Meta-analysis of quality-of-life improvement after cochlear implantation and associations with speech recognition abilities

Low-frequency pitch sensitivity and speech perception performance in adult cochlear implant users fitted with fine structure strategies

PURPOSE

Cochlear implant (CI) users may perceive pitch changes via repetition rate (RP) and place-of-stimulation (PP) coding mechanisms. This study investigated whether CI users fitted with fine structure (FS) strategies can discriminate low-frequency (LF) pitch changes via RP and whether RP performers show better speech recognition than PP performers.

METHODS

Thirty postlingually deafened adult CI users (15 unilateral, 15 bilateral) participated in this study. LF pitch discrimination linked to temporal fine structure (TFS) sensitivity was assessed with the Disharmonic Intonation test (A§E psychoacoustic test suite), while speech perception was evaluated with phonetically balanced words and everyday sentences (both in quiet and noise), and the Italian Matrix test (in adaptive mode).

RESULTS

Just noticeable differences (JNDs) in RP performers were significantly better compared to PP JNDs (p < 0.001, r = 0.80). No significant differences were found between unilateral and bilateral CI users for LF pitch perception (p > 0.05). Within-group comparisons (better ear versus bilateral listening) revealed that better ear JNDs were not significantly different from the bilateral performance (p > 0.05), whereas significant bilateral benefit was observed for word recognition score (WRS) + 10 (p = 0.016, r = 1.00), WRS + 5 (p = 0.021, r = 1.00), and Matrix performance (p = 0.033, r = 0.80). Speech recognition in noise was significantly better in RP performers compared to PP performers across multiple tests, including WRS + 10 (p = 0.002, r = 0.90), WRS + 5 (p = 0.001, r = 0.90), and the Matrix test (p = 0.03, r = 0.60).

CONCLUSION

These findings highlight the advantages of FS coding strategies in improving TFS sensitivity and speech perception in complex listening environments.

Investigating Bimodal Fitting Solutions in Children

PURPOSE

The effectiveness of a dedicated bimodal hearing aid and fitting formula was investigated in pediatric cochlear implant recipients who were experienced Desired Sensation Level (DSL) v5.0 users.

METHOD

In Experiment 1, five children assessed four hearing aid fittings based on combinations of fitting formula (Adaptive Phonak Digital Bimodal [APDB], DSL v5.0, APDB fit to DSL v5.0 targets), hearing aid type (dedicated hearing aid for bimodal listeners, independent hearing aid), and/or prescriptive targets. Speech recognition scores were obtained in a sound booth in quiet and in noise. In Experiment 2, two participants from Experiment 1 were retested with an updated bimodal system.

RESULTS

Bimodal speech recognition in quiet in both experiments was similar across all fitting formulas. In Experiment 1, bimodal speech recognition in noise was similar across fitting formulas; however, both in noise and in quiet, individual differences were observed. In Experiment 2, optimized APDB improved speech recognition in noise performance compared to APDB and similar performance compared to DSL v5.0 in a small set of bimodal listeners.

CONCLUSION

Preliminary results point to the value of individualized selection of hearing aid fitting formula settings for pediatric bimodal recipients.

Factors Associated with Preoperative Patient Expectations in the Cochlear Implant Evaluation Process

OBJECTIVE

To determine what factors are associated with patients' preoperative expectations of their postimplantation experience with their cochlear implant devices.

STUDY DESIGN

A retrospective review of data from a prospectively maintained cochlear implant database was conducted.

SETTING

Tertiary, academic hospital.

PATIENTS

Adult patients who underwent a cochlear implant candidacy evaluation and completed the CIQOL-Expectations validated instrument were included.

RESULTS

Age was found to have a weak association with increased expectations in some domains of the CIQOL-Expectations. There were some very weak associations identified between a patient's baseline functional ability and their expectations in the corresponding domain. However, no modifiable variable included in the current analysis was found to have an association with patient expectations.

CONCLUSION

Understanding patient expectations is a critical part of the success of medical interventions such as cochlear implantation. However, they are complex and likely multifactorial, and future studies are needed to look at other potential variables that may contribute to their formation.

Evaluating Patient Motivation Behind Device Removal in Cochlear Implant Patients

OBJECTIVE

To assess indications behind cochlear implant (CI) removal without subsequent re-implantation.

PATIENTS

Patients who underwent CI explantation between January 2013 and December 2022.

INTERVENTIONS

Explantation of CI device without ipsilateral re-implantation.

MAIN OUTCOME MEASURES

Indications for and audiometric testing before CI explantation.

RESULTS

Within a cohort of 743 CI patients, 35 patients (5%) underwent implant revision. A total of 16 patients (2%) underwent explantation without ipsilateral re-implantation (mean age of 51 yr [SD, 23]), and 19 (3%) underwent explantation followed by re-implantation (mean age of 51 yr [SD, 18]). The average time between CI insertion and removal was 56 months (SD, 72). Six explantations (6 of 16 [37.5%]) were due to infectious complications: 2 (13%) did not undergo re-implantation given severe life-threatening comorbidities, 1 (6%) underwent simultaneous contralateral implantation, 1 (6%) experienced insurance barriers preventing re-implantation, and 2 (13%) were lost to follow-up. Ten patients (10 of 16 [62.5%]) underwent device removal for noninfectious indications, including 6 (38%) with non-audiologic symptoms attributed to CI, 3 (19%) who required repeated MRIs and desired avoidance of peri-imaging procedures, and 1 (6%) who had poor audiometric outcomes due to cochlear ossification. Patients who were not re-implanted performed worse on AzBio (35% versus 59%; p = 0.10) and CNC testing (27% versus. 70%; p = 0.02) after initial successful implantation compared with those who did undergo re-implantation.

CONCLUSIONS

Patients undergo explantation for a variety of reasons, with ill-defined symptoms being the motive in over half of the cases. These desires are compounded by poor postoperative audiometric performance, which likely hinders the patient's desire to undergo re-implantation.

Speech Outcomes of Cochlear Implantation, from 1983 to Present: A Systematic Review

OBJECTIVE

We sought to assess whether the totality of advancements seen in cochlear implant (CI) design and implementation have translated to significant improvements in speech perception scores.

DATABASES REVIEWED

EMBASE, PubMed/MEDLINE, and the Cochrane Central Register of Controlled Trials.

METHODS

A systematic review of all English-language studies in peer-reviewed journals from 1946 to August 2022 was performed based on the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were of adult patients who underwent cochlear implantation with Cochlear®, Med-EL, or Advanced Bionics devices with 12 months postoperative sentence recognition testing results. Meta-regression was performed to assess the relationship between speech recognition score and year of implantation. Preimplantation score and unilateral versus bilateral implantation were adjusted for. Subgroup analysis was performed by restricting to studies of <5 years duration and in which outcomes were measured ≤12 months postoperatively to reduce the likelihood of patients with remotely implanted devices having undergone upgrades to more contemporary coding software.

RESULTS

A total of 37 studies met criteria for inclusion, representing CIs implanted between 1983 and 2019. No significant association was identified between median study year and scores on 12-month postoperative sentence recognition testing on any of AzBio in quiet, CNC words, or HINT sentences in quiet. Subgroup analysis showed no difference in outcomes across 15 studies including patients implanted from 2007 to 2019.

CONCLUSION

In the absence of improved CI coding strategies since 2007, speech recognition outcomes in quiet have also not improved significantly since this time.

Functional Benefits of Behind-the-Ear Processors Compared With Off-the-Ear Processors in Adult Cochlear Implant Users

OBJECTIVE

Cochlear implant (CI) devices are fitted with two external processor styles-a behind-the-ear (BTE) or an off-the-ear (OTE) option. Although previous research has predominantly focused on speech recognition abilities between processor styles, the current study aims to examine the potential real-world functional differences between processor types.

STUDY DESIGN

Retrospective case-control, matched at a 1:2 ratio.

SETTING

Tertiary Otolaryngology Referral Center.

PATIENTS

Patients with bilateral sensorineural hearing loss.

INTERVENTION

Cochlear implantation.

MAIN OUTCOME MEASURES

Cochlear Implant Quality of Life 35 Profile (CIQOL-35 Profile), and CNC word (CNCw) and AzBio sentence (quiet) recognition.

RESULTS

A total of 36 patients were included (n = 12 OTE and n = 24 BTE users). The overall study population demonstrated improvements in CNCw ( d = 1.9 [1.3, 2.4]), AzBio sentences in quiet ( d = 2.1 [1.5, 2.6]), and medium-to-large effect sizes for domains of the CIQOL-35 ( d range: 0.5-0.9) after cochlear implantation. Between-group analysis demonstrated that BTE users performed better in CNCw ( d = 0.4 [-0.3, 1.1]) and AzBio quiet ( d = 0.5 [-0.2, 1.2]) than their OTE counterparts. However, there were minimal differences identified between processor types based on CIQOL domain and global scores ( d range: 0.04-0.2).

CONCLUSION

BTE users may have a better speech recognition ability than their OTE counterparts. However, CIQOL domain and global scores are comparable between the two processor types. A prospective, randomized controlled trial will be needed to address the limitations of a retrospective analysis.

Elective Versus Corrective Cochlear Implant Revision Surgery of Legacy Internal Devices

OBJECTIVE

To assess the time course of speech recognition restoration for recipients of legacy devices who underwent cochlear implant revision (CIR) surgery in the presence or absence of device failure.

STUDY DESIGN

Retrospective review.

SETTING

Tertiary academic referral center.

PATIENTS

Forty-four adult recipients of a first- or second-generation internal device who underwent CIR surgery.

INTERVENTIONS

Cases were categorized by whether the CIR surgery was elective (n = 18) or corrective due to a hard (n = 7) or soft (n = 19) failure.

MAIN OUTCOME MEASURES

Aided consonant-nucleus-consonant (CNC) word recognition scores were queried for the following visits: best performance pre-CIR and 3, 6, and 12 months post-CIR. A linear mixed effects model evaluated the main effects of visit, CIR category, and age at CIR surgery, and the interaction of interval and revision category on CNC scores.

RESULTS

Limited surgical challenges were reported (n = 4), which included one case of incomplete insertion of the new device. Post-CIR CNC scores were similar to the best pre-CIR scores by 6 months post-CIR ( p = 0.055). There was a significant effect of age ( p = 0.006), with better performance observed for younger adults. The time course of speech recognition restoration post-CIR did not differ significantly for cases of corrective CIR due to hard or soft failures or elective CIR ( F(2,40) = 0.08, p = 0.923).

