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Debruyne JA, Janssen AM, Brokx JPL. Systematic Review on Late Cochlear Implantation in Early-Deafened Adults and Adolescents: Clinical Effectiveness. Ear Hear 2021; 41:1417-1430. [PMID: 33136619 DOI: 10.1097/aud.0000000000000884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cochlear implantation in early-deafened patients, implanted as adolescents or adults, is not always advised due to poor expected outcomes. In order to judge whether such reluctance is justified, the current systematic review aimed to gather all available evidence on postoperative outcomes obtained by early-deafened patients using a state-of-the art cochlear implant (CI). DESIGN Five electronic databases (PubMed, Embase, the Cochrane library, CINAHL, and PsycInfo) were systematically searched for studies in English, French, German, or Dutch, published between 2000 and September 2017. Studies that reported pre- and postoperative outcomes on any measure of speech or sound perception, audiovisual or subjective benefit (quality of life) were included. Study quality was assessed with the Institute of Health Economics quality appraisal tool for case series studies. RESULTS The systematic search and subsequent full-text evaluation identified 38 studies meeting the inclusion criteria. Only a limited number of studies were judged to be of high quality according to the Institute of Health Economics tool, with lack of (clear) presentation of relevant study information being a recurring problem. Twenty-five studies presented viable outcomes on open-set speech understanding in quiet: mean postoperative scores obtained with CI remained below 50% for the vast majority of studies; significant postoperative improvements were found in 16 studies, although this number might have been higher if appropriate statistical testing had been performed in all studies. Eight studies observed increased audiovisual performance after implantation, which was statistically significant in six studies. A validated measure of hearing-related quality of life was used in only 5 of the 16 studies assessing subjective outcomes, showing significant postoperative improvements for most questionnaire domains. The relation between auditory and subjective outcomes was assessed in two studies, with contradictory results. CONCLUSIONS The current review showed that late cochlear implantation in early-deafened subjects resulted in significantly improved open-set speech perception, audiovisual speech perception, and (hearing-related) quality of life in the majority of the studies involved. Nonetheless, more and especially higher-quality research is needed in order to gain a more detailed understanding of the outcomes of cochlear implantation in this population.
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Affiliation(s)
- Joke A Debruyne
- Department of ENT/Audiology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Miranda Janssen
- Department of ENT/Audiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan P L Brokx
- Department of ENT/Audiology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center, Maastricht, The Netherlands
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Zaltz Y, Bugannim Y, Zechoval D, Kishon-Rabin L, Perez R. Listening in Noise Remains a Significant Challenge for Cochlear Implant Users: Evidence from Early Deafened and Those with Progressive Hearing Loss Compared to Peers with Normal Hearing. J Clin Med 2020; 9:jcm9051381. [PMID: 32397101 PMCID: PMC7290476 DOI: 10.3390/jcm9051381] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 01/17/2023] Open
Abstract
Cochlear implants (CIs) are the state-of-the-art therapy for individuals with severe to profound hearing loss, providing them with good functional hearing. Nevertheless, speech understanding in background noise remains a significant challenge. The purposes of this study were to: (1) conduct a novel within-study comparison of speech-in-noise performance across ages in different populations of CI and normal hearing (NH) listeners using an adaptive sentence-in-noise test, and (2) examine the relative contribution of sensory information and cognitive–linguistic factors to performance. Forty CI users (mean age 20 years) were divided into “early-implanted” <4 years (n = 16) and “late-implanted” >6 years (n = 11), all prelingually deafened, and “progressively deafened” (n = 13). The control group comprised 136 NH subjects (80 children, 56 adults). Testing included the Hebrew Matrix test, word recognition in quiet, and linguistic and cognitive tests. Results show poorer performance in noise for CI users across populations and ages compared to NH peers, and age at implantation and word recognition in quiet were found to be contributing factors. For those recognizing 50% or more of the words in quiet (n = 27), non-verbal intelligence and receptive vocabulary explained 63% of the variance in noise. This information helps delineate the relative contribution of top-down and bottom-up skills for speech recognition in noise and can help set expectations in CI counseling.
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Affiliation(s)
- Yael Zaltz
- The Department of Communication Disorders, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (Y.B.); (D.Z.); (L.K.-R.)
