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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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Panario J, Bester C, O'Leary S. Predicting Postoperative Speech Perception and Audiometric Thresholds Using Intracochlear Electrocochleography in Cochlear Implant Recipients. Ear Hear 2024:00003446-990000000-00289. [PMID: 38816899 DOI: 10.1097/aud.0000000000001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Electrocochleography (ECochG) appears to offer the most accurate prediction of post-cochlear implant hearing outcomes. This may be related to its capacity to interrogate the health of underlying cochlear tissue. The four major components of ECochG (cochlear microphonic [CM], summating potential [SP], compound action potential [CAP], and auditory nerve neurophonic [ANN]) are generated by different cochlear tissue components. Analyzing characteristics of these components can reveal the state of hair and neural cell in a cochlea. There is limited evidence on the characteristics of intracochlear (IC) ECochG recordings measured across the array postinsertion but compared with extracochlear recordings has better signal to noise ratio and spatial specificity. The present study aimed to examine the relationship between ECochG components recorded from an IC approach and postoperative speech perception or audiometric thresholds. DESIGN In 113 human subjects, responses to 500 Hz tone bursts were recorded at 11 IC electrodes across a 22-electrode cochlear implant array immediately following insertion. Responses to condensation and rarefaction stimuli were then subtracted from one another to emphasize the CM and added to one another to emphasize the SP, ANN, and CAP. Maximum amplitudes and extracochlear electrode locations were recorded for each of these ECochG components. These were added stepwise to a multi-factor generalized additive model to develop a best-fit model predictive model for pure-tone audiometric thresholds (PTA) and speech perception scores (speech recognition threshold [SRT] and consonant-vowel-consonant phoneme [CVC-P]) at 3- and 12-month postoperative timepoints. This best-fit model was tested against a generalized additive model using clinical factors alone (preoperative score, age, and gender) as a null model proxy. RESULTS ECochG-factor models were superior to clinical factor models in predicting postoperative PTA, CVC-P, and SRT outcomes at both timepoints. Clinical factor models explained a moderate amount of PTA variance ( r2 = 45.9% at 3-month, 31.8% at 12-month, both p < 0.001) and smaller variances of CVC-P and SRT ( r2 range = 6 to 13.7%, p = 0.008 to 0.113). Age was not a significant predictive factor. ECochG models explained more variance at the 12-month timepoint ( r2 for PTA = 52.9%, CVC-P = 39.6%, SRT = 36.4%) compared with the 3-month one timepoint ( r2 for PTA = 49.4%, CVC-P = 26.5%, SRT = 22.3%). The ECochG model was based on three factors: maximum SP deflection amplitude, and electrode position of CM and SP peaks. Adding neural (ANN and/or CAP) factors to the model did not improve variance explanation. Large negative SP deflection was associated with poorer outcomes and a large positive SP deflection with better postoperative outcomes. Mid-array peaks of SP and CM were both associated with poorer outcomes. CONCLUSIONS Postinsertion IC-ECochG recordings across the array can explain a moderate amount of postoperative speech perception and audiometric thresholds. Maximum SP deflection and its location across the array appear to have a significant predictive value which may reflect the underlying state of cochlear health.
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Affiliation(s)
- Jared Panario
- Department Otolaryngology, University of Melbourne, Melbourne, Victoria, Australia
| | - Christofer Bester
- Department Otolaryngology, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen O'Leary
- Department Otolaryngology, University of Melbourne, Melbourne, Victoria, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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Khayr R, Khnifes R, Shpak T, Banai K. Task-Specific Rapid Auditory Perceptual Learning in Adult Cochlear Implant Recipients: What Could It Mean for Speech Recognition. Ear Hear 2024:00003446-990000000-00285. [PMID: 38829780 DOI: 10.1097/aud.0000000000001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Speech recognition in cochlear implant (CI) recipients is quite variable, particularly in challenging listening conditions. Demographic, audiological, and cognitive factors explain some, but not all, of this variance. The literature suggests that rapid auditory perceptual learning explains unique variance in speech recognition in listeners with normal hearing and those with hearing loss. The present study focuses on the early adaptation phase of task-specific rapid auditory perceptual learning. It investigates whether adult CI recipients exhibit this learning and, if so, whether it accounts for portions of the variance in their recognition of fast speech and speech in noise. DESIGN Thirty-six adult CI recipients (ages = 35 to 77, M = 55) completed a battery of general speech recognition tests (sentences in speech-shaped noise, four-talker babble noise, and natural-fast speech), cognitive measures (vocabulary, working memory, attention, and verbal processing speed), and a rapid auditory perceptual learning task with time-compressed speech. Accuracy in the general speech recognition tasks was modeled with a series of generalized mixed models that accounted for demographic, audiological, and cognitive factors before accounting for the contribution of task-specific rapid auditory perceptual learning of time-compressed speech. RESULTS Most CI recipients exhibited early task-specific rapid auditory perceptual learning of time-compressed speech within the course of the first 20 sentences. This early task-specific rapid auditory perceptual learning had unique contribution to the recognition of natural-fast speech in quiet and speech in noise, although the contribution to natural-fast speech may reflect the rapid learning that occurred in this task. When accounting for demographic and cognitive characteristics, an increase of 1 SD in the early task-specific rapid auditory perceptual learning rate was associated with ~52% increase in the odds of correctly recognizing natural-fast speech in quiet, and ~19% to 28% in the odds of correctly recognizing the different types of speech in noise. Age, vocabulary, attention, and verbal processing speed also had unique contributions to general speech recognition. However, their contribution varied between the different general speech recognition tests. CONCLUSIONS Consistent with previous findings in other populations, in CI recipients, early task-specific rapid auditory perceptual, learning also accounts for some of the individual differences in the recognition of speech in noise and natural-fast speech in quiet. Thus, across populations, the early rapid adaptation phase of task-specific rapid auditory perceptual learning might serve as a skill that supports speech recognition in various adverse conditions. In CI users, the ability to rapidly adapt to ongoing acoustical challenges may be one of the factors associated with good CI outcomes. Overall, CI recipients with higher cognitive resources and faster rapid learning rates had better speech recognition.
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Affiliation(s)
- Ranin Khayr
- Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Technion-Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Riyad Khnifes
- Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Technion-Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Talma Shpak
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Technion-Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Karen Banai
- Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
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Deroche MLD, Wolfe J, Neumann S, Manning J, Hanna L, Towler W, Wilson C, Bien AG, Miller S, Schafer E, Gemignani J, Alemi R, Muthuraman M, Koirala N, Gracco VL. Cross-modal plasticity in children with cochlear implant: converging evidence from EEG and functional near-infrared spectroscopy. Brain Commun 2024; 6:fcae175. [PMID: 38846536 PMCID: PMC11154148 DOI: 10.1093/braincomms/fcae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/02/2024] [Accepted: 05/17/2024] [Indexed: 06/09/2024] Open
Abstract
Over the first years of life, the brain undergoes substantial organization in response to environmental stimulation. In a silent world, it may promote vision by (i) recruiting resources from the auditory cortex and (ii) making the visual cortex more efficient. It is unclear when such changes occur and how adaptive they are, questions that children with cochlear implants can help address. Here, we examined 7-18 years old children: 50 had cochlear implants, with delayed or age-appropriate language abilities, and 25 had typical hearing and language. High-density electroencephalography and functional near-infrared spectroscopy were used to evaluate cortical responses to a low-level visual task. Evidence for a 'weaker visual cortex response' and 'less synchronized or less inhibitory activity of auditory association areas' in the implanted children with language delays suggests that cross-modal reorganization can be maladaptive and does not necessarily strengthen the dominant visual sense.