CONCLUSIONS

Legacy CI users who undergo corrective or elective CIR may experience a similar time course in restoration of speech recognition post-CIR. Legacy device recipients considering elective CIR to access technology upgrades should be counseled on the associated potential risks and benefits.

Clinical Outcomes for Adult Single-Sided Deafness Cochlear Implantees Exceeding the 5% Candidacy Criterion

OBJECTIVES

While single-sided deafness cochlear implants (SSD-CIs) have now received regulatory approval in the United States, candidate-ear candidacy criteria (no better than 5% word-recognition score) are stricter than for traditional CI candidates (50 to 60% speech recognition, best-aided condition). SSD implantation in our center began before regulatory approval, using a criterion derived from traditional candidacy: 50% consonant-nucleus-consonant (CNC) word-identification score in the candidate ear. A retrospective analysis investigated whether SSD patients exceeding the 5% CNC criterion nevertheless benefitted from a CI as assessed by spatial-hearing tests (speech understanding in noise [SIN] and localization) and by a patient-reported outcome measure quality-of-life instrument validated for patients with CIs.

DESIGN

A retrospective chart review assessed the clinical experience of a single CI center. Subjects consisted of 27 adult CI recipients with SSD (N = 21) or asymmetric hearing loss (AHL; N = 6) implanted since September 2019 with at least 3 months of postoperative follow-up. Patients with revision surgery or simultaneous labyrinthectomy and CI surgery were excluded from the sample. Subjects were divided into 2 groups based on preoperative CNC scores measured under best-aided conditions with a behind-the-ear hearing aid in the sound field at 0.9 m from a front loudspeaker, and the better ear masked using an insert earphone with 45 dB HL speech-weighted noise. The "MEETS" group had preoperative CNC word scores <5%; the "EXCEEDS" group had scores >5%. The clinical protocol also included intelligibility tests using AzBio sentences in the same test conditions as CNC; binaural spatial testing (broadband-noise sound localization, and matrix-sentence speech-reception thresholds in spatially separated noise) using a custom-built 7-speaker array; and the CI Quality of Life (CIQOL) instrument. To evaluate CI benefit, preoperative unaided performance was compared with postoperative binaural (acoustic ear + CI ear) performance at a clinic visit closest to 6 months postsurgery.

RESULTS

Of 27 SSD-CI recipients, 11 subjects exceeded the 5% preoperative CNC candidacy criterion. Both the MEETS and EXCEEDS groups improved significantly on all 5 primary study outcome measures (CI-alone CNC and AzBio, binaural SIN and sound localization, and CIQOL). The only statistically significant differences observed between the MEETS and EXCEEDS groups were that preoperative CNC and AzBio scores were significantly higher for the EXCEEDS group, as expected given that the groups were defined based on preoperative speech-perception scores in quiet. There were no statistically significant differences between the MEETS and EXCEEDS groups in postoperative scores in any test or in the magnitude of the improvement from preoperative to postoperative assessment.

CONCLUSIONS

SSD- and AHL-CI recipients exceeding the 5% CNC preoperative candidacy criterion significantly improved in CI-alone speech perception, spatial hearing, and subjectively reported CIQOL outcomes and the observed benefits were indistinguishable from SSD- and AHL-CI recipients who met the 5% criterion. A less-restrictive SSD-CI and AHL-CI candidacy criterion should be considered, and larger-scale clinical trials to evaluate CI efficacy using a less-stringent candidate-ear criterion are warranted.

Cochlear Implant Outcomes: A Focused Way of Looking at Speech Perception and Health-Related Quality of Life

INTRODUCTION

The relationship between health-related quality of life (HRQoL) and speech perception in cochlear implant (CI) users is inconsistent across existing research. To investigate this relationship, we assessed HRQoL using the Glasgow Benefit Inventory (GBI) and speech perception using the Minimum Speech Test Battery (MSTB). The present study proposes an additional subscore to the GBI: CI global outcomes.

METHODS

Seventeen bimodal CI users between the ages of 55 and 85 years participated in the study. All participants completed the GBI as well as the MSTB (e.g., AzBio sentence test in quiet and noise, the Bamford-Kowal-Bench Speech-in-Noise test [BKB-SIN], and the Consonant-Nucleus-Consonant test [CNC]). Correlations were calculated between HRQoL and speech perception measures.

RESULTS

Improvement in QoL as measured by the GBI CI global outcomes subscore significantly related to better performance on the AzBio in noise. No other significant relationships between the GBI and CI speech perception ability were observed.

CONCLUSION

CI global outcomes significantly related to speech perception ability in noise (AzBio), suggesting that this novel metric may be useful for capturing bimodal CI patient-reported outcomes.

Cochlear Implant Electrode Placement and Music Perception

Importance

Cochlear implants enable improvements in speech perception, but music perception outcomes remain variable. Image-guided cochlear implant programming has emerged as a potential programming strategy for increasing the quality of spectral information delivered through the cochlear implant to improve outcomes.

Objectives

To perform 2 experiments, the first of which modeled the variance in music perception scores as a function of electrode positioning factors, and the second of which evaluated image-guided cochlear implant programming as a strategy to improve music perception with a cochlear implant.

Design, Setting, and Participants

This single-center, prospective study recruited 50 adult patients with at least 6 months of cochlear implant listening experience and normal cochlear anatomy to participate in experiment 1 from 2013 to 2023. Data analysis was conducted from January to February 2024. Thirty-four of the 50 patients from experiment 1 also completed experiment 2.

Interventions

Cochlear implant programming using a computed tomography-guided electrode selection strategy.

Main Outcomes and Measures

University of Washington Clinical Assessment of Music score, including subtests of pitch discrimination thresholds, isochronous familiar melody recognition, and timbre recognition.

Results

Of 50 participants, 20 (40%) were female, and the mean (SD) age was 57.7 (16.4) years. Experiment 1 suggested that better music perception abilities in the 50 participants were associated with patients who were younger and had a postlingual onset of deafness, as well as electrode arrays with a full scala tympani insertion, higher modiolar distance, and shallower insertion depth. Experiment 2 suggested improvements in melody recognition in the 34 participants using the image-guided cochlear implant programming strategy. Patients with apical electrodes that were deactivated were more likely to demonstrate an improvement in their pitch perception thresholds with the image-guided strategy, likely due to the low-frequency stimuli used in the University of Washington Clinical Assessment of Music.

Conclusions and Relevance

This study identified patient and device factors that were associated with music perception outcomes with a cochlear implant. These findings suggest that a personalized, image-guided approach to programming may improve music perception abilities for patients with cochlear implants.

Dual-Task Interference in the Assessment of Listening Effort Before and After Cochlear Implantation in Adults: A Longitudinal Study

PURPOSE

This study aimed to assess the magnitude and direction of dual-task interference in a listening effort dual-task paradigm in individuals with severe-to-profound hearing loss before and in the short- and long-term after cochlear implantation.

DESIGN

The study sample consisted of 26 adult candidates for cochlear implantation with severe-to-profound hearing loss. The dual-task paradigm consisted of a primary speech understanding task, conducted in a quiet condition, and a favorable and unfavorable noise condition on the one hand and a secondary visual memory task on the other hand. The dual-task effect for both tasks and the derived patterns of dual-task interference were determined. Participants were evaluated at four test moments: before cochlear implantation and at 3 months, 6 months, and 12 months after implantation.

RESULTS

Across all listening conditions, a shift was observed from patterns of dual-task interference with worse and stable scores for the primary speech understanding task in the dual-task condition compared to the baseline condition before implantation, toward patterns in which stable or better scores were obtained, respectively, for the primary task in the dual-task condition after implantation. This indicates that more attention could be allocated to the primary speech understanding task during the dual-task condition after implantation, implying a decreased listening effort.

CONCLUSIONS

A decreased listening effort was found after cochlear implantation. This study provides additional insights into the evolution of dual-task interference after cochlear implantation. It highlights the importance of interpreting both the primary and secondary tasks using a dual-task paradigm in the assessment of listening effort.

Essential Equipment for Baseline Otolaryngology-Head and Neck Surgery Care: A Global Cross-Sectional Survey

Objective

Availability of surgical equipment and access to essential clinical services remains an important barrier to surgical care delivery, particularly in low- and middle-income countries (LMICs). This study aims to characterize the relative availability of essential equipment for otolaryngology-head and neck surgery (OHNS) care across World Bank income groups.

Methods

We conducted a cross-sectional survey on otolaryngologists' perceptions on the availability of surgical equipment and ancillary services in their respective practice settings per a 5-point Likert scale ranging from never to always available. The study was disseminated online via professional societies, personal contacts, and social media. Eligible participants included otolaryngologists from 194 WHO-recognized countries, which were grouped by World Bank income group classification and WHO region.

Results

The study involved 146 otolaryngologists, 69 (47%) from high-income countries (HICs), and 77 (53%) from LMICs. LMIC respondents were predominantly from the African and South-East Asian regions, which comprised 48% and 7.8% of all LMIC respondents, respectively. Results revealed significant differences in the availability of otologic, rhinologic, and endoscopic airway equipment between HICs and LMICs. Differences existed among commonly used equipment such as tympanomastoidectomy equipment and rigid bronchoscopy, to subspecialized equipment such as functional endoscopic sinus surgery equipment and cochlear implants (p < 0.05 each).

Conclusions

The study highlighted key disparities in the availability of essential equipment for baseline OHNS care, especially for pediatric airway and otologic conditions. These results can be used to guide investment and advocacy efforts to improve specialty-specific surgical infrastructure relative to the global burden of OHNS diseases in low-resource settings.

Level of Evidence

3.

Contributions and future potential of animal models for geroscience research on sensory systems

Sensory systems mediate our social interactions, food intake, livelihoods, and other essential daily functions. Age-related decline and disease in sensory systems pose a significant challenge to healthy aging. Research on sensory decline in humans is informative but can often be difficult, subject to sampling bias, and influenced by environmental variation. Study of animal models, including mice, rats, rabbits, pigs, cats, dogs, and non-human primates, plays a complementary role in biomedical research, offering advantages such as controlled conditions and shorter lifespans for longitudinal study. Various species offer different advantages and limitations but have provided key insights in geroscience research. Here we review research on age-related decline and disease in vision, hearing, olfaction, taste, and touch. For each sense, we provide an epidemiological overview of impairment in humans, describing the physiological processes and diseases for each sense. We then discuss contributions made by research on animal models and ideas for future research. We additionally highlight the need for integrative, multimodal research across the senses as well as across disciplines. Long-term studies spanning multiple generations, including on species with longer life spans, are also highly valuable. Overall, integrative studies of appropriate animal models have high translational potential for clinical applications, the development of novel diagnostics, therapies, and medical interventions and future research will continue to close gaps in these areas. Research on animal models to improve understanding of the biology of the aging senses and improve the healthspan and additional research on sensory systems hold special promise for new breakthroughs.

