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Lo CY, Clay‐Williams R, Elks B, Warren C, Rapport F. The (in)visibility of deafness: Identity, stigma, quality of life and the potential role of totally implantable cochlear implants. Health Expect 2024; 27:e14060. [PMID: 38685588 PMCID: PMC11058281 DOI: 10.1111/hex.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION The disclosure of deafness is complex, given the historic and on-going stigma associated with being deaf. The aim of this study was to explore how identity, stigma, and quality of life may be impacted when using cochlear implants (CIs) and totally implantable cochlear implants (TICIs). The physical difference between these two assistive listening devices is significant, given many CI users opt to hide their sound processor behind hair or headwear, in contrast to TICIs (an emerging technology) whereby all components are implanted internally and thus invisible. METHODS This qualitative study involved semistructured interviews and demographic questionnaires with 12 adult participants with more than 1 year of experience using their CI. Participants were recruited Australia-wide through community organisations that support deaf and hard-of-hearing individuals. Interview transcripts were analysed thematically, with the themes generated through an inductive process, with consensus generated through group working with three members from the research team. RESULTS Four major themes were identified: (1) CI challenges; (2) The importance of social and support networks; (3) Identity and disclosure and (4) Concerns about TICIs. The underlying finding was centred around the construction of deaf identity. Participant attitudes were generally categorised as 'Loud and proud', with the recognition that displaying the CI was an extension of self, something to be proud of, and a means to normalise deafness; or 'Out of sight and out of mind', which sought to minimise the visibility of deafness. While both identities differed in how deafness is disclosed, they are fundamentally related to the same ideas of self-agency and empowerment. CONCLUSION TICIs present a novel opportunity-the ability for CI users to control the visibility of their deafness and thus control disclosure. This study explored the impact of stigma and categorised two core identities that CI users construct. Future directions include investigating potential CI candidates, to explore if TICIs may be a facilitator to CI uptake. PATIENT OR PUBLIC CONTRIBUTION The semistructured interview guide was developed in consultation with adults with CIs. Feedback led to adjustments and improvement to the interview guide. In addition, F. R. has a lived experience with hearing loss, and C. Y. L. is an executive committee member for a nonprofit charity organisation that supports families that are D/deaf and hard-of-hearing.
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Affiliation(s)
- Chi Yhun Lo
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Robyn Clay‐Williams
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Beth Elks
- Cochlear LimitedMacquarie UniversitySydneyAustralia
| | - Chris Warren
- Cochlear LimitedMacquarie UniversitySydneyAustralia
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Cullington H, Dickinson AM, Martinez de Estibariz U, Blackaby J, Kennedy L, McNeill K, O'Neill S. Cochlear implant referral patterns in the UK suggest a postcode lottery with inequitable access for older adults; results of a pilot audit in five Audiology sites. Int J Audiol 2024:1-6. [PMID: 38279891 DOI: 10.1080/14992027.2023.2298751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 12/11/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVE To use a standardised reporting tool to identify potential eligible candidates for cochlear implant (CI) referral and quantify the proportion of adults who had a CI referral discussion after presenting with an audiogram within United Kingdom (UK) audiometric criteria. DESIGN Retrospective multicentre 6-month audit of Audiology clinic databases. STUDY SAMPLE A total of 810 adults from five geographically diverse UK Audiology sites. RESULTS Data were collected in late 2019 after UK CI audiometric candidacy criteria changed; one site collected only 3 months of data. The proportion of potential eligible adults (based only on audiometry) considered for CI referral was 64% (521 out of 810) and varied by site (from 50% to 83%). About 24% of patients (123 out of 521) declined CI referral; this also varied across sites (12-45%). The median age of patients where CI referral was not considered was 80 years - significantly higher than the group where CI referral was considered (73 years). CONCLUSIONS CI referral is dependent on where adults live, and how old they are. Older adults are significantly less likely to be considered for CI referral by Audiologists. Audiology clinics need more support to empower staff to talk to patients about CI referral.
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Affiliation(s)
- Helen Cullington
- Auditory Implant Service, University of Southampton, Southampton, UK
| | | | - Unai Martinez de Estibariz
- The Richard Ramsden Centre for Hearing Implants, Manchester University NHS Foundation Trust, Hannover, Germany
| | | | - Lisa Kennedy
- Northeast Regional Cochlear Implant Programme, Middlesbrough, UK
| | | | - Sara O'Neill
- St George's University Hospitals NHS Foundation Trust, London, UK
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Sturm JJ, Brandner G, Ma C, Schvartz-Leyzac KC, Dubno JR, McRackan TR. Why Do Candidates Forgo Cochlear Implantation? Laryngoscope 2023; 133:3548-3553. [PMID: 37114650 DOI: 10.1002/lary.30721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/15/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
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.
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Affiliation(s)
- Joshua J Sturm
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gabriel Brandner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cheng Ma
- Department of Otolaryngology - Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kara C Schvartz-Leyzac
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judy R Dubno
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Looi V, de Jongh N, Kelly-Campbell R. From hearing aids to cochlear implants: The journey for private patients in New Zealand. Cochlear Implants Int 2023; 24:115-129. [PMID: 36624980 DOI: 10.1080/14670100.2022.2154426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To understand adults' journey from hearing aids to cochlear implants (CIs). METHODS Qualitative, exploratory design using semi-structured interviews with twelve postlingually-deafened adults. RESULTS AND DISCUSSION All participants reported social isolation and/or depression. 'Not hearing well enough' was the most-common motivator to seek a CI. Due to the long wait for a public CI, they opted to pay for their implant privately. Funding was the most prominent barrier identified, with most participants using their own savings. The biggest struggle was in the period 3-months post switch-on. Many participants felt progress was slow and that they should have been doing better. After this period, benefits were most noted in quiet, with environmental sounds, and in helping them become more sociable. Music and telephone use were still areas many struggled with. CONCLUSIONS Participants reported the CI was worth the cost, that they would recommend it to others, and would do it again. Self-motivation was the biggest facilitator to success, with hearing professionals playing an integral role throughout the entire journey. There was a large variety of subthemes reflecting the diversity and individuality of the transition.