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Affiliation(s)
- Mickael L D Deroche
- Department of Psychology, Concordia University, Montreal, Quebec, Canada, H4B 1R6
| | - Jace Wolfe
- Hearts for Hearing Foundation, Oklahoma City, OK 73120, USA
| | - Sara Neumann
- Hearts for Hearing Foundation, Oklahoma City, OK 73120, USA
| | - Jacy Manning
- Hearts for Hearing Foundation, Oklahoma City, OK 73120, USA
| | - Lindsay Hanna
- Hearts for Hearing Foundation, Oklahoma City, OK 73120, USA
| | - Will Towler
- Hearts for Hearing Foundation, Oklahoma City, OK 73120, USA
| | - Caleb Wilson
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Alexander G Bien
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Sharon Miller
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, TX 76201, USA
| | - Erin Schafer
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, TX 76201, USA
| | - Jessica Gemignani
- Department of Developmental and Social Psychology, University of Padova, 35131 Padua, Italy
| | - Razieh Alemi
- Department of Psychology, Concordia University, Montreal, Quebec, Canada, H4B 1R6
| | - Muthuraman Muthuraman
- Section of Neural Engineering with Signal Analytics and Artificial Intelligence, Department of Neurology, University Hospital Würzburg, 97080 Würzburg, Germany
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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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Valentin O, Lehmann A, Nguyen D, Paquette S. Integrating Emotion Perception in Rehabilitation Programs for Cochlear Implant Users: A Call for a More Comprehensive Approach. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1635-1642. [PMID: 38619441 DOI: 10.1044/2024_jslhr-23-00660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
PURPOSE Postoperative rehabilitation programs for cochlear implant (CI) recipients primarily emphasize enhancing speech perception. However, effective communication in everyday social interactions necessitates consideration of diverse verbal social cues to facilitate language comprehension. Failure to discern emotional expressions may lead to maladjusted social behavior, underscoring the importance of integrating social cues perception into rehabilitation initiatives to enhance CI users' well-being. After conventional rehabilitation, CI users demonstrate varying levels of emotion perception abilities. This disparity notably impacts young CI users, whose emotion perception deficit can extend to social functioning, encompassing coping strategies and social competence, even when relying on nonauditory cues such as facial expressions. Knowing that emotion perception abilities generally decrease with age, acknowledging emotion perception impairments in aging CI users is crucial, especially since a direct correlation between quality-of-life scores and vocal emotion recognition abilities has been observed in adult CI users. After briefly reviewing the scope of CI rehabilitation programs and summarizing the mounting evidence on CI users' emotion perception deficits and their impact, we will present our recommendations for embedding emotional training as part of enriched and standardized evaluation/rehabilitation programs that can improve CI users' social integration and quality of life. CONCLUSIONS Evaluating all aspects, including emotion perception, in CI rehabilitation programs is crucial because it ensures a comprehensive approach that enhances speech comprehension and the emotional dimension of communication, potentially improving CI users' social interaction and overall well-being. The development of emotion perception training holds promises for CI users and individuals grappling with various forms of hearing loss and sensory deficits. Ultimately, adopting such a comprehensive approach has the potential to significantly elevate the overall quality of life for a broad spectrum of patients.
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Affiliation(s)
- Olivier Valentin
- International Laboratory for Brain, Music and Sound Research and Centre for Research on Brain, Language and Music (BRAMS and CRBLM), Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Music Media and Technology, Montréal, Québec, Canada
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Alexandre Lehmann
- International Laboratory for Brain, Music and Sound Research and Centre for Research on Brain, Language and Music (BRAMS and CRBLM), Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Music Media and Technology, Montréal, Québec, Canada
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Don Nguyen
- International Laboratory for Brain, Music and Sound Research and Centre for Research on Brain, Language and Music (BRAMS and CRBLM), Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Music Media and Technology, Montréal, Québec, Canada
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Sébastien Paquette
- International Laboratory for Brain, Music and Sound Research and Centre for Research on Brain, Language and Music (BRAMS and CRBLM), Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Music Media and Technology, Montréal, Québec, Canada
- Department of Psychology, Faculty of Arts and Science, Trent University, Peterborough, Ontario, Canada
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Ezenwa AC, Goupell MJ, Gordon-Salant S. Cochlear-implant listeners benefit from training with time-compressed speech, even at advanced ages. JASA EXPRESS LETTERS 2024; 4:054402. [PMID: 38717468 PMCID: PMC11075136 DOI: 10.1121/10.0025431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/11/2024] [Indexed: 05/12/2024]
Abstract
This study evaluated whether adaptive training with time-compressed speech produces an age-dependent improvement in speech recognition in 14 adult cochlear-implant users. The protocol consisted of a pretest, 5 h of training, and a posttest using time-compressed speech and an adaptive procedure. There were significant improvements in time-compressed speech recognition at the posttest session following training (>5% in the average time-compressed speech recognition threshold) but no effects of age. These results are promising for the use of adaptive training in aural rehabilitation strategies for cochlear-implant users across the adult lifespan and possibly using speech signals, such as time-compressed speech, to train temporal processing.
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Affiliation(s)
- Amara C Ezenwa
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland 20742, , ,
| | - Matthew J Goupell
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland 20742, , ,
| | - Sandra Gordon-Salant
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland 20742, , ,
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Ceuleers D, Keppler H, Degeest S, Baudonck N, Swinnen F, Kestens K, Dhooge I. Auditory, Visual, and Cognitive Abilities in Normal-Hearing Adults, Hearing Aid Users, and Cochlear Implant Users. Ear Hear 2024; 45:679-694. [PMID: 38192017 DOI: 10.1097/aud.0000000000001458] [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: 01/10/2024]
Abstract
OBJECTIVES Speech understanding is considered a bimodal and bidirectional process, whereby visual information (i.e., speechreading) and also cognitive functions (i.e., top-down processes) are involved. Therefore, the purpose of the present study is twofold: (1) to investigate the auditory (A), visual (V), and cognitive (C) abilities in normal-hearing individuals, hearing aid (HA) users, and cochlear implant (CI) users, and (2) to determine an auditory, visual, cognitive (AVC)-profile providing a comprehensive overview of a person's speech processing abilities, containing a broader variety of factors involved in speech understanding. DESIGN Three matched groups of subjects participated in this study: (1) 31 normal-hearing adults (mean age = 58.76), (2) 31 adults with moderate to severe hearing loss using HAs (mean age = 59.31), (3) 31 adults with a severe to profound hearing loss using a CI (mean age = 58.86). The audiological assessments consisted of pure-tone audiometry, speech audiometry in quiet and in noise. For evaluation of the (audio-) visual speech processing abilities, the Test for (Audio) Visual Speech perception was used. The cognitive test battery consisted of the letter-number sequencing task, the letter detection test, and an auditory Stroop test, measuring working memory and processing speed, selective attention, and cognitive flexibility and inhibition, respectively. Differences between the three groups were examined using a one-way analysis of variance or Kruskal-Wallis test, depending on the normality of the variables. Furthermore, a principal component analysis was conducted to determine the AVC-profile. RESULTS Normal-hearing individuals scored better for both auditory, and cognitive abilities compared to HA users and CI users, listening in a best aided condition. No significant differences were found for speech understanding in a visual condition, despite a larger audiovisual gain for the HA users and CI users. Furthermore, an AVC-profile was composed based on the different auditory, visual, and cognitive assessments. On the basis of that profile, it is possible to determine one comprehensive score for auditory, visual, and cognitive functioning. In the future, these scores could be used in auditory rehabilitation to determine specific strengths and weaknesses per individual patient for the different abilities related to the process of speech understanding in daily life. CONCLUSIONS It is suggested to evaluate individuals with hearing loss from a broader perspective, considering more than only the typical auditory abilities. Also, cognitive and visual abilities are important to take into account to have a more complete overview of the speech understanding abilities in daily life.
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Affiliation(s)
- Dorien Ceuleers
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Hannah Keppler
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Sofie Degeest
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Nele Baudonck
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Freya Swinnen
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Katrien Kestens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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9
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Sriperumbudur KK, Appali R, Gummer AW, van Rienen U. Understanding the impact of modiolus porosity on stimulation of spiral ganglion neurons by cochlear implants. Sci Rep 2024; 14:9593. [PMID: 38671022 PMCID: PMC11053021 DOI: 10.1038/s41598-024-59347-2] [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: 09/29/2023] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Moderate-to-profound sensorineural hearing loss in humans is treatable by electrically stimulating the auditory nerve (AN) with a cochlear implant (CI). In the cochlea, the modiolus presents a porous bony interface between the CI electrode and the AN. New bone growth caused by the presence of the CI electrode or neural degeneration inflicted by ageing or otological diseases might change the effective porosity of the modiolus and, thereby, alter its electrical material properties. Using a volume conductor description of the cochlea, with the aid of a 'mapped conductivity' method and an ad-hoc 'regionally kinetic' equation system, we show that even a slight variation in modiolus porosity or pore distribution can disproportionately affect AN stimulation. Hence, because of porosity changes, an inconsistent CI performance might occur if neural degeneration or new bone growth progress after implantation. Appropriate electrical material properties in accordance with modiolar morphology and pathology should be considered in patient-specific studies. The present first-of-its-kind in-silico study advocates for contextual experimental studies to further explore the utility of modiolus porous morphology in optimising the CI outcome.
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Affiliation(s)
- Kiran K Sriperumbudur
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany.
- Research and Development, MED-EL Medical Electronics GmbH, Innsbruck, Austria.
| | - Revathi Appali
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany
- Ageing of Individuals and Society, Interdisciplinary Faculty, University of Rostock, Rostock, Germany
| | - Anthony W Gummer
- Department of Otolaryngology, University of Tübingen, Tübingen, Germany.