Beyond hearing: the impact of Cochlear implantation on the quality of life of users and their communication partners after 1 year

OBJECTIVE

To assess the impact of cochlear implantation (CI) and speech perception outcomes on the quality of life (QoL) of adult CI users and their communication partners (CP) one-year post-implantation.

DESIGN

This research is part of a prospective multicenter study in The Netherlands, called SMILE (Societal Merit of Intervention for hearing Loss Evaluation).

STUDY SAMPLE

Eighty adult CI users completed speech perception testing and the Nijmegen Cochear Implant Questionnaire (NCIQ). Fifty-four CPs completed the Hearing Impairment Impact - Significant Other Profile (HII-SOP).

RESULTS

CI resulted in a large improvement in the QoL of both users and CPs. Despite this, some users still reported difficulties in the NCIQ sub-domains Social Interactions, Activity Limitations and Self-esteem. Similarly, some CPs still reported moderate and severe third-party disability on the HII-SOP. Additionally, the correlation between speech perception results and self-reported QoL was weak to negligible for both groups.

CONCLUSIONS

Speech perception in quiet is not an accurate measure of real-life success with a CI. A subset of CI users and CPs still experience substantial QoL challenges regardless of speech perception performance. To improve counselling and intervention, QoL measures should be a standard part of the CI care pathway for CI users and their CPs.

Health-Related Quality of Life and the Role of the Big Five Personality Traits in Postlingually Deaf Cochlear Implant Users

PURPOSE

This study aimed to investigate the relationships between generic health-related quality of life (HRQoL), the Big Five personality traits, speech understanding, and sociodemographic factors in a group of postlingually deaf cochlear implant (CI) users.

METHOD

The study group included 81 participants who met the inclusion criteria: profound sensorineural hearing loss, 18 years of age or more, and using at least one CI implanted after 18 years of age. Some 18% were bilateral CI users. The mean age of the participants was 60 ± 11 years. They completed the Assessment of Quality of Life (AQoL-8D) and the Short Form IPIP-BFM-20 (shortened version of the 50-item Big Five Markers Questionnaire from the International Personality Item Pool). The response rate was 57%.

RESULTS

The HRQoL was lower in the study group than in the general population. Moreover, all Big Five personality characteristics were significantly lower than the Polish norm. The personality traits of intellect/imagination, emotional stability, and extraversion contributed to higher overall HRQoL scores, particularly for most psychosocial AQoL-8D dimensions. Higher agreeableness predicted higher HRQoL in the Independent Living, Pain, Coping, and Relations dimensions, whereas higher extraversion predicted higher physical HRQoL in the Senses dimension. Better speech understanding in quiet and noisy environments correlated with better physical HRQoL. Additionally, male gender and higher education were linked to higher global HRQoL. Conversely, being female was associated with lower global psychosocial and physical HRQoL, particularly in Pain. Higher education also contributed to improved physical HRQoL.

CONCLUSIONS

In general, CI users have lower physical and psychosocial HRQoL as well as in measures that depend on personality traits. In terms of physical HRQoL, speech understanding plays an important role. It might prove useful if CI candidates and users were given a Big Five personality evaluation and an HRQoL assessment based on which they might be offered counseling or psychological intervention.

Evaluation of the Nijmegen Cochlear Implant Questionnaire in Danish

Introduction  The Nijmegen cochlear implant questionnaire (NCIQ) is a quantifiable self-assessment health-related quality of life (HRQoL) tool used internationally to determine quality of life (QoL) in cochlear implant (CI) users and to evaluate the implant's subjective benefits. Objective  This study aimed to validate the Danish version of the questionnaire (DA-NCIQ) with a test-retest including 60 participants (30 CI users and 30 CI candidates). Methods  The intraclass correlation coefficients (ICC) were calculated to evaluate the temporal stability of the participants' answers and the internal consistency of the questionnaire domains was determined using the Cronbach alpha in order to compare these results with the NCIQ's other language versions. Results  The DA-NCIQ was found to have Cronbach alpha coefficients between 0.7 and 0.91, as well as test-retest reliability with ICC values between 0.7 and 0.92. These findings were similar to the original and other language versions of this questionnaire. The Cronbach alpha coefficients varied between 0.73 and 0.89, while the ICC test-retest reliability varied between 0.64 and 0.85. Furthermore, the present study found that participants with CIs had an improved HRQoL in all subdomains, except for the advanced sound perception one, when compared to the CI candidates. Conclusion The results supported the DA-NCIQ as a reliable instrument to measure the subjective benefits of CIs in postlingually deafened/hearing-impaired adults.

Associations between illness perceptions, word recognition, and perceived sound quality in cochlear implant users

OBJECTIVE

Illness perceptions refer to thoughts and ideas an individual has about an illness. The aim was to understand how cochlear implant (CI) users' illness perceptions, in addition to their monosyllabic word recognition abilities, are associated with their self-perceived sound quality.

DESIGN

Data were collected during routine CI check-up appointments. Participants completed the Brief Illness Perception Questionnaire (assessing their illness perceptions) and the Hearing Implant Sound Quality Index (assessing their subjective sound quality). Additionally, monosyllabic word recognition abilities were measured with the Freiburg Monosyllable Word Test. Hierarchical regression analysis were utilised to model users' sound quality ratings. Participants' age was entered first as a control variable. In the next step, monosyllabic word recognition was entered. Finally, participants' illness perceptions were entered.

STUDY SAMPLE

Fifty-five participants with unilateral CI provision.

RESULTS

Monosyllabic word recognition was significant in the second step. When illness perceptions and monosyllabic word recognition were both included in the third step, illness perceptions, but not monosyllabic word recognition, were significant. The model explained 22% of the variance of subjective sound quality.

CONCLUSIONS

Monosyllabic word recognition abilities and illness perceptions of CI users are important for their self-reported sound quality, but illness perceptions appear to be potentially more relevant.

Changes in Outcomes Expectations During the Cochlear Implant Evaluation Process

OBJECTIVES

Patient expectations are a critical factor in determining cochlear implant (CI) candidacy. However, minimal data are available on how potential CI recipients develop their expectations and if expectations can be modified by providers. In addition, there is little insight into the resources patients use to inform their decision to undergo implantation. This project aims to assess (1) the role of the CI evaluation (CIE) process on patients' expectations, (2) the extent to which patients' pre-CI outcome expectations can be modified, (3) the information patients use to inform their expectations, and patients' preferences for the discussion/display of potential CI outcomes.

DESIGN

Prospective mixed methods study of 32 adult CI patients undergoing CIEs. Outcome measures included: pre-CI Cochlear Implant Quality of Life-35 Profile scores (CIQOL-35 Profile); pre-CIE/post-CIE/day of surgery CIQOL-Expectations scores; post-CIE/day of surgery Decisional Conflict Scale (DCS) scores; and pre-CI aided CNC-word and AzBio sentence scores. Thematic analyses of key informant interviews with 19 potential CI recipients were also performed.

RESULTS

In aim 1, CI CIQOL-Expectation domain scores remained essentially unchanged following the CIE when averaged across all participants ( d = 0.01 to 0.17). However, changes in expectations were observed for many participants at the individual level. Regarding the second aim, participants with higher pre-CIE expectations showed a decrease in expectations following the CIE for all CIQOL domains except emotional and social ( d = -0.27 to -0.77). In contrast, the only significant change in participants with lower expectations was an increase in expectations in the environment score from pre-CIE to the day of surgery ( d = 0.76). Expectations remained essentially unchanged or continued to change in the same direction between the post-CIE and the day of surgery, narrowing the gap between participants with higher and lower expectations. Overall, participants demonstrated low overall conflict related to their decision to proceed with cochlear implantation (mean DCS of 11.4 post-CIE and 14.2 at time of surgery out of 100) but DCS scores were higher for participants with lower pre-CIE expectations ( d = 0.71). In aim 3, key informant interviews demonstrated no differences between the low- and high expectation cohorts regarding resources used to develop their perception of CI outcomes. Potential CI recipients placed high value in talking with patients who had previously received a CI, and preferred discussing CI functional abilities via clinical vignettes described in the CIQOL Functional Staging System rather than by discussing speech recognition or CIQOL-35 Profile scores.

CONCLUSIONS

The results of the present study suggest that, although overall expectations averaged across the cohort remained essentially unchanged, individual participants' pre-CI expectations can be modified and there is value in measuring these expectations using the CIQOL-Expectations tool to determine if they are realistic. This information can then be utilized during personalized counseling to present a more accurate representation of likely CI outcomes for each patient. Discussions between potential CI recipients and current CI users may also provide valuable information to inform their expectations. In addition, communicating potential CI benefits using CIQOL functional stages and associated clinical vignettes may result in more realistic patient expectations and support shared decision-making related to CI surgery.

Early Hearing Outcomes and Audiological Experiences With a Novel Fully Implanted Cochlear Implant

OBJECTIVE

To review audiological experiences and early hearing outcomes from the early feasibility study of a fully implanted cochlear implant.

STUDY DESIGN

Prospective cohort.

SETTING

Tertiary academic medical center.

PATIENT

Three adults (two-male, one female) with bilateral sensorineural hearing loss.

INTERVENTIONS

Implantation with a fully implanted cochlear implant as part of an early feasibility study.

OUTCOMES

Postoperative unaided and aided pure-tone audiometry, tympanometry, mapping parameters, speech perception, battery life, and quality-of-life assessment.

RESULTS

All patients in the early feasibility study of this fully implanted cochlear implant now use their devices regularly. Preoperative and postoperative audiometric measurements showed that their residual hearing in the implanted ear decreased slightly after surgery but was preserved. All patients had type A tympanograms after their transient middle ear effusion resolved. Electrical stimulation levels were comparable to those routinely used in traditional cochlear implants. Two of the three patients use a hearing aid in the implanted ear for additional gain and show significant improvement in speech perception since implantation. Average battery life before recharging is 4 days. All patients are regular users with two showing improvement in quality-of-life metrics after receiving the fully implanted cochlear implant.

