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Bartholomew RA, Hoffman SE, Juliano AF, Wu PZ, Zhao Y, de Gruttola V, Liberman MC, Maison SF. On the Difficulty Predicting Word Recognition Performance After Cochlear Implantation. Otol Neurotol 2024; 45:e393-e399. [PMID: 38573598 PMCID: PMC11087198 DOI: 10.1097/mao.0000000000004176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
HYPOTHESIS Preimplantation word scores cannot reliably predict postimplantation outcomes. BACKGROUND To date, there is no model based on preoperative data that can reliably predict the postoperative outcomes of cochlear implantation in the postlingually deafened adult patient. METHODS In a group of 228 patients who received a cochlear implant between 2002 and 2021, we tested the predictive power of nine variables (age, etiology, sex, laterality of implantation, preimplantation thresholds and word scores, as well as the design, insertion approach, and angular insertion depth of the electrode array) on postimplantation outcomes. Results of multivariable linear regression analyses were then interpreted in light of data obtained from histopathological analyses of human temporal bones. RESULTS Age and etiology were the only significant predictors of postimplantation outcomes. In agreement with many investigations, preimplantation word scores failed to significantly predict postimplantation outcomes. Analysis of temporal bone histopathology suggests that neuronal survival must fall below 40% before word scores in quiet begin to drop. Scores fall steeply with further neurodegeneration, such that only 20% survival can support acoustically driven word scores of 50%. Because almost all cochlear implant implantees have at least 20% of their spiral ganglion neurons (SGNs) surviving, it is expected that most cochlear implant users on average should improve to at least 50% word recognition score, as we observed, even if their preimplantation score was near zero as a result of widespread hair cell damage and the fact that ~50% of their SGNs have likely lost their peripheral axons. These "disconnected" SGNs would not contribute to acoustic hearing but likely remain electrically excitable. CONCLUSION The relationship between preimplantation word scores and data describing the survival of SGNs in humans can explain why preimplantation word scores obtained in unaided conditions fail to predict postimplantation outcomes.
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Affiliation(s)
| | | | - Amy F Juliano
- Department of Radiology, Massachusetts Eye & Ear, Harvard Medical School
| | | | - Yan Zhao
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear
| | - Victor de Gruttola
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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de Quillettes R, Kaandorp M, Merkus P, Kramer SE, Smits C. Experienced Adult Cochlear Implant Users Show Improved Speech Recognition When Target Fitting Parameters Are Applied. Ear Hear 2024:00003446-990000000-00274. [PMID: 38755742 DOI: 10.1097/aud.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The aim of the present study was to investigate whether prediction models built by de Graaff et al. (2020) can be used to improve speech recognition in experienced adult postlingual implanted Cochlear CI users. de Graaff et al. (2020) found relationships between elevated aided thresholds and a not optimal electrical dynamic range (<50 CL or >60 CL), and poorer speech recognition in quiet and in noise. The primary hypothesis of the present study was that speech recognition improves both in quiet and in noise when the sound processor is refitted to match targets derived from the prediction models from de Graaff et al. (2020). A second hypothesis was that subjectively, most of the CI users would find the new setting too loud because of an increase in C levels, and therefore, prefer the old settings. DESIGN A within-participant repeated measures design with 18 adult Cochlear CI users was used. T- and C-levels were changed to "optimized settings," as predicted by the model of de Graaff et al. (2020). Aided thresholds, speech recognition in quiet, and speech recognition in noise were measured with the old settings and after a 4-week acclimatization period with the optimized settings. Subjective benefit was measured using the Device Oriented Subjective Outcome Scale questionnaire. RESULTS The mean electrical dynamic range changed from 41.1 (SD = 6.6) CL to 48.6 (SD = 3.0) CL. No significant change in aided thresholds was measured. Speech recognition improved for 16 out of 18 participants and remained stable for 2 participants. Average speech recognition scores in quiet significantly improved by 4.9% (SD = 3.8%). No significant change for speech recognition in noise was found. A significant improvement in subjective benefit was found for one of the Device Oriented Subjective Outcome subscales (speech cues) between the old and optimized settings. All participants chose to keep the optimized settings at the end of the study. CONCLUSIONS We were able to improve speech recognition in quiet by optimizing the electrical dynamic range of experienced adult CI users, according to the prediction models built by de Graaff et al. (2020). There was no significant change in aided thresholds nor in speech recognition in noise. The findings of the present study suggest that improved performance for speech recognition in quiet in adult Cochlear CI users can be achieved by setting the dynamic range as close as possible to values between 50 and 60 CL when the volume level is at 10.
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Affiliation(s)
- Richard de Quillettes
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marre Kaandorp
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Paul Merkus
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Sophia E Kramer
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Cas Smits
- Amsterdam UMC, Location University of Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Kady W, Sioshansi PC, Wall N, Bojrab I I D, Tu N, Lin K, Zappia J, Hong R, Porps S, Babu SC. Impact of superior semicircular canal dehiscence on cochlear implant audiologic outcomes. Am J Otolaryngol 2024; 45:104320. [PMID: 38677151 DOI: 10.1016/j.amjoto.2024.104320] [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: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Determine whether adult cochlear implant users with radiographic superior semicircular canal dehiscence experience clinically significant differences in audiological outcomes when compared to cochlear implant users with normal temporal bone anatomy. MATERIALS AND METHODS Retrospective, single institution review. Adult, post-lingual deaf patients implanted between 2010 and 2020. Inclusion criteria included age 18 years or older, available preoperative computed tomography imaging, and preoperative and postoperative AzBio audiological data for at least 6 months of cochlear implant use. Preoperative and postoperative AzBio Sentence Test scores were compared between patients with normal temporal bone anatomy and those with radiographic superior semicircular canal dehiscence or near dehiscence. RESULTS 110 patients met inclusion criteria. Mean AzBio score for normal temporal bone anatomy group improved from 35.2 % (SD 28.2) preoperatively to 70.3 % (SD 25.7) postoperatively, an improvement of 35.1 % (SD 28.6). Mean AzBio score for near dehiscent temporal bone anatomy group improved from 26.6 % (SD 28.9) preoperatively to 64.5 % (SD 30.6) postoperatively, an improvement of 37.9 % (SD 27.9). Mean AzBio score for dehiscent temporal bone anatomy group improved from 26.3 % (SD 20.4) preoperatively to 65.1 % (SD 27.6) postoperatively, an improvement of 38.7 % (SD 26.9). Utilizing the one-way analysis of variance test, there was no significant difference in audiologic outcomes between the three groups. CONCLUSIONS Patients with complete or near complete radiographic superior canal dehiscence at the time of cochlear implantation achieve similar improvements in speech perception scores compared to normal anatomy adult cochlear implant users.
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Affiliation(s)
- William Kady
- Ascension Macomb-Oakland Hospital, Otolaryngology - Head & Neck Surgery, 27351 Dequindre Road, Madison Heights, MI 48071, USA; Michigan State University College of Osteopathic Medicine, 965 Wilson Road, East Lansing, MI 48824, USA; Ear Nose and Throat Consultants, 29201 Telegraph Road Suite 500, Southfield, MI 48034, USA.
| | - Pedrom C Sioshansi
- Michigan Ear Institute Department of Neurotology, 30055 Northwestern Highway Suite 101, Farmington Hills, MI 48334, USA
| | - Natalie Wall
- Ascension Macomb-Oakland Hospital, Otolaryngology - Head & Neck Surgery, 27351 Dequindre Road, Madison Heights, MI 48071, USA; Michigan State University College of Osteopathic Medicine, 965 Wilson Road, East Lansing, MI 48824, USA.
| | - Denny Bojrab I I
- Michigan Ear Institute Department of Neurotology, 30055 Northwestern Highway Suite 101, Farmington Hills, MI 48334, USA
| | - Nathan Tu
- Michigan Ear Institute Department of Neurotology, 30055 Northwestern Highway Suite 101, Farmington Hills, MI 48334, USA
| | - Kenny Lin
- Michigan Ear Institute Department of Neurotology, 30055 Northwestern Highway Suite 101, Farmington Hills, MI 48334, USA
| | - John Zappia
- Michigan Ear Institute Department of Neurotology, 30055 Northwestern Highway Suite 101, Farmington Hills, MI 48334, USA
| | - Robert Hong
- Michigan Ear Institute Department of Neurotology, 30055 Northwestern Highway Suite 101, Farmington Hills, MI 48334, USA
| | - Sandra Porps
- Michigan Ear Institute Department of Neurotology, 30055 Northwestern Highway Suite 101, Farmington Hills, MI 48334, USA
| | - Seilesh C Babu
- Ascension Macomb-Oakland Hospital, Otolaryngology - Head & Neck Surgery, 27351 Dequindre Road, Madison Heights, MI 48071, USA; Michigan State University College of Human Medicine, 15 Michigan Street NE, Grand Rapids, MI 49503, USA; Michigan Ear Institute Department of Neurotology, 30055 Northwestern Highway Suite 101, Farmington Hills, MI 48334, USA
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Thompson NJ, Dillon MT, Nix EP, Overton AB, Selleck AM, Dedmon MM, Brown KD. Variables Affecting Cochlear Implant Performance After Loss of Residual Hearing. Laryngoscope 2024; 134:1868-1873. [PMID: 37767794 DOI: 10.1002/lary.31066] [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: 02/13/2023] [Revised: 08/15/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Determine variables that influence post-activation performance for cochlear implant (CI) recipients who lost low-frequency acoustic hearing. METHODS A retrospective review evaluated CNC word recognition for adults with normal to moderately severe low-frequency hearing (preoperative unaided thresholds of ≤70 dB HL at 250 Hz) who were implanted between 2012 and 2021 at a tertiary academic center, lost functional acoustic hearing, and were fit with a CI-alone device. Performance scores were queried from the 1, 3, 6, 12, and 24-month post-activation visits. A linear mixed model evaluated the effects of age at implantation, array length (long vs. mid/short), and preoperative low-frequency hearing (normal to mild, moderate, and moderately severe) on speech recognition with a CI alone. RESULTS 113 patients met the inclusion criteria. There was a significant main effect of interval (p < 0.001), indicating improved word recognition post-activation despite loss of residual hearing. There were significant main effects of age (p = 0.029) and array length (p = 0.038), with no effect of preoperative low-frequency hearing (p = 0.171). There was a significant 2-way interaction between age and array length (p = 0.018), indicating that older adults with mid/short arrays performed more poorly than younger adults with long lateral wall arrays when functional acoustic hearing was lost. CONCLUSION CI recipients with preoperative functional low-frequency hearing experience a significant improvement in speech recognition with a CI alone as compared to preoperative performance-despite the loss of low-frequency hearing. Age and electrode array length may play a role in post-activation performance. These data have implications for the preoperative counseling and device selection for hearing preservation candidates. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1868-1873, 2024.
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Affiliation(s)
- Nicholas J Thompson
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Margaret T Dillon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Evan P Nix
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Andrea B Overton
- Audiology Department, UNC Health, Chapel Hill, North Carolina, U.S.A
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Matthew M Dedmon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Kevin D Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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He S, Skidmore J, Bruce IC, Oleson JJ, Yuan Y. Peripheral Neural Synchrony in Postlingually Deafened Adult Cochlear Implant Users. Ear Hear 2024:00003446-990000000-00264. [PMID: 38503720 DOI: 10.1097/aud.0000000000001502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES This paper reports a noninvasive method for quantifying neural synchrony in the cochlear nerve (i.e., peripheral neural synchrony) in cochlear implant (CI) users, which allows for evaluating this physiological phenomenon in human CI users for the first time in the literature. In addition, this study assessed how peripheral neural synchrony was correlated with temporal resolution acuity and speech perception outcomes measured in quiet and in noise in postlingually deafened adult CI users. It tested the hypothesis that peripheral neural synchrony was an important factor for temporal resolution acuity and speech perception outcomes in noise in postlingually deafened adult CI users. DESIGN Study participants included 24 postlingually deafened adult CI users with a Cochlear™ Nucleus® device. Three study participants were implanted bilaterally, and each ear was tested separately. For each of the 27 implanted ears tested in this study, 400 sweeps of the electrically evoked compound action potential (eCAP) were measured at four electrode locations across the electrode array. Peripheral neural synchrony was quantified at each electrode location using the phase-locking value (PLV), which is a measure of trial-by-trial phase coherence among eCAP sweeps/trials. Temporal resolution acuity was evaluated by measuring the within-channel gap detection threshold (GDT) using a three-alternative, forced-choice procedure in a subgroup of 20 participants (23 implanted ears). For each ear tested in these participants, GDTs were measured at two electrode locations with a large difference in PLVs. For 26 implanted ears tested in 23 participants, speech perception performance was evaluated using consonant-nucleus-consonant (CNC) word lists presented in quiet and in noise at signal to noise ratios (SNRs) of +10 and +5 dB. Linear Mixed effect Models were used to evaluate the effect of electrode location on the PLV and the effect of the PLV on GDT after controlling for the stimulation level effects. Pearson product-moment correlation tests were used to assess the correlations between PLVs, CNC word scores measured in different conditions, and the degree of noise effect on CNC word scores. RESULTS There was a significant effect of electrode location on the PLV after controlling for the effect of stimulation level. There was a significant effect of the PLV on GDT after controlling for the effects of stimulation level, where higher PLVs (greater synchrony) led to lower GDTs (better temporal resolution acuity). PLVs were not significantly correlated with CNC word scores measured in any listening condition or the effect of competing background noise presented at an SNR of +10 dB on CNC word scores. In contrast, there was a significant negative correlation between the PLV and the degree of noise effect on CNC word scores for a competing background noise presented at an SNR of +5 dB, where higher PLVs (greater synchrony) correlated with smaller noise effects on CNC word scores. CONCLUSIONS This newly developed method can be used to assess peripheral neural synchrony in CI users, a physiological phenomenon that has not been systematically evaluated in electrical hearing. Poorer peripheral neural synchrony leads to lower temporal resolution acuity and is correlated with a larger detrimental effect of competing background noise presented at an SNR of 5 dB on speech perception performance in postlingually deafened adult CI users.
