From hearing aids to cochlear implants: The journey for private patients in New Zealand

OBJECTIVES

To understand adults' journey from hearing aids to cochlear implants (CIs).

METHODS

Qualitative, exploratory design using semi-structured interviews with twelve postlingually-deafened adults.

RESULTS AND DISCUSSION

All participants reported social isolation and/or depression. 'Not hearing well enough' was the most-common motivator to seek a CI. Due to the long wait for a public CI, they opted to pay for their implant privately. Funding was the most prominent barrier identified, with most participants using their own savings. The biggest struggle was in the period 3-months post switch-on. Many participants felt progress was slow and that they should have been doing better. After this period, benefits were most noted in quiet, with environmental sounds, and in helping them become more sociable. Music and telephone use were still areas many struggled with.

CONCLUSIONS

Participants reported the CI was worth the cost, that they would recommend it to others, and would do it again. Self-motivation was the biggest facilitator to success, with hearing professionals playing an integral role throughout the entire journey. There was a large variety of subthemes reflecting the diversity and individuality of the transition.

The suitability and readability of cochlear implant information brochures for potential adult recipients

OBJECTIVE

Adult cochlear implant (CI) candidates seeking to make an informed decision about cochlear implantation can find themselves needing to quickly understand large volumes of complex information provided by different professionals in different formats. This study investigates the suitability, within a health literacy context, of one of those sources of information: the CI brochure.

DESIGN

A single-observation design.

STUDY SAMPLE

Thirty English passages of approximately 100-words each were sampled from 15 sections of seven CI brochures. All brochures were readily available to the general public on the Australian websites of four CI manufacturers at the time of the analysis (June 2019).

RESULTS

Analyses by two examiners using the Suitability Assessment of Materials (SAM) classified all 15 sections from all seven CI brochures as being "not suitable" for general, adult readers. Analyses by the same examiners using four readability formulae (Flesch Reading Ease Scale, Fry Readability Graph, Flesch-Kincaid Readability Formula, and the Fog index) showed sampled passages from the 15 sections were written at a level best suited for persons with 10 to 14 years of schooling.

CONCLUSIONS

Brochures intended for adult CI candidates should be revised to improve their suitability and readability for adult CI candidates. Specific recommendations are suggested.

Music Training for Children With Sensorineural Hearing Loss Improves Speech-in-Noise Perception

Purpose A growing body of evidence suggests that long-term music training provides benefits to auditory abilities for typical-hearing adults and children. The purpose of this study was to evaluate how music training may provide perceptual benefits (such as speech-in-noise, spectral resolution, and prosody) for children with hearing loss. Method Fourteen children aged 6-9 years with prelingual sensorineural hearing loss using bilateral cochlear implants, bilateral hearing aids, or bimodal configuration participated in a 12-week music training program, with nine participants completing the full testing requirements of the music training. Activities included weekly group-based music therapy and take-home music apps three times a week. The design was a pseudorandomized, longitudinal study (half the cohort was wait-listed, initially serving as a passive control group prior to music training). The test battery consisted of tasks related to music perception, music appreciation, and speech perception. As a comparison, 16 age-matched children with typical hearing also completed this test battery, but without participation in the music training. Results There were no changes for any outcomes for the passive control group. After music training, perception of speech-in-noise, question/statement prosody, musical timbre, and spectral resolution improved significantly, as did measures of music appreciation. There were no benefits for emotional prosody or pitch perception. Conclusion The findings suggest even a modest amount of music training has benefits for music and speech outcomes. These preliminary results provide further evidence that music training is a suitable complementary means of habilitation to improve the outcomes for children with hearing loss.