CONCLUSION

The patient experience and hearing outcomes from the early feasibility study of a novel fully implanted cochlear implant are detailed in this study and demonstrate ease of operation and daily use by all participants. All patients obtained hearing, but two of three use a hearing aid with their device to overcome unanticipated implant circuitry noise and achieve improved speech perception scores. Current work is focused on reducing this system noise to allow for the device to be used as intended, without a hearing aid.

A Scoping Review and Meta-Analysis of the Relations Between Cognition and Cochlear Implant Outcomes and the Effect of Quiet Versus Noise Testing Conditions

OBJECTIVES

Evidence continues to emerge of associations between cochlear implant (CI) outcomes and cognitive functions in postlingually deafened adults. While there are multiple factors that appear to affect these associations, the impact of speech recognition background testing conditions (i.e., in quiet versus noise) has not been systematically explored. The two aims of this study were to (1) identify associations between speech recognition following cochlear implantation and performance on cognitive tasks, and to (2) investigate the impact of speech testing in quiet versus noise on these associations. Ultimately, we want to understand the conditions that impact this complex relationship between CI outcomes and cognition.

DESIGN

A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed on published literature evaluating the relation between outcomes of cochlear implantation and cognition. The current review evaluates 39 papers that reported associations between over 30 cognitive assessments and speech recognition tests in adult patients with CIs. Six cognitive domains were evaluated: Global Cognition, Inhibition-Concentration, Memory and Learning, Controlled Fluency, Verbal Fluency, and Visuospatial Organization. Meta-analysis was conducted on three cognitive assessments among 12 studies to evaluate relations with speech recognition outcomes. Subgroup analyses were performed to identify whether speech recognition testing in quiet versus in background noise impacted its association with cognitive performance.

RESULTS

Significant associations between cognition and speech recognition in a background of quiet or noise were found in 69% of studies. Tests of Global Cognition and Inhibition-Concentration skills resulted in the highest overall frequency of significant associations with speech recognition (45% and 57%, respectively). Despite the modest proportion of significant associations reported, pooling effect sizes across samples through meta-analysis revealed a moderate positive correlation between tests of Global Cognition ( r = +0.37, p < 0.01) as well as Verbal Fluency ( r = +0.44, p < 0.01) and postoperative speech recognition skills. Tests of Memory and Learning are most frequently utilized in the setting of CI (in 26 of 39 included studies), yet meta-analysis revealed nonsignificant associations with speech recognition performance in a background of quiet ( r = +0.30, p = 0.18), and noise ( r = -0.06, p = 0.78).

CONCLUSIONS

Background conditions of speech recognition testing may influence the relation between speech recognition outcomes and cognition. The magnitude of this effect of testing conditions on this relationship appears to vary depending on the cognitive construct being assessed. Overall, Global Cognition and Inhibition-Concentration skills are potentially useful in explaining speech recognition skills following cochlear implantation. Future work should continue to evaluate these relations to appropriately unify cognitive testing opportunities in the setting of cochlear implantation.

The Effort of Repairing a Misperceived Word Can Impair Perception of Following Words, Especially for Listeners With Cochlear Implants

OBJECTIVES

In clinical and laboratory settings, speech recognition is typically assessed in a way that cannot distinguish accurate auditory perception from misperception that was mentally repaired or inferred from context. Previous work showed that the process of repairing misperceptions elicits greater listening effort, and that this elevated effort lingers well after the sentence is heard. That result suggests that cognitive repair strategies might appear successful when testing a single utterance but fail for everyday continuous conversational speech. The present study tested the hypothesis that the effort of repairing misperceptions has the consequence of carrying over to interfere with perception of later words after the sentence.

DESIGN

Stimuli were open-set coherent sentences that were presented intact or with a word early in the sentence replaced with noise, forcing the listener to use later context to mentally repair the missing word. Sentences were immediately followed by digit triplets, which served to probe carryover effort from the sentence. Control conditions allowed for the comparison to intact sentences that did not demand mental repair, as well as to listening conditions that removed the need to attend to the post-sentence stimuli, or removed the post-sentence digits altogether. Intelligibility scores for the sentences and digits were accompanied by time-series measurements of pupil dilation to assess cognitive load during the task, as well as subjective rating of effort. Participants included adults with cochlear implants (CIs), as well as an age-matched group and a younger group of listeners with typical hearing for comparison.

RESULTS

For the CI group, needing to repair a missing word during a sentence resulted in more errors on the digits after the sentence, especially when the repair process did not result in a coherent sensible perception. Sentences that needed repair also contained more errors on the words that were unmasked. All groups showed substantial increase of pupil dilation when sentences required repair, even when the repair was successful. Younger typical hearing listeners showed clear differences in moment-to-moment allocation of effort in the different conditions, while the other groups did not.

CONCLUSIONS

For CI listeners, the effort of needing to repair misperceptions in a sentence can last long enough to interfere with words that follow the sentence. This pattern could pose a serious problem for regular communication but would go overlooked in typical testing with single utterances, where a listener has a chance to repair misperceptions before responding. Carryover effort was not predictable by basic intelligibility scores, but can be revealed in behavioral data when sentences are followed immediately by extra probe words such as digits.

When to Start Computer-Based Auditory Training After Cochlear Implantation: Effects on Quality of Life and Speech Recognition

OBJECTIVE

Computer-based auditory training (CBAT) has been shown to improve outcomes in adult cochlear implant (CI) users. This study evaluates in new CI users whether starting CBAT within 3 months of activation or later impacts CI outcomes.

STUDY DESIGN

Prospective natural experiment.

SETTING

Tertiary academic medical center.

PATIENTS

Sixty-five new adult CI users.

INTERVENTIONS

CBAT use over the first-year postactivation.

MAIN OUTCOME MEASURES

Speech recognition scores and CIQOL-35 Profile score improvements between CI recipients who started CBAT resources early (<3 mo) and late (3-12 mo) postactivation.

RESULTS

A total of 43 CI recipients started using CBAT within 3 months postactivation (early) and 22 after 3 months (late). Patients who used CBAT within 3 months postactivation showed significantly greater improvement in consonant-nucleus-consonant words (CNCw) (48.3 ± 24.2% vs 27.8 ± 24.9%; d = 0.84), AzBio Sentences in quiet (55.1 ± 28.0% vs 35.7 ± 36.5%; d = 0.62), and CIQOL-35 listening domain scores (18.2 ± 16.3 vs 6.9 ± 12.9, d = 0.73 [0.023, 1.43]), at 3 months postactivation, compared to those who had not yet initiated CBAT. However, by 12 months postactivation, after which all CI recipients had started CBAT, there were no differences observed between patients who started CBAT early or late in speech recognition scores (CNCw: d = 0.26 [-0.35, 0.88]; AzBio: d = 0.37 [-0.23, 0.97]) or in any CIQOL global or domain score (d-range = 0.014-0.47).

CONCLUSIONS

Auditory training with self-directed computer software (CBAT) may yield speech recognition and quality-of-life benefits for new adult CI recipients. While early users showed greater improvement in outcomes at 3 months postactivation than users who started later, both groups achieved similar benefits by 12 months postactivation.

Investigating the Minimal Clinically Important Difference for AzBio and CNC Speech Recognition Scores

OBJECTIVE

To assess the minimal clinically important difference (MCID) values for cochlear implant-related speech recognition scores, which have not been previously reported.

STUDY DESIGN

Retrospective cohort.

SETTING

Tertiary referral center.

PATIENTS

Eight hundred sixty-three adult patients who underwent cochlear implantation between 2009 and 2022.

MAIN OUTCOME MEASURES

MCID values for consonant-nucleus-consonant (CNC) word scores and AzBio sentences in quiet and noise scores using distribution-based methods (half-standard deviation, standard error of measurement, Cohen's d, and minimum detectable change).

RESULTS

In this cohort, the mean preoperative CNC word score was 13.9% (SD, 15.6). The mean preoperative AzBio sentences in quiet score was 19.1% (SD, 22.1), and the mean preoperative AzBio sentences in noise score was 13.0% (SD, 12.0). The average MCID values of several distribution-based methods for CNC, AzBio in quiet, and AzBio in noise were 7.4%, 9.0%, and 4.9%, respectively. Anchor-based approaches with the Speech, Spatial, and Qualities of hearing patient-reported measure did not have strong classification accuracy across CNC or AzBio in quiet and noise scores (ROC areas under-the-curve ≤0.69), highlighting weak associations between improvements in speech recognition scores and subjective hearing-related abilities.

CONCLUSIONS

Our estimation of MCID values for CNC and AzBio in quiet and noise allows for enhanced patient counseling and clinical interpretation of past, current, and future research studies assessing cochlear implant outcomes.

Using Machine Learning and Multifaceted Preoperative Measures to Predict Adult Cochlear Implant Outcomes: A Prospective Pilot Study

OBJECTIVES

To use machine learning and a battery of measures for preoperative prediction of speech recognition and quality of life (QOL) outcomes after cochlear implant (CI) surgery.

DESIGN

Demographic, audiologic, cognitive-linguistic, and QOL predictors were collected from 30 postlingually deaf adults before CI surgery. K-means clustering separated patients into groups. Reliable change index scores were computed for speech recognition and QOL from pre-CI to 6 months post-CI, and group differences were determined.

RESULTS

Clustering yielded three groups with differences in reliable change index for sentence recognition. One group demonstrated low baseline sentence recognition and only small improvements post-CI, suggesting a group "at risk" for limited benefits. This group showed lower pre-CI scores on verbal learning and memory and lack of musical training.

CONCLUSIONS

Preoperative assessments can prognosticate CI recipients' postoperative performance and identify individuals at risk for experiencing poor sentence recognition outcomes, which may help guide counseling and rehabilitation.

Long-term outcome of patients with Ménière's disease following cochlear implantation: a comprehensive outcome study with validated assessment tools

PURPOSE

Patients suffering from Ménière's disease (MD) experience vertigo, and impairments in hearing and quality of life (QoL). This study aims to investigate the impact of cochlear implantation (CI) on various aspects affecting patients with MD.

METHODS

A single tertiary centre's CI database for CI recipients with MD between 2014 and 2022 was screened retrospectively. Hearing, vertigo, tinnitus symptoms, and hearing-related QoL were assessed. Pre- and postoperative hearing tests in conjunction with subjective outcome measures by visual analogue scale (VAS) and validated tools such as the Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI) and Nijmegen Cochlear Implant Questionnaire (NCIQ), as well as the assessment of the pre- and postoperative Functional Level Scale (FLS) were examined.