- Department of Otolaryngology, University of Melbourne, Melbourne, Australia.
| | - Ursula van Rienen
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany
- Ageing of Individuals and Society, Interdisciplinary Faculty, University of Rostock, Rostock, Germany
- Life, Light and Matter, Interdisciplinary Faculty, University of Rostock, Rostock, Germany
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Lamounier P, Carasek N, Daher VB, Costa CC, Ramos HVL, Martins SDC, Borges ALDF, Oliveira LAT, Bahmad Jr F. Cochlear Implants after Meningitis and Otosclerosis: A Comparison between Cochlear Ossification and Speech Perception Tests. J Pers Med 2024; 14:428. [PMID: 38673055 PMCID: PMC11050886 DOI: 10.3390/jpm14040428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can influence CI performance. (2) Methods: Retrospective analysis of CI performance in patients with etiological diagnosis of meningitis or otosclerosis, comparing the etiologies and analyzing the image findings, along with electrode array insertion status and technique. (3) Results: Speech recognition in CI patients with otosclerosis improves faster than in patients with meningitis. Other features such as radiological findings, degree of cochlear ossification, surgical technique used and total or partial insertion of electrodes do not seem to be directly related to speech recognition test performance. (4) Conclusions: Patients should be warned that their postoperative results have a strong correlation with the disease that caused their hearing loss and that, in cases of meningitis, a longer duration of speech-language training may be necessary to reach satisfactory results.
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Affiliation(s)
- Pauliana Lamounier
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Natalia Carasek
- Department of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; (N.C.); (L.A.T.O.)
| | - Valeria Barcelos Daher
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Claudiney Cândido Costa
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Hugo Valter Lisboa Ramos
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Sergio de Castro Martins
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
- Otorhinolaryngology Department, Universidade Estadual de Goiás (UEG), Itumbiara 75536-100, Brazil
| | - Alda Linhares de Freitas Borges
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | | | - Fayez Bahmad Jr
- Department of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; (N.C.); (L.A.T.O.)
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11
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Nagels L, Gaudrain E, Vickers D, Hendriks P, Başkent D. Prelingually Deaf Children With Cochlear Implants Show Better Perception of Voice Cues and Speech in Competing Speech Than Postlingually Deaf Adults With Cochlear Implants. Ear Hear 2024:00003446-990000000-00272. [PMID: 38616318 DOI: 10.1097/aud.0000000000001489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Postlingually deaf adults with cochlear implants (CIs) have difficulties with perceiving differences in speakers' voice characteristics and benefit little from voice differences for the perception of speech in competing speech. However, not much is known yet about the perception and use of voice characteristics in prelingually deaf implanted children with CIs. Unlike CI adults, most CI children became deaf during the acquisition of language. Extensive neuroplastic changes during childhood could make CI children better at using the available acoustic cues than CI adults, or the lack of exposure to a normal acoustic speech signal could make it more difficult for them to learn which acoustic cues they should attend to. This study aimed to examine to what degree CI children can perceive voice cues and benefit from voice differences for perceiving speech in competing speech, comparing their abilities to those of normal-hearing (NH) children and CI adults. DESIGN CI children's voice cue discrimination (experiment 1), voice gender categorization (experiment 2), and benefit from target-masker voice differences for perceiving speech in competing speech (experiment 3) were examined in three experiments. The main focus was on the perception of mean fundamental frequency (F0) and vocal-tract length (VTL), the primary acoustic cues related to speakers' anatomy and perceived voice characteristics, such as voice gender. RESULTS CI children's F0 and VTL discrimination thresholds indicated lower sensitivity to differences compared with their NH-age-equivalent peers, but their mean discrimination thresholds of 5.92 semitones (st) for F0 and 4.10 st for VTL indicated higher sensitivity than postlingually deaf CI adults with mean thresholds of 9.19 st for F0 and 7.19 st for VTL. Furthermore, CI children's perceptual weighting of F0 and VTL cues for voice gender categorization closely resembled that of their NH-age-equivalent peers, in contrast with CI adults. Finally, CI children had more difficulties in perceiving speech in competing speech than their NH-age-equivalent peers, but they performed better than CI adults. Unlike CI adults, CI children showed a benefit from target-masker voice differences in F0 and VTL, similar to NH children. CONCLUSION Although CI children's F0 and VTL voice discrimination scores were overall lower than those of NH children, their weighting of F0 and VTL cues for voice gender categorization and their benefit from target-masker differences in F0 and VTL resembled that of NH children. Together, these results suggest that prelingually deaf implanted CI children can effectively utilize spectrotemporally degraded F0 and VTL cues for voice and speech perception, generally outperforming postlingually deaf CI adults in comparable tasks. These findings underscore the presence of F0 and VTL cues in the CI signal to a certain degree and suggest other factors contributing to the perception challenges faced by CI adults.
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Affiliation(s)
- Leanne Nagels
- Center for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Etienne Gaudrain
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
- CNRS UMR 5292, Lyon Neuroscience Research Center, Auditory Cognition and Psychoacoustics, Inserm UMRS 1028, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Deborah Vickers
- Cambridge Hearing Group, Sound Lab, Clinical Neurosciences Department, University of Cambridge, Cambridge, United Kingdom
| | - Petra Hendriks
- Center for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Deniz Başkent
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
- W.J. Kolff Institute for Biomedical Engineering and Materials Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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12
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Patro A, Lindquist NR, Holder JT, Freeman MH, Gifford RH, Tawfik KO, O’Malley MR, Bennett ML, Haynes DS, Perkins EL. Improved Postoperative Speech Recognition and Processor Use With Early Cochlear Implant Activation. Otol Neurotol 2024; 45:386-391. [PMID: 38437818 PMCID: PMC10939836 DOI: 10.1097/mao.0000000000004150] [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: 03/06/2024]
Abstract
OBJECTIVE To report speech recognition outcomes and processor use based on timing of cochlear implant (CI) activation. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS A total of 604 adult CI recipients from October 2011 to March 2022, stratified by timing of CI activation (group 1: ≤10 d, n = 47; group 2: >10 d, n = 557). MAIN OUTCOME MEASURES Average daily processor use; Consonant-Nucleus-Consonant (CNC) and Arizona Biomedical (AzBio) in quiet at 1-, 3-, 6-, and 12-month visits; time to peak performance. RESULTS The groups did not differ in sex ( p = 0.887), age at CI ( p = 0.109), preoperative CNC ( p = 0.070), or preoperative AzBio in quiet ( p = 0.113). Group 1 had higher median daily processor use than group 2 at the 1-month visit (12.3 versus 10.7 h/d, p = 0.017), with no significant differences at 3, 6, and 12 months. The early activation group had superior median CNC performance at 3 months (56% versus 46%, p = 0.007) and 12 months (60% versus 52%, p = 0.044). Similarly, the early activation group had superior median AzBio in quiet performance at 3 months (72% versus 59%, p = 0.008) and 12 months (75% versus 68%, p = 0.049). Both groups were equivalent in time to peak performance for CNC and AzBio. Earlier CI activation was significantly correlated with higher average daily processor use at all follow-up intervals. CONCLUSION CI activation within 10 days of surgery is associated with increased early device usage and superior speech recognition at both early and late follow-up visits. Timing of activation and device usage are modifiable factors that can help optimize postoperative outcomes in the CI population.
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Affiliation(s)
- Ankita Patro
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathan R. Lindquist
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Jourdan T. Holder
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael H. Freeman
- 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, Nashville, Tennessee
| | - Kareem O. Tawfik
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew R. O’Malley
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc L. Bennett
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S. Haynes
- 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
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13
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Cychosz M, Winn MB, Goupell MJ. How to vocode: Using channel vocoders for cochlear-implant research. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 155:2407-2437. [PMID: 38568143 PMCID: PMC10994674 DOI: 10.1121/10.0025274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024]
Abstract
The channel vocoder has become a useful tool to understand the impact of specific forms of auditory degradation-particularly the spectral and temporal degradation that reflect cochlear-implant processing. Vocoders have many parameters that allow researchers to answer questions about cochlear-implant processing in ways that overcome some logistical complications of controlling for factors in individual cochlear implant users. However, there is such a large variety in the implementation of vocoders that the term "vocoder" is not specific enough to describe the signal processing used in these experiments. Misunderstanding vocoder parameters can result in experimental confounds or unexpected stimulus distortions. This paper highlights the signal processing parameters that should be specified when describing vocoder construction. The paper also provides guidance on how to determine vocoder parameters within perception experiments, given the experimenter's goals and research questions, to avoid common signal processing mistakes. Throughout, we will assume that experimenters are interested in vocoders with the specific goal of better understanding cochlear implants.