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Affiliation(s)
- Shuman He
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
- Department of Audiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jeffrey Skidmore
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ian C Bruce
- Department of Electrical & Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Jacob J Oleson
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | - Yi Yuan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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He S, Skidmore J, Bruce IC, Oleson JJ, Yuan Y. Peripheral neural synchrony in post-lingually deafened adult cochlear implant users. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.07.07.23292369. [PMID: 37461681 PMCID: PMC10350140 DOI: 10.1101/2023.07.07.23292369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective This paper reports a noninvasive method for quantifying neural synchrony in the cochlear nerve (i.e., peripheral neural synchrony) in cochlear implant (CI) users, which allows for evaluating this physiological phenomenon in human CI users for the first time in the literature. In addition, this study assessed how peripheral neural synchrony was correlated with temporal resolution acuity and speech perception outcomes measured in quiet and in noise in post-lingually deafened adult CI users. It tested the hypothesis that peripheral neural synchrony was an important factor for temporal resolution acuity and speech perception outcomes in noise in post-lingually deafened adult CI users. Design Study participants included 24 post-lingually deafened adult CI users with a Cochlear™ Nucleus® device. Three study participants were implanted bilaterally, and each ear was tested separately. For each of the 27 implanted ears tested in this study, 400 sweeps of the electrically evoked compound action potential (eCAP) were measured at four electrode locations across the electrode array. Peripheral neural synchrony was quantified at each electrode location using the phase locking value (PLV), which is a measure of trial-by-trial phase coherence among eCAP sweeps/trials. Temporal resolution acuity was evaluated by measuring the within-channel gap detection threshold (GDT) using a three-alternative, forced-choice procedure in a subgroup of 20 participants (23 implanted ears). For each ear tested in these participants, GDTs were measured at two electrode locations with a large difference in PLVs. For 26 implanted ears tested in 23 participants, speech perception performance was evaluated using Consonant-Nucleus-Consonant (CNC) word lists presented in quiet and in noise at signal-to-noise ratios (SNRs) of +10 and +5 dB. Linear Mixed effect Models were used to evaluate the effect of electrode location on the PLV and the effect of the PLV on GDT after controlling for the stimulation level effects. Pearson product-moment correlation tests were used to assess the correlations between PLVs, CNC word scores measured in different conditions, and the degree of noise effect on CNC word scores. Results There was a significant effect of electrode location on the PLV after controlling for the effect of stimulation level. There was a significant effect of the PLV on GDT after controlling for the effects of stimulation level, where higher PLVs (greater synchrony) led to lower GDTs (better temporal resolution acuity). PLVs were not significantly correlated with CNC word scores measured in any listening condition or the effect of competing background noise presented at a SNR of +10 dB on CNC word scores. In contrast, there was a significant negative correlation between the PLV and the degree of noise effect on CNC word scores for a competing background noise presented at a SNR of +5 dB, where higher PLVs (greater synchrony) correlated with smaller noise effects on CNC word scores. Conclusions This newly developed method can be used to assess peripheral neural synchrony in CI users, a physiological phenomenon that has not been systematically evaluated in electrical hearing. Poorer peripheral neural synchrony leads to lower temporal resolution acuity and is correlated with a larger detrimental effect of competing background noise presented at a SNR of 5 dB on speech perception performance in post-lingually deafened adult CI users.
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Affiliation(s)
- Shuman He
- Department of Otolaryngology – Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
- Department of Audiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205
| | - Jeffrey Skidmore
- Department of Otolaryngology – Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
| | - Ian C. Bruce
- Department of Electrical & Computer Engineering, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Jacob J. Oleson
- Department of Biostatistics, The University of Iowa, Iowa City, IA 52242
| | - Yi Yuan
- Department of Otolaryngology – Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
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Kaul VF, Brannan Z, Keith J, Hittle B, Riggs W, Hiss M, Varadarajan V, Zhan K, Powell K, Wiet GJ, Adunka OF. Post-operative evaluation of computed tomography imaging following cochlear implantation. Am J Otolaryngol 2024; 45:104081. [PMID: 37820391 DOI: 10.1016/j.amjoto.2023.104081] [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] [Received: 08/21/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE This study utilized an automated segmentation algorithm to assess the cochlear implant electrode array within the cochlea and investigate its impact on audiologic outcomes as measured by post-operative speech perception scores. Furthermore, manual evaluations of electrode placement were compared to automatic segmentation methods to determine their accuracy in predicting post-operative audiologic outcomes. MATERIALS AND METHODS This retrospective chart review was conducted at a tertiary care referral center involving adult post-lingually deafened cochlear implant recipients implanted from 2015 to 2019. Patients with appropriate postoperative imaging and speech testing were included. Patients were excluded if non-English speaking, had a cognitive deficit, or a labyrinthine malformation. Automated and manual methods were used to analyze computed tomography (CT) scans and correlate the findings with post-operative speech perception scores and detection of electrode translocation. RESULTS Among the 47 patients who met inclusion criteria, 15 had electrode translocations confirmed by automatic segmentation methods. Controlling for CI usage and pre-operative AzBio scores, patients with translocation exhibited significantly lower consonant-nucleus consonant (CNC) and AzBio scores at 6-months post-implantation compared to patients with ST insertions. Moreover, the number of translocated electrode contacts was significantly associated with post-operative CNC scores. Manual evaluations of electrode location were predictive but less sensitive to electrode translocations when compared with automated 3D segmentation. CONCLUSIONS Placement of CI electrode contacts within ST without translocation into SV, leads to improved audiologic outcomes. Manual assessment of electrode placement via temporal bone CT, without 3D reconstruction, provides a less sensitive method to determine electrode placement than automated methods. LEVEL OF EVIDENCE Level 4. LAY SUMMARY This study investigated the impact of electrode placement on speech outcomes for cochlear implant recipients. Using advanced imaging techniques, the researchers compared automated and manual methods for evaluating electrode position and examined the relationship between electrode translocation and audiologic outcomes. The findings revealed that proper placement within the cochlea without translocation into inappropriate compartments inside the cochlea improves speech understanding. Manual evaluations were somewhat accurate but less sensitive in detecting translocations compared to automated methods, which offer more precise predictions of patient outcomes. These results contribute to our understanding of factors influencing cochlear implant success and highlight the importance of optimizing electrode placement for improved speech outcomes.
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Affiliation(s)
- Vivian F Kaul
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America.
| | - Zachary Brannan
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States of America
| | - Jason Keith
- Ohio State University College of Engineering, 2070 Neil Ave, Columbus, OH 43210, United States of America.
| | - Bradley Hittle
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States of America.
| | - William Riggs
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America
| | - Meghan Hiss
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America.
| | - Varun Varadarajan
- Associates of Otolaryngology Colorado, 850 E Harvard Ave # 505, Denver, CO 80210, United States of America
| | - Kevin Zhan
- Northwestern Medical Group, 251 East Huron Street, Chicago, IL 60611, United States of America.
| | - Kimerly Powell
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America.
| | - Gregory J Wiet
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America; Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, United States of America.
| | - Oliver F Adunka
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America; Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, United States of America.
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Walia A, Shew MA, Lefler SM, Ortmann AJ, Durakovic N, Wick CC, Herzog JA, Buchman CA. Factors Affecting Performance in Adults With Cochlear Implants: A Role for Cognition and Residual Cochlear Function. Otol Neurotol 2023; 44:988-996. [PMID: 37733968 PMCID: PMC10840600 DOI: 10.1097/mao.0000000000004015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To evaluate the impact of preoperative and perioperative factors on postlinguistic adult cochlear implant (CI) performance and design a multivariate prediction model. STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. PATIENTS AND INTERVENTIONS Two hundred thirty-nine postlinguistic adult CI recipients. MAIN OUTCOME MEASURES Speech-perception testing (consonant-nucleus-consonant [CNC], AzBio in noise +10-dB signal-to-noise ratio) at 3, 6, and 12 months postoperatively; electrocochleography-total response (ECochG-TR) at the round window before electrode insertion. RESULTS ECochG-TR strongly correlated with CNC word score at 6 months ( r = 0.71, p < 0.0001). A multivariable linear regression model including age, duration of hearing loss, angular insertion depth, and ECochG-TR did not perform significantly better than ECochG-TR alone in explaining the variability in CNC. AzBio in noise at 6 months had moderate linear correlations with Montreal Cognitive Assessment (MoCA; r = 0.38, p < 0.0001) and ECochG-TR ( r = 0.42, p < 0.0001). ECochG-TR and MoCA and their interaction explained 45.1% of the variability in AzBio in noise scores. CONCLUSIONS This study uses the most comprehensive data set to date to validate ECochG-TR as a measure of cochlear health as it relates to suitability for CI stimulation, and it further underlies the importance of the cochlear neural substrate as the main driver in speech perception performance. Performance in noise is more complex and requires both good residual cochlear function (ECochG-TR) and cognition (MoCA). Other demographic, audiologic, and surgical variables are poorly correlated with CI performance suggesting that these are poor surrogates for the integrity of the auditory substrate.
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Affiliation(s)
- Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Skidmore J, Oleson JJ, Yuan Y, He S. The Relationship Between Cochlear Implant Speech Perception Outcomes and Electrophysiological Measures of the Electrically Evoked Compound Action Potential. Ear Hear 2023; 44:1485-1497. [PMID: 37194125 DOI: 10.1097/aud.0000000000001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study assessed the relationship between electrophysiological measures of the electrically evoked compound action potential (eCAP) and speech perception scores measured in quiet and in noise in postlingually deafened adult cochlear implant (CI) users. It tested the hypothesis that how well the auditory nerve (AN) responds to electrical stimulation is important for speech perception with a CI in challenging listening conditions. DESIGN Study participants included 24 postlingually deafened adult CI users. All participants used Cochlear Nucleus CIs in their test ears. In each participant, eCAPs were measured at multiple electrode locations in response to single-pulse, paired-pulse, and pulse-train stimuli. Independent variables included six metrics calculated from the eCAP recordings: the electrode-neuron interface (ENI) index, the neural adaptation (NA) ratio, NA speed, the adaptation recovery (AR) ratio, AR speed, and the amplitude modulation (AM) ratio. The ENI index quantified the effectiveness of the CI electrodes in stimulating the targeted AN fibers. The NA ratio indicated the amount of NA at the AN caused by a train of constant-amplitude pulses. NA speed was defined as the speed/rate of NA. The AR ratio estimated the amount of recovery from NA at a fixed time point after the cessation of pulse-train stimulation. AR speed referred to the speed of recovery from NA caused by previous pulse-train stimulation. The AM ratio provided a measure of AN sensitivity to AM cues. Participants' speech perception scores were measured using Consonant-Nucleus-Consonant (CNC) word lists and AzBio sentences presented in quiet, as well as in noise at signal-to-noise ratios (SNRs) of +10 and +5 dB. Predictive models were created for each speech measure to identify eCAP metrics with meaningful predictive power. RESULTS The ENI index and AR speed individually explained at least 10% of the variance in most of the speech perception scores measured in this study, while the NA ratio, NA speed, the AR ratio, and the AM ratio did not. The ENI index was identified as the only eCAP metric that had unique predictive power for each of the speech test results. The amount of variance in speech perception scores (both CNC words and AzBio sentences) explained by the eCAP metrics increased with increased difficulty under the listening condition. Over half of the variance in speech perception scores measured in +5 dB SNR noise (both CNC words and AzBio sentences) was explained by a model with only three eCAP metrics: the ENI index, NA speed, and AR speed. CONCLUSIONS Of the six electrophysiological measures assessed in this study, the ENI index is the most informative predictor for speech perception performance in CI users. In agreement with the tested hypothesis, the response characteristics of the AN to electrical stimulation are more important for speech perception with a CI in noise than they are in quiet.
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Affiliation(s)
- Jeffrey Skidmore
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Jacob J Oleson
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Yi Yuan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Shuman He
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
- Department of Audiology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Atak HBO, Sennaroglu G, Sennaroglu L. Speech recognition and quality of life outcomes of adults with cochlear implants following a quarter-century of deafness: what should be the maximum duration? Eur Arch Otorhinolaryngol 2023; 280:4903-4913. [PMID: 37672104 DOI: 10.1007/s00405-023-08214-3] [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] [Received: 04/26/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE This study was aimed at examining the pre- and post-cochlear implant (CI) speech recognition and quality of life results of postlingually deaf adult CI users with a duration of deafness (DoD) > 25 years and determining the maximum DoD limit. METHODS We enrolled 54 postlingually deaf CI users and divided them into ages ≤ 60 and > 60 years and DoDs ≤ 25 and > 25 years. All participants were evaluated using multisensory measures (auditory and auditory + visual) and open-set Speech Recognition Test (SRT) before CI and 3 years postoperatively. They were administered with The Hearing Handicap Inventory for the Elderly (HHIE) to determine the effects of hearing impairment on daily life. RESULTS DoD and open-set SRT for auditory and auditory + visual stimuli showed a strong negative linear relationship (r = - 0.506, p < 0.01). Open-set SRT scores of patients with DoD aged ≤ 25 and > 25 years (p < 0.01) differed significantly. The chronological age and HHIE scores in social and emotional subfactors showed a strong negative linear relationship (r = - 0.519, p < 0.01). CONCLUSIONS The present study showed that the number of years was a major factor determining that postlingual adults with profound hearing loss had hearing loss. The results support CI use as soon as possible in adults to prevent degeneration of the auditory pathways and possible central remodeling. However, auditory rehabilitation outcomes in adults using CI vary widely. Investigating the causes of this variability contributes to audiology.