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Affiliation(s)
- Valerie Looi
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Advanced Bionics (Asia Pacific), Sydney, NSW, Australia
| | - Natasha de Jongh
- School of Psychology, Speech and Hearing, The University of Canterbury, Christchurch, New Zealand
| | - Rebecca Kelly-Campbell
- School of Psychology, Speech and Hearing, The University of Canterbury, Christchurch, New Zealand
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Williams CYK, Li RX, Luo MY, Bance M. Exploring patient experiences and concerns in the online Cochlear implant community: A cross-sectional study and validation of automated topic modelling. Clin Otolaryngol 2023; 48:442-450. [PMID: 36645237 DOI: 10.1111/coa.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/20/2022] [Accepted: 01/07/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE There is a paucity of research examining patient experiences of cochlear implants. We sought to use natural language processing methods to explore patient experiences and concerns in the online cochlear implant (CI) community. MATERIALS AND METHODS Cross-sectional study of posts on the online Reddit r/CochlearImplants forum from 1 March 2015 to 11 November 2021. Natural language processing using the BERTopic automated topic modelling technique was employed to cluster posts into semantically similar topics. Topic categorisation was manually validated by two independent reviewers and Cohen's kappa calculated to determine inter-rater reliability between machine vs human and human vs human categorisation. RESULTS We retrieved 987 posts from 588 unique Reddit users on the r/CochlearImplants forum. Posts were initially categorised by BERTopic into 16 different Topics, which were increased to 23 Topics following manual inspection. The most popular topics related to CI connectivity (n = 112), adults considering getting a CI (n = 107), surgery-related posts (n = 89) and day-to-day living with a CI (n = 85). Cohen's kappa among all posts was 0.62 (machine vs. human) and 0.72 (human vs. human), and among categorised posts was 0.85 (machine vs. human) and 0.84 (human vs. human). CONCLUSIONS This cross-sectional study of social media discussions among the online cochlear implant community identified common attitudes, experiences and concerns of patients living with, or seeking, a cochlear implant. Our validation of natural language processing methods to categorise topics shows that automated analysis of similar Otolaryngology-related content is a viable and accurate alternative to manual qualitative approaches.
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Affiliation(s)
- Christopher Y K Williams
- School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rosia X Li
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Michael Y Luo
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Manohar Bance
- Department of Otolaryngology-Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK
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Ebrahimi-Madiseh A, Nickbakht M, Eikelboom RH, Bennett RJ, Friedland PL, Atlas MD, Jessup RL. Models of service delivery in adult cochlear implantation and evaluation of outcomes: A scoping review of delivery arrangements. PLoS One 2023; 18:e0285443. [PMID: 37163533 PMCID: PMC10171603 DOI: 10.1371/journal.pone.0285443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/23/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND This study aimed to describe available evidence of cochlear implantation delivery arrangements in adults and the outcomes by which these service models are measured. METHODS Scoping review of English language, primary studies conducted on adults (≥18 years) with ten or more subjects, published between January 2000 and June 2022, which assessed the effects of delivery arrangements of cochlear implantation were included. MEDLINE, EMBASE, CINAHL Plus, AMED, PsycINFO, LILACS, KoreaMed, IndMed, Cochrane CRCT, ISRCTN registry, WHO ICTRP and Web of Science were systematically searched. Included studies had to have a method section explicitly measure at least one of the Cochrane Effective Practice and Organization of Care (EPOC) outcome category. Criteria for systematic reviews and delivery arrangement category based on EPOC taxonomy was included in data extraction. Data was narratively synthesized based on EPOC categories. RESULTS A total of 8135 abstracts were screened after exclusion of duplicates, of these 357 studies fulfilled the inclusion criteria. Around 40% of the studies investigated how care is delivered, focusing on quality and safety systems. New care pathways to coordinate care and the use of information and communication technology were emerging areas. There was little evidence on continuity, coordination and integration of care, how the workforce is managed, where care is provided and changes in the healthcare environment. The main outcome measure for various delivery arrangements were the health status and performance in a test. CONCLUSION A substantial body of evidence exists about safety and efficacy of cochlear implantation in adults, predominantly focused on surgical aspects and this area is rapidly growing. There is a lack of evidence on aspects of care delivery that may have more impact on patients' experience such as continuity, coordination and integration of care and should be a focus of future research. This would lead to a better understanding of how patient's view CI experience, associated costs and the value of different care models.
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Affiliation(s)
- Azadeh Ebrahimi-Madiseh
- UWA Medical School, The University of Western Australia, Perth, Australia
- Telethon Speech and Hearing, Perth, Australia
- Ear Science Institute Australia, Perth, Australia
| | - Mansoureh Nickbakht
- Centre for Hearing Research (CHEAR), School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Robert H Eikelboom
- Ear Science Institute Australia, Perth, Australia
- Center for Ear Sciences, The University of Western Australia, Perth, Australia
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Rebecca J Bennett
- Ear Science Institute Australia, Perth, Australia
- Centre for Hearing Research (CHEAR), School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Center for Ear Sciences, The University of Western Australia, Perth, Australia
| | - Peter L Friedland
- UWA Medical School, The University of Western Australia, Perth, Australia
- University of Notre Dame Australia, Perth, Australia
| | - Marcus D Atlas
- Ear Science Institute Australia, Perth, Australia
- Center for Ear Sciences, The University of Western Australia, Perth, Australia
| | - Rebecca L Jessup
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- School of Medicine, Nursing and Health Sciences, Rural Health, Monash University, Melbourne, Australia
- Northern Health, Hospital Without Walls Service, Melbourne, Australia