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Affiliation(s)
- Margaret Cychosz
- Department of Linguistics, University of California, Los Angeles, Los Angeles, California 90095, USA
| | - Matthew B Winn
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Matthew J Goupell
- Department of Hearing and Speech Sciences, University of Maryland, College Park, College Park, Maryland 20742, USA
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14
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Dang S, Kallogjeri D, Dizdar K, Lee D, Bao JW, Varghese J, Walia A, Zhan K, Youssef S, Durakovic N, Wick CC, Herzog JA, Buchman CA, Piccirillo JF, Shew MA. Individual Patient Comorbidities and Effect on Cochlear Implant Performance. Otol Neurotol 2024; 45:e281-e288. [PMID: 38437816 PMCID: PMC10939851 DOI: 10.1097/mao.0000000000004144] [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: 03/06/2024]
Abstract
OBJECTIVE To examine the association between preoperative comorbidities and cochlear implant speech outcomes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS A total of 976 patients who underwent cochlear implantation (CI) between January 2015 and May 2022. Adult patients with follow-up, preoperative audiologic data, and a standardized anesthesia preoperative note were included. EXPOSURE Adult Comorbidity Evaluation 27 (ACE-27) based on standardized anesthesia preoperative notes. MAIN OUTCOME MEASURES Postoperative change in consonant-nucleus-consonant (CNC) score, AzBio Sentence score in quiet, and AzBio + 10 dB signal-to-noise ratio (SNR). Sentence score of the implanted ear at 3, 6, and 12 months. RESULTS A total of 560 patients met inclusion criteria; 112 patients (20%) had no comorbidity, 204 patients (36.4%) had mild comorbidities, 161 patients (28.8%) had moderate comorbidities, and 83 patients (14.8%) had severe comorbidities. Mixed model analysis revealed all comorbidity groups achieved a clinically meaningful improvement in all speech outcome measures over time. This improvement was significantly different between comorbidity groups over time for AzBio Quiet ( p = 0.045) and AzBio + 10 dB SNR ( p = 0.0096). Patients with severe comorbidities had worse outcomes. From preop to 12 months, the estimated marginal mean difference values (95% confidence interval) between the no comorbidity group and the severe comorbidity group were 52.3 (45.7-58.9) and 32.5 (24.6-40.5), respectively, for AzBio Quiet; 39.5 (33.8-45.2) and 21.2 (13.6-28.7), respectively, for AzBio + 10 dB SNR; and 43.9 (38.7-49.0) and 31.1 (24.8-37.4), respectively, for CNC. CONCLUSIONS Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.
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Affiliation(s)
- Sabina Dang
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | | | - Karmela Dizdar
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - David Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - James W Bao
- Miller School of Medicine, University of Miami, Florida
| | - Jordan Varghese
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Kevin Zhan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Stephanie Youssef
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Nedim Durakovic
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jacques A Herzog
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Matthew A Shew
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
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15
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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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16
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Quatre R, Schmerber S, Attyé A. Improving rehabilitation of deaf patients by advanced imaging before cochlear implantation. J Neuroradiol 2024; 51:145-154. [PMID: 37806523 DOI: 10.1016/j.neurad.2023.10.002] [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: 09/17/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Cochlear implants have advanced the management of severe to profound deafness. However, there is a strong disparity in hearing performance after implantation from one patient to another. Moreover, there are several advanced kinds of imaging assessment before cochlear implantation. Microstructural white fiber degeneration can be studied with Diffusion weighted MRI (DWI) or tractography of the central auditory pathways. Functional MRI (fMRI) allows us to evaluate brain function, and CT or MRI segmentation to better detect inner ear anomalies. OBJECTIVE This literature review aims to evaluate how helpful pre-implantation anatomic imaging can be to predict hearing rehabilitation outcomes in deaf patients. These techniques include DWI and fMRI of the central auditory pathways, and automated labyrinth segmentation by CT scan, cone beam CT and MRI. DESIGN This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected by searching in PubMed and by checking the reference lists of relevant articles. Inclusion criteria were adults over 18, with unilateral or bilateral hearing loss, who had DWI acquisition or fMRI or CT/ Cone Beam CT/ MRI image segmentation. RESULTS After reviewing 172 articles, we finally included 51. Studies on DWI showed changes in the central auditory pathways affecting the white matter, extending to the primary and non-primary auditory cortices, even in sudden and mild hearing impairment. Hearing loss patients show a reorganization of brain activity in various areas, such as the auditory and visual cortices, as well as regions involved in language and emotions, according to fMRI studies. Deep Learning's automatic segmentation produces the best CT segmentation in just a few seconds. MRI segmentation is mainly used to evaluate fluid space of the inner ear and determine the presence of an endolymphatic hydrops. CONCLUSION Before cochlear implantation, a DWI with tractography can evaluate the central auditory pathways up to the primary and non-primary auditory cortices. This data is then used to generate predictions on the auditory rehabilitation of patients. A CT segmentation with systematic 3D reconstruction allow a better evaluation of cochlear malformations and predictable difficulties during surgery.
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Affiliation(s)
- Raphaële Quatre
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France; BrainTech Lab INSERM UMR 2015, Grenoble, France; GeodAIsics, Grenoble, France.
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France; BrainTech Lab INSERM UMR 2015, Grenoble, France
| | - Arnaud Attyé
- Department of Neuroradiology, University Hospital, Grenoble, France; GeodAIsics, Grenoble, France
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Young TJ, Schneider KJ, Moberly A, Tamati T. The Impact of the COVID-19 Pandemic on Real-world Functioning in Adult Cochlear-implant Users. OTOLOGY & NEUROTOLOGY OPEN 2024; 4:e048. [PMID: 38533345 PMCID: PMC10962884 DOI: 10.1097/ono.0000000000000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/11/2023] [Indexed: 03/28/2024]
Abstract
Hypothesis As a result of COVID-19 lockdowns and the associated effects on the auditory-social environments of cochlear-implant (CI) users, we expected that adult CI users would report a decrease in real-world communication abilities, a decrease in social isolation, and a decrease in quality of life (QOL) from pre- to post-pandemic. Background The COVID-19 pandemic brought many changes to the environments in which adults with CIs interact and communicate. However, the impact of these changes on CI users' real-world functioning is not well understood. This study investigated the impact of the COVID-19 pandemic on real-world communication abilities, social isolation, and CI-related QOL in adult CI users. Methods Fourteen adult CI users completed self-report questionnaires assessing communication abilities, social isolation, and CI-related QOL at time points before and after the onset of the COVID-19 pandemic. Responses at the 2 time points were compared to evaluate changes in CI users' real-world functioning. Results Adult CI users showed a significant decrease in self-reported communication ability and a nonsignificant decline in CI-related QOL from before to during COVID-19. However, a nonsignificant trend of a decline in social isolation was also observed in adult CI users. Conclusion Findings showed a decrease in self-reported communication abilities and, to a lesser extent, CI-related QOL, suggesting that changes to the auditory-social environment brought on by the COVID-19 pandemic may have negatively impacted communication abilities in real-world, challenging environments. Yet, the potential decrease in social isolation suggests that these changes may have had an overall positive effect on social interaction, potentially with close family and friends in well-controlled environments. Assessing changes in real-world functioning in the same CI users from both before and during the COVID-19 pandemic provided a unique glimpse into how changes in the auditory-social environment may impact outcomes in adult CI users.
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Affiliation(s)
- Tyler J Young
- Department of Otolaryngology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Kara J Schneider
- Department of Otolaryngology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Aaron Moberly
- Department of Otolaryngology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Terrin Tamati
- Department of Otolaryngology, Ohio State University Wexner Medical Center, Columbus, OH
- Department Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Räth M, Schurzig D, Timm ME, Lenarz T, Warnecke A. Correlation of Scalar Cochlear Volume and Hearing Preservation in Cochlear Implant Recipients with Residual Hearing. Otol Neurotol 2024; 45:256-265. [PMID: 38361293 DOI: 10.1097/mao.0000000000004122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Preservation of residual hearing is one of the main goals in cochlear implantation. There are many factors that can influence hearing preservation after cochlear implantation. The purpose of the present study was to develop an algorithm for validated preoperative cochlear volume analysis and to elucidate the role of cochlear volume in preservation of residual hearing preservation after atraumatic cochlear implantation. STUDY DESIGN Retrospective analysis. SETTING Tertiary referral center. PATIENTS A total of 166 cochlear implant recipients were analyzed. All patients were implanted with either a MED-EL (Innsbruck, Austria) FLEXSOFT (n = 3), FLEX28 (n = 72), FLEX26 (n = 1), FLEX24 (n = 41), FLEX20 (n = 38), or FLEX16 (n = 11, custom made device) electrode array through a round window approach. Main outcome measures: Cochlear volume as assessed after manual segmentation of cochlear cross-sections in cone beam computed tomography, and preservation of residual hearing 6 months after implantation were analyzed. The association between residual hearing preservation and cochlear volume was then assessed statistically. RESULTS Rapid and valid cochlear volume analysis was possible using the individual cross-sections and a newly developed and validated algorithm. Cochlear volume had the tendency to be larger in patients with hearing preservation than in those with hearing loss. Significant correlations with hearing preservation could be observed for the basal width and length of the basal turn. CONCLUSIONS Preservation of residual hearing after cochlear implantation may depend on cochlear volume but appears to be influenced more strongly by other cochlear dimensions.