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Affiliation(s)
- Hilal Burcu Ozkan Atak
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey.
| | - Gonca Sennaroglu
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey
| | - Levent Sennaroglu
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
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11
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Bogdanov C, Mulders WH, Goulios H, Távora-Vieira D. The Impact of Patient Factors on Objective Cochlear Implant Verification Using Acoustic Cortical Auditory-Evoked Potentials. Audiol Neurootol 2023; 29:96-106. [PMID: 37690449 PMCID: PMC10994594 DOI: 10.1159/000533273] [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] [Received: 04/17/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Hearing loss is a major global public health issue that negatively impacts quality of life, communication, cognition, social participation, and mental health. The cochlear implant (CI) is the most efficacious treatment for severe-to-profound sensorineural hearing loss. However, variability in outcomes remains high among CI users. Our previous research demonstrated that the existing subjective methodology of CI programming does not consistently produce optimal stimulation for speech perception, thereby limiting the potential for CI users to derive the maximum device benefit to achieve their peak potential. We demonstrated the benefit of utilising the objective method of measuring auditory-evoked cortical responses to speech stimuli as a reliable tool to guide and verify CI programming and, in turn, significantly improve speech perception performance. The present study was designed to investigate the impact of patient- and device-specific factors on the application of acoustically-evoked cortical auditory-evoked potential (aCAEP) measures as an objective clinical tool to verify CI mapping in adult CI users with bilateral deafness (BD). METHODS aCAEP responses were elicited using binaural peripheral auditory stimulation for four speech tokens (/m/, /g/, /t/, and /s/) and recorded by HEARLab™ software in adult BD CI users. Participants were classified into groups according to subjective or objective CI mapping procedures to elicit present aCAEP responses to all four speech tokens. The impact of patient- and device-specific factors on the presence of aCAEP responses and speech perception was investigated between participant groups. RESULTS Participants were categorised based on the presence or absence of the P1-N1-P2 aCAEP response to speech tokens. Out of the total cohort of adult CI users (n = 132), 63 participants demonstrated present responses pre-optimisation, 37 participants exhibited present responses post-optimisation, and the remaining 32 participants either showed an absent response for at least one speech token post-optimisation or did not accept the optimised CI map adjustments. Overall, no significant correlation was shown between patient and device-specific factors and the presence of aCAEP responses or speech perception scores. CONCLUSION This study reinforces that aCAEP measures offer an objective, non-invasive approach to verify CI mapping, irrespective of patient or device factors. These findings further our understanding of the importance of personalised CI rehabilitation through CI mapping to minimise the degree of speech perception variation post-CI and allow all CI users to achieve maximum device benefit.
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Affiliation(s)
- Caris Bogdanov
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia
- Department of Audiology, Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
| | | | - Helen Goulios
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Dayse Távora-Vieira
- Department of Audiology, Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
- Division of Surgery, Medical School, The University of Western Australia, Perth, WA, Australia
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DeFreese AJ, Lindquist NR, Shi L, Holder JT, Berg KA, Haynes DS, Gifford RH. The Impact of Daily Processor Use on Adult Cochlear Implant Outcomes: Reexamining the Roles of Duration of Deafness and Age at Implantation. Otol Neurotol 2023; 44:672-678. [PMID: 37367733 PMCID: PMC10524754 DOI: 10.1097/mao.0000000000003920] [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] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To quantify the roles and relationships between age at implantation, duration of deafness (DoD), and daily processor use via data logging on speech recognition outcomes for postlingually deafened adults with cochlear implants. STUDY DESIGN Retrospective case review. SETTING Cochlear implant (CI) program at a tertiary medical center. PATIENTS Six-hundred fourteen postlingually deafened adult ears with CIs (mean age, 63 yr; 44% female) were included. MAIN OUTCOME MEASURES A stepwise multiple regression analysis was completed to investigate the combined effects of age, DoD, and daily processor use on CI-aided speech recognition (Consonant-Nucleus-Consonant monosyllables and AzBio sentences). RESULTS Results indicated that only daily processor use was significantly related to Consonant-Nucleus-Consonant word scores ( R2 = 0.194, p < 0.001) and AzBio in quiet scores ( R2 = 0.198, p < 0.001), whereas neither age nor DoD was significantly related. In addition, there was no significant relationship between daily processor use, age at implantation, or DoD and AzBio sentences in noise ( R2 = 0.026, p = 0.005). CONCLUSIONS Considering the clinical factors of age at implantation, DoD, and daily processor use, only daily processor use significantly predicted the ~20% of variance in postoperative outcomes (CI-aided speech recognition) accounted for by these clinical factors.
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Affiliation(s)
- Andrea J DeFreese
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linjie Shi
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katelyn A Berg
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
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Lindquist NR, Dietrich MS, Patro A, Henry MR, DeFreese AJ, Freeman MH, Perkins EL, Gifford RH, Haynes DS, Holder JT. Early Datalogging Predicts Cochlear Implant Performance: Building a Recommendation for Daily Device Usage. Otol Neurotol 2023; 44:e479-e485. [PMID: 37442607 PMCID: PMC10361622 DOI: 10.1097/mao.0000000000003917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To quantify the effect of datalogging on speech recognition scores and time to achievement for a "benchmark" level of performance within the first year, and to provide a data-driven recommendation for minimum daily cochlear implant (CI) device usage to better guide patient counseling and future outcomes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS Three hundred thirty-seven adult CI patients with data logging and speech recognition outcome data who were implanted between August 2015 and August 2020. MAIN OUTCOME MEASURES Processor datalogging, speech recognition scores, achievement of "benchmark speech recognition performance" defined as 80% of the median score for speech recognition outcomes at our institution. RESULTS The 1-month datalogging measure correlated positively with word and sentences scores at 1, 3, 6, and 12 months postactivation. Compared with age, sex, and preoperative performance, datalogging was the largest predictive factor of benchmark achievement on multivariate analysis. Each hour/day increase of device usage at 1 month resulted in a higher likelihood of achieving benchmark consonant-nucleus-consonant and AzBio scores within the first year (odds ratio = 1.21, p < 0.001) as well as earlier benchmark achievement. Receiver operating characteristic curve analysis identified the optimal data logging threshold at an average of 12 hours/day. CONCLUSIONS Early CI device usage, as measured by 1-month datalogging, predicts benchmark speech recognition achievement in adults. Datalogging is an important predictor of CI performance within the first year postimplantation. These data support the recommended daily CI processor utilization of at least 12 hours/day to achieve optimal speech recognition performance for most patients.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary S Dietrich
- Vanderbilt University Schools of Medicine (Biostatistics, VICC, Psychiatry) and Nursing, Nashville, Tennessee
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R Henry
- Division of Audiology, Henry Ford Health, Dearborn, Michigan
| | - Andrea J DeFreese
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael H Freeman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jourdan T Holder
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
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14
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Weller T, Timm ME, Lenarz T, Büchner A. Cochlear coverage with lateral wall cochlear implant electrode arrays affects post-operative speech recognition. PLoS One 2023; 18:e0287450. [PMID: 37437046 DOI: 10.1371/journal.pone.0287450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The goal was to investigate the relationship between the insertion angle/cochlear coverage of cochlear implant electrode arrays and post-operative speech recognition scores in a large cohort of patients implanted with lateral wall electrode arrays. METHODS Pre- and post-operative cone beam computed tomography scans of 154 ears implanted with lateral wall electrode arrays were evaluated. Traces of lateral wall and electrode arrays were combined into a virtual reconstruction of the implanted cochlea. This reconstruction was used to measure insertion angles and proportional cochlear coverage. Word recognition scores and sentence recognition scores measured 12 months after implantation using electric-only stimulation were used to examine the relationship between cochlear coverage/insertion angle and implantation outcomes. RESULTS Post-operative word recognition scores and the difference between post- and pre-operative word recognition scores were positively correlated with both cochlear coverage and insertion angle, however sentence recognition scores were not. A group-wise comparison of word recognition scores revealed that patients with cochlear coverage below 70% performed significantly worse than patients with coverage between 79%-82% (p = 0.003). Performance of patients with coverage above 82% was on average poorer than between 79%-82, although this finding was not statistically significant (p = 0.84). Dividing the cohort into groups based on insertion angle quadrants revealed that word recognition scores were highest above 450° insertion angle, sentence recognition scores were highest between 450° and 630° and the difference between pre- and post-operative word recognition scores was largest between 540° and 630°, however none of these differences reached statistical significance. CONCLUSIONS The results of this study show that cochlear coverage has an effect on post-operative word recognition abilities and the benefit patients receive from their implant. Generally, higher coverage led to better outcomes, however there were results indicating that insertion past 82% cochlear coverage may not provide an additional benefit for word recognition. These findings can be useful for choosing the optimal electrode array and thereby improving cochlear implantation outcomes on a patient-individual basis.
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Affiliation(s)
- Tobias Weller
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| | - Max Eike Timm
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
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15
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Sander KL, Warren SE, Mendel LL. Survey of selective electrode deactivation attitudes and practices by cochlear implant audiologists. Cochlear Implants Int 2023; 24:167-175. [PMID: 36732065 DOI: 10.1080/14670100.2023.2166571] [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: 02/04/2023]
Abstract
OBJECTIVES The purpose of this study was to explore clinician attitudes regarding selective electrode deactivation and to investigate the primary methodology used to identify poorly encoded electrodes, deactivate identified electrodes, and measure outcomes. METHODS An online survey consisting of 32 questions was administered to certified clinical and research cochlear implant (CI) audiologists. Questions asked participants about their demographic information, device programming patterns, and attitudes regarding selective electrode deactivation. RESULTS Fifty-four audiologists completed the survey. When asked whether they believed selectively deactivating poorly encoded electrodes could improve speech perception outcomes, 43% of respondents selected 'Probably Yes,' 39% selected 'Definitely Yes,' and 18% selected 'Might or Might Not.' Of those who reported deactivating electrodes as part of CI programming, various methodology was reported to identify and deactivate poorly encoding electrodes and evaluate effectiveness of deactivation. General reasons against deactivation were also reported. DISCUSSION CI audiologists generally believed selective electrode deactivation could be used to improve speech perception outcomes for patients; however, few reported implementing selective electrode deactivation in practice. Among those who do perform selective electrode deactivation, the reported methodology was highly variable. CONCLUSION These findings support the need for clinical practice guidelines to assist audiologists in performing selective electrode deactivation.
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Affiliation(s)
- Kara L Sander
- Department of Communication Sciences and Disorders, University of Memphis, Memphis, TN, USA
| | - Sarah E Warren
- Department of Communication Sciences and Disorders, University of Memphis, Memphis, TN, USA
| | - Lisa Lucks Mendel
- Department of Communication Sciences and Disorders, University of Memphis, Memphis, TN, USA
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Gaurav V, Mishra AK, Karmani S. Long Term Impact of Age at Implantation on Quality-of-Life Outcomes in Cochlear Implant Recipient Children. Indian J Otolaryngol Head Neck Surg 2023; 75:103-111. [PMID: 37206782 PMCID: PMC10188752 DOI: 10.1007/s12070-022-03260-5] [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: 01/13/2022] [Accepted: 10/23/2022] [Indexed: 11/26/2022] Open
Abstract
Cochlear implantation (CI) is used in management of children with bilateral severe to profound sensorineural hearing loss (SNHL). Recently, due to technological advancements, more and more infants and toddlers are undertaking the CI. The age at implantation may have an impact on CI outcomes. The primary aim of this study was to determine the long-term impact of 'age at implantation' on Health Related Quality of Life (HRQoL) outcome post-CI. In this prospective study at a tertiary care centre, we evaluated 50 CI recipient children from 2011 to 2018. Group A consisted of 35 (70%) children who received CI at less than or equal to 5 years of age and Group B with 15 (30%) children who underwent CI at more than 5 years of age. Following CI, all children received auditory-verbal therapy and thereafter we evaluated their long-term HRQoL outcomes at 5 years post-CI. Children were assessed by Nijmegen Cochlear Implant Questionnaire (NCIQ) and Children with cochlear implants: parental perspectives-questionnaire (CCIPPQ). There were significantly improved HRQoL outcomes (with an increase of 11.7% in mean NCIQ and 11.4% in mean CCIPPQ scores) at 5 years post-CI in CI recipients of age group '5 years or less' as compared to those who underwent CI at 'more than 5 years' age [P value < 0.05 for both the mean NCIQ scores and mean CCIPPQ scores respectively]. However, for children with 'more than 5 years' age at implantation, mean NCIQ and CCIPPQ scores were still more than 80% of maximum achievable NCIQ and CCIPPQ scores. In this study, CI recipient children who were implanted at less than or equal to 5 years of age were found to have significantly improved HRQoL outcomes at 5 years post-CI. Hence, it seems desirable to provide CI at an early age. However, even in children who received CI at more than 5 years of age, there was a substantial enhancement in HRQoL outcomes and CI was still effective in these children. Hence, knowledge of 'age at implantation' may provide reasonable assistance in predicting the HRQoL outcomes and optimal counseling of parents and families of CI candidates.
