted to very young children in contrast to adults.

Positive ratings were obtained for ease of use, comfort and usefulness of the new functions and features of the Naída CI sound processor. Seventy-seven percent of the experienced CI users rated the new processor as being better than their previous sound processor from a general point of view. The survey also showed that fitting practices were influenced by the age of the user.