The Role of Music in Families of Children With Hearing Loss and Normal Hearing in Australia, Finland, and the UK

The primary aim of this current study was to compare the role, importance and value placed on music by families with normally hearing (NH) children, to those who had a child with a hearing loss (HL) who wore either hearing aids and/or cochlear implants. A secondary aim was to see whether this differed between the countries. Parents of children aged 2-6 years living in Australia, Finland, and the United Kingdom were invited to complete the Role of Music in Families Questionnaire (RMFQ). Two groups of participants were recruited from each country: (i) parents of NH children, and (ii) parents of children with a HL. The RMFQ had seven subsections covering topics such as music participation, attitudes to music, importance of music in the family, and future perspectives on music. Three hundred and twenty-two families of NH children, and 56 families of children with HL completed the questionnaire (Australia: 50 NH, 25 HL; Finland: 242 NH, 21 HL; United Kingdom: 30 NH, 10 HL). Analyses compared between NH and HL groups within each country, and between the three countries for the NH group, and the HL group, independently. Overall, there were few significant differences between the participation levels, role, or importance of music in families with NH children compared to those with a child who had a HL, regardless of whether the families lived in Australia, Finland or the United Kingdom. Children first started to respond to music at similar ages, and overall music participation frequency, and music enjoyment were relatively similar. The importance of music in the family was also similar between the NH and HL groups. In comparing between the countries, Finnish children had a tendency to have higher participation rates in musical activities, with few other differences noted. Overall, the results of this study indicate that children, regardless of hearing levels or country of residence, have similar levels of music engagement and enjoyment, and HL is not seen as a contraindication to music participation and involvement by the parents involved in this study.

Speech Recognition Outcomes After Cochlear Reimplantation Surgery

This study compares speech recognition outcomes before and after cochlear reimplantation surgery, in relation to clinical factors known before and at time of surgery. Between 2006 and 2015, 2,055 adult cochlear implant surgeries were conducted at this center, of which 87 were reimplantation surgeries (4.2%). Speech recognition scores (SRS) assessed before and after reimplantation were available for 54 adults. Overall, SRS measured after reimplantation were similar to the best SRS obtained by the patient and greater than the last SRS measured before surgery. Additional complications were noted in the clinical files of all patients for which reimplantation was considered unsuccessful (16%).

Pitch and lexical tone perception of bilingual English-Mandarin-speaking cochlear implant recipients, hearing aid users, and normally hearing listeners

OBJECTIVES

The purpose of this current study was to investigate whether pitch, lexical tone, and/or speech-in-noise perception were significantly correlated for Singaporean teenagers or adults who spoke both Mandarin and English.

METHODS

Thirty-three normal hearing or near-normal hearing listeners who did not use a hearing device (NNH group), eight postlingually deafened cochlear implant (CI) recipients (CI group), and three postlingually deafened bilateral hearing aid (HA) users (HA group) were recruited. All participants were bilingual Mandarin-English-speaking Singaporean residents. Participants were assessed on tests of pitch-ranking, lexical tone perception, and speech-in-noise.

RESULTS

The NNH group scored significantly better than the CI group for all tests and subtests. There were no significant differences for the pitch test between the HA group and either the CI or NNH group. However, HA users scored significantly better than the CI group, and more aligned with the NNH group's scores for both the lexical tone and Mandarin speech-in-noise test. There were highly significant moderate positive correlations between all three tests. Discussion Overall, the performance of the CI users in this study indicates that CI recipients still struggle on pitch-related auditory perception tasks. Additionally, although the test scores from the HA users were better than the CI recipients, they were not as good as the NNH listeners. The significant moderate correlations between all three tests indicate that there is at least some degree of overlap in the skills required to accurately perceive these stimuli.

CONCLUSION

The overall results suggest that CI users, and to a lesser extent HA users, still struggle with complex auditory perceptual tasks, particularly when it requires the perception of pitch. However, it may be possible that training one of these skills (e.g. musical pitch) may then generalize to other tasks (e.g. lexical tone and/or speech-in-noise). This is important for counseling, as well as for planning effective rehabilitation programs.