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Ghiselli S, Pizzol E, Vincenti V, Fabrizi E, Salsi D, Cuda D. Do Different Types of Microphones Affect Listening Effort in Cochlear Implant Recipients? A Pupillometry Study. J Clin Med 2024; 13:1134. [PMID: 38398447 PMCID: PMC10889176 DOI: 10.3390/jcm13041134] [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: 01/02/2024] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND It is known that subjects with a cochlear implant (CI) need to exert more listening effort to achieve adequate speech recognition compared to normal hearing subjects. One tool for assessing listening effort is pupillometry. The aim of this study is to evaluate the effectiveness of adaptive directional microphones in reducing listening effort for CI recipients. METHODS We evaluated listening in noise and listening effort degree (by pupillometry) in eight bimodal subjects with three types of CI microphones and in three sound configurations. RESULTS We found a correlation only between sound configurations and listening in noise score (p-value 0.0095). The evaluation of the microphone types shows worse scores in listening in noise with Opti Omni (+3.15 dB SNR) microphone than with Split Dir (+1.89 dB SNR) and Speech Omni (+1.43 dB SNR). No correlation was found between microphones and sound configurations and within the pupillometric data. CONCLUSIONS Different types of microphones have different effects on the listening of CI patients. The difference in the orientation of the sound source is a factor that has an impact on the listening effort results. However, the pupillometry measurements do not significantly correlate with the different microphone types.
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Affiliation(s)
- Sara Ghiselli
- Department of Otolaryngology, AUSL Piacenza, 29121 Piacenza, Italy; (E.P.); (D.S.); (D.C.)
| | - Erica Pizzol
- Department of Otolaryngology, AUSL Piacenza, 29121 Piacenza, Italy; (E.P.); (D.S.); (D.C.)
| | - Vincenzo Vincenti
- Department of Otolaryngology and Otoneurosurgery, University of Parma, 43126 Parma, Italy;
| | - Enrico Fabrizi
- Department of Economics and Social Sciences, Università Cattolica del S. Cuore, 29121 Piacenza, Italy;
| | - Daria Salsi
- Department of Otolaryngology, AUSL Piacenza, 29121 Piacenza, Italy; (E.P.); (D.S.); (D.C.)
| | - Domenico Cuda
- Department of Otolaryngology, AUSL Piacenza, 29121 Piacenza, Italy; (E.P.); (D.S.); (D.C.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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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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Zeitler DM, Buchlak QD, Ramasundara S, Farrokhi F, Esmaili N. Predicting Acoustic Hearing Preservation Following Cochlear Implant Surgery Using Machine Learning. Laryngoscope 2024; 134:926-936. [PMID: 37449725 DOI: 10.1002/lary.30894] [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: 02/10/2023] [Revised: 05/24/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES The aim of the study was to train and test supervised machine-learning classifiers to predict acoustic hearing preservation after CI using preoperative clinical data. STUDY DESIGN Retrospective predictive modeling study of prospectively collected single-institution CI dataset. METHODS One hundred and seventy-five patients from a REDCap database including 761 patients >18 years who underwent CI and had audiometric testing preoperatively and one month after surgery were included. The primary outcome variable was the lowest quartile change in acoustic hearing at one month after CI using various formulae (standard pure tone average, SPTA; low-frequency PTA, LFPTA). Analysis involved applying multivariate logistic regression to detect statistical associations and training and testing supervised learning classifiers. Classifier performance was assessed with numerous metrics including area under the receiver operating characteristic curve (AUC) and Matthews correlation coefficient (MCC). RESULTS Lowest quartile change (indicating hearing preservation) in SPTA was positively associated with a history of meningitis, preoperative LFPTA, and preoperative SPTA. Lowest quartile change in SPTA was negatively associated with sudden hearing loss, noise exposure, aural fullness, and abnormal anatomy. Lowest quartile change in LFPTA was positively associated with preoperative LFPTA. Lowest quartile change in LFPTA was negatively associated with tobacco use. Random forest demonstrated the highest mean classification performance on the validation dataset when predicting each of the outcome variables. CONCLUSIONS Machine learning demonstrated utility for predicting preservation of residual acoustic hearing in patients undergoing CI surgery, and the detected associations facilitated the interpretation of our machine-learning models. The models and statistical associations together may be used to facilitate improvements in shared clinical decision-making and patient outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 134:926-936, 2024.
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Affiliation(s)
- Daniel M Zeitler
- Neuroscience Institute, Virginia Mason Franciscan Health, Seattle, Washington, USA
- Department of Otolaryngology-Head Neck Surgery, Section of Otology/Neurotology, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Quinlan D Buchlak
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Savindi Ramasundara
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Farrokh Farrokhi
- Neuroscience Institute, Virginia Mason Franciscan Health, Seattle, Washington, USA
- Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Nazanin Esmaili
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, New South Wales, Australia
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Minami S, Takahashi M, Shinden S, Shirai K, Oishi N, Nishimura H, Masuda M, Masuda S, Nishiyama T, Hosoya M, Ueno M, Kashio A, Yamada H, Matsunaga T, Kaga K, Shintani A, Nemoto K. Prediction of Cochlear Implant Effectiveness With Surface-Based Morphometry. Otol Neurotol 2024; 45:114-120. [PMID: 38082456 DOI: 10.1097/mao.0000000000004070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE This study aimed to determine whether surface-based morphometry of preoperative whole-brain three-dimensional T1-weighted magnetic resonance imaging (MRI) images can predict the clinical outcomes of cochlear implantation. STUDY DESIGN This was an observational, multicenter study using preoperative MRI data. SETTING The study was conducted at tertiary care referral centers. PATIENTS Sixty-four patients with severe to profound hearing loss (≥70 dB bilaterally), who were scheduled for cochlear implant (CI) surgery, were enrolled. The patients included 19 with congenital hearing loss and 45 with acquired hearing loss. INTERVENTIONS Participants underwent CI surgery. Before surgery, high-resolution three-dimensional T1-weighted brain MRI was performed, and the images were analyzed using FreeSurfer. MAIN OUTCOME MEASURES The primary outcome was monosyllable audibility under quiet conditions 6 months after surgery. Cortical thickness residuals within 34 regions of interest (ROIs) as per the Desikan-Killiany cortical atlas were calculated based on age and healthy-hearing control regression lines. RESULTS Rank logistic regression analysis detected significant associations between CI effectiveness and five right hemisphere ROIs and five left hemisphere ROIs. Predictive modeling using the cortical thickness of the right entorhinal cortex and left medial orbitofrontal cortex revealed a significant correlation with speech discrimination ability. This correlation was higher in patients with acquired hearing loss than in those with congenital hearing loss. CONCLUSIONS Preoperative surface-based morphometry could potentially predict CI outcomes and assist in patient selection and clinical decision making. However, further research with larger, more diverse samples is necessary to confirm these findings and determine their generalizability.
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Affiliation(s)
| | - Masahiro Takahashi
- Department of Otolaryngology, Mita Hospital, International University of Health and Welfare, Tokyo
| | - Seiichi Shinden
- Department of Otolaryngology, Saiseikai Utsunomiya Hospital, Tochigi
| | - Kyoko Shirai
- Department of Otolaryngology, Head and Neck Surgery, Tokyo Medical University
| | - Naoki Oishi
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Keio University, Tokyo
| | | | - Masatsugu Masuda
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Kyorin University, Tokyo
| | - Sawako Masuda
- Department of Otorhinolaryngology, NHO Mie National Hospital, Mie
| | - Takanori Nishiyama
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Keio University, Tokyo
| | - Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Keio University, Tokyo
| | - Masafumi Ueno
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Keio University, Tokyo
| | - Akinori Kashio
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, The University of Tokyo, Tokyo
| | | | | | - Kimitaka Kaga
- Department of Otolaryngology, NHO Tokyo Medical Center
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka
| | - Kiyotaka Nemoto
- Department of Psychiatry, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
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Reddy P, Schneider KJ, Tamati TN, Moberly AC. Effect of Cochlear Implantation on Social Life. Otol Neurotol 2024; 45:e78-e83. [PMID: 38082459 PMCID: PMC11027959 DOI: 10.1097/mao.0000000000004068] [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: 01/12/2024]
Abstract
OBJECTIVE Explore the effects of hearing loss on social life and identify residual social life deficits that remain after cochlear implantation. STUDY DESIGN Retrospective review of prospectively obtained data. SETTING Tertiary care adult neurotology center. PATIENTS Adults between the ages of 35 and 83 years were included with either normal hearing (NH) or a cochlear implant (CI). INTERVENTIONS CI and non-CI-specific quality-of-life (QOL) surveys focused on social and overall QOL. MAIN OUTCOME MEASURES (1) The difference in QOL survey responses between NH and CI participants. (2) The relationship between CI-specific global and social QOL responses and non-CI-specific social QOL responses in CI users. RESULTS A total of 51 participants were included: 31 CI users and 20 NH participants. Of the social QOL questionnaires, CI users reported significantly poorer scores on Self-Efficacy in Social Interactions than NH peers ( p = 0.049). Both Self-Efficacy in Social Interactions scores and Social Isolation Questionnaire scores were significantly correlated with the CI-specific social domain of QOL ( r = 0.64 and -0.58, respectively). Only the Self-Efficacy in Social Interactions scores had a moderate association with global CI QOL ( r = 0.47). CONCLUSIONS CI users self-report similar social life outcomes as their NH peers with the exception of poorer self-efficacy in social situations. Moreover, self-efficacy in social interactions and social isolation were associated with social QOL in CI users, and self-efficacy in social interactions was associated with broader CI-related QOL. Findings support the relevance of individuals' perception of social life to their overall QOL with a CI.