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Affiliation(s)
- Vishal Gaurav
- ENT Specialist and Neurotologist, Command Hospital (WC), Chandimandir, Haryana 134107 India
| | - A. K. Mishra
- ENT Specialist and Neurotologist, Command Hospital (WC), Chandimandir, Haryana 134107 India
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Jaiswal AS, Kumar R, Kumar R, Kairo AK, Raveendran S, Sagar P. Cochlear Implantation in Adults with Post-lingual Hearing Loss: Clinico-Demographical Study and Outcomes in the Current Times. Indian J Otolaryngol Head Neck Surg 2023; 75:548-551. [PMID: 37200896 PMCID: PMC10016170 DOI: 10.1007/s12070-022-03467-6] [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: 09/24/2022] [Accepted: 12/31/2022] [Indexed: 03/17/2023] Open
Abstract
To describe clinico-demographical profile for post-lingual hearing loss in the adults undergoing cochlear implantation and their outcomes. A retrospective chart review was conducted including adult patients (> 18 years) with bilateral post-lingual severe to profound hearing loss who underwent cochlear implantation in a tertiary care hospital of north India. The clinico-demographical details were collected and the outcomes of the procedure were assessed in terms of speech intelligibility scores, usage and satisfaction scores. Twenty-one patients were included with a mean age of 38.6 years with 15 males and 6 females. The major cause of deafness was infections followed by ototoxicity. The complication rate was 4.8%. Preoperative SDS was not recordable in any of the patients. The mean postoperative SDS was 74%, with no issue of device malfunction in a mean follow-up of 44 months. Cochlear implantation is a safe surgery with good outcomes in post-lingually deafened adults with the major cause for deafness being infections.
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Affiliation(s)
- Avinash Shekhar Jaiswal
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Rakesh Kumar
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Arvind Kumar Kairo
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sarath Raveendran
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Prem Sagar
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
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An overview of factors affecting bimodal and electric-acoustic stimulation (EAS) speech understanding outcomes. Hear Res 2023; 431:108736. [PMID: 36931019 DOI: 10.1016/j.heares.2023.108736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/13/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
Improvements in device technology, surgical technique, and patient outcomes have resulted in a broadening of cochlear implantation criteria to consider those with increasing levels of useful low-to-mid frequency residual acoustic hearing. Residual acoustic hearing allows for the addition of a hearing aid (HA) to complement the cochlear implant (CI) and has demonstrated enhanced listening outcomes. However, wide inter-subject outcome variability exists and thus identification of contributing factors would be of clinical interest and may aid with pre-operative patient counselling. The optimal fitting procedure and frequency assignments for the two hearing devices used in combination to enhance listening outcomes also remains unclear. The understanding of how acoustic and electric speech information is fundamentally combined and utilised by the listener may allow for the optimisation of device fittings and frequency allocations to provide best bimodal and electric-acoustic stimulation (EAS) patient outcomes. This article will provide an overview of contributing factors to bimodal and EAS listening outcomes, explore areas of contention, and discuss common study limitations.
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Lazard DS, Doelling KB, Arnal LH. Plasticity After Hearing Rehabilitation in the Aging Brain. Trends Hear 2023; 27:23312165231156412. [PMID: 36794429 PMCID: PMC9936397 DOI: 10.1177/23312165231156412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Age-related hearing loss, presbycusis, is an unavoidable sensory degradation, often associated with the progressive decline of cognitive and social functions, and dementia. It is generally considered a natural consequence of the inner-ear deterioration. However, presbycusis arguably conflates a wide array of peripheral and central impairments. Although hearing rehabilitation maintains the integrity and activity of auditory networks and can prevent or revert maladaptive plasticity, the extent of such neural plastic changes in the aging brain is poorly appreciated. By reanalyzing a large-scale dataset of more than 2200 cochlear implant users (CI) and assessing the improvement in speech perception from 6 to 24 months of use, we show that, although rehabilitation improves speech understanding on average, age at implantation only minimally affects speech scores at 6 months but has a pejorative effect at 24 months post implantation. Furthermore, older subjects (>67 years old) were significantly more likely to degrade their performances after 2 years of CI use than the younger patients for each year increase in age. Secondary analysis reveals three possible plasticity trajectories after auditory rehabilitation to account for these disparities: Awakening, reversal of deafness-specific changes; Counteracting, stabilization of additional cognitive impairments; or Decline, independent pejorative processes that hearing rehabilitation cannot prevent. The role of complementary behavioral interventions needs to be considered to potentiate the (re)activation of auditory brain networks.
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Affiliation(s)
- Diane S. Lazard
- Institut Pasteur, Université Paris Cité, INSERM AU06, Institut de l’Audition, Paris, France,ENT department, Institut Arthur Vernes, Paris, France,Diane Lazard, Institut de l’Audition, Institut Pasteur, 63 rue de Charenton, 75012 Paris, France.
| | - Keith B. Doelling
- Institut Pasteur, Université Paris Cité, INSERM AU06, Institut de l’Audition, Paris, France
| | - Luc H. Arnal
- Institut Pasteur, Université Paris Cité, INSERM AU06, Institut de l’Audition, Paris, France
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Rader T, Waleka OJ, Strieth S, Eichhorn KWG, Bohnert A, Koutsimpelas D, Matthias C, Ernst BP. Hearing rehabilitation for unilateral deafness using a cochlear implant: the influence of the subjective duration of deafness on speech intelligibility. Eur Arch Otorhinolaryngol 2023; 280:651-659. [PMID: 35792917 PMCID: PMC9849293 DOI: 10.1007/s00405-022-07531-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/27/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND For patients with single sided deafness (SSD) or severe asymmetric sensorineural hearing loss (ASHL), cochlear implantation remains the only solution to restore bilateral hearing capacity. Prognostically, the duration of hearing loss in terms of audiological outcome is not yet clear. Therefore, the aim of this study was to retrospectively investigate the influence of subjective deafness duration on postoperative speech perception after cochlear implantation for SSD as well as its impact on quality of life. MATERIALS AND METHODS The present study included a total of 36 adults aged 50.2 ± 15.5 years who underwent CI for SSD/ASHL at our clinic between 2010 and 2015. Patients were audiometrically assessed at 3 and 12-36 months postoperatively. Test results were correlated with self-reported duration of deafness. Quality of life was assessed by questionnaire. RESULTS Mean duration of deafness was 193.9 ± 185.7 months. The side-separated hearing threshold showed an averaged target range between 30 and 40 dB HL. Freiburg monosyllable test increased from 0% pre-operatively to 20% after 3 months (p = 0.001) and to 50% after 12-36 months (p = 0.002). There was a significant correlation between audiometric outcome and subjective deafness duration at 12-36 months postoperatively (r = - 0.564; p = 0.02) with a cutoff for open-set monosyllable recognition at a duration of deafness of greater than 408 months. Quality of life was significantly improved by CI. CONCLUSIONS CI implantation in unilaterally deafened patients provides objective and subjective benefits. Duration of deafness is unlikely to be an independent negative predictive factor and thus should not generally be considered as contraindication.
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Affiliation(s)
- Tobias Rader
- Division of Audiology, Department of Otorhinolaryngology, Ludwig-Maximilians-University Medical Center, Munich, Germany. .,Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany. .,LMU Klinikum, Klinik für Hals-Nasen-Ohrenheilkunde, Abteilung Audiologie, Marchioninistr. 15, 81377, Munich, Germany.
| | - Oliver Julian Waleka
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany.,Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | | | - Andrea Bohnert
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany
| | | | - Christoph Matthias
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany
| | - Benjamin Philipp Ernst
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany.,Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
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21
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Chen YS, Cabrera E, Tucker BJ, Shin TJ, Moawad JV, Totten DJ, Booth KT, Nelson RF. TMPRSS3 expression is limited in spiral ganglion neurons: implication for successful cochlear implantation. J Med Genet 2022; 59:1219-1226. [PMID: 35961784 DOI: 10.1136/jmg-2022-108654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND It is well established that biallelic mutations in transmembrane protease, serine 3 (TMPRSS3) cause hearing loss. Currently, there is controversy regarding the audiological outcomes after cochlear implantation (CI) for TMPRSS3-associated hearing loss. This controversy creates confusion among healthcare providers regarding the best treatment options for individuals with TMPRSS3-related hearing loss. METHODS A literature review was performed to identify all published cases of patients with TMPRSS3-associated hearing loss who received a CI. CI outcomes of this cohort were compared with published adult CI cohorts using postoperative consonant-nucleus-consonant (CNC) word performance. TMPRSS3 expression in mouse cochlea and human auditory nerves (HAN) was determined by using hybridisation chain reaction and single-cell RNA-sequencing analysis. RESULTS In aggregate, 27 patients (30 total CI ears) with TMPRSS3-associated hearing loss treated with CI, and 85% of patients reported favourable outcomes. Postoperative CNC word scores in patients with TMPRSS3-associated hearing loss were not significantly different than those seen in adult CI cohorts (8 studies). Robust Tmprss3 expression occurs throughout the mouse organ of Corti, the spindle and root cells of the lateral wall and faint staining within <5% of the HAN, representing type II spiral ganglion neurons. Adult HAN express negligible levels of TMPRSS3. CONCLUSION The clinical features after CI and physiological expression of TMPRSS3 suggest against a major role of TMPRSS3 in auditory neurons.
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Affiliation(s)
- Yuan-Siao Chen
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ernesto Cabrera
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brady J Tucker
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Timothy J Shin
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jasmine V Moawad
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas J Totten
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kevin T Booth
- Neurobiology, Harvard Medical School, Boston, Massachusetts, USA
- Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rick F Nelson
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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22
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Wang Y, Wu M, Wu K, Liu H, Wu S, Zhang Z, Liu M, Wei C, Zhang YX, Liu Y. Differential auditory cortical development in left and right cochlear implanted children. Cereb Cortex 2022; 32:5438-5454. [PMID: 35165693 DOI: 10.1093/cercor/bhac025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 12/27/2022] Open
Abstract
Unilateral aural stimulation has been shown to cause massive cortical reorganization in brain with congenital deafness, particularly during the sensitive period of brain development. However, it is unclear which side of stimulation provides most advantages for auditory development. The left hemisphere dominance of speech and linguistic processing in normal hearing adult brain has led to the assumption of functional and developmental advantages of right over left implantation, but existing evidence is controversial. To test this assumption and provide evidence for clinical choice, we examined 34 prelingually deaf children with unilateral cochlear implants using near-infrared spectroscopy. While controlling for age of implantation, residual hearing, and dominant hand, cortical processing of speech showed neither developmental progress nor influence of implantation side weeks to months after implant activation. In sharp contrast, for nonspeech (music signal vs. noise) processing, left implantation showed functional advantages over right implantation that were not yet discernable using clinical, questionnaire-based outcome measures. These findings support the notion that the right hemisphere develops earlier and is better preserved from adverse environmental influences than its left counterpart. This study thus provides, to our knowledge, the first evidence for differential influences of left and right auditory peripheral stimulation on early cortical development of the human brain.
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Affiliation(s)
- Yuyang Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.,Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), Changsha 610041, China
| | - Meiyun Wu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Kun Wu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Haotian Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.,Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Shinan Wu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Zhikai Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Min Liu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Chaogang Wei
- Department of Otolaryngology Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China
| | - Yu-Xuan Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Yuhe Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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23
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He S, Skidmore J, Carter BL, Lemeshow S, Sun S. Postlingually Deafened Adult Cochlear Implant Users With Prolonged Recovery From Neural Adaptation at the Level of the Auditory Nerve Tend to Have Poorer Speech Perception Performance. Ear Hear 2022; 43:1761-1770. [PMID: 35652833 PMCID: PMC9588496 DOI: 10.1097/aud.0000000000001244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study investigated the effects of two temporal response properties of the auditory nerve (i.e., neural adaptation and recovery from neural adaptation) on speech perception performance in postlingually deafened adult cochlear implant (CI) users. DESIGN Study participants included 18 postlingually deafened adults who were Cochlear Nucleus device users with a full electrode array insertion in the test ear(s). Neural adaptation and adaptation recovery of the auditory nerve (AN) were evaluated using electrophysiological measures of the electrically evoked compound action potential (eCAP). The amount of neural adaptation was quantified by the adaptation index within three time windows: 0 to 8.89 (window 1), 44.44 to 50.00 (window 2), and 94.44 to 100.00 ms (window 3). The speed of neural adaptation was estimated using a two-parameter power law function. To evaluate adaptation recovery of the AN, eCAPs to the last pulse of the 100-ms pulse train were recorded at masker-probe-intervals ranging from 1.054 to 256 ms in logarithmic steps. The amount of adaptation recovery was quantified by the adaptation recovery ratio. The time-constant of adaptation recovery was estimated using an exponential function with up to three components. Speech perception performance was evaluated by measuring consonant-nucleus-consonant (CNC) word scores presented in quiet and in speech-shaped noise at a signal-to-noise ratio (SNR) of +10 dB. One-tailed Pearson Product Moment correlation tests were used (1) to assess the associations among parameters of neural adaptation and adaptation recovery and (2) to evaluate the strength of association between these parameters and CNC word scores measured in quiet and in noise. The contributions of different parameters quantifying neural adaptation and adaptation recovery on speech perception scores were evaluated using multivariable linear regression analyses. RESULTS The Pearson Product Moment correlation coefficient demonstrated a moderate, negative correlation between the speed of adaptation recovery and CNC word scores measured in quiet and in noise. The speed of adaptation recovery accounted for 14.1% of variability in CNC word scores measured in quiet and 16.7% of variability in CNC word scores measured in noise. The correlation strengths between CNC word scores and the adaptation index, the adaptation recovery ratio and the speed of neural adaptation ranged from negligible to weak. CONCLUSIONS The speed of adaptation recovery plays a more important role than other features of neural adaptation and adaptation recovery of the AN in speech perception in postlingually deafened adult CI users. Patients with prolonged adaptation recovery tend to show poorer speech perception performance.