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Rapport F, Lo CY, Elks B, Warren C, Clay-Williams R. Cochlear implant aesthetics and its impact on stigma, social interaction and quality of life: a mixed-methods study protocol. BMJ Open 2022; 12:e058406. [PMID: 35321898 PMCID: PMC8943735 DOI: 10.1136/bmjopen-2021-058406] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Awareness of the benefits of cochlear implants is low, and barriers such as fear of surgery and ongoing rehabilitation have been noted. Perceived stigma associated with hearing loss also plays a key role, with many adults not wanting to appear old or be identified as a person with a disability. In effect, a cochlear implant makes deafness visible. New technologies have led to a smaller external profile for some types of cochlear implants, but qualitative assessments of benefit have not been explored. This study will examine cochlear implant aesthetics and cosmetics, and its impact on perceived stigma, social interactions, communication and quality of life. A particular focus will be the examination of totally implantable device concepts. A secondary aim is to understand what research techniques are best suited and most appealing for cochlear implant recipients, to assist in future study design and data collection methods. METHODS AND ANALYSIS This study utilises a mixed-methods design. Three datasets will be collected from each participant with an expected sample size of 10-15 participants to allow for data saturation of themes elicited. Each participant will complete a demographic questionnaire, a quickfire survey (a short concise questionnaire on a topic of research familiarity and preference) and a semi-structured interview. Questionnaire and quickfire survey data will be analysed using descriptive statistics. Interviews will be transcribed and analysed thematically. All participants will be adults with more than 1 year of experience using cochlear implants. ETHICS AND DISSEMINATION This study has been granted ethical approval from Macquarie University (HREC: 520211056232432) and meets the requirements set out in the National Statement on Ethical Conduct in Human Research. Study findings will be disseminated widely through international peer-reviewed journal articles, public and academic presentations, plain language summaries for participants and an executive summary for the project funder. This work was supported by Cochlear Limited (Cochlear Ltd). The funder will have no role in conducting or reporting on the study.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Chi Yhun Lo
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Beth Elks
- Cochlear Limited, Macquarie University, Sydney, New South Wales, Australia
| | - Chris Warren
- Cochlear Limited, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Mashal M, Au A, Leigh J, Távora-Vieira D, Wedekind A, Pedley K, Swiderski N, Chester-Browne R, Balke C, Brew J, Arkcoll A, Dahm MR, Boisvert I. Perspectives on Support Material for Referrals to Cochlear Implantation Teams. Am J Audiol 2022; 31:11-20. [PMID: 35041798 DOI: 10.1044/2021_aja-21-00127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE This study used a collaborative approach to explore the needs, barriers, and facilitators to developing cochlear implant referral information material that would be valuable for hard of hearing adults and referring audiologists. METHOD During the development of a prototype referral aid to be used within the Australian context, a multistage qualitative study was conducted using a consultative process, informal and semistructured interviews, as well as online surveys. A deductive directed content analysis approach was applied to assess respondents' perspectives. A total of 106 participants (37 hard of hearing adults and 69 audiologists) were involved across the multiple phases of this study. RESULTS Referral practices for the evaluation of cochlear implantation candidacy in Australia are highly inconsistent, supporting the need to streamline referral information. The following facilitators were identified to support the development of referral material: appropriate content, perceived patient benefit, and objectivity. Areas for improvement related to the broadness of the content, impact on professional identity, and accessibility. CONCLUSIONS Practical insight from patients and referrers can inform the development of patient-facing material related to cochlear implant referrals. Streamlining information used in educational material could alleviate confusion inherent to varied health literacy levels and support patients in making informed decisions related to pursuing, or not, cochlear implantation candidacy evaluation services.
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Affiliation(s)
- Marjan Mashal
- H:EAR (Hearing: Education, Application, Research), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Agnes Au
- HEARnet, The HEARing Cooperative Research Centre (CRC), Melbourne, Victoria, Australia
- Audiology and Speech Pathology, The University of Melbourne, Victoria, Australia
| | - Jaime Leigh
- HEARnet, The HEARing Cooperative Research Centre (CRC), Melbourne, Victoria, Australia
- Audiology and Speech Pathology, The University of Melbourne, Victoria, Australia
- Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital
| | - Dayse Távora-Vieira
- Audiology Department, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia
| | | | - Karen Pedley
- Attune Hearing Implant Centre, Brisbane, Queensland, Australia
| | | | | | | | - Jane Brew
- SCIC Cochlear Implant Program, Sydney, New South Wales, Australia
| | | | - Maria R. Dahm
- Institute for Communication in Health Care (ICH), The Australian National University, Canberra, Australian Capital Territory
| | - Isabelle Boisvert
- H:EAR (Hearing: Education, Application, Research), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- HEARnet, The HEARing Cooperative Research Centre (CRC), Melbourne, Victoria, Australia
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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Reddy P, Dornhoffer JR, Camposeo EL, Dubno JR, McRackan TR. Using Clinical Audiologic Measures to Determine Cochlear Implant Candidacy. Audiol Neurootol 2022; 27:235-242. [PMID: 35038700 PMCID: PMC9133005 DOI: 10.1159/000520077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 10/06/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Only a small percentage (6-10%) of patients who are candidates receive cochlear implants (CIs). One potential reason contributing to low usage rates may be confusion regarding which patients to refer for CI evaluation. The extent to which information provided by standard clinical audiologic assessments is sufficient for selecting appropriate CI evaluation referrals is uncertain. The objective of this study is to evaluate the capacity of standard clinical audiologic measures to differentiate CI candidates from noncandidates. METHOD The study design is a retrospective review of a prospectively maintained CI database from a university-based tertiary medical center of 518 patients undergoing CI evaluations from 2012 to 2020. Each ear of each patient was treated as an independent value. Receiver operating characteristic (ROCs) curves were constructed using aided AzBio sentence recognition scores in quiet and aided AzBio +10 dB signal-to-noise ratio scores <60% as binary classifiers for CI candidacy. For each ROC, we examined the capacity of multiple pure-tone thresholds, pure-tone average (PTA), and CNC word recognition scores (WRSs) measured under earphones to determine CI candidacy. Area under the curve ROC (AUC-ROC) values were calculated to demonstrate the capacity of each model to differentiate CI candidates from noncandidates. RESULTS Variables with the greatest capacity to accurately differentiate CI candidates from noncandidates using aided AzBio in quiet scores were earphone CNC WRS, earphone pure-tone threshold at 1,000 Hz, and earphone PTA (AUC-ROC values = 0.86-0.88). Using aided AzBio +10 scores as the measure for candidacy, only CNC word recognition had a fair capacity to identify candidates (AUC-ROC value = 0.73). Based on the ROCs, a 1,000 Hz pure-tone threshold >50 dB HL, PTA >57 dB HL, and a monosyllabic WRS <60% can each serve as individual indicators for referral for CI evaluations. CONCLUSION The current study provides initial indicators for referral and a first step at developing evidence-based criteria for CI evaluation referral using standard audiologic assessments.