A multicentre clinical evaluation of paediatric cochlear implant users upgrading to the Nucleus(®) 6 system

OBJECTIVES

The aim of this study was to investigate whether experienced paediatric cochlear implant users could show benefits to speech perception outcomes from the introduction of noise reduction and automated scene classification technologies as implemented in the Nucleus(®) 6 sound processor. Previous research with adult cochlear implant users had shown significant improvements in speech intelligibility for listening in noisy conditions and good user acceptance for upgrading to the Nucleus 6 processor. In adults, these improvements for listening in noise were primarily attributed to the use of a range of new input processing technologies including noise reduction, as well as introduction of automatic scene classification technology.

METHODS

Experienced paediatric cochlear implant users (n=25) were recruited from four clinics located in three countries. Research participants were evaluated on three occasions, an initial session using their Nucleus 5 sound processor; a second session in which participants used the Nucleus 6 processor programmed with the same technologies as were used in their Nucleus 5 sound processor; and a final session in which participants used the Nucleus 6 processor programmed with the default technologies including automatic scene classification (SCAN) which automatically selects the microphone directionality, noise reduction (SNR-NR), and wind noise reduction (WNR) technologies. Prior to both the second and third evaluations, research participants had approximately two weeks take-home experience with the new system. Speech perception performances on monosyllabic word tests presented in quiet and in noise, and a sentence test presented in noise, were compared across the three processor conditions. Acceptance of the Nucleus 6 default settings was assessed in a final session.

RESULTS

No group mean difference in performance was found for monosyllabic words in quiet. A significant improvement in speech perception was found for both monosyllabic words and sentences in noise with the default Nucleus 6 program condition as compared with the Nucleus 5 condition. No acceptance issues were noted for any of the children.

CONCLUSIONS

Experienced paediatric cochlear implant users showed a significant improvement in speech perception in listening in noise when upgraded to the Nucleus 6 sound processor primarily due to the introduction of a noise reduction technology, and all children accepted the default program. These findings suggest that school-aged children may benefit from upgrading to the Nucleus 6 sound processor using the default program.

Quality of life outcomes for children with hearing impairment in Singapore

OBJECTIVES

This study aimed to investigate the hearing-related quality of life (hearing-QOL) of children with hearing loss in Singapore using hearing aids (HAs) and/or cochlear implants (CIs). Their health-related QOL (health-QOL) as well as their families' health-QOL were compared with normally hearing (NH) children and their families.

METHODS

This cross-sectional study recruited families (i.e., children aged 2-18 years and their parents) of NH children (n=44), children wearing HAs (n=22) and children wearing CIs (n=14). Hearing-QOL was assessed using the parent-reported Children Using Hearing Devices QOL questionnaire. General health-QOL was assessed using parent and child-reported measures from the PedsQL inventory consisting of the Generic Core Scales, General Well-being Scale and Family Impact Module. The questionnaires were self-administered for children aged 8-18 years, and interviewer-administered for children aged 5-7 years.

RESULTS

The NH children and their families had significantly higher general health-QOL scores compared to the children with hearing loss and their families. This indicates that hearing loss significantly impacts on the well-being of children and their families. Congruence between parent and child reports was only observed in the NH group. Parents of children wearing HAs rated their child's overall hearing-QOL significantly higher than parents of children wearing CIs. Family household income was the only significant predictor of child hearing-QOL scores with parents from the middle income families rating their child's hearing-QOL significantly poorer than parents from high income families.

CONCLUSION

Overall, NH children and their families have higher self-rated general health-QOL than children with hearing loss and their families, with children using HAs providing higher hearing-QOL than those using CIs. Evaluating both general health and hearing specific QOL from both the child and their parent/caregiver is worthwhile, allowing a more holistic measure of real-life outcomes and better individualised clinical care.