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Affiliation(s)
- Priyanka Reddy
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kara J Schneider
- Hearing Health Solutions from Ohio ENT & Allergy Physicians, Columbus, Ohio
| | - Terrin N Tamati
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron C Moberly
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Czurda R, Wesarg T, Aschendorff A, Beck RL, Hocke T, Ketterer MC, Arndt S. Investigation of Maximum Monosyllabic Word Recognition as a Predictor of Speech Understanding with Cochlear Implant. J Clin Med 2024; 13:646. [PMID: 38337340 PMCID: PMC10856473 DOI: 10.3390/jcm13030646] [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: 11/28/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Background: The cochlear implant (CI) is an established treatment option for patients with inadequate speech understanding and insufficient aided scores. Nevertheless, reliable predictive models and specific therapy goals regarding achievable speech understanding are still lacking. Method: In this retrospective study, 601 cases of CI fittings between 2005 and 2021 at the University Medical Center Freiburg were analyzed. We investigated the preoperative unaided maximum word recognition score (mWRS) as a minimum predictor for post-interventional scores at 65 dB SPL, WRS65(CI). The WRS65(CI) was compared with the preoperative-aided WRS, and a previously published prediction model for the WRS65(CI) was reviewed. Furthermore, the effect of duration of hearing loss, duration of HA fitting, and etiology on WRS65(CI) were investigated. Results: In 95.5% of the cases, a significant improvement in word recognition was observed after CI. WRS65(CI) achieved or exceeded mWRS in 97% of cases. Etiology had a significant impact on WRS65(CI). The predicted score was missed by more than 20 percentage points in 12.8% of cases. Discussion: Our results confirmed the minimum prediction via mWRS. A more precise prediction of the expected WRS65(CI) is possible. The etiology of hearing loss should be considered in the indication and postoperative care to achieve optimal results.
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Affiliation(s)
- Ronja Czurda
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Thomas Wesarg
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Antje Aschendorff
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Rainer Linus Beck
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Thomas Hocke
- Cochlear Deutschland GmbH & Co., KG, Mailänder Straße 4 a, 30539 Hannover, Germany;
| | - Manuel Christoph Ketterer
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Susan Arndt
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
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25
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Chen Y, Wang S, Yang L, Liu Y, Fu X, Wang Y, Zhang X, Wang S. Features of the speech processing network in post- and prelingually deaf cochlear implant users. Cereb Cortex 2024; 34:bhad417. [PMID: 38163443 DOI: 10.1093/cercor/bhad417] [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: 09/13/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 01/03/2024] Open
Abstract
The onset of hearing loss can lead to altered brain structure and functions. However, hearing restoration may also result in distinct cortical reorganization. A differential pattern of functional remodeling was observed between post- and prelingual cochlear implant users, but it remains unclear how these speech processing networks are reorganized after cochlear implantation. To explore the impact of language acquisition and hearing restoration on speech perception in cochlear implant users, we conducted assessments of brain activation, functional connectivity, and graph theory-based analysis using functional near-infrared spectroscopy. We examined the effects of speech-in-noise stimuli on three groups: postlingual cochlear implant users (n = 12), prelingual cochlear implant users (n = 10), and age-matched individuals with hearing controls (HC) (n = 22). The activation of auditory-related areas in cochlear implant users showed a lower response compared with the HC group. Wernicke's area and Broca's area demonstrated differences network attributes in speech processing networks in post- and prelingual cochlear implant users. In addition, cochlear implant users maintain a high efficiency of the speech processing network to process speech information. Taken together, our results characterize the speech processing networks, in varying noise environments, in post- and prelingual cochlear implant users and provide new insights for theories of how implantation modes impact remodeling of the speech processing functional networks.
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Affiliation(s)
- Younuo Chen
- Beijing Institute of Otolaryngology, Otolaryngology-Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
| | - Songjian Wang
- Beijing Institute of Otolaryngology, Otolaryngology-Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
| | - Liu Yang
- School of Biomedical Engineering, Capital Medical University, No. 10, Xitoutiao, YouAnMen, Fengtai District, Beijing 100069, China
| | - Yi Liu
- Beijing Institute of Otolaryngology, Otolaryngology-Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
| | - Xinxing Fu
- Beijing Institute of Otolaryngology, Otolaryngology-Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
| | - Yuan Wang
- Beijing Institute of Otolaryngology, Otolaryngology-Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
| | - Xu Zhang
- School of Biomedical Engineering, Capital Medical University, No. 10, Xitoutiao, YouAnMen, Fengtai District, Beijing 100069, China
| | - Shuo Wang
- Beijing Institute of Otolaryngology, Otolaryngology-Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
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26
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Patro A, Lindquist NR, Schauwecker N, Holder JT, Perkins EL, Haynes DS, Tawfik KO. Comparison of Speech Recognition and Hearing Preservation Outcomes Between the Mid-Scala and Lateral Wall Electrode Arrays. Otol Neurotol 2024; 45:52-57. [PMID: 38013487 PMCID: PMC10842140 DOI: 10.1097/mao.0000000000004064] [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: 11/29/2023]
Abstract
OBJECTIVE To assess speech recognition and hearing preservation (HP) outcomes with the Advanced Bionics Mid-Scala and SlimJ electrodes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS A total of 237 adult patients implanted between 2013 and 2020 (Mid-Scala, n = 136; SlimJ, n = 101). MAIN OUTCOME MEASURES Consonant-nucleus-consonant (CNC) and AzBio (Arizona Biomedical) scores at 6 and 12 months; postoperative HP, defined as low-frequency pure-tone average ≤ 80 dB HL; scalar position. RESULTS Mean CNC scores did not significantly differ between Mid-Scala and SlimJ recipients at 6 (45.8% versus 46.0%, p = 0.962) and 12 (51.9% versus 48.8%, p = 0.363) months. Similarly, mean AzBio in quiet scores were equivalent for both groups at 6 (55.1% versus 59.2%, p = 0.334) and 12 (60.6% versus 62.3%, p = 0.684) months. HP rates were significantly higher with the SlimJ (48.4%) than the Mid-Scala (30.8%; p = 0.033). Scalar translocations were 34.8 and 16.1% for the Mid-Scala and SlimJ groups, respectively ( p = 0.019). Ears with postoperative HP had significantly fewer scalar translocations (16.7% versus 37.2%, p = 0.048), and postoperative HP was associated with higher AzBio in noise scores at the most recent follow-up interval (38.7% versus 25.1%, p = 0.042). CNC, AzBio in quiet and noise, low-frequency pure-tone average shifts, and PTA at 6 and 12 months were not significantly different between patients with scala tympani insertions of the SlimJ versus the Mid-Scala ( p > 0.05). CONCLUSIONS Compared with the Mid-Scala, the lateral wall electrode has superior HP rates and fewer scalar translocations, whereas speech recognition scores are equivalent between both electrode arrays. These findings can help providers with electrode selection and patient counseling.
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Affiliation(s)
- Ankita Patro
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathan R. Lindquist
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natalie Schauwecker
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jourdan T. Holder
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L. Perkins
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S. Haynes
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kareem O. Tawfik
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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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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Everhardt MK, Jung DE, Stiensma B, Lowie W, Başkent D, Sarampalis A. Foreign Language Acquisition in Adolescent Cochlear Implant Users. Ear Hear 2024; 45:174-185. [PMID: 37747307 PMCID: PMC10718217 DOI: 10.1097/aud.0000000000001410] [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: 10/14/2022] [Accepted: 06/20/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES This study explores to what degree adolescent cochlear implant (CI) users can learn a foreign language in a school setting similar to their normal-hearing (NH) peers despite the degraded auditory input. DESIGN A group of native Dutch adolescent CI users (age range 13 to 17 years) learning English as a foreign language at secondary school and a group of NH controls (age range 12 to 15 years) were assessed on their Dutch and English language skills using various language tasks that either relied on the processing of auditory information (i.e., listening task) or on the processing of orthographic information (i.e., reading and/or gap-fill task). The test battery also included various auditory and cognitive tasks to assess whether the auditory and cognitive functioning of the learners could explain the potential variation in language skills. RESULTS Results showed that adolescent CI users can learn English as a foreign language, as the English language skills of the CI users and their NH peers were comparable when assessed with reading or gap-fill tasks. However, the performance of the adolescent CI users was lower for English listening tasks. This discrepancy between task performance was not observed in their native language Dutch. The auditory tasks confirmed that the adolescent CI users had coarser temporal and spectral resolution than their NH peers, supporting the notion that the difference in foreign language listening skills may be due to a difference in auditory functioning. No differences in the cognitive functioning of the CI users and their NH peers were found that could explain the variation in the foreign language listening tasks. CONCLUSIONS In short, acquiring a foreign language with degraded auditory input appears to affect foreign language listening skills, yet does not appear to impact foreign language skills when assessed with tasks that rely on the processing of orthographic information. CI users could take advantage of orthographic information to facilitate foreign language acquisition and potentially support the development of listening-based foreign language skills.