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Affiliation(s)
- Shuman He
- Department of Otolaryngology – Head and Neck Surgery, College of Medicine, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
- Department of Audiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205
| | - Jeffrey Skidmore
- Department of Otolaryngology – Head and Neck Surgery, College of Medicine, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
| | - Brittney L. Carter
- Department of Otolaryngology – Head and Neck Surgery, College of Medicine, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
| | - Stanley Lemeshow
- Division of Biostatistics, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210
| | - Shuai Sun
- Division of Biostatistics, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210
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24
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Walia A, Shew MA, Lee DS, Lefler SM, Kallogjeri D, Wick CC, Durakovic N, Fitzpatrick DC, Ortmann AJ, Herzog JA, Buchman CA. Promontory Electrocochleography Recordings to Predict Speech-Perception Performance in Cochlear Implant Recipients. Otol Neurotol 2022; 43:915-923. [PMID: 35861658 PMCID: PMC9621328 DOI: 10.1097/mao.0000000000003628] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE 1) To determine the relationship of electrocochleography (ECochG) responses measured on the promontory with responses measured at the round window (RW) and various intracochlear sites. 2) To evaluate if promontory ECochG responses correlate with postoperative speech-perception performance using the cochlear implant (CI). STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. PATIENTS AND INTERVENTIONS Ninety-six adult CI recipients with no cochlear malformations or previous otologic surgery. MAIN OUTCOME MEASURES Acoustically evoked ECochG responses were measured intraoperatively at both extracochlear and intracochlear locations. ECochG total response (ECochG-TR), a measure of residual cochlear function, was calculated by summing the fast Fourier transformation amplitudes in response to 250-Hz to 2-kHz acoustic stimuli. Speech-perception performance was measured at 3 months. RESULTS There were strong linear correlations for promontory ECochG-TR with the ECochG-TRs measured at the RW ( r = 0.95), just inside scala tympani ( r = 0.91), and after full insertion ( r = 0.83). For an individual subject, the morphology of the ECochG response was similar in character across all positions; however, the response amplitude increased from promontory to RW (~1.6-fold) to just inside scala tympani (~2.6-fold), with the largest response at full insertion (~13.1-fold). Promontory ECochG-TR independently explained 51.8% of the variability ( r2 ) in consonant-nucleus-consonant at 3 months. CONCLUSIONS Promontory ECochG recordings are strongly correlated with responses previously recorded at extracochlear and intracochlear sites and explain a substantial portion of the variability in CI performance. These findings are a critical step in supporting translation of transtympanic ECochG into the clinic preoperatively to help predict postoperative CI performance.
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Affiliation(s)
- Amit Walia
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Matthew A. Shew
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - David S. Lee
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Shannon M. Lefler
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Cameron C. Wick
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Nedim Durakovic
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Douglas C. Fitzpatrick
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda J. Ortmann
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Jacques A. Herzog
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Craig A. Buchman
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
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25
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American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness. Ear Hear 2022; 43:1605-1619. [PMID: 35994570 PMCID: PMC9592177 DOI: 10.1097/aud.0000000000001260] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The indications for cochlear implantation have expanded to include individuals with profound sensorineural hearing loss in the impaired ear and normal hearing (NH) in the contralateral ear, known as single-sided deafness (SSD). There are additional considerations for the clinical assessment and management of adult cochlear implant candidates and recipients with SSD as compared to conventional cochlear implant candidates with bilateral moderate to profound sensorineural hearing loss. The present report reviews the current evidence relevant to the assessment and management of adults with SSD. A systematic review was also conducted on published studies that investigated outcomes of cochlear implant use on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population. Expert consensus and systematic review of the current literature were combined to provide guidance for the clinical assessment and management of adults with SSD.
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26
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Croner AM, Heshmat A, Schrott-Fischer A, Glueckert R, Hemmert W, Bai S. Effects of Degrees of Degeneration on the Electrical Excitation of Human Spiral Ganglion Neurons Based on a High-Resolution Computer Model. Front Neurosci 2022; 16:914876. [PMID: 35873813 PMCID: PMC9298973 DOI: 10.3389/fnins.2022.914876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
After hearing loss retrograde degeneration of spiral ganglion neurons (SGNs) has been described. Studies modeling the effects of degeneration mostly omitted peripheral processes (dendrites). Recent experimental observations indicated that degenerating SGNs manifested also a reduced diameter of their dendrites. We simulated populations of 400 SGNs inside a high resolution cochlear model with a cochlear implant, based on μCT scans of a human temporal bone. Cochlear implant stimuli were delivered as biphasic pulses in a monopolar configuration. Three SGN situations were simulated, based on our previous measurements of human SGN dendrites: (A) SGNs with intact dendrites (before degeneration), (B) degenerating SGNs, dendrites with a smaller diameter but original length, (C) degenerating SGNs, dendrites omitted. SGN fibers were mapped to characteristic frequency, and place pitch was estimated from excitation profiles. Results from degenerating SGNs (B, C) were similar. Most action potentials were initiated in the somatic area for all cases (A, B, C), except for areas near stimulating electrodes in the apex with intact SGNs (A), where action potentials were initiated in the distal dendrite. In most cases, degenerating SGNs had lower thresholds than intact SGNs (A) (down to -2 dB). Excitation profiles showed increased ectopic activation, i.e., activation of unintended neuronal regions, as well as similar neuronal regions excited by different apical electrodes, for degenerating SGNs (B, C). The estimated pitch showed cases of pitch reversals in apical electrodes for intact SGNs (A), as well as mostly identical pitches evoked by the four most apical electrodes for degenerating SGNs (B, C). In conclusion, neuronal excitation profiles to electrical stimulation exhibited similar traits in both ways of modeling SGN degeneration. Models showed degeneration of dendrites caused increased ectopic activation, as well as similar excitation profiles and pitch evoked by different apical electrodes. Therefore, insertion of electrodes beyond approximately 450° may not provide any benefit if SGN dendrites are degenerated.
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Affiliation(s)
- Albert M Croner
- Department of Electrical and Computer Engineering, Technical University of Munich, Munich, Germany.,Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
| | - Amirreza Heshmat
- Laboratory for Inner Ear Biology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Rudolf Glueckert
- Laboratory for Inner Ear Biology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Hemmert
- Department of Electrical and Computer Engineering, Technical University of Munich, Munich, Germany.,Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
| | - Siwei Bai
- Department of Electrical and Computer Engineering, Technical University of Munich, Munich, Germany.,Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
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27
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He S, Skidmore J, Conroy S, Riggs WJ, Carter BL, Xie R. Neural Adaptation of the Electrically Stimulated Auditory Nerve Is Not Affected by Advanced Age in Postlingually Deafened, Middle-aged, and Elderly Adult Cochlear Implant Users. Ear Hear 2022; 43:1228-1244. [PMID: 34999595 PMCID: PMC9232840 DOI: 10.1097/aud.0000000000001184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study aimed to investigate the associations between advanced age and the amount and the speed of neural adaptation of the electrically stimulated auditory nerve (AN) in postlingually deafened adult cochlear implant (CI) users. DESIGN Study participants included 26 postlingually deafened adult CI users, ranging in age between 28.7 and 84.0 years (mean: 63.8 years, SD: 14.4 years) at the time of testing. All study participants used a Cochlear Nucleus device with a full electrode array insertion in the test ear. The stimulus was a 100-ms pulse train with a pulse rate of 500, 900, 1800, or 2400 pulses per second (pps) per channel. The stimulus was presented at the maximum comfortable level measured at 2400 pps with a presentation rate of 2 Hz. Neural adaptation of the AN was evaluated using electrophysiological measures of the electrically evoked compound action potential (eCAP). The amount of neural adaptation was quantified by the adaptation index (AI) within three time windows: around 0 to 8 ms (window 1), 44 to 50 ms (window 2), and 94 to 100 ms (window 3). The speed of neural adaptation was quantified using a two-parameter power law estimation. In 23 participants, four electrodes across the electrode array were tested. In three participants, three electrodes were tested. Results measured at different electrode locations were averaged for each participant at each pulse rate to get an overall representation of neural adaptation properties of the AN across the cochlea. Linear-mixed models (LMMs) were used (1) to evaluate the effects of age at testing and pulse rate on the speed of neural adaptation and (2) to assess the effects of age at testing, pulse rate, and duration of stimulation (i.e., time window) on the amount of neural adaptation in these participants. RESULTS There was substantial variability in both the amount and the speed of neural adaptation of the AN among study participants. The amount and the speed of neural adaptation increased at higher pulse rates. In addition, larger amounts of adaptation were observed for longer durations of stimulation. There was no significant effect of age on the speed or the amount of neural adaptation. CONCLUSIONS The amount and the speed of neural adaptation of the AN are affected by both the pulse rate and the duration of stimulation, with higher pulse rates and longer durations of stimulation leading to faster and greater neural adaptation. Advanced age does not affect neural adaptation of the AN in postlingually deafened, middle-aged and elderly adult CI users.
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Affiliation(s)
- Shuman He
- Department of Otolaryngology – Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
- Department of Audiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205
| | - Jeffrey Skidmore
- Department of Otolaryngology – Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
| | - Sara Conroy
- Center for Biostatistics, Department of Bioinformatics, The Ohio State University, 1800 Cannon Drive, Columbus, OH 43210
| | - William J. Riggs
- Department of Otolaryngology – Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
- Department of Audiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205
| | - Brittney L. Carter
- Department of Otolaryngology – Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
| | - Ruili Xie
- Department of Otolaryngology – Head and Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212
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28
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van der Mescht L, le Roux T, Mahomed-Asmail F, De Sousa KC, Swanepoel DW. Remote Monitoring of Adult Cochlear Implant Recipients Using Digits-in-Noise Self-Testing. Am J Audiol 2022; 31:923-935. [PMID: 35738000 DOI: 10.1044/2022_aja-21-00248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has accelerated the uptake and scope of telehealth. This study determined the accuracy and reliability of a smartphone digits-in-noise (DIN) test when conducted by adult cochlear implant (CI) recipients in a simulated home environment compared with a clinic setup. Perceptions of remote monitoring using speech-in-noise (SIN) testing were also explored. METHOD Thirty-three adult CI recipients between 18 and 78 years of age (M = 46.7, SD = ±20.4) conducted the DIN test in a simulated home environment and a clinic setup. Test-retest reliability across the two environments and comparisons between test settings were evaluated. A survey explored the perceptions of adult CI recipients regarding remote monitoring and use of the DIN self-test. RESULTS Mean-aided speech reception thresholds (SRTs) in the clinic and simulated home environment test conditions and clinic and simulated home environment retest conditions did not differ significantly. Mean test-retest SRTs in the clinic and simulated home environment were significantly different (p < .05). High intraclass correlation coefficient and low standard error of measurement scores reflected good and excellent reliability between test-retest measures and between clinic and simulated home environment measures. Most participants were positive about the possibility of using the DIN test at home to self-assess speech perception, although some test adjustments such as including training items and a less adverse starting signal-to-noise ratio may be required. CONCLUSION Adult CI recipients can use the smartphone DIN test to self-assess aided SIN performance in a home environment with accuracy and reliability relatively similar to clinic testing. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20044418.
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Affiliation(s)
- Lize van der Mescht
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Faheema Mahomed-Asmail
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Virtual Hearing Lab, Collaborative initiative between University of Colorado School of Medicine, Aurora, and University of Pretoria, South Africa
| | - Karina C De Sousa
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Virtual Hearing Lab, Collaborative initiative between University of Colorado School of Medicine, Aurora, and University of Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Virtual Hearing Lab, Collaborative initiative between University of Colorado School of Medicine, Aurora, and University of Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Western Australia
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29
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Dillon MT, O'Connell BP, Canfarotta MW, Buss E, Hopfinger J. Effect of Place-Based Versus Default Mapping Procedures on Masked Speech Recognition: Simulations of Cochlear Implant Alone and Electric-Acoustic Stimulation. Am J Audiol 2022; 31:322-337. [PMID: 35394798 DOI: 10.1044/2022_aja-21-00123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Cochlear implant (CI) recipients demonstrate variable speech recognition when listening with a CI-alone or electric-acoustic stimulation (EAS) device, which may be due in part to electric frequency-to-place mismatches created by the default mapping procedures. Performance may be improved if the filter frequencies are aligned with the cochlear place frequencies, known as place-based mapping. Performance with default maps versus an experimental place-based map was compared for participants with normal hearing when listening to CI-alone or EAS simulations to observe potential outcomes prior to initiating an investigation with CI recipients. METHOD A noise vocoder simulated CI-alone and EAS devices, mapped with default or place-based procedures. The simulations were based on an actual 24-mm electrode array recipient, whose insertion angles for each electrode contact were used to estimate the respective cochlear place frequency. The default maps used the filter frequencies assigned by the clinical software. The filter frequencies for the place-based maps aligned with the cochlear place frequencies for individual contacts in the low- to mid-frequency cochlear region. For the EAS simulations, low-frequency acoustic information was filtered to simulate aided low-frequency audibility. Performance was evaluated for the AzBio sentences presented in a 10-talker masker at +5 dB signal-to-noise ratio (SNR), +10 dB SNR, and asymptote. RESULTS Performance was better with the place-based maps as compared with the default maps for both CI-alone and EAS simulations. For instance, median performance at +10 dB SNR for the CI-alone simulation was 57% correct for the place-based map and 20% for the default map. For the EAS simulation, those values were 59% and 37% correct. Adding acoustic low-frequency information resulted in a similar benefit for both maps. CONCLUSIONS Reducing frequency-to-place mismatches, such as with the experimental place-based mapping procedure, produces a greater benefit in speech recognition than maximizing bandwidth for CI-alone and EAS simulations. Ongoing work is evaluating the initial and long-term performance benefits in CI-alone and EAS users. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19529053.