Melodic Contour Training and Its Effect on Speech in Noise, Consonant Discrimination, and Prosody Perception for Cochlear Implant Recipients

Cochlear implant (CI) recipients generally have good perception of speech in quiet environments but difficulty perceiving speech in noisy conditions, reduced sensitivity to speech prosody, and difficulty appreciating music. Auditory training has been proposed as a method of improving speech perception for CI recipients, and recent efforts have focussed on the potential benefits of music-based training. This study evaluated two melodic contour training programs and their relative efficacy as measured on a number of speech perception tasks. These melodic contours were simple 5-note sequences formed into 9 contour patterns, such as "rising" or "rising-falling." One training program controlled difficulty by manipulating interval sizes, the other by note durations. Sixteen adult CI recipients (aged 26-86 years) and twelve normal hearing (NH) adult listeners (aged 21-42 years) were tested on a speech perception battery at baseline and then after 6 weeks of melodic contour training. Results indicated that there were some benefits for speech perception tasks for CI recipients after melodic contour training. Specifically, consonant perception in quiet and question/statement prosody was improved. In comparison, NH listeners performed at ceiling for these tasks. There was no significant difference between the posttraining results for either training program, suggesting that both conferred benefits for training CI recipients to better perceive speech.

A global patient outcomes registry: Cochlear paediatric implanted recipient observational study (Cochlear(™) P-IROS)

BACKGROUND

Currently, there is a paucity of data concerning the long-term outcomes, educational placement and quality of life of children implanted with hearing devices from large and representative samples of the population. To address this concern, a large, prospective, multicentre, multinational patient-outcomes registry for paediatric recipients of implantable hearing devices was developed. The benefits of this registry, its approach and methodology are described.

METHODS/DESIGN

The Cochlear(™) Paediatric Implanted Recipient Observational Study (Cochlear P-IROS) is a prospective international patient-outcomes registry for children who are implanted in routine clinical practice with one or more hearing devices. The study aims to collect data on patient comorbidities, device use, auditory performance, quality of life and health-related utilities, across different types of implantable hearing devices from a range of manufacturers. Patients will be evaluated with a set of standardised and non-standardised questionnaires prior to initial device activation (baseline) and at six-monthly follow-up intervals up to 24 months and annually thereafter. The Cochlear P-IROS utilises a secure web interface to administer electronic case report forms to clinicians and families of implanted children. The web interface is currently available in five languages: English, Japanese, Korean, Mandarin and Russian. The interface also provides printable versions of the case report forms translated into 22 local languages for collection of data prior to entry online; additional languages may be added, as required. Participation in the Cochlear P-IROS registry is investigator-driven and voluntary. To date, the Cochlear P-IROS has recruited implant clinics across Australia, China, India, Indonesia, Turkey and Vietnam. The registry also aims to recruit multiple clinics in Cuba, Israel, Japan, Malaysia, Singapore, South Africa, South Korea and Russia.

DISCUSSION

The use of a registry such as the Cochlear P-IROS will generate valuable data to support research interests of academics and clinicians around the globe. The data generated will be relevant for a wide range of stakeholders including regulators, payers, providers, policy makers, patients and their families, each with a different perspective for the acceptance and adoption of implantable hearing devices for the treatment of hearing loss.

MUSIC APPRECIATION AND TRAINING FOR COCHLEAR IMPLANT RECIPIENTS: A REVIEW

In recent years, there has been increasing interest in music perception of cochlear implant (CI) recipients, and a growing body of research conducted in this area. The majority of these studies have examined perceptual accuracy for pitch, rhythm, and timbre. Another important, but less commonly studied aspect of music listening is appreciation, or appraisal. Despite the ongoing research into potential technological improvements that may improve music perception for recipients, both perceptual accuracy and appreciation generally remain poor for most recipients. Whilst perceptual accuracy for music is important, appreciation and enjoyment also warrants research as it also contributes to clinical outcomes and perceived benefits. Music training is being shown to offer excellent potential for improving music perception and appreciation for recipients.Therefore, the primary topics of this review are music appreciation and training. However, a brief overview of the psychoacoustic, technical, and physiological factors associated with a recipient's perception of music is provided, as these are important factors in understanding the listening experience for CI recipients. The purpose of this review is to summarize key papers that have investigated these issues, in order to demonstrate that i) music enjoyment and appraisal is an important and valid consideration in evaluating music outcomes for recipients, and ii) that music training can improve music listening for many recipients, and is something that can be offered to persons using current technology.