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Affiliation(s)
- Marita K. Everhardt
- Center for Language and Cognition Groningen, University of Groningen, Netherlands
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Netherlands
| | - Dorit Enja Jung
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Netherlands
- Department of Psychology, University of Groningen, Netherlands
| | - Berrit Stiensma
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Netherlands
| | - Wander Lowie
- Center for Language and Cognition Groningen, University of Groningen, Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Netherlands
| | - Deniz Başkent
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Netherlands
- W.J. Kolff Institute for Biomedical Engineering and Materials Science, University Medical Center Groningen, University of Groningen, Netherlands
| | - Anastasios Sarampalis
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Netherlands
- Department of Psychology, University of Groningen, Netherlands
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Anderson SR, Burg E, Suveg L, Litovsky RY. Review of Binaural Processing With Asymmetrical Hearing Outcomes in Patients With Bilateral Cochlear Implants. Trends Hear 2024; 28:23312165241229880. [PMID: 38545645 PMCID: PMC10976506 DOI: 10.1177/23312165241229880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 04/01/2024] Open
Abstract
Bilateral cochlear implants (BiCIs) result in several benefits, including improvements in speech understanding in noise and sound source localization. However, the benefit bilateral implants provide among recipients varies considerably across individuals. Here we consider one of the reasons for this variability: difference in hearing function between the two ears, that is, interaural asymmetry. Thus far, investigations of interaural asymmetry have been highly specialized within various research areas. The goal of this review is to integrate these studies in one place, motivating future research in the area of interaural asymmetry. We first consider bottom-up processing, where binaural cues are represented using excitation-inhibition of signals from the left ear and right ear, varying with the location of the sound in space, and represented by the lateral superior olive in the auditory brainstem. We then consider top-down processing via predictive coding, which assumes that perception stems from expectations based on context and prior sensory experience, represented by cascading series of cortical circuits. An internal, perceptual model is maintained and updated in light of incoming sensory input. Together, we hope that this amalgamation of physiological, behavioral, and modeling studies will help bridge gaps in the field of binaural hearing and promote a clearer understanding of the implications of interaural asymmetry for future research on optimal patient interventions.
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Affiliation(s)
- Sean R. Anderson
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Physiology and Biophysics, University of Colorado Anschutz Medical School, Aurora, CO, USA
| | - Emily Burg
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lukas Suveg
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Ruth Y. Litovsky
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA
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Dziemba OC, Merz S, Hocke T. Evaluative audiometry after cochlear implant provision. HNO 2024; 72:56-62. [PMID: 37812257 PMCID: PMC10799098 DOI: 10.1007/s00106-023-01317-7] [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] [Accepted: 05/15/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND One of the main treatment goals in cochlear implant (CI) patients is to improve speech perception. One of the target parameters is speech intelligibility in quiet. However, treatment results show a high variability, which has not been sufficiently explained so far. The aim of this noninterventional retrospective study was to elucidate this variability using a selected population of patients in whom etiology was not expected to have a negative impact on postoperative speech intelligibility. MATERIALS AND METHODS Audiometric findings of the CI follow-up of 28 adult patients after 6 months of CI experience were evaluated. These were related to the preoperative audiometric examination and evaluated with respect to a recently published predictive model for the postoperative monosyllabic score. RESULTS Inclusion of postoperative categorical loudness scaling and hearing loss for Freiburg numbers in the model explained 55% of the variability in fitting outcomes with respect to monosyllabic word recognition. CONCLUSION The results of this study suggest that much of the cause of variability in fitting outcomes can be captured by systematic postoperative audiometric checks. Immediate conclusions for CI system fitting adjustments may be drawn from these results. However, the extent to which these are accepted by individual patients and thus lead to an improvement in outcome must be subject of further studies, preferably prospective.
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Affiliation(s)
- Oliver C Dziemba
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenkrankheiten, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | | | - Thomas Hocke
- Cochlear Deutschland GmbH & Co. KG, Hannover, Germany
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Franke-Trieger A, Lailach S, Shetty J, Murrmann K, Zahnert T, Neudert M. Word Recognition with a Cochlear Implant in Relation to Prediction and Electrode Position. J Clin Med 2023; 13:183. [PMID: 38202190 PMCID: PMC10780042 DOI: 10.3390/jcm13010183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND the word recognition score (WRS) achieved with cochlear implants (CIs) varies widely. To account for this, a predictive model was developed based on patients' age and their pre-operative WRS. This retrospective study aimed to find out whether the insertion depth of the nucleus lateral-wall electrode arrays contributes to the deviation of the CI-achieved WRS from the predicted WRS. MATERIALS AND METHODS patients with a pre-operative maximum WRS > 0 or a pure-tone audiogram ≥80 dB were included. The insertion depth was determined via digital volume tomography. RESULTS fifty-three patients met the inclusion criteria. The median WRS achieved with the CI was 70%. The comparison of pre- and post-operative scores achieved with a hearing aid and a CI respectively in the aided condition showed a median improvement of 65 percentage points (pp). A total of 90% of the patients improved by at least 20 pp. The majority of patients reached or exceeded the prediction, with a median absolute error of 11 pp. No significant correlation was found between the deviation from the predicted WRS and the insertion depth. CONCLUSIONS our data support a previously published model for the prediction of the WRS after cochlear implantation. For the lateral-wall electrode arrays evaluated, the insertion depth did not influence the WRS with a CI.
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Affiliation(s)
- Annett Franke-Trieger
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany (T.Z.)
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Zhang Y, Callejón-Leblic MA, Picazo-Reina AM, Blanco-Trejo S, Patou F, Sánchez-Gómez S. Impact of SNR, peripheral auditory sensitivity, and central cognitive profile on the psychometric relation between pupillary response and speech performance in CI users. Front Neurosci 2023; 17:1307777. [PMID: 38188029 PMCID: PMC10768066 DOI: 10.3389/fnins.2023.1307777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Despite substantial technical advances and wider clinical use, cochlear implant (CI) users continue to report high and elevated listening effort especially under challenging noisy conditions. Among all the objective measures to quantify listening effort, pupillometry is one of the most widely used and robust physiological measures. Previous studies with normally hearing (NH) and hearing-impaired (HI) listeners have shown that the relation between speech performance in noise and listening effort (as measured by peak pupil dilation) is not linear and exhibits an inverted-U shape. However, it is unclear whether the same psychometric relation exists in CI users, and whether individual differences in auditory sensitivity and central cognitive capacity affect this relation. Therefore, we recruited 17 post-lingually deaf CI adults to perform speech-in-noise tasks from 0 to 20 dB SNR with a 4 dB step size. Simultaneously, their pupillary responses and self-reported subjective effort were recorded. To characterize top-down and bottom-up individual variabilities, a spectro-temporal modulation task and a set of cognitive abilities were measured. Clinical word recognition in quiet and Quality of Life (QoL) were also collected. Results showed that at a group level, an inverted-U shape psychometric curve between task difficulty (SNR) and peak pupil dilation (PPD) was not observed. Individual shape of the psychometric curve was significantly associated with some individual factors: CI users with higher clinical word and speech-in-noise recognition showed a quadratic decrease of PPD over increasing SNRs; CI users with better non-verbal intelligence and lower QoL showed smaller average PPD. To summarize, individual differences in CI users had a significant impact on the psychometric relation between pupillary response and task difficulty, hence affecting the interpretation of pupillary response as listening effort (or engagement) at different task difficulty levels. Future research and clinical applications should further characterize the possible effects of individual factors (such as motivation or engagement) in modulating CI users' occurrence of 'tipping point' on their psychometric functions, and develop an individualized method for reliably quantifying listening effort using pupillometry.