- Correspondence:
| | - Yossi Bugannim
- The Department of Communication Disorders, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (Y.B.); (D.Z.); (L.K.-R.)
| | - Doreen Zechoval
- The Department of Communication Disorders, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (Y.B.); (D.Z.); (L.K.-R.)
| | - Liat Kishon-Rabin
- The Department of Communication Disorders, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (Y.B.); (D.Z.); (L.K.-R.)
| | - Ronen Perez
- Department of Otolaryngology and Head and Neck Surgery, Shaare Zedek Medical Center Affiliated to The Hebrew University Medical School, Jerusalem 9190501, Israel;
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A Systematic Review of Cochlear Implant Outcomes in Prelingually-deafened, Late-implanted Patients. Otol Neurotol 2020; 41:444-451. [DOI: 10.1097/mao.0000000000002555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Forli F, Turchetti G, Giuntini G, Bellelli S, Fortunato S, Bruschini L, Barillari MR, Berrettini S. Cochlear implant in prelingually deafened oralist adults: speech perception outcomes, subjective benefits and quality of life improvement. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:416-422. [PMID: 29165436 PMCID: PMC5720870 DOI: 10.14639/0392-100x-1493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/11/2017] [Indexed: 11/23/2022]
Abstract
The aim of this study is to report our results in a group of prelingually deafened adults, who followed an oralist rehabilitation programme, and submitted to cochlear implant at our institution. We evaluated 30 prelingually deafened adult patients, 18 males and 12 females, median age 35 years, of a group of 36 prelingually deafened adult patients consecutively submitted to unilateral cochlear implantation at the ENT Unit of the University of Pisa. After implantation, patients achieved significant benefits in terms of speech perception skills, including the ability to have telephone conversations in some cases, quality of life and their own perception of disability. According to literature data, the results herein reported are quite variable but generally satisfactory. Procedures other than traditional speech perception measures should be used to evaluate the benefits of cochlear implant in such patients, to compressively evaluate the global benefits, not only in terms of speech perception, but also in terms of quality of life and daily life.
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Affiliation(s)
- F Forli
- ENT, Audiology and Phoniatric Unit, University of Pisa, Italy
| | - G Turchetti
- Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - G Giuntini
- ENT, Audiology and Phoniatric Unit, University of Pisa, Italy
| | - S Bellelli
- Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - S Fortunato
- ENT, Audiology and Phoniatric Unit, University of Pisa, Italy
| | - L Bruschini
- ENT, Audiology and Phoniatric Unit, University of Pisa, Italy
| | - M R Barillari
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Divisione di Audiologia e Foniatria, II Università di Napoli, Italy
| | - S Berrettini
- ENT, Audiology and Phoniatric Unit, University of Pisa, Italy.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 17177, Stockholm, Sweden
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Debruyne J, Janssen M, Brokx J. Late Cochlear Implantation in Early-Deafened Adults: A Detailed Analysis of Auditory and Self-Perceived Benefits. Audiol Neurootol 2018; 22:364-376. [PMID: 29953973 DOI: 10.1159/000488023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/26/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES It is known that early-deafened cochlear implant (CI) users are a very heterogeneously performing group. To gain more insight into this population, this study investigated (1) postoperative changes in auditory performance over time based on various outcome measures, focusing on poor performers, (2) self-perceived outcomes, (3) relations between auditory and self-perceived outcomes, and (4) preimplantation factors predicting postoperative outcomes. METHODS Outcomes were assessed prospectively in a group of 27 early-deafened, late-implanted CI users, up to 3 years after implantation. Outcome measures included open-set word and sentence recognition, closed-set word recognition, speech tracking and a questionnaire on self-perceived outcomes. Additionally, the relative influence of 8 preimplantation factors on CI outcome was assessed with linear regression analyses. RESULTS Significant improvements were found for auditory performance measures and most of the questionnaire domains. Significant changes of the closed-set word test, speech tracking and questionnaire were also found for a subgroup of poor performers. Correlations between auditory and self-perceived outcomes were weak and nonsignificant. Preoperative word recognition and preoperative hearing thresholds, both for the implanted ear, were significant predictors of postoperative outcome in the multivariable regression model, explaining 63.5% of the variation. CONCLUSIONS Outcome measurement in this population should be adjusted to the patients' individual performance level and include self-perceived benefit. There is still a need for more knowledge regarding predictors of CI outcomes in this group, but the current study suggests the importance of the preoperative performance of the ear to be implanted.