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Affiliation(s)
- Priyanka Reddy
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James R Dornhoffer
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth L Camposeo
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judy R Dubno
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Melo SCSD, Vieira FS. Critérios para a classificação do grau da perda auditiva e proteção social de pessoas com essa deficiência. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222437321s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: identificar critérios adotados nacional e internacionalmente para classificação do grau da perda auditiva, compará-los com o estabelecido na legislação brasileira e discutir as possíveis consequências dessa legislação para a proteção social de Pessoas com Deficiência (PcD) auditiva. Métodos: realizou-se uma revisão narrativa para a identificação dos critérios utilizados nessa classificação. A busca foi realizada em abril de 2020, a partir das plataformas BVS e PUBMED. Foram incluídos estudos publicados entre 2015 e 2019, em inglês, espanhol e português, sobre pesquisas primárias realizadas com seres humanos e menção explícita aos critérios utilizados para a classificação do grau da perda auditiva. Revisão da Literatura: observou-se que há uma predileção pela média entre as frequências de 0,5, 1, 2 e 4 kHz. A legislação brasileira não segue esse critério, o que pode ser uma barreira para o acesso das PcD auditiva aos programas de proteção social. Considerações Finais: não há consenso sobre qual é o melhor critério, todavia há predominância de utilização do considerado mais abrangente para a avaliação auditiva, que não é o legalmente adotado no Brasil. É necessário um debate sobre o critério legal brasileiro, a fim de promover os direitos sociais instituídos para parte das PcD auditiva no Brasil.
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Affiliation(s)
| | - Fabiola Sulpino Vieira
- Universidade Federal de Pernambuco, Brazil; Instituto de Pesquisa Econômica Aplicada, Brasil
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Melo SCSD, Vieira FS. Criteria to classify degrees of hearing loss and the social protection of people with this disability. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222437321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Purpose: to identify criteria used nationally and internationally to classify degrees of hearing loss, compare them with what is established in the Brazilian law, and discuss possible consequences of such a law on the social protection of people with hearing loss. Methods: a narrative review was conducted to identify the criteria used in this classification, by searching the platforms VHL and PubMed in April 2020. It included primary human research explicitly mentioning the criteria used to classify the degree of hearing loss, published between 2015 and 2019 in English, Spanish, and Portuguese. Literature Review: there is a preference for the four-frequency mean at 0.5, 1, 2, and 4 kHz. The Brazilian law does not follow these criteria, which may pose a barrier to people with hearing loss, hindering their access to social protection programs. Final Considerations: there is no consensus on the best criteria, although the most encompassing ones in hearing assessment predominate - which are not the ones legally used in Brazil. It is necessary to debate the Brazilian legal criteria to ensure existing social rights to part of people with hearing loss in Brazil.
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Affiliation(s)
| | - Fabiola Sulpino Vieira
- Universidade Federal de Pernambuco, Brazil; Instituto de Pesquisa Econômica Aplicada, Brasil
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Ngombu SJ, Ray C, Vasil K, Moberly AC, Varadarajan VV. Development of a novel screening tool for predicting Cochlear implant candidacy. Laryngoscope Investig Otolaryngol 2021; 6:1406-1413. [PMID: 34938881 PMCID: PMC8665459 DOI: 10.1002/lio2.673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/21/2021] [Accepted: 09/15/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Cochlear implantation (CI) is a well-established treatment for sensorineural hearing loss. Due in part to a lack of referral guidelines, CI technology remains underutilized, and many patients who could benefit from CI may not be referred for evaluation. This study aimed to develop a model for predicting CI candidacy using routine audiometric measures, with the goal of providing guidance to clinicians regarding when to refer a patient for CI evaluation. METHODS Unaided three-frequency pure tone average (PTA), unaided speech discrimination score (SDS), and best-aided sentence recognition testing with AZBio sentence lists were collected from 252 subjects undergoing CIE. Candidacy was defined by meeting traditional (AZBio score ≤ 60%), or Medicare criteria (≤40%). A logistic regression model was developed to predict candidacy. Confusion matrices were plotted to determine the sensitivity and specificity at various probability thresholds. RESULTS Logistic regression models were capable of predicting probability of candidacy for traditional criteria (P < .001) and Medicare criteria (P < .001). PTA and SDS were significant predictors (P < .001). Using a probability cutoff of .5, the models yielded a sensitivity rate of 91% and 78% for traditional and Medicare criteria, respectively. CONCLUSION Probability of CI candidacy may be determined using a novel screening tool for referral. This tool supports individualized counseling, serves as a proof of concept for candidacy prediction, and could be modified based on an institution's philosophy regarding an acceptable false positive rate of referral. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Stephany J. Ngombu
- Department of Otolaryngology – Head & Neck SurgeryWexner Medical Center at The Ohio State UniversityColumbusOhioUSA
| | - Christin Ray
- Department of Otolaryngology – Head & Neck SurgeryWexner Medical Center at The Ohio State UniversityColumbusOhioUSA
| | - Kara Vasil
- Department of Otolaryngology – Head & Neck SurgeryWexner Medical Center at The Ohio State UniversityColumbusOhioUSA
| | - Aaron C. Moberly
- Department of Otolaryngology – Head & Neck SurgeryWexner Medical Center at The Ohio State UniversityColumbusOhioUSA
| | - Varun V. Varadarajan
- Department of Otolaryngology – Head & Neck SurgeryWexner Medical Center at The Ohio State UniversityColumbusOhioUSA
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Self-Identified Patient Barriers to Pursuit of Cochlear Implantation. Otol Neurotol 2021; 42:S26-S32. [PMID: 34766941 DOI: 10.1097/mao.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cochlear implantation (CI) is an underutilized treatment for hearing loss in the United States for reasons which remain unclear. This study explores self-identified barriers to CI employing a survey of adults who qualified for CI. METHODS A single-institutional review of CI candidates between December 2010 and December 2018 was performed to identify patients who did not pursue surgery. A 21-question survey was developed, aimed at rating patients' concerns regarding CI, including surgical risks, adaptation, costs, time commitment, loss of residual hearing, and lack of benefit, among others. Current hearing aid usage and familiarity with other CI users were also analyzed. The survey was administered to patients who did not pursue CI and a control group who eventually did pursue CI, via email or telephone. RESULTS There were 199 patients who initially did not pursue CI. Fifty-two survey responses were received, comprised of 27 patients who did not pursue CI and 25 patients who did. A belief that CI would not significantly improve the ability to communicate was the most common reported barrier, followed by the postoperative recovery process, risks of surgery, and risks of losing music appreciation. Anesthetic risk and cost were the least important reasons not to pursue CI. Half of patients reported concerns regarding the period of adjustment with the CI. CONCLUSION The decision not to pursue CI despite eligibility is multifactorial and includes concern for minimal hearing benefit and perioperative risks. These factors should be taken into consideration when counseling patients on CI surgery.