Environmental sound perception of cochlear implant users

The purposes of this study were (1) to develop a new test of environmental sound perception, the Environmental Sounds Perception Test (EST), (2) to compare the performance of experienced cochlear implant (CI) recipients with that of age-equivalent normally hearing (NH) listeners using this new test, and (3) to pilot test its clinical use as a pre-to-post assessment tool. The closed-set EST consisted of 45 different sounds classified into 9 categories, with each sound being represented by 2 different tokens. The results showed that the NH participants scored significantly higher than the experienced CI users (p<0.001). For the pre-to-post CI group, higher scores were obtained post-surgery with the CI; this difference was approaching significance (p=0.068). Overall these results suggest that CI recipients perform poorer than NH participants on the EST but better than hearing-aid users with a similar level of hearing loss.

Quality-of-life outcomes for adult cochlear implant recipients in New Zealand

AIM

There were two aims to this study: to investigate the effect of a cochlear implant (CI) on quality-of-life (QOL) for adult recipients in New Zealand; and to determine which aspects of life that these changes are most noticed.

METHOD

There were two groups of participants: CI Group - 94 postlingually deafened adult CI recipients; and WL group - 70 postlingually deafened adults on the waiting list (WL) for a CI. Two questionnaires were developed for this study.

RESULTS

The results showed that cochlear implantation had a significant positive impact on QOL for recipients. The CI group had significantly higher ratings in all areas of QOL and satisfaction compared to the WL group.

CONCLUSION

Overall, high QOL and satisfaction ratings were obtained from CI recipients. The significantly lower ratings from those on the WL for an implant highlight the difficulties experienced by those with a significant hearing impairment. Assessment of CI outcomes should include QOL measures in order to provide a more holistic picture.

Comparisons of Quality Ratings for Music by Cochlear Implant and Hearing Aid Users

OBJECTIVES

This study aimed to compare the quality ratings by cochlear implant (CI) and hearing aid (HA) users in response to musical sounds.

DESIGN

The ratings of 15 experienced adult Nucleus CI users (using the Advanced Combination Encoder (ACE) or Spectral Peak (SPEAK) strategy) were compared with those of 15 experienced adult HA users who met the audiological criteria for implantation. Additionally, nine subjects on the waiting list (WL) for an implant were tested before and after implantation. Three types of musical stimuli were used: single instruments, solo instruments with background accompaniment, and ensembles. For each of these categories, 12 different instruments or ensembles were presented four times each. Subjects were asked to provide a rating out of 10 according to how pleasant each extract sounded, with 10 being "very pleasant."

RESULTS

For the WL subjects, ratings provided after implantation were significantly higher than their preimplant ratings obtained when using HAs (p = 0.026). This was consistent with a trend observed from the experienced CI and HA groups, whereby the CI group provided higher ratings than the HA group for all three subtests, although the difference was not statistically significant. For all groups, single-instrument stimuli received significantly higher ratings than those involving multiple instruments (CI and HA subjects: p < 0.001; WL subjects: p = 0.034). With this research being part of a larger study in which identification testing of these stimuli had previously been conducted, significant correlations were also obtained between the subjects' ability to identify musical stimuli and the corresponding quality ratings (CI: rho = 0.325, p = 0.029; HA: rho = 0.491, p = 0.001).

CONCLUSIONS

The findings of this study suggest that although neither device enables highly satisfactory music appreciation, the CI users judged music to sound more pleasant than the HA users (who had similar levels of hearing impairment). Also, all subject groups appraised music that involved multiple instruments to sound less pleasant, on average, than music played by single instruments.