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Affiliation(s)
- Joke Debruyne
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Miranda Janssen
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Jan Brokx
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
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Watson V, Verschuur C, Lathlean J. Exploring the experiences of teenagers with cochlear implants. Cochlear Implants Int 2016; 17:293-301. [PMID: 28004611 DOI: 10.1080/14670100.2016.1257472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Teenage cochlear implant users' perceptions of deafness, surgery, fitting of the device and life as a cochlear implant wearer were explored in order to gain a more comprehensive understanding of teenagers' experiences of living with the device. METHODS Semi-structured in-depth interviews were undertaken and analysed using thematic analysis. Ten teenagers aged 14-16 years with at least one cochlear implant were interviewed. RESULTS Seven teenagers experienced great pre-operative anxiety and two reported significant post-operative pain. Four of the teenagers described a mismatch between their expectations and the disappointing reality of adjusting to the device. However, all the teenagers reported an enhanced sense of well-being as a result of being able to interact more easily with their world around them. The teenagers differed in the extent to which they identified with the hearing and deaf world. DISCUSSION Despite the early challenges, over time the teenagers experienced many functional and psychosocial benefits. Most felt their lives were now easier as a result of the cochlear implant(s). They described complex, flexible identities. CONCLUSIONS By giving prominence to the teenagers' voices this study has added new knowledge concerning their experience of surgery. The findings also more fully revealed the challenges of adjusting to the device and the impact of having a cochlear implant on the teenagers' identities. Clinical recommendations are made to address the gaps in service highlighted by these findings.
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Affiliation(s)
- Victoria Watson
- a Hearing and Balance Centre , ISVR, University of Southampton , UK
| | - Carl Verschuur
- b University of Southampton Auditory Implant Service , University of Southampton , UK
| | - Judith Lathlean
- c Faculty of Health Sciences , University of Southampton , UK
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Rey P, Cochard N, Rizzoli M, Laborde ML, Tartayre M, Mondain M, Deguine O. Technical aids for speech understanding in cochlear implanted adults using cell-phones. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:253-6. [PMID: 27183819 DOI: 10.1016/j.anorl.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The present study sought to assess (1) phone use habits and awareness of listening aids in adult cochlear implant bearers, and (2) objective and subjective benefit of listening aids for cell-phone communication. MATERIAL AND METHODS A questionnaire was sent to 17 cochlear (Cochlear(®)) implanted adults to assess phone use and awareness of available listening aids. Speech perception without lip-reading was assessed in silence and in noise using Fournier dissyllabic word lists recorded on an iPhone 5C(®), with and without listening aids. Subjective benefit was assessed according to listening aid system. RESULTS Sixty-five percent of adult cochlear implant bearers regularly used a phone with all kinds of correspondent. Eighty-eight percent phoned only in quiet conditions; 53% did not answer unknown callers; 71% never used listening aids. Speech discrimination scores for disyllabic words recorded on the phone were respectively 69%, 63%, 45% and 16% in quiet and 50, 60 and 70dB SPL noise. Speech perception in quiet and noise was improved by listening aids; the Roger system was the most beneficial, followed by the FM system, then the inductive system. CONCLUSION Listening aids are effective, but little known by adult cochlear implant bearers.
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Affiliation(s)
- P Rey
- Centre d'Implantation Cochléaire, place du Docteur-Baylac, TSA 4003, 31059 Toulouse cedex 9, France
| | - N Cochard
- Centre d'Implantation Cochléaire, place du Docteur-Baylac, TSA 4003, 31059 Toulouse cedex 9, France
| | - M Rizzoli
- Centre d'Implantation Cochléaire Montpellier Palavas, 34295 Montpellier cedex 5, France
| | - M-L Laborde
- Centre d'Implantation Cochléaire, place du Docteur-Baylac, TSA 4003, 31059 Toulouse cedex 9, France
| | - M Tartayre
- Centre d'Implantation Cochléaire, place du Docteur-Baylac, TSA 4003, 31059 Toulouse cedex 9, France
| | - M Mondain
- Centre d'Implantation Cochléaire Montpellier Palavas, 34295 Montpellier cedex 5, France.