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Affiliation(s)
- Margaret T. Dillon
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Brendan P. O'Connell
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - Michael W. Canfarotta
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - Emily Buss
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill
| | - Joseph Hopfinger
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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Wichova H, Mills D, Beatty S, Peng K, Miller M. Cochlear implantation performance outcomes in patients over 80 years old. Laryngoscope Investig Otolaryngol 2022; 7:847-853. [PMID: 35734051 PMCID: PMC9194979 DOI: 10.1002/lio2.825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To examine device datalogging characteristics and postoperative performance in the very elderly CI users. Methods Retrospective chart review of postoperative speech recognition outcomes and datalogging characteristics in patients older than 80 years old who underwent cochlear implantation and remain active users with longer than 6 months post‐activation follow‐up. Results(s) The mean age at implantation was 84.8 ± 3.8 years old. Pre‐ and post‐operative AzBio sentences in quiet scores were 12.4 ± 16.4% and 53.0 ± 23.5%, respectively (p < .001). Pre‐ and post‐operative consonant‐nucleus‐consonant (CNC) word scores were 9.4 ± 12.8% and 40.5 ± 20.7%, respectively (p < .001). A nonsignificant negative correlation was noted between the age of implantation and postoperative CNC words and AzBio sentence performance. Significantly decreased performance was noted in the subpopulation with a preoperative diagnosis of dementia. Mean daily use was 10.9 h per day. When available the mean daily usage distribution was 16% speech in noise, 19.1% speech, 51% quiet, 3.8% music, and 9.6% noise. A significant positive correlation was noted between daily use and AzBio sentence and CNC word performance. Conclusions Very elderly patients have significant postoperative auditory performance benefits after CI. Mean daily use is comparable to previously published results in the younger population. Age of implantation does not play a significant role in overall performance. Elderly patients who are medically cleared for implantation receive significant postoperative benefits.
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Affiliation(s)
- Helena Wichova
- Division of Neurotology House Clinic Los Angeles California USA
| | - Dawna Mills
- Department of Audiology University of California Davis Sacramento California USA
| | - Sarah Beatty
- Hearing Services of Santa Barbara Santa Barbara California USA
| | - Kevin Peng
- Division of Neurotology House Clinic Los Angeles California USA
| | - Mia Miller
- Department of Otolaryngology Cedar Sinai Los Angeles California USA
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Effect of Serious Gaming on Speech-in-Noise Intelligibility in Adult Cochlear Implantees: A Randomized Controlled Study. J Clin Med 2022; 11:jcm11102880. [PMID: 35629004 PMCID: PMC9145632 DOI: 10.3390/jcm11102880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/29/2022] [Accepted: 05/17/2022] [Indexed: 12/03/2022] Open
Abstract
Listening in noise remains challenging for adults with cochlear implants (CI) even after prolonged experience. Personalized auditory training (AT) programs can be proposed to improve specific auditory skills in adults with CI. The objective of this study was to assess serious gaming as a rehabilitation tool to improve speech-in-noise intelligibility in adult CI users. Thirty subjects with bilateral profound hearing loss and at least 9 months of CI experience were randomized to participate in a 5-week serious game-based AT program (n = 15) or a control group (n = 15). All participants were tested at enrolment and at 5 weeks using the sentence recognition-in-noise matrix test to measure the signal-to-noise ratio (SNR) allowing 70% of speech-in-noise understanding (70% speech reception threshold, SRT70). Thirteen subjects completed the AT program and nine of them were re-tested 5 weeks later. The mean SRT70 improved from 15.5 dB to 11.5 dB SNR after 5 weeks of AT (p < 0.001). No significant change in SRT70 was observed in the control group. In the study group, the magnitude of SRT70 improvement was not correlated to the total number of AT hours. A large inter-patient variability was observed for speech-in-noise intelligibility measured once the AT program was completed and at re-test. The results suggest that serious game-based AT may improve speech-in-noise intelligibility in adult CI users. Potential sources of inter-patient variability are discussed. Serious gaming may be considered as a complementary training approach for improving CI outcomes in adults.
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Deliano M, Seidel P, Vorwerk U, Stadler B, Angenstein N. Effect of cochlear implant side on early speech processing in adults with single-sided deafness. Clin Neurophysiol 2022; 140:29-39. [DOI: 10.1016/j.clinph.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/22/2022] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
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Dong Y, Briaire JJ, Stronks HC, Frijns JH. Short- and long-latency components of the eCAP reveal different refractory properties. Hear Res 2022; 420:108522. [DOI: 10.1016/j.heares.2022.108522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/16/2022]
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Grégoire A, Deggouj N, Dricot L, Decat M, Kupers R. Brain Morphological Modifications in Congenital and Acquired Auditory Deprivation: A Systematic Review and Coordinate-Based Meta-Analysis. Front Neurosci 2022; 16:850245. [PMID: 35418829 PMCID: PMC8995770 DOI: 10.3389/fnins.2022.850245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Neuroplasticity following deafness has been widely demonstrated in both humans and animals, but the anatomical substrate of these changes is not yet clear in human brain. However, it is of high importance since hearing loss is a growing problem due to aging population. Moreover, knowing these brain changes could help to understand some disappointing results with cochlear implant, and therefore could improve hearing rehabilitation. A systematic review and a coordinate-based meta-analysis were realized about the morphological brain changes highlighted by MRI in severe to profound hearing loss, congenital and acquired before or after language onset. 25 papers were included in our review, concerning more than 400 deaf subjects, most of them presenting prelingual deafness. The most consistent finding is a volumetric decrease in gray matter around bilateral auditory cortex. This change was confirmed by the coordinate-based meta-analysis which shows three converging clusters in this region. The visual areas of deaf children is also significantly impacted, with a decrease of the volume of both gray and white matters. Finally, deafness is responsible of a gray matter increase within the cerebellum, especially at the right side. These results are largely discussed and compared with those from deaf animal models and blind humans, which demonstrate for example a much more consistent gray matter decrease along their respective primary sensory pathway. In human deafness, a lot of other factors than deafness could interact on the brain plasticity. One of the most important is the use of sign language and its age of acquisition, which induce among others changes within the hand motor region and the visual cortex. But other confounding factors exist which have been too little considered in the current literature, such as the etiology of the hearing impairment, the speech-reading ability, the hearing aid use, the frequent associated vestibular dysfunction or neurocognitive impairment. Another important weakness highlighted by this review concern the lack of papers about postlingual deafness, whereas it represents most of the deaf population. Further studies are needed to better understand these issues, and finally try to improve deafness rehabilitation.
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Affiliation(s)
- Anaïs Grégoire
- Department of ENT, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
| | - Naïma Deggouj
- Department of ENT, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
| | - Laurence Dricot
- Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
| | - Monique Decat
- Department of ENT, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
| | - Ron Kupers
- Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
- Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
- Ecole d’Optométrie, Université de Montréal, Montréal, QC, Canada
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Shader MJ, Kwon BJ, Gordon-Salant S, Goupell MJ. Open-Set Phoneme Recognition Performance With Varied Temporal Cues in Younger and Older Cochlear Implant Users. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1196-1211. [PMID: 35133853 PMCID: PMC9150732 DOI: 10.1044/2021_jslhr-21-00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/20/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The goal of this study was to investigate the effect of age on phoneme recognition performance in which the stimuli varied in the amount of temporal information available in the signal. Chronological age is increasingly recognized as a factor that can limit the amount of benefit an individual can receive from a cochlear implant (CI). Central auditory temporal processing deficits in older listeners may contribute to the performance gap between younger and older CI users on recognition of phonemes varying in temporal cues. METHOD Phoneme recognition was measured at three stimulation rates (500, 900, and 1800 pulses per second) and two envelope modulation frequencies (50 Hz and unfiltered) in 20 CI participants ranging in age from 27 to 85 years. Speech stimuli were multiple word pairs differing in temporal contrasts and were presented via direct stimulation of the electrode array using an eight-channel continuous interleaved sampling strategy. Phoneme recognition performance was evaluated at each stimulation rate condition using both envelope modulation frequencies. RESULTS Duration of deafness was the strongest subject-level predictor of phoneme recognition, with participants with longer durations of deafness having poorer performance overall. Chronological age did not predict performance for any stimulus condition. Additionally, duration of deafness interacted with envelope filtering. Participants with shorter durations of deafness were able to take advantage of higher frequency envelope modulations, while participants with longer durations of deafness were not. CONCLUSIONS Age did not significantly predict phoneme recognition performance. In contrast, longer durations of deafness were associated with a reduced ability to utilize available temporal information within the signal to improve phoneme recognition performance.
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Affiliation(s)
- Maureen J. Shader
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | | | | | - Matthew J. Goupell
- Department of Hearing and Speech Sciences, University of Maryland, College Park
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Boullaud L, Blasco H, Trinh TT, Bakhos D. Metabolomic Studies in Inner Ear Pathologies. Metabolites 2022; 12:metabo12030214. [PMID: 35323657 PMCID: PMC8955628 DOI: 10.3390/metabo12030214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 12/25/2022] Open
Abstract
Sensorineural hearing loss is the most common sensory deficit. The etiologies of sensorineural hearing loss have been described and can be congenital or acquired. For congenital non-syndromic hearing loss, mutations that are related to sites of cochlear damage have been discovered (e.g., connexin proteins, mitochondrial genes, etc.). For cytomegalovirus infection or auditory neuropathies, mechanisms are also well known and well researched. Although the etiologies of sensorineural hearing loss may be evident for some patients, the damaged sites and pathological mechanisms remain unclear for patients with progressive post-lingual hearing loss. Metabolomics is an emerging technique in which all metabolites present in a sample at a given time are analyzed, reflecting a physiological state. The objective of this study was to review the literature on the use of metabolomics in hearing loss. The findings of this review suggest that metabolomic studies may help to develop objective tests for diagnosis and personalized treatment.
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Affiliation(s)
- Luc Boullaud
- ENT Department and Cervico-Facial Surgery, University Center Hospital of Tours, 2 Boulevard Tonnellé, 37044 Tours, France; (T.-T.T.); (D.B.)
- INSERM U1253, iBrain, University of Tours, 10 Boulevard Tonnellé, 37000 Tours, France;
- Correspondence: ; Tel.: +33-247-474-785; Fax: +33-247-473-600
| | - Hélène Blasco
- INSERM U1253, iBrain, University of Tours, 10 Boulevard Tonnellé, 37000 Tours, France;
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000 Tours, France
- Department of Biochemistry and Molecular Biology, University Center Hospital of Tours, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Thuy-Trân Trinh
- ENT Department and Cervico-Facial Surgery, University Center Hospital of Tours, 2 Boulevard Tonnellé, 37044 Tours, France; (T.-T.T.); (D.B.)
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000 Tours, France
| | - David Bakhos
- ENT Department and Cervico-Facial Surgery, University Center Hospital of Tours, 2 Boulevard Tonnellé, 37044 Tours, France; (T.-T.T.); (D.B.)
- INSERM U1253, iBrain, University of Tours, 10 Boulevard Tonnellé, 37000 Tours, France;
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000 Tours, France
- House Institute Foundation, Los Angeles, CA 90057, USA
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Walia A, Shew MA, Kallogjeri D, Wick CC, Durakovic N, Lefler SM, Ortmann AJ, Herzog JA, Buchman CA. Electrocochleography and cognition are important predictors of speech perception outcomes in noise for cochlear implant recipients. Sci Rep 2022; 12:3083. [PMID: 35197556 PMCID: PMC8866505 DOI: 10.1038/s41598-022-07175-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/10/2022] [Indexed: 11/15/2022] Open
Abstract
Although significant progress has been made in understanding outcomes following cochlear implantation, predicting performance remains a challenge. Duration of hearing loss, age at implantation, and electrode positioning within the cochlea together explain ~ 25% of the variability in speech-perception scores in quiet using the cochlear implant (CI). Electrocochleography (ECochG) responses, prior to implantation, account for 47% of the variance in the same speech-perception measures. No study to date has explored CI performance in noise, a more realistic measure of natural listening. This study aimed to (1) validate ECochG total response (ECochG-TR) as a predictor of performance in quiet and (2) evaluate whether ECochG-TR explained variability in noise performance. Thirty-five adult CI recipients were enrolled with outcomes assessed at 3-months post-implantation. The results confirm previous studies showing a strong correlation of ECochG-TR with speech-perception in quiet (r = 0.77). ECochG-TR independently explained 34% of the variability in noise performance. Multivariate modeling using ECochG-TR and Montreal Cognitive Assessment (MoCA) scores explained 60% of the variability in speech-perception in noise. Thus, ECochG-TR, a measure of the cochlear substrate prior to implantation, is necessary but not sufficient for explaining performance in noise. Rather, a cognitive measure is also needed to improve prediction of noise performance.