RESULTS

Eleven ears were included (median age: 59 years at implantation). Following implantation, there was a significant enhancement in Word Recognition Scores at sound levels of 65 dB and 80 dB compared to before treatment (preop vs. 12 months postop: p = 0.012). However, no significant enhancement was observed for 50 dB. MD-related impairments improved significantly postoperatively, as measured by the VAS (vertigo: p = 0.017; tinnitus: p = 0.042), DHI (p = 0.043), THI (p = 0.043) and NCIQ (p < 0.001). The FLS improved significantly (p = 0.020).

CONCLUSION

CI has positive effects on all areas examined in our cohort. However, discrimination of speech at low sound pressure levels remained problematic postoperatively. In patients suffering from MD, the prioritized treatment goals include not only improved hearing but also the rehabilitation of vertigo and tinnitus, as well as the enhancement of QoL. Validated instruments are useful screening tools.

Machine learning application in otology

This review presents a comprehensive history of Artificial Intelligence (AI) in the context of the revolutionary application of machine learning (ML) to medical research and clinical utilization, particularly for the benefit of researchers interested in the application of ML in otology. To this end, we discuss the key components of ML-input, output, and algorithms. In particular, some representation algorithms commonly used in medical research are discussed. Subsequently, we review ML applications in otology research, including diagnosis, influential identification, and surgical outcome prediction. In the context of surgical outcome prediction, specific surgical treatments, including cochlear implantation, active middle ear implantation, tympanoplasty, and vestibular schwannoma resection, are considered. Finally, we highlight the obstacles and challenges that need to be overcome in future research.

Generic and Hearing-Specific Quality of Life in Older Adult Cochlear Implant Users

Background This study aimed to evaluate the quality of life (QOL) of older adults using cochlear implants (CIs) by focusing on how individual characteristics and speech perception are related to generic QOL ratings and utilizing the Health Utilities Index Mark III (HUI3) for assessment. Methodology A cross-sectional study was conducted with 19 participants aged ≥60 years, who were within one to five years post-implant activation. Data were obtained through self-administered questionnaires, including the HUI3 for generic QOL assessment and disease-specific indexes. Speech perception tests and chart reviews provided personal characteristic data. Statistical analysis was performed using the Mann-Whitney U-test, one-way analysis of variance, and Pearson's correlation coefficient. Results In total, 18 patients responded to the study. This study revealed that the generic QOL in older adult CI users was lower than that in the general older adult population. There was no significant association between QOL and variables such as sex, duration of implant usage, or age. However, a longer duration of hearing loss before receiving an implant was associated with higher generic QOL scores. Additionally, a strong correlation was observed between the hearing-related QOL score and utility scores. Conclusions Longer pre-implantation hearing loss correlated with better post-implantation QOL. Additionally, a reduced QOL, specifically within the hearing attribute, a subdomain of the HUI3, was associated with a lower overall generic QOL. The results suggest that generic QOL cannot be evaluated based on hearing ability alone and that cochlear implantation does not completely improve generic QOL. This study represents an important first step in understanding the QOL of older adult CI users from a variety of backgrounds.

Factors to Describe the Outcome Characteristics of a CI Recipient

Background: In cochlear implant (CI) treatment, there is a large variability in outcome. The aim of our study was to identify the independent audiometric measures that are most directly relevant for describing this variability in outcome characteristics of CI recipients. An extended audiometric test battery was used with selected adult patients in order to characterize the full range of CI outcomes. Methods: CI users were recruited for this study on the basis of their postoperative results and divided into three groups: low (1st quartile), moderate (medium decentile), and high hearing performance (4th quartile). Speech recognition was measured in quiet by using (i) monosyllabic words (40-80 dB SPL), (ii) speech reception threshold (SRT) for numbers, and (iii) the German matrix test in noise. In order to reconstruct demanding everyday listening situations in the clinic, the temporal characteristics of the background noise and the spatial arrangements of the signal sources were varied for tests in noise. In addition, a survey was conducted using the Speech, Spatial, and Qualities (SSQ) questionnaire and the Listening Effort (LE) questionnaire. Results: Fifteen subjects per group were examined (total N = 45), who did not differ significantly in terms of age, time after CI surgery, or CI use behavior. The groups differed mainly in the results of speech audiometry. For speech recognition, significant differences were found between the three groups for the monosyllabic tests in quiet and for the sentences in stationary (S0°N0°) and fluctuating (S0°NCI) noise. Word comprehension and sentence comprehension in quiet were both strongly correlated with the SRT in noise. This observation was also confirmed by a factor analysis. No significant differences were found between the three groups for the SSQ questionnaire and the LE questionnaire results. The results of the factor analysis indicate that speech recognition in noise provides information highly comparable to information from speech intelligibility in quiet. Conclusions: The factor analysis highlighted three components describing the postoperative outcome of CI patients. These were (i) the audiometrically measured supra-threshold speech recognition and (ii) near-threshold audibility, as well as (iii) the subjective assessment of the relationship to real life as determined by the questionnaires. These parameters appear well suited to setting up a framework for a test battery to assess CI outcomes.

Knowledge and Practice in Cochlear Re-Implantation in the UK: A Survey for Audiologists

BACKGROUND

Cochlear implantation (CI) has proven to be a highly effective method for rehabilitating individuals with severe to profound hearing loss. However, challenges persist, particularly in cases where CI failure necessitates re-implantation. This study aims to address the gap in understanding the knowledge and practices of audiologists in the UK regarding cochlear re-implantation through a comprehensive questionnaire survey.

METHODS

A bespoke questionnaire was distributed to audiologists working with CI across the UK. The survey, which included multiple-choice items, open-text responses, and visual analogue scales, was made accessible via an online link shared through professional bodies, email groups, and social media platforms.

RESULTS

The survey received 27 responses, predominantly from female audiologists (71.4%), with significant representation from London (28.6%) and the East of England (21.4%). A majority of respondents had over 16 years of CI experience (35.7%) and held a master's degree (60.7%). Key reasons for CI re-implantation included electrode failure (82.1%) and hermetic seal failure (60.7%). While respondents showed strong confidence in counselling (88.8%) and managing re-implanted devices (84.6%), there was a noted variation in opinions regarding the need for additional training in intraoperative measures.

CONCLUSION

This survey highlights the current practices and training needs of UK audiologists in CI re-implantation. This underscores the importance of targeted training to fill knowledge gaps and improve clinical care during CI re-implantation, ultimately enhancing outcomes for both audiologists and CI recipients.

Client Oriented Scale of Improvement in First-Time and Experienced Hearing Aid Users: An Analysis of Five Predetermined Predictability Categories through Audiometric and Speech Testing

Objectives: The aim of our investigation was to explore the relationship between unaided pure-tone and speech audiometry and self-reported aided performance measured according to five predetermined COSI categories among first-time hearing aid users and experienced hearing aid users. Methods: Data from 286 patients were retrospectively evaluated. We divided the sample into first-time hearing aid users (G1) and experienced hearing aid users (G2). The correlation between unaided tonal and speech audiometry and five preliminary selected client-oriented scale of improvement (COSI) categories was studied. Results: A greater percentage of hearing aid users aged >80 years and a higher prevalence of severe-to-profound hearing loss in G2 group were observed (p < 0.05). For the total cohort, a mean hearing threshold of 60.37 ± 18.77 db HL emerged in the right ear, and 59.97 ± 18.76 db HL was detected in the left ear (p > 0.05). A significant statistical difference was observed in the group of first-time hearing aid users for the "Television/Radio at normal volume" item, where patients with a lower speech intellection threshold (SIT) were associated with higher COSI scores (p = 0.019). Studying the relationship between the speech reception threshold (SRT) and the COSI item "conversation with 1 or 2 in noise" evidenced worse speech audiometry in patients who scored ≤2 among experienced hearing aid users (p = 0.00012); a higher mean 4-8 kHz frequencies threshold for the better ear was found within the G2 group among those who scored ≤2 in the COSI item "conversation with 1 or 2 in quiet" (p = 0.043). Conclusions: Our study confirms a poor correlation between unaided tonal and speech audiometry and self-reported patient assessment. Although we included only five COSI categories in this study, it is clear that unaided audiometric tests may drive the choice of proper hearing rehabilitation, but their value in predicting the benefit of hearing aids remains limited.

Speech Perception and Quality-of-Life Outcomes in Mandarin-Speaking Postlingual Deaf Adults With Cochlear Implant: Any Difference With the Intonation Language Users?

OBJECTIVE

To evaluate the effects of related factors on long-term speech perception and quality-of-life (QoL) outcomes in postlingual deaf Mandarin-speaking adult cochlear implant (CI) recipients and to assess any differences between tone language and other intonation language CI adult users.

STUDY DESIGN

Retrospective cases review.

SETTING

Tertiary referral center.

PATIENTS

Forty-five adult CI recipients (48 implanted ears).

MAIN OUTCOME MEASURES

Post-CI outcomes were evaluated after follow-ups of more than 24 months using speech perception tests and QoL questionnaires. We analyzed the related factors affecting CI outcomes.

RESULTS

A shorter duration of profound deafness was predictive factors for better post-CI speech perception. Earlier implantation and better performance of vowel scores were predictive of better subjective improvements in social and emotional life. Post-CI vowel scores of over 56% indicated promising improvements in QoL.

CONCLUSION

Shorter duration of deafness could have better post-CI speech perception. Post-CI vowel scores instead of monosyllable words have the more potential to predict the QoL in Mandarin-speaking adult CI recipients.

Computer-based Auditory Training by New Adult Cochlear Implant Recipients Is Associated With Durable Improvements in Cochlear Implant Quality of Life

OBJECTIVE

The process of adapting to communicate with a cochlear implant (CI) is complex. The use of auditory training after cochlear implantation may help to facilitate improvements in postoperative speech recognition and quality-of-life outcomes in new adult CI recipients. However, the effectiveness of auditory training remains uncertain and long-term effects have not been examined in a large sample of new adult CI users. As such, the objective of this study was to examine the influence of common forms of auditory training on speech recognition and CI-related quality-of-life (CI-related QOL) outcomes at 1 year after cochlear implantation. We hypothesized that patients who reported use of computer-based auditory training (CBAT) would show improved speech and CIQOL-35 Profile scores at 1 year after activation of their implant, compared with their peers.