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Development and Evaluation of a Language-Independent Test of Auditory Discrimination for Referrals for Cochlear Implant Candidacy Assessment. Ear Hear 2021; 43:1151-1163. [PMID: 34812793 PMCID: PMC9197147 DOI: 10.1097/aud.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to (1) develop a Language-independent Test of Auditory Discrimination (LIT-AD) between speech sounds so that people with hearing loss who derive limited speech perception benefits from hearing aids (HAs) may be identified for consideration of cochlear implantation and (2) examine the relationship between the scores for the new discrimination test and those of a standard sentence test for adults wearing either HAs or cochlear implants (CIs). DESIGN The test measures the ability of the listener to correctly discriminate pairs of nonsense syllables, presented as sequential triplets in an odd-one-out format, implemented as a game-based software tool for self-administration using a tablet computer. Stage 1 included first a review of phonemic inventories in the 40 most common languages in the world to select the consonants and vowels. Second, discrimination testing of 50 users of CIs at several signal to noise ratios (SNRs) was carried out to generate psychometric functions. These were used to calculate the corrections in SNR for each consonant-pair and vowel combination required to equalize difficulty across items. Third, all items were individually equalized in difficulty and the overall difficulty set. Stage 2 involved the validation of the LIT-AD in English-speaking listeners by comparing discrimination scores with performance in a standard sentence test. Forty-one users of HAs and 40 users of CIs were assessed. Correlation analyses were conducted to examine test-retest reliability and the relationship between performance in the two tests. Multiple regression analyses were used to examine the relationship between demographic characteristics and performance in the LIT-AD. The scores of the CI users were used to estimate the probability of superior performance with CIs for a non-CI user having a given LIT-AD score and duration of hearing loss. RESULTS The LIT-AD comprises 81 pairs of vowel-consonant-vowel syllables that were equalized in difficulty to discriminate. The test can be self-administered on a tablet computer, and it takes about 10 min to complete. The software automatically scores the responses and gives an overall score and a list of confusable items as output. There was good test-retest reliability. On average, higher LIT-AD discrimination scores were associated with better sentence perception for users of HAs (r = -0.54, p <0.001) and users of CIs (r = -0.73, p <0.001). The probability of superior performance with CIs for a certain LIT-AD score was estimated, after allowing for the effect of duration of hearing loss. CONCLUSIONS The LIT-AD could increase access to CIs by screening for those who obtain limited benefits from HAs to facilitate timely referrals for CI candidacy evaluation. The test results can be used to provide patients and professionals with practical information about the probability of potential benefits for speech perception from cochlear implantation. The test will need to be evaluated for speakers of languages other than English to facilitate adoption in different countries.
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Nassiri AM, Marinelli JP, Sorkin DL, Carlson ML. Barriers to Adult Cochlear Implant Care in the United States: An Analysis of Health Care Delivery. Semin Hear 2021; 42:311-320. [PMID: 34912159 PMCID: PMC8660164 DOI: 10.1055/s-0041-1739281] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Persistent underutilization of cochlear implants (CIs) in the United States is in part a reflection of a lack of hearing health knowledge and the complexities of care delivery in the treatment of sensorineural hearing loss. An evaluation of the patient experience through the CI health care delivery process systematically exposes barriers that must be overcome to undergo treatment for moderate-to-severe hearing loss. This review analyzes patient-facing obstacles including diagnosis of hearing loss, CI candidate identification and referral to surgeon, CI evaluation and candidacy criteria interpretation, and lastly CI surgery and rehabilitation. Pervasive throughout the process are several themes which demand attention in addressing inequities in hearing health disparities in the United States.
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Affiliation(s)
- Ashley M. Nassiri
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - John P. Marinelli
- Department of Otolaryngology - Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | | | - Matthew L. Carlson
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Ebrahimi-Madiseh A, Eikelboom RH, Bennett RJ, Upson GS, Friedland PL, Swanepoel DW, Psarros C, Lai WK, Atlas MD. What Influences Decision-Making for Cochlear Implantation in Adults? Exploring Barriers and Drivers From a Multistakeholder Perspective. Ear Hear 2021; 41:1752-1763. [PMID: 33136648 DOI: 10.1097/aud.0000000000000895] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To explore the factors influencing the uptake of cochlear implants in adults, determine the impact of each factor, and to conceptualize the journey to implantation from a multistakeholder perspective. DESIGN Concept mapping was used to integrate input from multiple stakeholders, each with their own experience and expertise. This mixed participatory method collects qualitative and quantitative data collection and enables further quantitative analysis. There were two participant cohorts: clients (cochlear implant recipients, candidates, and family members) and professionals (cochlear implant audiologists, ear, nose, and throat surgeons, administration staff, managers. and manufacturer representatives). A total of 93 people participated in the study: client cohort (n = 60, M age = 66.60 years) and professional cohort (n = 33, M age = 45.24 years). Participants brainstormed statements in response to the question "What influences people's decision to get/not get a cochlear implant?" They subsequently grouped the statements and named each group. They rated each statement as to its impact on the decision and prioritized the need for each to be changed/improved using a five-point Likert scale. Multidimensional scaling was used to produce a visual representation of the ideas and their relationship in the form of concepts. Further analysis was conducted to determine the differences between the cohorts, subcohorts, and concepts. RESULTS One hundred ten unique statements were generated and grouped into six concepts which either directly affected the client or their environment. These concepts were: external influences (awareness and attitude of non-implant professionals about uptake, cost, logistics, the referral pathway, public awareness); uncertainties, beliefs, and fears (fears, negative effect of word of mouth, unsuccessful previous ear surgery, cosmetics of the device, misunderstanding of how a cochlear implant functions, eligibility for an implant and outcomes after implantation); health problems (mental and physical health); hearing difficulties (social, emotional, and communication impacts of hearing loss, severity of hearing loss, benefit from and experience with hearing aids); implant professionals (implant team's attitude, knowledge and relationship with clients, quality of overall service); and goals and support (clients 'hearing desires and goals, motivation, positive impact of word of mouth, family support, having a cochlear implant mentor. The six concepts fell into two overarching domains: the client-driven domain with four concepts and the external domain with two concepts. The mean rating of concepts in terms of impact on a client's decision to get an implant ranged from 2.24 (external influences, the main barrier) to 4.45 (goals and support, the main driver). Ratings significantly differed between the client and professional cohorts. CONCLUSIONS This study increases our understanding of the factors, which influence a client's decision choose a cochlear implant as a hearing treatment. It also provides new information on the influence of the other stakeholders on the client journey. The magnitude of the generated statements in the client-driven domain highlights the pivotal role of individualized care in clinical settings in influencing a client's decision and the need for the professionals to understand a client's needs and expectations. A client's persistent hearing difficulties, goals, and support network were identified as drivers to the uptake of cochlear implants. However, the barriers identified highlight the need for a collaborative multi- and interdisciplinary approach to raise awareness in and educate non-implant hearing professionals about the cochlear implant process, as well as providing information to empower clients to make educated decisions and consider a cochlear implant as a hearing management option.