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Affiliation(s)
- Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8115, St. Louis, MO, 63110, USA.
| | - Matthew A Shew
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8115, St. Louis, MO, 63110, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8115, St. Louis, MO, 63110, USA
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8115, St. Louis, MO, 63110, USA
| | - Nedim Durakovic
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8115, St. Louis, MO, 63110, USA
| | - Shannon M Lefler
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8115, St. Louis, MO, 63110, USA
| | - Amanda J Ortmann
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8115, St. Louis, MO, 63110, USA
| | - Jacques A Herzog
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8115, St. Louis, MO, 63110, USA
| | - Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8115, St. Louis, MO, 63110, USA
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Canfarotta MW, Dillon MT, Brown KD, Pillsbury HC, Dedmon MM, O'Connell BP. Insertion Depth and Cochlear Implant Speech Recognition Outcomes: A Comparative Study of 28- and 31.5-mm Lateral Wall Arrays. Otol Neurotol 2022; 43:183-189. [PMID: 34772886 PMCID: PMC8752482 DOI: 10.1097/mao.0000000000003416] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES 1) To compare speech recognition outcomes between cochlear implant (CI) recipients of 28- and 31.5-mm lateral wall electrode arrays, and 2) to characterize the relationship between angular insertion depth (AID) and speech recognition. STUDY DESIGN Retrospective review. SETTING Tertiary academic referral center. PATIENTS Seventy-five adult CI recipients of fully inserted 28-mm (n = 28) or 31.5-mm (n = 47) lateral wall arrays listening with a CI-alone device. INTERVENTIONS Cochlear implantation with postoperative computed tomography. MAIN OUTCOME MEASURES Consonant-nucleus-consonant (CNC) word recognition assessed with the CI-alone at 12 months postactivation. RESULTS The mean AID of the most apical electrode contact for the 31.5-mm array recipients was significantly deeper than the 28-mm array recipients (628° vs 571°, p < 0.001). Following 12 months of listening experience, mean CNC word scores were significantly better for recipients of 31.5-mm arrays compared with those implanted with 28-mm arrays (59.5% vs 48.3%, p = 0.004; Cohen's d = 0.70; 95% CI [0.22, 1.18]). There was a significant positive correlation between AID and CNC word scores (r = 0.372, p = 0.001), with a plateau in performance observed around 600°. CONCLUSIONS Cochlear implant recipients implanted with a 31.5-mm array experienced better speech recognition than those with a 28-mm array at 12 months postactivation. Deeper insertion of a lateral wall array appears to confer speech recognition benefit up to ∼600°, with a plateau in performance observed thereafter. These data provide preliminary evidence of the insertion depth necessary to optimize speech recognition outcomes for lateral wall electrode arrays among CI-alone users.
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Affiliation(s)
- Michael W Canfarotta
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Zucca M, Albera A, Albera R, Montuschi C, Della Gatta B, Canale A, Rainero I. Cochlear Implant Results in Older Adults with Post-Lingual Deafness: The Role of “Top-Down” Neurocognitive Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031343. [PMID: 35162365 PMCID: PMC8834693 DOI: 10.3390/ijerph19031343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 12/04/2022]
Abstract
To date, no clear specific cognitive predictors of speech perception outcome in older adult cochlear implant (CI) users have yet emerged. The aim of this prospective study was to increase knowledge on cognitive and clinical predictors of the audiological outcome in adult cochlear implant users. A total of 21 patients with post-lingual deafness, who were candidates for cochlear implantation, were recruited at the Department of Ear, Nose and Throat, University of Torino (Italy) and subjected to a pre-operatory neuropsychological assessment (T0) and an audiological examination after 12 months of implantation (T12). Patients who, at T12, had a 60 dB verbal recognition above 80%, were younger (z = −2.131, p = 0.033) and performed better in the Verbal Semantic Fluency Test at T0 (z = −1.941, p = 0.052) than subjects who had a 60 dB verbal recognition at T12 below 80%. The most significant predictors of the CI audiological outcome at T12 were age (β = −0.492, p = 0.024) and patients’ TMT-A performance at baseline (β = −0.486, p = 0.035). We conclude that cognitive processing speed might be a good predictor of the level of speech understanding in older adult patients with CI after one year of implantation.
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Affiliation(s)
- Milena Zucca
- Department of Neuroscience, Aging Brain and Memory Clinic, University of Torino, 10126 Turin, Italy;
- Correspondence:
| | - Andrea Albera
- Department of Surgical Sciences, ENT Division, University of Torino, 10126 Turin, Italy; (A.A.); (R.A.); (B.D.G.); (A.C.)
| | - Roberto Albera
- Department of Surgical Sciences, ENT Division, University of Torino, 10126 Turin, Italy; (A.A.); (R.A.); (B.D.G.); (A.C.)
| | - Carla Montuschi
- Section of Otorhinolaryngology, Department of Surgery, Ospedale degli Infermi, 13875 Biella, Italy;
| | - Beatrice Della Gatta
- Department of Surgical Sciences, ENT Division, University of Torino, 10126 Turin, Italy; (A.A.); (R.A.); (B.D.G.); (A.C.)
| | - Andrea Canale
- Department of Surgical Sciences, ENT Division, University of Torino, 10126 Turin, Italy; (A.A.); (R.A.); (B.D.G.); (A.C.)
| | - Innocenzo Rainero
- Department of Neuroscience, Aging Brain and Memory Clinic, University of Torino, 10126 Turin, Italy;
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Caswell-Midwinter B, Doney EM, Arjmandi MK, Jahn KN, Herrmann BS, Arenberg JG. The Relationship Between Impedance, Programming and Word Recognition in a Large Clinical Dataset of Cochlear Implant Recipients. Trends Hear 2022; 26:23312165211060983. [PMID: 35018875 PMCID: PMC8761885 DOI: 10.1177/23312165211060983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cochlear implant programming typically involves measuring electrode impedance, selecting a speech processing strategy and fitting the dynamic range of electrical stimulation. This study retrospectively analyzed a clinical dataset of adult cochlear implant recipients to understand how these variables relate to speech recognition. Data from 425 implanted post-lingually deafened ears with Advanced Bionics devices were analyzed. A linear mixed-effects model was used to infer how impedance, programming and patient factors were associated with monosyllabic word recognition scores measured in quiet. Additional analyses were conducted on subsets of data to examine the role of speech processing strategy on scores, and the time taken for the scores of unilaterally implanted patients to plateau. Variation in basal impedance was negatively associated with word score, suggesting importance in evaluating the profile of impedance. While there were small, negative bivariate correlations between programming level metrics and word scores, these relationships were not clearly supported by the model that accounted for other factors. Age at implantation was negatively associated with word score, and duration of implant experience was positively associated with word score, which could help to inform candidature and guide expectations. Electrode array type was also associated with word score. Word scores measured with traditional continuous interleaved sampling and current steering speech processing strategies were similar. The word scores of unilaterally implanted patients largely plateaued within 6-months of activation. However, there was individual variation which was not related to initially measured impedance and programming levels.
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Affiliation(s)
- Benjamin Caswell-Midwinter
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | | | - Meisam K Arjmandi
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | - Kelly N Jahn
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA
| | - Barbara S Herrmann
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | - Julie G Arenberg
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
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Harrison SC, Lawrence R, Hoare DJ, Wiggins IM, Hartley DEH. Use of Functional Near-Infrared Spectroscopy to Predict and Measure Cochlear Implant Outcomes: A Scoping Review. Brain Sci 2021; 11:brainsci11111439. [PMID: 34827438 PMCID: PMC8615917 DOI: 10.3390/brainsci11111439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
Outcomes following cochlear implantation vary widely for both adults and children, and behavioral tests are currently relied upon to assess this. However, these behavioral tests rely on subjective judgements that can be unreliable, particularly for infants and young children. The addition of an objective test of outcome following cochlear implantation is therefore desirable. The aim of this scoping review was to comprehensively catalogue the evidence for the potential of functional near infrared spectroscopy (fNIRS) to be used as a tool to objectively predict and measure cochlear implant outcomes. A scoping review of the literature was conducted following the PRISMA extension for scoping review framework. Searches were conducted in the MEDLINE, EMBASE, PubMed, CINAHL, SCOPUS, and Web of Science electronic databases, with a hand search conducted in Google Scholar. Key terms relating to near infrared spectroscopy and cochlear implants were used to identify relevant publications. Eight records met the criteria for inclusion. Seven records reported on adult populations, with five records only including post-lingually deaf individuals and two including both pre- and post-lingually deaf individuals. Studies were either longitudinal or cross-sectional, and all studies compared fNIRS measurements with receptive speech outcomes. This review identified and collated key work in this field. The homogeneity of the populations studied so far identifies key gaps for future research, including the use of fNIRS in infants. By mapping the literature on this important topic, this review contributes knowledge towards the improvement of outcomes following cochlear implantation.
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Affiliation(s)
- Samantha C. Harrison
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK; (R.L.); (D.J.H.); (I.M.W.); (D.E.H.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK
- Correspondence: ; Tel.: +44-115-823-2640
| | - Rachael Lawrence
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK; (R.L.); (D.J.H.); (I.M.W.); (D.E.H.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK
- Nottingham University Hospitals National Health Service Trust, Nottingham NG5 1PB, UK
| | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK; (R.L.); (D.J.H.); (I.M.W.); (D.E.H.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK
| | - Ian M. Wiggins
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK; (R.L.); (D.J.H.); (I.M.W.); (D.E.H.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK
| | - Douglas E. H. Hartley
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK; (R.L.); (D.J.H.); (I.M.W.); (D.E.H.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK
- Nottingham University Hospitals National Health Service Trust, Nottingham NG5 1PB, UK
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Holder JT, Gifford RH. Effect of Increased Daily Cochlear Implant Use on Auditory Perception in Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4044-4055. [PMID: 34546763 PMCID: PMC9132064 DOI: 10.1044/2021_jslhr-21-00066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/27/2021] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
Purpose Despite the recommendation for cochlear implant (CI) processor use during all waking hours, variability in average daily wear time remains high. Previous work has shown that objective wear time is significantly correlated with speech recognition outcomes. We aimed to investigate the causal link between daily wear time and speech recognition outcomes and assess one potential underlying mechanism, spectral processing, driving the causal link. We hypothesized that increased CI use would result in improved speech recognition via improved spectral processing. Method Twenty adult CI recipients completed two study visits. The baseline visit included auditory perception testing (speech recognition and spectral processing measures), questionnaire administration, and documentation of data logging from the CI software. Participants watched an educational video, and they were informed of the compensation schedule. Participants were then asked to increase their daily CI use over a 4-week period during everyday life. Baseline measures were reassessed following the 4-week period. Results Seventeen out of 20 participants increased their daily CI use. On average, participants' speech recognition improved by 3.0, 2.4, and 7.0 percentage points per hour of increased average daily CI use for consonant-nucleus-consonant words, AzBio sentences, and AzBio sentences in noise, respectively. Questionnaire scores were similar between visits. Spectral processing showed significant improvement and accounted for a small amount of variance in the change in speech recognition values. Conclusions Improved consistency of processor use over a 4-week period yielded significant improvements in speech recognition scores. Though a significant factor, spectral processing is likely not the only mechanism driving improvement in speech recognition; further research is warranted.
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Affiliation(s)
- Jourdan T. Holder
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - René H. Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Gao X, Grayden D, McDonnell M. Unifying information theory and machine learning in a model of electrode discrimination in cochlear implants. PLoS One 2021; 16:e0257568. [PMID: 34543336 PMCID: PMC8451994 DOI: 10.1371/journal.pone.0257568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/06/2021] [Indexed: 12/02/2022] Open
Abstract
Despite the development and success of cochlear implants over several decades, wide inter-subject variability in speech perception is reported. This suggests that cochlear implant user-dependent factors limit speech perception at the individual level. Clinical studies have demonstrated the importance of the number, placement, and insertion depths of electrodes on speech recognition abilities. However, these do not account for all inter-subject variability and to what extent these factors affect speech recognition abilities has not been studied. In this paper, an information theoretic method and machine learning technique are unified in a model to investigate the extent to which key factors limit cochlear implant electrode discrimination. The framework uses a neural network classifier to predict which electrode is stimulated for a given simulated activation pattern of the auditory nerve, and mutual information is then estimated between the actual stimulated electrode and predicted ones. We also investigate how and to what extent the choices of parameters affect the performance of the model. The advantages of this framework include i) electrode discrimination ability is quantified using information theory, ii) it provides a flexible framework that may be used to investigate the key factors that limit the performance of cochlear implant users, and iii) it provides insights for future modeling studies of other types of neural prostheses.
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Affiliation(s)
- Xiao Gao
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
- School of Physics, The University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - David Grayden
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
| | - Mark McDonnell
- Computational Learning Systems Laboratory, School of Information Technology & Mathematical Sciences, University of South Australia, Mawson Lakes, SA, Australia
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Goudey B, Plant K, Kiral I, Jimeno-Yepes A, Swan A, Gambhir M, Büchner A, Kludt E, Eikelboom RH, Sucher C, Gifford RH, Rottier R, Anjomshoa H. A MultiCenter Analysis of Factors Associated with Hearing Outcome for 2,735 Adults with Cochlear Implants. Trends Hear 2021; 25:23312165211037525. [PMID: 34524944 PMCID: PMC8450683 DOI: 10.1177/23312165211037525] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
While the majority of cochlear implant recipients benefit from the device, it
remains difficult to estimate the degree of benefit for a specific patient prior
to implantation. Using data from 2,735 cochlear-implant recipients from across
three clinics, the largest retrospective study of cochlear-implant outcomes to
date, we investigate the association between 21 preoperative factors and speech
recognition approximately one year after implantation and explore the
consistency of their effects across the three constituent datasets. We provide
evidence of 17 statistically significant associations, in either univariate or
multivariate analysis, including confirmation of associations for several
predictive factors, which have only been examined in prior smaller studies.
Despite the large sample size, a multivariate analysis shows that the variance
explained by our models remains modest across the datasets (R2=0.12–0.21). Finally, we report a novel statistical interaction
indicating that the duration of deafness in the implanted ear has a stronger
impact on hearing outcome when considered relative to a candidate’s age. Our
multicenter study highlights several real-world complexities that impact the
clinical translation of predictive factors for cochlear implantation outcome. We
suggest several directions to overcome these challenges and further improve our
ability to model patient outcomes with increased accuracy.