DESIGN

This study was designed as a prospective study and was undertaken at a tertiary academic CI center. Participants included 114 adults undergoing cochlear implantation for bilateral hearing loss. Patients serially self-reported use of the following types of post-CI auditory training over their first-year postactivation: (1) face-to-face training (e.g., speech-language pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) CBAT (e.g., self-directed software). Outcomes measures for this study included change in Consonant-Nucleus-Consonant phoneme (CNCp), CNC word (CNCw), AzBio sentences in quiet, and CIQOL-35 Profile global and domain scores from pre-CI to 12-mo post-CI.

RESULTS

Of 114 patients, 94 (82.5%) used one or more auditory training resources. Of these, 19.3% used face-to-face training, 67.5% passive home-based training, and 46.5% CBAT. Of 114 patients, 73 had complete CIQOL data. At 12 mo, only CBAT use was associated with significantly greater improvements in global and all domain-specific CIQOL scores ( d -range  =  0.72-0.87), compared with those not using CBAT. Controlling for demographics and use of multiple training resources, CBAT remained the strongest positive predictor of CIQOL improvement, with significant associations with global score (ß  =  12.019[4.127,19.9]) and all domain scores at 12-mo post-CI: communication (ß  =  11.937[2.456,21.318), emotional (ß  =  12.293[1.827,22.759), entertainment (ß  =  17.014[5.434,28.774), environment (ß  =  13.771[1.814,25.727]), listening effort (ß  =  12.523[2.798,22.248]), and social (ß  =  18.114[7.403,28.826]). No significant benefits were noted with use of CBAT or any other form of auditory training and speech recognition scores at 12-mo post-CI ( d -range  =  -0.12-0.22).

CONCLUSIONS

Auditory training with CBAT was associated with improved CI-related QOL outcomes at 12-mo post-CI. Given its availability and low cost, this study provides evidence to support using CBAT to improve real-world functional abilities in new adult CI recipients.

Impact of Cochlear Implantation on Quality of Life in Chinese Americans

OBJECTIVES

To investigate the quality of life (QOL) of adult Mandarin-speaking Chinese Americans after cochlear implantation (CI) using the cross-culturally adapted Chinese Cochlear Implant Quality of Life-10 (CIQOL-10) Global.

STUDY DESIGN

Cross-sectional.

SETTING

Tertiary care neurotology practice in New York City.

PATIENTS

Thirty adult Mandarin-speaking Chinese Americans (22.8-89.4 yr, mean 48.9 yr) with prelingual (12) or postlingual (18) deafness who underwent CI between 1995 and 2020. All patients were at least 1 year from CI activation.

INTERVENTION

CI.

MAIN OUTCOMES MEASURES

Chinese CIQOL-10 Global score.

RESULTS

There were no detectable differences in mean Chinese CIQOL-10 Global scores between the prelingual (mean 51.9, SD 11.0) and postlingual (mean 44.0, SD 16.4) cohorts (p = 0.1; 95% CI, -2.3 to 18.1; Hedges' g = 0.5). Comparison of the overall cohort (mean 47.1, SD 14.8) with previously published CIQOL-10 Global scores of English-speaking American CI users (mean 51.5, SD 10.4) demonstrated a significant difference (p = 0.02; 95% CI, 0.4-8.4; Hedges' g = 0.4). For the overall cohort, multivariable analysis demonstrated that combined household income (p = 0.007, β = 7.4; 95% CI, 0.7-14.0) was positively associated with Chinese CIQOL-10 Global scores.

CONCLUSIONS

This study is the first to evaluate QOL after CI in Mandarin-speaking Chinese American adults. The CIQOL-10 Global scores of Mandarin-speaking Chinese Americans CI users are significantly worse than those of English-speaking American CI users. Combined household income may be positively associated with QOL in the Mandarin-speaking Chinese American CI population. More resources are needed to assess outcomes and support rehabilitation in this population.

Frequency-to-Place Mismatch Impacts Cochlear Implant Quality of Life, But Not Speech Recognition

OBJECTIVE

To retrospectively compare frequency-place mismatch among adult cochlear implant (CI) recipients with lateral wall (LW) and perimodiolar/Mid Scala (PM/MS) arrays, and to quantify the impact of these factors on early post-activation (3 months) speech recognition abilities and CI-specific quality of life.

METHODS

One hundred and twenty-six adult participants were separated into two groups: (1) 83 participants who underwent CI with a PM/MS array and 43 patients who underwent CI with a LW array. All participants completed the Cochlear Implant Quality of Life Profile (CIQOL-35 Profile) instrument. Angular insertion depth and semitone mismatch, which contribute to frequency-place mismatch, were assessed using post-operative CT scans. Word and speech recognition in quiet were determined using the Consonant-Nucleus-Consonant (CNC) and the AzBio tests, respectively (n = 82 patients).

RESULTS

LW arrays were more deeply inserted and exhibited less semitone mismatch compared to PM/MS arrays. No significant relationship was found between semitone mismatch and early post-operative speech perception scores for either PM/MS or LW arrays. However, greater degrees of semitone mismatch were associated with lower CIQOL-35 profile scores for PM/MS arrays.

CONCLUSIONS AND RELEVANCE

The results of this study indicate that both the degree of frequency-place mismatch, and its impact on CI-specific quality of life, vary by CI array design.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:2898-2905, 2024.

Cochlear Implant Qualification in Noise Versus Quiet: Do Patients Demonstrate Similar Postoperative Benefits?

OBJECTIVE

To assess patient factors, audiometric performance, and patient-reported outcomes in cochlear implant (CI) patients who would not have qualified with in-quiet testing alone.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral center.

METHODS

Adult CI recipients implanted between 2012 and 2022 were identified. Patients with preoperative AzBio Quiet > 60% in the implanted ear, requiring multitalker babble to qualify, comprised the in-noise qualifying (NQ) group. NQ postoperative performance was compared with the in-quiet qualifying (QQ) group using CNC, AzBio Quiet, and AzBio +5 dB signal-to-noise ratio. Speech, Spatial and Qualities of Hearing Scale (SSQ), Cochlear Implant Quality of Life scale (CIQOL-10), and daily device usage were also compared between the groups.

RESULTS

The QQ group (n = 771) and NQ group (n = 67) were similar in age and hearing loss duration. NQ had higher average preoperative and postoperative speech recognition scores. A larger proportion of QQ saw significant improvement in CNC and AzBio Quiet scores in the CI-only listening condition (eg, CI-only AzBio Quiet: 88% QQ vs 51% NQ, P < .001). Improvement in CI-only AzBio +5 dB and in all open set testing in the best-aided binaural listening condition was similar between groups (eg, Binaural AzBio Quiet 73% QQ vs 59% NQ, P = .345). Postoperative SSQ ratings, CIQOL scores, and device usage were also equivalent between both groups.

CONCLUSION

Patients who require in-noise testing to meet CI candidacy demonstrate similar improvements in best-aided speech perception and patient-reported outcomes as in-QQ, supporting the use of in-noise testing to determine CI qualification for borderline CI candidates.

Post-operative patient perception of decisional regret in cochlear implant recipients

IMPORTANCE

Decision regret post-surgery has has been linked to health outcomes for a number of elective procedures but is understudied in cochlear implantation satisfaction. Theunpredictability in outcomes may lead to unmet expectations by the recipient. This study is the first study to investigate the decision regret concept in cochlear implant recipients.

OBJECTIVE

Tto investigate post-operative decision regret in (CI) recipients.

DESIGN

This was a prospective cohort study using the validated Ottawa Decision Regret Scale, and whether the CI met the patient's expectations. Variables potentially associated with decision regret including patient demographics, post-operative speech perception scores, duration of deafness, duration of CI use and age were analyzed using the logistic regression model.

SETTING

This was a multi-center study. Participants were recruited and enrolled from the University of Miami and the University of Kansas in an outpatient setting.

PARTICIPANTS

Adult, English-speaking CI recipients with at least 6 months of listening experience with their implant.

RESULTS

Out of 173 58% reported no regret, 27% reported mild, and 15% reported moderate-to-strong regret. Expectations were met in 77% while not meeting expectations in 14%. The remaining 8% were neutral. Decisional regret was significantly associated (p = 0.02) with poor post-operative speech perception. No other variables were associated with regret.

CONCLUSIONS

Post-operative decision regret was reported by 42% of CI recipients. Poor speech perception abilities were associated with increased risk of regret. Further research is required to identify regret risks and provide resources to mitigate regret in CI recipients.

Bilateral Cochlear Implants and Bimodal Hearing: A Comparison of Quality of Life

BACKGROUND

 Despite significant advances in the field of cochlear implants (CIs), there is no widely accepted criterion for when to counsel on bilateral CIs in adults. This is partly due to conflicting findings on the advantages of bilateral CIs versus bimodal hearing (i.e., CI with a contralateral hearing aid). Because of this, clinicians rely on a poorly defined combination of clinical measures and patient discussion to evaluate a patient's listening needs and preferences. Patients' needs and preferences are often used to guide recommendations on whether bilateral CIs or bimodal hearing is best for that individual, suggesting that an in-depth comparison of each group's self-reported outcomes is warranted.

PURPOSE

 Given the limited number of studies directly comparing quality of life (QoL) in bimodal and bilateral patients, the current study conducted a preliminary comparison of self-reported outcomes to better understand patient-reported benefits of each listening configuration.

RESEARCH DESIGN

 This was a between-subjects comparison.

STUDY SAMPLE

 Fifteen bimodal and nine bilateral adult CI users made the study sample.

DATA COLLECTION AND ANALYSIS

 Participants completed the Cochlear Implant Quality of Life (CIQOL) Profile 35. For group comparison purposes, monosyllabic word recognition and nonverbal intelligence were measured. Independent samples t-tests with Holm-Bonferroni corrections were used to compare bimodal and bilateral patients across domains of the CIQOL.

RESULTS

 Bilateral CI users self-reported better environmental, emotional, social, and global QoL when compared to bimodal users. The groups did not differ on age, nonverbal intelligence, speech recognition abilities, and duration of hearing loss; however, bimodal users had less experience listening with their CI than the bilateral CI users.

CONCLUSION

 Bilateral CI users showed widespread advantages in QoL when compared to bimodal users. Bilateral CI users self-reported significantly better environmental QoL which conflicts with previous in-lab and self-report results suggesting a bimodal advantage. Additionally, due to a lack of current literature, it is unclear why a bilateral advantage is observed for emotional and social QoL. Results of the current study not only provide additional support on the benefits of bilateral implantation but also stress the need to further explore the self-reported benefits of each listening configuration.

Teledelivery of Aural Rehabilitation to Improve Cochlear Implant Outcomes

OBJECTIVE(S)

This randomized controlled study evaluated the effectiveness of a Telehealth Aural Rehabilitation (TeleAR) training protocol to improve outcomes for adult cochlear implant (CI) users.