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Affiliation(s)
- Azadeh Ebrahimi-Madiseh
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia
| | - Robert H Eikelboom
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Rebecca J Bennett
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia
| | | | - Peter L Friedland
- Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia
- University of Notre Dame Australia, Fremantle, Australia
| | - De Wet Swanepoel
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Colleen Psarros
- Sydney Cochlear Implant Centre, Royal Institute for Deaf and Blind Children, Sydney, Australia
| | - Wai Kong Lai
- Sydney Cochlear Implant Centre, Royal Institute for Deaf and Blind Children, Sydney, Australia
| | - Marcus D Atlas
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia
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Henkin Y, Shapira Y, Yaar Soffer Y. Current demographic and auditory profiles of adult cochlear implant candidates and factors affecting uptake. Int J Audiol 2021; 61:483-489. [PMID: 34191666 DOI: 10.1080/14992027.2021.1941327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Despite growth of CI and widening of implantation criteria, penetration rates remain low and the clinical profile of adult CI candidates has not substantially changed. This study evaluated the demographic and auditory profiles of current adult CI candidates and identified factors affecting CI uptake. DESIGN Preoperative data from patients who underwent CI candidacy evaluation between 2016-2018 were retrospectively reviewed. Data included demographics, medical reports, audiological results, and reasons for not pursuing implantation. Comparisons between candidates who pursued implantation and those who did not were performed. STUDY SAMPLE Ninety-five candidates (54 females), average age 52 years. RESULTS Most candidates exhibited post-lingual bilateral hearing loss with mean unaided PTA4 of 105dBHL and monosyllabic word score of 26%. Forty-nine candidates were implanted, and the main reason for not pursuing CI was candidates' reluctance. Candidates that pursued CI were mostly younger females with poorer unaided PTA4. Age was the only significant predictor of CI uptake. CONCLUSIONS While current candidates demonstrated greater demographic diversity and better speech perception compared to previous findings, unaided thresholds are still within the profound range. Our findings indicate that eligible candidates face barriers to the utilisation of CI, some of which are modifiable by means of updated candidacy protocols.
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Affiliation(s)
- Yael Henkin
- Hearing, Speech, and Language Center, Sheba Medical Center, Tel Hashomer, Israel.,Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yisgav Shapira
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yifat Yaar Soffer
- Hearing, Speech, and Language Center, Sheba Medical Center, Tel Hashomer, Israel.,Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Hunter JB, Tolisano AM. When to Refer a Hearing-impaired Patient for a Cochlear Implant Evaluation. Otol Neurotol 2021; 42:e530-e535. [PMID: 33394941 DOI: 10.1097/mao.0000000000003023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore the predictive value of utilizing routine audiometry to best determine cochlear implant (CI) candidacy using AzBio sentences. METHODS A retrospective chart review was performed between 2011 and 2018 for 206 adult patients who underwent CI evaluation assessed with AzBio sentences. Better hearing ear word recognition score (WRS) using Northwestern University-6 word lists presented at decibel hearing level from a standard audiogram was used to determine when best to refer a patient for CI evaluation. Predicted AzBio scores from multivariate regression models were calculated and compared with the actual CI candidacy to assess accuracy of the regression models. RESULTS Race, marital status, hearing aid type, better hearing ear WRS, and HL were all independently and significantly associated with AzBio testing in quiet on univariate analyses. Better hearing ear WRS and better hearing ear decibel hearing level predicted AzBio Quiet on multivariate regression analysis. For AzBio +10 dB signal-to-noise ratio (SNR), sex, and better hearing ear WRS each significantly predicted speech perception testing. Predicted CI candidacy was based on AzBio sentence testing of ≤60% for the ease of statistical analysis. Regression models for AzBio sentence testing in quiet and +10 dB SNR agreed with the actual testing most of the time (85.0 and 87.9%, respectively). A generalized linear model was built for both AzBio testing in quiet and +10 dB SNR. CONCLUSION A WRS of <60% in the better hearing ear derived from a routine audiogram will identify 83.1% of CI candidates while appropriately excluding 63.8% of patients.
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Affiliation(s)
- Jacob B Hunter
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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Sucher CM, Eikelboom RH, Stegeman I, Jayakody DMP, Atlas MD. The effect of hearing loss configuration on cochlear implantation uptake rates: an Australian experience. Int J Audiol 2020; 59:828-834. [PMID: 32496880 DOI: 10.1080/14992027.2020.1768445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Recent changes to cochlear implant (CI) candidacy criteria have led to the inclusion of candidates with greater levels of hearing in the contralateral and/or implanted ear. This study assessed the impact of various hearing loss configurations on CI uptake rates (those assessed as eligible for CI, who proceed to CI).Design: Retrospective cohort study.Study sample: Post-lingually deaf adult CI candidates (n = 619) seen at a Western Australian cochlear implant clinic.Results: An overall CI uptake rate of 44% was observed. Hearing loss configuration significantly impacted uptake rates. Uptake rates of 62% for symmetrical hearing loss, 48% for asymmetrical hearing loss (four-frequency average hearing loss (4FAHL) asymmetry ≤60 dB), 25% for highly asymmetrical hearing loss (4FAHL asymmetry >60 dB), 38% for hearing losses eligible for electric-acoustic stimulation, and 22% for individuals with single-sided hearing loss were observed. Hearing loss configuration and age were both significant factors in relation to CI uptake although the impact of age was limited.Conclusion: CI clinics who apply or are considering applying expanded CI candidacy criteria within their practice should be aware that candidates with greater levels of residual hearing in at least the contralateral ear are less likely to proceed to CI.