| | - O Deguine
- Centre d'Implantation Cochléaire, place du Docteur-Baylac, TSA 4003, 31059 Toulouse cedex 9, France
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Rousset A, Dowell R, Leigh J. Receptive language as a predictor of cochlear implant outcome for prelingually deaf adults. Int J Audiol 2016; 55 Suppl 2:S24-30. [PMID: 27160793 DOI: 10.3109/14992027.2016.1157269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study investigated outcomes and predictive factors, specifically language skills, for a group of prelingually hearing-impaired adults who received a cochlear implant. DESIGN Speech perception data, demographic information, and other related variables such as communication mode, residual hearing, and receptive language abilities were explored. Pre- and post-implant speech perception scores were compared and multiple regression analysis was used to identify significant predictive relationships. STUDY SAMPLE The study included 43 adults with a prelingual onset of hearing loss, who proceeded with cochlear implantation at the Royal Victorian Eye and Ear Hospital in Melbourne, Australia. RESULTS The majority of patients experienced benefit from their cochlear implants, with 88% demonstrating significant improvement in speech perception performance. Volunteers achieved better post-operative speech perception scores if they had a shorter duration of severe-to-profound hearing loss, better language skills, and used an exclusively oral communication mode. CONCLUSIONS Although post-operative speech perception performance is significantly poorer for prelingually hearing-impaired adults compared to postlingually hearing-impaired patients, the study group demonstrated significant benefit from their cochlear implants. The variability in post-operative outcomes can be predicted to some extent from the hearing history and language abilities of the individual patient.
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Affiliation(s)
- Alexandra Rousset
- a Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital , Melbourne , Australia .,b The University of Melbourne , Australia , and.,c The Cooperative Research Centre for Cochlear Implant and Hearing Aid Innovation , Melbourne , Australia
| | - Richard Dowell
- a Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital , Melbourne , Australia .,b The University of Melbourne , Australia , and.,c The Cooperative Research Centre for Cochlear Implant and Hearing Aid Innovation , Melbourne , Australia
| | - Jaime Leigh
- a Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital , Melbourne , Australia .,b The University of Melbourne , Australia , and.,c The Cooperative Research Centre for Cochlear Implant and Hearing Aid Innovation , Melbourne , Australia
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Bosco E, Nicastri M, Ballantyne D, Viccaro M, Ruoppolo G, Ionescu Maddalena A, Mancini P. Long term results in late implanted adolescent and adult CI recipients. Eur Arch Otorhinolaryngol 2012. [PMID: 23179930 DOI: 10.1007/s00405-012-2264-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the present study is to assess long-term outcomes of CI in prelingual deafened adolescents and adults, describing, where present, differences in performance, self perceived benefit and highlighting specific characteristics. Twenty-three patients were enrolled: 10 adolescents, 13 young adults. Each patient underwent speech perception/language development, psychological evaluation and structured interviews on self perception concerning CI. 70 % adolescents and 100 % adults used their cochlear implant for most of the day; two adolescents were partial users and one was a non-user. Adolescents' average word recognition and comprehension scores improved respectively from 7 to 29.8 % (p = 0.01) and 3 to 26 % (p = 0.1). Adults' average scores improved significantly from 1.5 to 41.9 % (p = 0.01) and from 18.5 to 52.7% (p = 0.001), respectively. None of the subjects showed a linguistic age adequate to the chronological one: average linguistic age was 7.6 years for adolescents and 19.3 for adults. Structured interviews showed improvement in self-esteem. Adults and most adolescents were fully or moderately satisfied with their implant. Cochlear implantation can be considered a valid option for the rehabilitation of highly motivated and well-selected pre-lingual deafened adolescents and adults. Although there is a substantial variability in both groups of patients and language skills are only marginally influenced by CI, there is still a significant improvement in speech perception. CI was described by both groups as having had a positive impact on their lives; nevertheless adolescents were the ones with a tendency to under-use CI, even those with better hearing outcomes.
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Affiliation(s)
- Ersilia Bosco
- Department of Sensorial Organs, University Sapienza of Rome, Policlinico Umberto I Viale del Policlinico, 00161 Rome, Italy
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