METHODS

This was a multisite clinical study with participants randomized to either an AR treatment or active control group. The AR protocol consisted of auditory training (words, sentences, and speech tracking), informational counseling, and communication strategies. The control group participants engaged in cognitive stimulation activities (crosswords, sudoku, etc.). Each group completed 6 weekly 90-min individual treatment sessions delivered remotely. Twenty postlingually deafened adult CI users participated. Assessments were completed pretreatment and 1 week and 2 months posttreatment.

RESULTS

Repeated-measures ANOVA and planned contrasts were used to compare group performance on AzBio Sentences, Hearing Handicap Inventory (HHI), Client Oriented Scale of Improvement (COSI), and Glasgow Benefit Inventory (GBI). The two groups were statistically equivalent on all outcome measures at pre-assessment. There was a statistically significant main effect of time for all measures. Improvement over time was observed for participants in both groups, with greater improvement seen for the AR than the CT group on all outcome measures. The AR group showed medium to large effect sizes on all measures over time, suggesting clinically significant outcomes.

CONCLUSION

This randomized controlled study provides evidence of improved speech recognition and psychosocial outcomes following 6 weeks of TeleAR intervention. For adult post-lingually deafened CI users, including those >3 months post-activation, AR treatment can leverage neuroplasticity to maximize outcomes.

LEVEL OF EVIDENCE

2 Laryngoscope, 134:1861-1867, 2024.

Comparison of Quality of Life Outcomes for Percutaneous Versus Transcutaneous Implantable Hearing Devices: A Systematic Review and Meta-analysis

OBJECTIVE

To compare quality of life (QOL) outcomes of percutaneous and transcutaneous bone conduction devices (pBCD and tBCD, respectively).

DATABASES REVIEWED

Pubmed, Scopus, CINAHL.

METHODS

A systematic review was performed searching for English language articles from inception to March 15, 2023. Studies reporting QOL outcomes measured using a validated tool following implantation of either pBCDs or tBCDs were considered for inclusion. QOL outcomes included scores for Glasgow Benefit Inventory, Glasgow Children's Benefit Inventory, Abbreviated Profile of Hearing Aid Benefit, and the Speech, Spatial, and Qualities of Hearing Scale. A meta-analysis of continuous measures was performed.

RESULTS

A total of 52 articles with 1,469 patients were included. Six hundred eighty-nine patients were implanted with pBCDs, and the remaining 780 were implanted with tBCDs. Average Glasgow Benefit Inventory scores for the tBCD group (33.0, 95% confidence interval [22.7-43.3]) were significantly higher than the pBCD group (30.9 [25.2-36.6]) (Δ2.1 [1.4-2.8], p < 0.0001). Mean Glasgow Children's Benefit Inventory scores (Δ3.9 [2.0-5.8], p = 0.0001) and mean gain in Abbreviated Profile of Hearing Aid Benefit scores (Δ5.6 [4.8-6.4], p < 0.0001) were significantly higher among patients implanted with tBCDs than those implanted with pBCDs. Patients implanted with tBCDs also had significantly higher gains on the Speech (Δ1.1 [0.9-1.3], p < 0.0001), Spatial (Δ0.8 [0.7-0.9], p < 0.0001), and Qualities of Hearing (Δ1.2 [1.1-1.3], p < 0.0001) portions of the Speech, Spatial, and Qualities of Hearing Scale than those implanted with pBCDs.

CONCLUSIONS

Patients implanted with transcutaneous devices had better QOL outcomes than those implanted with percutaneous devices.

Enhancing Cochlear Implant Outcomes across Age Groups: The Interplay of Forward Focus and Advanced Combination Encoder Coding Strategies in Noisy Conditions

Background: Hearing in noise is challenging for cochlear implant users and requires significant listening effort. This study investigated the influence of ForwardFocus and number of maxima of the Advanced Combination Encoder (ACE) strategy, as well as age, on speech recognition threshold and listening effort in noise. Methods: A total of 33 cochlear implant recipients were included (age ≤ 40 years: n = 15, >40 years: n = 18). The Oldenburg Sentence Test was used to measure 50% speech recognition thresholds (SRT50) in fluctuating and stationary noise. Speech was presented frontally, while three frontal or rear noise sources were used, and the number of ACE maxima varied between 8 and 12. Results: ForwardFocus significantly improved the SRT50 when noise was presented from the back, independent of subject age. The use of 12 maxima further improved the SRT50 when ForwardFocus was activated and when noise and speech were presented frontally. Listening effort was significantly worse in the older age group compared to the younger age group and was reduced by ForwardFocus but not by increasing the number of ACE maxima. Conclusion: Forward Focus can improve speech recognition in noisy environments and reduce listening effort, especially in older cochlear implant users.

Impact of Hearing Loss on Social Participation in Children: A Scoping Review

Social participation can be defined as involvement in activities that provide a platform to interact with society and others. Untreated hearing loss effects communication skills, academic achievements, and peer-group interaction. Since a typical body structure and body functioning are essential to demonstrate day to day activities. Altogether these factors can influence the social participation in children with HL. The aim of this study is to systematically review the impact of hearing loss on social participation in children.A literature search was carried out to obtain studies exploring social participation among children with HL. Two authors independently searched four electronic databases, PubMed, Scopus, Embase, and Web of Science. The search strategy was designed by using six main terms 'social participation', 'social engagement', 'social interaction', 'hearing loss', 'hearing impairment', 'hearing disorder', and Boolean operators 'AND', 'OR' were used to make the search strings. The current review included four studies after meeting the eligibility criteria. Findings showed that social participation is affected in children with HL. Reduced hearing ability is one of the factors of reduced social participation in children. Children using hearing aids or cochlear implants, participate more frequently in social activities. The findings of this review suggest that HL is associated with reduced social participation. However, using hearing aids and cochlear implants followed by auditory verbal therapy has significant improvement in social participation. Future studies need to investigate whether early rehabilitation can increase social participation in children.

Systematic Review of Auditory Training Outcomes in Adult Cochlear Implant Recipients and Meta-Analysis of Outcomes

Objective: to review evidence on the efficacy of auditory training in adult cochlear implant recipients. Data Sources: PRISMA guidelines for a systematic review of the literature were followed. PubMed, Scopus, and CINAHL databases were queried on 29 June 2023 for terms involving cochlear implantation and auditory training. Studies were limited to the English language and adult patient populations. Study Selection: Three authors independently reviewed publications for inclusion in the review based on a priori inclusion and exclusion criteria. Inclusion criteria encompassed adult cochlear implant populations, an analysis of clinician- or patient-directed auditory training, and an analysis of one or more measures of speech recognition and/or patient-reported outcome. Exclusion criteria included studies with only pediatric implant populations, music or localization training in isolation, and single-sample case studies. Data Extraction: The data were collected regarding study design, patient population, auditory training modality, auditory training timing, speech outcomes, and data on the durability of outcomes. A quality assessment of the literature was performed using a quality metric adapted from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group guidelines. Data Synthesis and Meta-Analysis: Data were qualitatively summarized for 23 studies. All but four studies demonstrated significant improvement in at least one measured or patient-reported outcome measure with training. For 11 studies with sufficient data reporting, pre-intervention and post-intervention pooled means of different outcome measures were compared for 132 patients using meta-analysis. Patient-direct training was associated with significant improvement in vowel-phoneme recognition and speech recognition in noise (p < 0.05 and p < 0.001, respectively), and clinician-directed training showed significant improvement in sentence recognition in noise (p < 0.001). Conclusions: The literature on auditory training for adult cochlear implant recipients is limited and heterogeneous, including a small number of studies with limited levels of evidence and external validity. However, the current evidence suggests that auditory training can improve speech recognition in adult cochlear implant recipients.

Improving quality of life in the elderly: hearing loss treatment with cochlear implants

BACKGROUND

Hearing loss impacts health-related quality of life and general well-being and was identified in a Lancet report as one of the largest potentially modifiable factors for the prevention of age-related dementia. There is a lack of robust data on how cochlear implant treatment in the elderly impacts quality of life. The primary objective was to measure the change in health utility following cochlear implantation in individuals aged ≥ 60 years.

METHODS

This study uniquely prospectively recruited a large multinational sample of 100 older adults (mean age 71.7 (SD7.6) range 60-91 years) with severe to profound hearing loss. In a repeated-measures design, pre and post implant outcome measures were analysed using mixed-effect models. Health utility was assessed with the Health Utilities Index Mark III (HUI3). Subjects were divided into groups of 60-64, 65-74 and 75 + years.

RESULTS

At 18 months post implant, the mean HUI3 score improved by 0.13 (95%CI: 0.07-0.18 p < 0.001). There was no statistically significant difference in the HUI3 between age groups (F[2,9228] = 0.53, p = 0.59). The De Jong Loneliness scale reduced by an average of 0.61 (95%CI: 0.25-0.97 p < 0.014) and the Lawton Instrumental Activities of Daily Living Scale improved on average (1.25, 95%CI: 0.85-1.65 p < 0.001). Hearing Handicap Inventory for the Elderly Screening reduced by an average of 8.7 (95%CI: 6.7-10.8, p < 0.001) from a significant to mild-moderate hearing handicap. Age was not a statistically significant factor for any of the other measures (p > 0.20). At baseline 90% of participants had no or mild depression and there was no change in mean depression scores after implant. Categories of Auditory perception scale showed that all subjects achieved a level of speech sound discrimination without lip reading post implantation (level 4) and at least 50% could use the telephone with a known speaker.

CONCLUSIONS

Better hearing improved individuals' quality of life, ability to communicate verbally and their ability to function independently. They felt less lonely and less handicapped by their hearing loss. Benefits were independent of age group. Cochlear implants should be considered as a routine treatment option for those over 60 years with bilateral severe to profound hearing loss.

TRIAL REGISTRATION

ClinicalTrials.gov ( http://www.

CLINICALTRIALS

gov/ ), 7 March 2017, NCT03072862.

Why Do Candidates Forgo Cochlear Implantation?

OBJECTIVE

Identify barriers and facilitating factors in cochlear implant (CI) utilization by comparing functional measures between CI candidates who undergo or forgo implantation.