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Affiliation(s)
- Cathy M Sucher
- Ear Science Clinic, Ear Science Institute Australia, Subiaco East, Australia.,Ear Sciences Centre, Medical School, The University of Western Australia, Nedlands, Australia
| | - Robert H Eikelboom
- Ear Science Clinic, Ear Science Institute Australia, Subiaco East, Australia.,Ear Sciences Centre, Medical School, The University of Western Australia, Nedlands, Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Inge Stegeman
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Dona M P Jayakody
- Ear Science Clinic, Ear Science Institute Australia, Subiaco East, Australia.,Ear Sciences Centre, Medical School, The University of Western Australia, Nedlands, Australia
| | - Marcus D Atlas
- Ear Science Clinic, Ear Science Institute Australia, Subiaco East, Australia.,Ear Sciences Centre, Medical School, The University of Western Australia, Nedlands, Australia
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Rapport F, Hughes SE, Boisvert I, McMahon CM, Braithwaite J, Faris M, Bierbaum M. Adults' cochlear implant journeys through care: a qualitative study. BMC Health Serv Res 2020; 20:457. [PMID: 32448127 PMCID: PMC7247254 DOI: 10.1186/s12913-020-05334-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Background Cochlear implants (CIs) can provide a sound sensation for those with severe sensorineural hearing loss (SNHL), benefitting speech understanding and quality of life. Nevertheless, rates of implantation remain low, and limited research investigates journeys from traditional hearing aids to implantable devices. Method Fifty-five adults (≥ 50 years), hearing aid users and/or CI users, General Practitioners, and Australian and United Kingdom audiologists took part in a multi-methods study. Focus groups, interviews, and surveys were thematically analysed. Results One hundred forty-three data-capture events disclosed 2 themes: 1) “The burden of hearing loss and the impact of Cochlear Implants”, and 2) “Professional Support and Practice, and HCPs Roles and Responsibilities”. Conclusions Care experience can include convoluted, complex journeys towards cochlear implantation. The significant impact of this, as hearing loss progresses, motivates people to consider implants, but they and healthcare professionals need clear supported with defined referral pathways, and less system complexity.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia.
| | - Sarah E Hughes
- Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom.,South Wales Cochlear Implant Programme, Princess of Wales Hospital, Bridgend, Mid Glamorgan, Wales, United Kingdom
| | - Isabelle Boisvert
- H:EAR [Hearing: Education, Application, Research], Australian Hearing Hub, Macquarie University, Macquarie Park, NSW, Australia.,The HEARing Cooperative Research Centre, Melbourne, VIC, Australia
| | - Catherine M McMahon
- H:EAR [Hearing: Education, Application, Research], Australian Hearing Hub, Macquarie University, Macquarie Park, NSW, Australia.,The HEARing Cooperative Research Centre, Melbourne, VIC, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Mona Faris
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
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Development of a 60/60 Guideline for Referring Adults for a Traditional Cochlear Implant Candidacy Evaluation. Otol Neurotol 2020; 41:895-900. [DOI: 10.1097/mao.0000000000002664] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Berardino FD, Conte G, Turati F, Ferraroni M, Zanetti D. Cochlear implantation in Ménière's disease: a systematic review of literature and pooled analysis. Int J Audiol 2020; 59:406-415. [PMID: 32027195 DOI: 10.1080/14992027.2020.1720922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The aim of this study was to evaluate the effect of cochlear implantation (CI) in advanced Ménière's disease (MD).Design: The initial search on PubMed, EMBASE, and Cochrane databases yielded 171 articles; no language restriction was applied.Study sample: A total of 11 articles met the inclusion criteria and were included in this systematic review. Six articles provided patient-level data on improvement in speech recognition testing after CI.Results: The methodological quality of included studies was assessed by examining the study design, level of evidence, method of measurement and adequacy of outcome reporting. A random-effect model was fitted for calculating weighted means. Post-operative improvement in word recognition score (WCS) was 50.8% (95% confidence interval: 34.6-67.1%); general improvement of vestibular symptoms after CI was found in 67% of the pooled patients; when reported in the studies, quality of life (QoL) and tinnitus were also generally improved after CI.Conclusions: CI in advanced MD is a valid option providing good outcomes in terms of speech performances, regardless of the disease duration, uni- or bilaterality, age at implantation, previous therapeutic procedures and stage of activity of MD.