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Affiliation(s)
- Benjamin Goudey
- 127113IBM Research Australia, Southbank, Victoria, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Kerrie Plant
- 104148Cochlear Limited, Sydney, New South Wales, Australia
| | - Isabell Kiral
- 127113IBM Research Australia, Southbank, Victoria, Australia
| | | | - Annalisa Swan
- 127113IBM Research Australia, Southbank, Victoria, Australia
| | - Manoj Gambhir
- 127113IBM Research Australia, Southbank, Victoria, Australia
| | - Andreas Büchner
- 9177Medizinische Hochschule Hannover, Hannover, Niedersachsen, Germany
| | - Eugen Kludt
- 9177Medizinische Hochschule Hannover, Hannover, Niedersachsen, Germany
| | - Robert H Eikelboom
- 104182Ear Science Institute Australia, Subiaco, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, South Africa
| | - Cathy Sucher
- 104182Ear Science Institute Australia, Subiaco, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Rene H Gifford
- Department of Hearing and Speech Sciences, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Riaan Rottier
- 104148Cochlear Limited, Sydney, New South Wales, Australia
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Šikolová S, Urík M, Hošnová D, Kruntorád V, Bartoš M, Motyka O, Jabandžiev P. Two Bonebridge bone conduction hearing implant generations: audiological benefit and quality of hearing in children. Eur Arch Otorhinolaryngol 2021; 279:3387-3398. [PMID: 34495351 PMCID: PMC9130159 DOI: 10.1007/s00405-021-07068-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/31/2021] [Indexed: 12/05/2022]
Abstract
Purpose The study aimed to evaluate audiological benefits, quality of hearing and safety of two Bonebridge generation: BCI601 and BCI602 (MED-EL, Innsbruck, Austria) in children. Methods Twelve children were implanted: five BCI601 and seven BCI602 comprising of ten conductive hearing loss, and two single sided deaf SSD subjects. Audiological outcomes tested were sound field audiometry, functional gain, speech recognition threshold (SRT50), speech recognition in noise (SPRINT) and localisation abilities. Subjective measures were Speech, Spatial and Qualities of Hearing Scale (SSQ12). Results The mean FG with the BCI601 was 25.0 dB and with the BCI602 28.0 dB. The benefit in SRT50 was 23.2 dB and 33.8 dB, respectively. The mean benefit in SPRINT was 15% and 6.7% and the localisation ability improved from 33.3° to 16° and from 26.2° to 17.6°, respectively. The two SSD subjects reported a FG of 17 dB, a benefit in SRT50 of 22.5 and a benefit in SPRINT of 20%. Subjective outcomes improved significantly and even exceeded the values of their age-and sex matched normal hearing peers. One revision was reported: a retroauricular emphysema above the implant occurred 12 months post-OP, it was resolved operatively with the implant still being functional. Conclusion The pediatric cohort reports significant audiological benefit, even exceeding that of the age- and sex matched control. The combination of the high safety and audiological benefit makes the Bonebridge a comfortable and effective option in hearing rehabilitation in children.
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Affiliation(s)
- Soňa Šikolová
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic.,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic
| | - Milan Urík
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic. .,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic.
| | - Dagmar Hošnová
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic.,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic
| | - Vít Kruntorád
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic.,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic
| | - Michal Bartoš
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, Černopolní 9, 61300, Brno, Czech Republic.,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic
| | - Oldřich Motyka
- Nanotechnology Centre, CEET, VSB-Technical University of Ostrava, 708 00, Ostrava-Poruba, Czech Republic.,Centre ENET, CEET, VSB-Technical University of Ostrava, 708 00, Ostrava-Poruba, Czech Republic
| | - Petr Jabandžiev
- Faculty of Medicine, Masaryk University Brno, Kamenice 5, 62500, Brno, Czech Republic.,Department of Pediatrics, University Hospital Brno, 61300, Brno, Czech Republic
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Assiri M, Khurayzi T, Alshalan A, Alsanosi A. Cochlear implantation among patients with otosclerosis: a systematic review of clinical characteristics and outcomes. Eur Arch Otorhinolaryngol 2021; 279:3327-3339. [PMID: 34402951 DOI: 10.1007/s00405-021-07036-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE There have been considerable advancements in cochlear implants in different clinical scenarios; however, their use in patients with otosclerosis remains challenging. This review aimed to investigate the surgical and clinical outcomes of cochlear implantation in patients with otosclerosis. METHODS An electronic literature search was performed using four main databases through February 2021 to identify original studies of cochlear implantation in patients with otosclerosis for inclusion in this systematic review. The study protocol was registered with the Prospectively Registered Systematic Reviews and Meta-analyses (reference number: CRD42021234753). RESULTS A total of 23 studies including 3162 patients were enrolled. Of these patients, only 392 had otosclerosis and underwent cochlear implantation. The duration of deafness was reported in only eight studies, extending up to 50 years. Far-advanced otosclerosis was observed in 153 patients. A total of 56 patients used hearing aids. Stapedectomy and stapedotomy were performed in 118 and 63 patients, respectively. In three studies, the temporary success of stapedectomy and stapedotomy was 6 (43%) and 5 (71%) patients, respectively. Computed tomography was used as a preoperative assessment tool in most studies (n = 14, 60.9%). Incomplete implant insertion occurred in 17 patients, while facial nerve stimulation occurred in 36 patients after implantation. CONCLUSION Cochlear implantation is a relatively safe modality that can provide promising audiological outcomes in patients with otosclerosis. However, several factors, including cochlear ossification, duration of deafness, and previous operations, can affect its outcomes. Further studies with a larger sample population are recommended.
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Affiliation(s)
- Majed Assiri
- King Abdullah Ear Specialist Centre (KAESC), King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | | | - Afrah Alshalan
- Otorhinolaryngology, Neurotology and Lateral Skull Base Surgery, King Abdullah Ear Specialist Centre (KAESC), King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Centre (KAESC), College of Medicine, King Saud University, Riyadh, 11411, Saudi Arabia
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Relationship Between Electrocochleography, Angular Insertion Depth, and Cochlear Implant Speech Perception Outcomes. Ear Hear 2021; 42:941-948. [PMID: 33369942 PMCID: PMC8217403 DOI: 10.1097/aud.0000000000000985] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Electrocochleography (ECochG), obtained before the insertion of a cochlear implant (CI) array, provides a measure of residual cochlear function that accounts for a substantial portion of variability in postoperative speech perception outcomes in adults. It is postulated that subsequent surgical factors represent independent sources of variance in outcomes. Prior work has demonstrated a positive correlation between angular insertion depth (AID) of straight arrays and speech perception under the CI-alone condition, with an inverse relationship observed for precurved arrays. The purpose of the present study was to determine the combined effects of ECochG, AID, and array design on speech perception outcomes. DESIGN Participants were 50 postlingually deafened adult CI recipients who received one of three straight arrays (MED-EL Flex24, MED-EL Flex28, and MED-EL Standard) and two precurved arrays (Cochlear Contour Advance and Advanced Bionics HiFocus Mid-Scala). Residual cochlear function was determined by the intraoperative ECochG total response (TR) measured before array insertion, which is the sum of magnitudes of spectral components in response to tones of different stimulus frequencies across the speech spectrum. The AID was then determined with postoperative imaging. Multiple linear regression was used to predict consonant-nucleus-consonant (CNC) word recognition in the CI-alone condition at 6 months postactivation based on AID, TR, and array design. RESULTS Forty-one participants received a straight array and nine received a precurved array. The AID of the most apical electrode contact ranged from 341° to 696°. The TR measured by ECochG accounted for 43% of variance in speech perception outcomes (p < 0.001). A regression model predicting CNC word scores with the TR tended to underestimate the performance for precurved arrays and deeply inserted straight arrays, and to overestimate the performance for straight arrays with shallower insertions. When combined in a multivariate linear regression, the TR, AID, and array design accounted for 72% of variability in speech perception outcomes (p < 0.001). CONCLUSIONS A model of speech perception outcomes that incorporates TR, AID, and array design represents an improvement over a model based on TR alone. The success of this model shows that peripheral factors including cochlear health and electrode placement may play a predominant role in speech perception with CIs.
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Abstract
Supplemental Digital Content is available in the text. The primary objective of this study is to identify the biographic, audiologic, and electrode position factors that influence speech perception performance in adult cochlear implant (CI) recipients implanted with a device from a single manufacturer. The secondary objective is to investigate the independent association of the type of electrode (precurved or straight) with speech perception.
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Frequency-to-Place Mismatch: Characterizing Variability and the Influence on Speech Perception Outcomes in Cochlear Implant Recipients. Ear Hear 2021; 41:1349-1361. [PMID: 32205726 DOI: 10.1097/aud.0000000000000864] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The spatial position of a cochlear implant (CI) electrode array affects the spectral cues provided to the recipient. Differences in cochlear size and array length lead to substantial variability in angular insertion depth (AID) across and within array types. For CI-alone users, the variability in AID results in varying degrees of frequency-to-place mismatch between the default electric frequency filters and cochlear place of stimulation. For electric-acoustic stimulation (EAS) users, default electric frequency filters also vary as a function of residual acoustic hearing in the implanted ear. The present study aimed to (1) investigate variability in AID associated with lateral wall arrays, (2) determine the subsequent frequency-to-place mismatch for CI-alone and EAS users mapped with default frequency filters, and (3) examine the relationship between early speech perception for CI-alone users and two aspects of electrode position: frequency-to-place mismatch and angular separation between neighboring contacts, a metric associated with spectral selectivity at the periphery. DESIGN One hundred one adult CI recipients (111 ears) with MED-EL Flex24 (24 mm), Flex28 (28 mm), and FlexSOFT/Standard (31.5 mm) arrays underwent postoperative computed tomography to determine AID. A subsequent comparison was made between AID, predicted spiral ganglion place frequencies, and the default frequency filters for CI-alone (n = 84) and EAS users (n = 27). For CI-alone users with complete insertions who listened with maps fit with the default frequency filters (n = 48), frequency-to-place mismatch was quantified at 1500 Hz and angular separation between neighboring contacts was determined for electrodes in the 1 to 2 kHz region. Multiple linear regression was used to examine how frequency-to-place mismatch and angular separation of contacts influence consonant-nucleus-consonant (CNC) scores through 6 months postactivation. RESULTS For CI recipients with complete insertions (n = 106, 95.5%), the AID (mean ± standard deviation) of the most apical contact was 428° ± 34.3° for Flex24 (n = 11), 558° ± 65.4° for Flex28 (n = 48), and 636° ± 42.9° for FlexSOFT/Standard (n = 47) arrays. For CI-alone users, default frequency filters aligned closely with the spiral ganglion map for deeply inserted lateral wall arrays. For EAS users, default frequency filters produced a range of mismatches; absolute deviations of ≤ 6 semitones occurred in only 37% of cases. Participants with shallow insertions and minimal or no residual hearing experienced the greatest mismatch. For CI-alone users, both smaller frequency-to-place mismatch and greater angular separation between contacts were associated with better CNC scores during the initial 6 months of device use. CONCLUSIONS There is significant variability in frequency-to-place mismatch among CI-alone and EAS users with default frequency filters, even between individuals implanted with the same array. When using default frequency filters, mismatch can be minimized with longer lateral wall arrays and insertion depths that meet the edge frequency associated with residual hearing for CI-alone and EAS users, respectively. Smaller degrees of frequency-to-place mismatch and decreased peripheral masking due to more widely spaced contacts may independently support better speech perception with longer lateral wall arrays in CI-alone users.
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Relationship Between Speech Recognition in Quiet and Noise and Fitting Parameters, Impedances and ECAP Thresholds in Adult Cochlear Implant Users. Ear Hear 2021; 41:935-947. [PMID: 31702597 DOI: 10.1097/aud.0000000000000814] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to identify parameters which are related to speech recognition in quiet and in noise of cochlear implant (CI) users. These parameters may be important to improve current fitting practices. DESIGN Adult CI users who visited the Amsterdam UMC, location VUmc, for their annual follow-up between January 2015 and December 2017 were retrospectively identified. After applying inclusion criteria, the final study population consisted of 138 postlingually deaf adult Cochlear CI users. Prediction models were built with speech recognition in quiet and in noise as the outcome measures, and aided sound field thresholds, and parameters related to fitting (i.e., T and C levels, dynamic range [DR]), evoked compound action potential thresholds and impedances as the independent variables. A total of 33 parameters were considered. Separate analyses were performed for postlingually deafened CI users with late onset (LO) and CI users with early onset (EO) of severe hearing impairment. RESULTS Speech recognition in quiet was not significantly different between the LO and EO groups. Speech recognition in noise was better for the LO group compared with the EO group. For CI users in the LO group, mean aided thresholds, mean electrical DR, and measures to express the impedance profile across the electrode array were identified as predictors of speech recognition in quiet and in noise. For CI users in the EO group, the mean T level appeared to be a significant predictor in the models for speech recognition in quiet and in noise, such that CI users with elevated T levels had worse speech recognition in quiet and in noise. CONCLUSIONS Significant parameters related to speech recognition in quiet and in noise were identified: aided thresholds, electrical DR, T levels, and impedance profiles. The results of this study are consistent with previous study findings and may guide audiologists in their fitting practices to improve the performance of CI users. The best performance was found for CI users with aided thresholds around the target level of 25 dB HL, and an electrical DR between 40 and 60 CL. However, adjustments of T and/or C levels to obtain aided thresholds around the target level and the preferred DR may not always be acceptable for individual CI users. Finally, clinicians should pay attention to profiles of impedances other than a flat profile with mild variations.
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