METHODS

Forty-three participants were separated into two groups: (1) 28 participants who underwent CI and (2) 15 participants who elected not to proceed with CI despite meeting eligibility criteria (no-CI). Prior to implantation, all participants completed the CI Quality of Life (CIQOL)-35 Profile and CIQOL-Expectations instrument. They were also surveyed on factors contributing to their decision to either undergo or forgo CI. Word and speech recognition were determined using the Consonant-Nucleus-Consonant (CNC) and the AzBio tests, respectively.

RESULTS

CIQOL-Expectations scores were indistinguishable between groups, but there were substantial differences in baseline CIQOL-35 Profile scores. Compared to the CI group, the no-CI group exhibited higher pre-CI scores in the Emotional (Cohen's d [95% CI] = 0.8 [0.1, 1.5]) and Entertainment (Cohen's d [95% CI] = 0.8 [0.1, 1.5]) domains. Survey data revealed that the most commonly reported barriers to pursuing CI in the no-CI cohort were fear of surgical complications (85%), cost associated with implantation (85%), and perception that hearing was not poor enough for CI surgery (85%).

CONCLUSIONS AND RELEVANCE

The results of this study indicate that functional outcome expectations are similar between candidates who elect to receive or forgo CI, yet those who forgo CI have higher baseline CI-specific QOL abilities.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:3548-3553, 2023.

Correlation Between Quality of Life and Speech Recognition Outcomes Following Cochlear Implantation

OBJECTIVE

To study the relationship between Cochlear Implant Quality of Life-10 Global (CIQOL-10) scores and speech recognition scores 6 and 12 months after cochlear implantation (CI) and to compare CIQOL-10 scores for patients who met the benchmark speech recognition scores with those who did not.

STUDY DESIGN

Retrospective review.

SETTING

Tertiary referral center.

PATIENTS

One hundred twenty-four adults who underwent CI between 2018 and 2021 and completed a CIQOL-10 questionnaire at their 6- and/or 12-month postoperative visit.

MAIN OUTCOME MEASURES

CIQOL-10, Consonant-Nucleus-Consonant (CNC) word, and AzBio in quiet and noise scores.

RESULTS

At 6 months, weak positive correlations were found between CIQOL-10 and CNC (n = 78, r = 0.234, p = 0.039) and AzBio in quiet (n = 73, r = 0.293, p = 0.012) scores but not AzBio in noise scores (n = 39, r = 0.207, p = 0.206). At 12 months, weak positive correlations were found between CIQOL-10 and CNC (n = 98, r = 0.315, p = 0.002), AzBio in quiet (n = 88, r = 0.271, p = 0.011), and AzBio in noise (n = 48, r = 0.291, p = 0.045) scores. Patients who met the benchmark CNC scores had notably higher CIQOL-10 scores than those who did not at 6 months (52.0 vs 45.5, p = 0.008) and 12 months (52.0 vs 45.5, p = 0.003). A similar relationship was found for those who met the benchmark AzBio in quiet scores at both 6 months (52.0 vs 44.0, p = 0.006) and 12 months (52.0 vs 46.5, p = 0.011).

CONCLUSION

CIQOL-10 scores have weak positive correlations with postoperative speech recognition outcomes at 6 and 12 months. This highlights the need for the continued use of quality-of-life measures, such as the CIQOL-10, in assessing CI outcomes to gain a more comprehensive understanding of patients' experiences.

Determinants of Cochlear Implant Satisfaction and Decisional Regret in Adult Cochlear Implant Users

OBJECTIVE

Determine associations expected and actual cochlear implant (CI) outcomes, decisional regret, and satisfaction in experienced adult CI users.

STUDY DESIGN

Cross-sectional cohort study.

SETTING

Tertiary medical center.

PATIENTS

Thirty-nine adult CI users meeting traditional bilateral hearing loss indications with ≥12 months CI experience.

INTERVENTIONS/MAIN OUTCOME MEASURES

Patients completed the validated Satisfaction with Amplification in Daily Living and Decisional Regret instruments. Pre- and post-CI outcomes (CI Quality of Life [CIQOL]-Expectations; CIQOL-35 Profile; CNC words, AzBio Sentences) were obtained from a prospectively maintained clinical database.

RESULTS

Using established cutoff scores, 29% of patients reported a substantial degree of post-CI decisional regret. For each CIQOL domain, patients without decisional regret obtained post-CI outcome scores closer to pre-CI expectations compared with patients with decisional regret ( d = 0.34 to 0.91); similar results were observed with higher CI user satisfaction ( d = 0.17-0.83). Notably, the degree of pre- to post-CI improvement in CNC or AzBio scores did not differ between patients with and without decisional regret or with lower and higher satisfaction. Finally, greater pre-/postimprovement in CIQOL-35 Profile domain scores demonstrated far stronger associations with lower decisional regret and higher satisfaction than changes in speech recognition scores.

CONCLUSIONS

Patients with better alignment of their pre-CI expectations and post-CI outcomes and greater pre-/post-CIQOL improvement had lower decisional regret and higher satisfaction. This emphasizes the importance of evidence-based pre-CI counseling regarding real-world CI benefits and caution against assuming that improvements in speech recognition are related to patient satisfaction.

Discrepancies Between Expected and Actual Cochlear Implant-Related Functional Outcomes

OBJECTIVE

Previous research has demonstrated that realistic patient expectations are a critical factor in determining cochlear implant (CI) candidacy. The current study uses the validated Cochlear Implant Quality of Life-Expectations (CIQOL-Expectations) instrument to determine expectations of potential CI users and the degree to which their pre-CI expectations are met after implantation.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary medical center.

PATIENTS

Sixty adult CI patients.

INTERVENTIONS/MAIN OUTCOME MEASURES

Pre-CI aided and post-CI consonant-nucleus-consonant word and AzBio sentence scores, pre-CI CIQOL-Expectations, and pre-CI and 3/6/12-month post-CI CIQOL-35 Profile scores.

RESULTS

Mean pre-CI CIQOL-Expectations exceeded 12-month mean CIQOL-35 Profile scores for the global measure and the communication, environment, and listening effort domains ( d = 0.65-0.97). The communication and listening effort domain scores had the largest discrepancy between expected and actual post-CI improvement (actual scores, 15.1 and 16.3 points lower than expected [ d = 0.93-0.97], respectively). For 42% of patients, pre-CI global expectations exceeded 12-month post-CI CIQOL-35 Profile global scores, 49% met their expectations, and actual scores exceeded expectations for only 10% of patients. Similar patterns were seen for all CIQOL domains except emotional.

CONCLUSIONS

Post-CI functional abilities seem to fall short of pre-CI expectations for a substantial percentage of CI users, which was most apparent for the communication and listening effort CIQOL domains. These results may help clinicians direct personalized counseling toward common misconceptions, which can aid shared decision making and potentially minimize the mismatch between expected and realized outcomes.Level of Evidence: III.IRB Pro00073019, approved December 20, 2017 (Medical University of South Carolina).

Complications of cochlear implants: a MAUDE database study

OBJECTIVE

A retrospective cross-sectional analysis was conducted of the US Food and Drug Administration's MAUDE (Manufacturer and User Facility Device Experience) database, to evaluate the complication profile of cochlear implantation according to manufacturer.

METHODS

A review of the MAUDE database was conducted from 1 January 2010 to 31 December 2020. Complications, including infection, extrusion, facial nerve stimulation, meningitis and cerebrospinal fluid leak, were identified using key word searches. The categorised data were analysed using a chi-square test to determine a difference in global complication incidence between three major cochlear implant manufacturers: manufacturer A (Cochlear Limited), manufacturer B (Med-El) and manufacturer C (Advanced Bionics).

RESULTS

A total of 31 857 adverse events were analysed. Implants of manufacturer C were associated with a statistically higher rate of infection (0.97 per cent), cerebrospinal fluid leak (0.07 per cent), extrusion (0.44 per cent) and facial nerve stimulation (0.11 per cent). Implants of manufacturer B were associated with a statistically higher rate of meningitis (0.07 per cent).

CONCLUSION

Consideration of patient risk factors along with cochlear implant manufacturers can heighten awareness of cochlear implant complications pre-operatively, intra-operatively and post-operatively.

Otological Planning Software-OTOPLAN: A Narrative Literature Review

The cochlear implant (CI) is a widely accepted option in patients with severe to profound hearing loss receiving limited benefit from traditional hearing aids. CI surgery uses a default setting for frequency allocation aiming to reproduce tonotopicity, thus mimicking the normal cochlea. One emerging instrument that may substantially help the surgeon before, during, and after the surgery is a surgical planning software product developed in collaboration by CASCINATION AG (Bern, Switzerland) and MED-EL (Innsbruck Austria). The aim of this narrative review is to present an overview of the main features of this otological planning software, called OTOPLAN®. The literature was searched on the PubMed and Web of Science databases. The search terms used were "OTOPLAN", "cochlear planning software" "three-dimensional imaging", "3D segmentation", and "cochlear implant" combined into different queries. This strategy yielded 52 publications, and a total of 31 studies were included. The review of the literature revealed that OTOPLAN is a useful tool for otologists and audiologists as it improves preoperative surgical planning both in adults and in children, guides the intraoperative procedure and allows postoperative evaluation of the CI.

Development of a Sentence Verification Task to Measure Speech Comprehension and Listening Effort in Cochlear Implant Users

PURPOSE

Tests measuring speech comprehension and listening effort for cochlear implant (CI) users may reflect important aspects of real-world speech communication. In this study, we describe the development of a multiple-talker, English-language sentence verification task (SVT) for use in adult CI users to measure speech comprehension and listening effort. We also examine whether talker differences affect speech comprehension and listening effort.

METHOD

Thirteen experienced adult CI users participated in the study and underwent testing using a newly developed multiple-talker SVT. Participants were sequentially presented with audio recordings of unique sentences spoken in English by six different talkers. Participants classified each sentence as either true or false. Accuracy of classification and the response time (RT) for correct responses were used as measures of comprehension and listening effort, respectively. The effect of talker on the results was further analyzed.

RESULTS

All 13 participants successfully completed the SVT. The mean verification accuracy for participants was 87.2% ± 8.8%. The mean RT for correct responses across participants was 1,050 ms ± 391 ms. When stratified by talker, verification accuracy ranged from 83.7% to 95.2% and mean RTs across participant ranged from 786 ms to 1,254 ms. Talker did not have a significant effect on sentence classification accuracy, but it did have a significant effect on RTs (p < .001).

CONCLUSIONS

The SVT is an easily implemented test that can assess speech comprehension and listening effort simultaneously. CI users may experience increased effort for comprehending certain talkers' speech, despite showing similar levels of comprehension accuracy.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24126630.