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Affiliation(s)
- Federica Di Berardino
- Audiology Unit, Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Specialist Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Giorgio Conte
- Department of Neuroradiology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Federica Turati
- Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Monica Ferraroni
- Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Diego Zanetti
- Audiology Unit, Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Specialist Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
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Francis-Auton E, Warren C, Braithwaite J, Rapport F. Exploring the recruitment, ethical considerations, conduct and information dissemination of an audiology trial: a pretrial qualitative study (q-COACH). Trials 2020; 21:28. [PMID: 31907073 PMCID: PMC6945488 DOI: 10.1186/s13063-019-3968-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/06/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Randomised controlled trials (RCTs), while still considered the gold standard approach in medical research, can encounter impediments to their successful conduct and the dissemination of results. Pretrial qualitative research can usefully address some of these impediments, including recruitment and retention, ethical conduct, and preferred methods of dissemination. However, pretrial qualitative work is rarely undertaken in audiology. The Comparison of outcomes with hearing aids and cochlear implants in adults with moderately severe-to-profound bilateral sensorineural hearing loss (COACH) is a proposed RCT aiming to clarify when hearing aids (HAs) or cochlear implants (CIs) are the most suitable for different degrees of hearing loss and for which kinds of patients. q-COACH is a pretrial, qualitative study examining stakeholders' experiences of HAs and CIs, current clinical practices and stakeholders' perspectives of the design, conduct and dissemination plans for the proposed COACH study. METHODS Twenty-four participants including general practitioners, audiologists, adult HA users, and adult support networks undertook either semi-structured individual or paired interviews and completed demographic questionnaires. Data were analysed thematically. RESULTS Four key themes arose from this study: 1) rethinking sampling and recruitment strategies, 2) ethical considerations, 3) refining trial conduct, and 4) interconnected, appropriate and accessible methods of results dissemination. CONCLUSIONS This qualitative investigation identified key considerations for the proposed RCT design, conduct and dissemination to help with successful implementation of COACH, and to indicate a plan of action at all RCT stages that would be acceptable to potential participants. By drawing on the perspectives of multiple key stakeholders and including a more general discussion of their experience and opinions of hearing loss, hearing device use and service availability, the study revealed experiential and ethical paradigms in which stakeholders operate. In so doing, q-COACH has exposed the benefits of preliminary qualitative investigations that enable detailed and rich understandings of the phenomenon at stake, forestalling problems and improving the quality of trial design, conduct and dissemination, while informing future RCT development discussions.
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Affiliation(s)
- Emilie Francis-Auton
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109 Australia
| | - Chris Warren
- Cochlear Ltd, 1 University Ave, Macquarie Park, NSW 2113 Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109 Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109 Australia
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Rapport F, Auton E, Warren C, Braithwaite J. Addressing clinical equipoise for hearing devices: the qualitative COACH (q-COACH) study protocol for Australian stakeholder involvement in the design of a randomised controlled trial. BMJ Open 2019; 9:e030100. [PMID: 31501120 PMCID: PMC6738701 DOI: 10.1136/bmjopen-2019-030100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hearing loss is a common chronic problem which can be effectively managed with hearing devices. At present, only a limited number of people with hearing loss use hearing aids (HAs) and cochlear implants (CIs) to improve hearing and sound quality and enhance quality of life. Clinical equipoise, by which we mean healthcare professional uncertainty about which treatment options are the most efficacious due to the lack of evidence-based information, can lead to inconsistent and poorly informed referral processes for hearing devices.A randomised controlled trial (RCT) that offers high-quality, generalisable information is needed to clarify which hearing device (HA or CI) is more suitable for different degrees of hearing loss and for which kinds of patients. Qualitative research can improve this RCT, by gathering the information on patient and provider perspectives, attitudes and values, which can inform design, conduct and information dissemination, either during preparatory stages of an intervention, or as a fully integrated methodology. The Comparison of Outcomes with hearing Aids and Cochlear implants in adults with moderately severe-to-profound bilateral sensorineural Hearing loss (COACH) study is being planned as an RCT with a qualitative arm (the qualitative COACH study, q-COACH), acting as a pretrial intervention examining views of HAs, CIs, equipoise and the impetus for an RCT of this nature. METHODS AND ANALYSIS The q-COACH study involves semistructured interviews and a demographic questionnaire which will be collected from four participant cohorts: General Practitioners (GPs) and Ear, Nose and Throat Surgeons (ENTs); audiologists; adult HA users and their support networks. Data will be analysed thematically and through descriptive statistics. ETHICS AND DISSEMINATION Macquarie University Human Research Ethics Committee, Australia, granted ethical approval (no. 5201833514848). Peer-reviewed journal articles, research conferences and a final report will present study findings.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Auton
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Chris Warren
- Cochlear Ltd, North Ryde, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Rapport F, Bierbaum M, McMahon C, Boisvert I, Lau A, Braithwaite J, Hughes S. Qualitative, multimethod study of behavioural and attitudinal responses to cochlear implantation from the patient and healthcare professional perspective in Australia and the UK: study protocol. BMJ Open 2018; 8:e019623. [PMID: 29844099 PMCID: PMC5988079 DOI: 10.1136/bmjopen-2017-019623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The growing prevalence of adults with 'severe or greater' hearing loss globally is of great concern, with hearing loss leading to diminished communication, and impacting on an individual's quality of life (QoL). Cochlear implants (CI) are a recommended device for people with severe or greater, sensorineural hearing loss, who obtain limited benefits from conventional hearing aids (HA), and through improved speech perception, CIs can improve the QoL of recipients. Despite this, utilisation of CIs is low. METHODS AND ANALYSIS This qualitative, multiphase and multimethod dual-site study (Australia and the UK) explores patients' and healthcare professionals' behaviours and attitudes to cochlear implantation. Participants include general practitioners, audiologists and older adults with severe or greater hearing loss, who are HA users, CI users and CI candidates. Using purposive time frame sampling, participants will be recruited to take part in focus groups or individual interviews, and will each complete a demographic questionnaire and a qualitative proforma. The study aims to conduct 147 data capture events across a sample of 49 participants, or until data saturation occurs. Schema and thematic analysis with extensive group work will be used to analyse data alongside reporting of demographic and participant characteristics. ETHICS AND DISSEMINATION Ethics approval for this study was granted by Macquarie University (HREC: 5201700539), and the study will abide by Australian National Health and Medical Research Council ethical guidelines. Study findings will be published through peer-reviewed journal articles, and disseminated through public and academic conference presentations, participant information sheets and a funders' final report.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Macquarie University Centre for Implementation of Hearing Research, Sydney, New South Wales, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Catherine McMahon
- Macquarie University Centre for Implementation of Hearing Research, Sydney, New South Wales, Australia
- The HEARing Cooperative Research Centre, Sydney, New South Wales, Australia
| | - Isabelle Boisvert
- Macquarie University Centre for Implementation of Hearing Research, Sydney, New South Wales, Australia
- The HEARing Cooperative Research Centre, Sydney, New South Wales, Australia
| | - Annie Lau
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Macquarie University Centre for Implementation of Hearing Research, Sydney, New South Wales, Australia
| | - Sarah Hughes
- Macquarie University Centre for Implementation of Hearing Research, Sydney, New South Wales, Australia
- South Wales Cochlear Implant Programme, Abertawe Bro Morgannwg University Health Board, Bridgend, UK
- Swansea University Medical School, Swansea, UK
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