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Affiliation(s)
- Yue Zhang
- Department of Research and Technology, Oticon Medical, Vallauris, France
| | - M. Amparo Callejón-Leblic
- Oticon Medical, Madrid, Spain
- ENT Department, Virgen Macarena University Hospital, Seville, Spain
- Biomedical Engineering Group, University of Sevillel, Sevillel, Spain
| | | | | | - François Patou
- Department of Research and Technology, Oticon Medical, Smørum, Denmark
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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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Quimby AE, Wen CZ, Ruckenstein MJ, Brant JA, Bigelow DC. Caloric function as a predictor of cochlear implant performance. Cochlear Implants Int 2023:1-8. [PMID: 38032414 DOI: 10.1080/14670100.2023.2286165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVES Changes in vestibular function have been demonstrated following cochlear implantation (CI). The functional impact of these changes on CI performance has not been well-studied. We sought to assess whether caloric changes postimplantation could predict CI performance. METHODS Retrospective review of a prospectively collected database at a tertiary care hospital. Patients who underwent CI over a 22-year period (1999-2021) and had videonystagmography (VNG) testing pre- and postimplantation were included. Caloric responses were compared pre- versus post-implantation, and assessed for their ability to predict CI performance as evaluated using AzBio +10 decibels signal-to-noise ratio (dB S/N) scores. RESULTS 43 CI recipients were included. There was a significant difference in the average maximal slow-phase velocity in response to caloric irrigation in the implanted ear pre- versus post-operatively (21.2 vs. 18.5 deg/s; p = 0.02). Controlling for age and pre-implantation speech recognition performance, pre- and post-implantation caloric responses in the implanted ear significantly predicted CI performance at 0-6 months and >6 months post-implantation. Caloric changes following implantation were not significantly correlated with CI performance. CONCLUSION CI impacts vestibular function as evidenced by changes in caloric responses. Vestibular function pre- and possibly post-CI may be clinically useful metrics for predicting some proportion of CI performance variability.
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Affiliation(s)
- Alexandra E Quimby
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Z Wen
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Douglas C Bigelow
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Tropitzsch A, Schade-Mann T, Gamerdinger P, Dofek S, Schulte B, Schulze M, Fehr S, Biskup S, Haack TB, Stöbe P, Heyd A, Harre J, Lesinski-Schiedat A, Büchner A, Lenarz T, Warnecke A, Müller M, Vona B, Dahlhoff E, Löwenheim H, Holderried M. Variability in Cochlear Implantation Outcomes in a Large German Cohort With a Genetic Etiology of Hearing Loss. Ear Hear 2023; 44:1464-1484. [PMID: 37438890 PMCID: PMC10583923 DOI: 10.1097/aud.0000000000001386] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES The variability in outcomes of cochlear implantation is largely unexplained, and clinical factors are not sufficient for predicting performance. Genetic factors have been suggested to impact outcomes, but the clinical and genetic heterogeneity of hereditary hearing loss makes it difficult to determine and interpret postoperative performance. It is hypothesized that genetic mutations that affect the neuronal components of the cochlea and auditory pathway, targeted by the cochlear implant (CI), may lead to poor performance. A large cohort of CI recipients was studied to verify this hypothesis. DESIGN This study included a large German cohort of CI recipients (n = 123 implanted ears; n = 76 probands) with a definitive genetic etiology of hearing loss according to the American College of Medical Genetics (ACMG)/Association for Molecular Pathology (AMP) guidelines and documented postoperative audiological outcomes. All patients underwent preoperative clinical and audiological examinations. Postoperative CI outcome measures were based on at least 1 year of postoperative audiological follow-up for patients with postlingual hearing loss onset (>6 years) and 5 years for children with congenital or pre/perilingual hearing loss onset (≤6 years). Genetic analysis was performed based on three different methods that included single-gene screening, custom-designed hearing loss gene panel sequencing, targeting known syndromic and nonsyndromic hearing loss genes, and whole-genome sequencing. RESULTS The genetic diagnosis of the 76 probands in the genetic cohort involved 35 genes and 61 different clinically relevant (pathogenic, likely pathogenic) variants. With regard to implanted ears (n = 123), the six most frequently affected genes affecting nearly one-half of implanted ears were GJB2 (21%; n = 26), TMPRSS3 (7%; n = 9), MYO15A (7%; n = 8), SLC26A4 (5%; n = 6), and LOXHD1 and USH2A (each 4%; n = 5). CI recipients with pathogenic variants that influence the sensory nonneural structures performed at or above the median level of speech performance of all ears at 70% [monosyllable word recognition score in quiet at 65 decibels sound pressure level (SPL)]. When gene expression categories were compared to demographic and clinical categories (total number of compared categories: n = 30), mutations in genes expressed in the spiral ganglion emerged as a significant factor more negatively affecting cochlear implantation outcomes than all clinical parameters. An ANOVA of a reduced set of genetic and clinical categories (n = 10) identified five detrimental factors leading to poorer performance with highly significant effects ( p < 0.001), accounting for a total of 11.8% of the observed variance. The single strongest category was neural gene expression accounting for 3.1% of the variance. CONCLUSIONS The analysis of the relationship between the molecular genetic diagnoses of a hereditary etiology of hearing loss and cochlear implantation outcomes in a large German cohort of CI recipients revealed significant variabilities. Poor performance was observed with genetic mutations that affected the neural components of the cochlea, supporting the "spiral ganglion hypothesis."
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Affiliation(s)
- Anke Tropitzsch
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Hearing Center, Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Center for Rare Hearing Disorders, Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Thore Schade-Mann
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Hearing Center, Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Philipp Gamerdinger
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Hearing Center, Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Saskia Dofek
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Björn Schulte
- CeGaT GmbH und Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Martin Schulze
- CeGaT GmbH und Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Sarah Fehr
- CeGaT GmbH und Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Saskia Biskup
- CeGaT GmbH und Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Tobias B. Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Petra Stöbe
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Andreas Heyd
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
| | - Jennifer Harre
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Anke Lesinski-Schiedat
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Athanasia Warnecke
- Department of Otorhinolaryngology—Head & Neck Surgery, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4all” of the German Research Foundation, Hannover, Germany
| | - Marcus Müller
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Barbara Vona
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Ernst Dahlhoff
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Hubert Löwenheim
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Neurosensory Center, Departments of Otolaryngology—Head & Neck Surgery and Ophthalmology, University of Tübingen Medical Center, Tübingen, Germany
| | - Martin Holderried
- Department of Otolaryngology—Head & Neck Surgery, University of Tübingen Medical Center, Tübingen, Germany
- Department of Medical Development and Quality Management, University Hospital Tübingen, Tübingen, Germany
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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: 4] [Impact Index Per Article: 4.0] [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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Bustos-Rubilar M, Kyle F, Luna E, Allel K, Hormazabal X, Tapia-Mora D, Mahon M. A country-wide health policy in Chile for deaf adults using cochlear implants: Analysis of health determinants and social impacts. PLoS One 2023; 18:e0286592. [PMID: 37878655 PMCID: PMC10599544 DOI: 10.1371/journal.pone.0286592] [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] [Received: 02/16/2023] [Accepted: 05/10/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Post-lingual deafness represents a critical challenge for adults' well-being with substantial public health burdens. One treatment of choice has been cochlear implants (CI) for people with severe to profound hearing loss (HL). Since 2018, Chile has implemented a high-cost policy to cover CI treatment, the "Ley Ricarte Soto" (LRS) health policy. However, wide variability exists in the use of this device. To date, no related study has been published on policy evaluation in Chile or other Latin American countries. OBJECTIVES This study aimed to evaluate the impact of the LRS policy on the treatment success and labour market inclusion among deaf or hard of hearing (DHH) adults using CI. We examined and characterised outcomes based on self-reports about treatment success and occupation status between 2018 and 2020. DESIGN We performed a prospective study using hospital clinical records and an online questionnaire with 76 DHH adults aged >15 who had received CIs since the introduction of the LRS policy in 2018. Using univariate and multivariate regression models, we investigated the relationship between demographic, audiological, and social determinants of health and outcomes, including treatment success for social inclusion (International Outcome inventory for Hearing Aids and CIs assessment: IOI-HA) and occupation status for labour market inclusion. RESULTS Our study showed elevated levels of treatment success in most of the seven sub-scores of the IOI-HA assessment. Similarly, around 70% of participants maintained or improved their occupations after receiving their CI. We found a significant positive association between treatment success and market inclusion. Participants diagnosed at younger ages had better results than older participants in both outcomes. Regarding social determinants of health, findings suggested participants with high social health insurance and a shorter commute time to the clinic had better results in treatment success. For labour market inclusion, participants with high education levels and better pre- CI occupation had better post-CI occupation status. CONCLUSIONS In evaluating the LRS policy for providing CIs for DHH adults in Chile, we found positive effects relating to treatment success and occupation status. Our study supports the importance of age at diagnosis and social determinants of health, which should be assessed by integrating public services and bringing them geographically closer to each beneficiary. Although evidence-based guidelines for candidate selection given by the LRS policy might contribute to good results, these guidelines could limit the policy access to people who do not meet the requirements of the guidelines due to social inequalities.
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Affiliation(s)
- Mario Bustos-Rubilar
- Division of Psychology and Language Science, University College London, London, United Kingdom
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Fiona Kyle
- Division of Psychology and Language Science, University College London, London, United Kingdom
| | - Eliazar Luna
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Kasim Allel
- Institute for Global Health, University College London, London, United Kingdom
| | - Ximena Hormazabal
- Carrera de Fonoaudiología, Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel Tapia-Mora
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Escuela de Fonoaudiología, Universidad de los Andes, Santiago, Chile
| | - Merle Mahon
- Division of Psychology and Language Science, University College London, London, United Kingdom
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Liebscher T, Hornung J, Hoppe U. Electrically evoked compound action potentials in cochlear implant users with preoperative residual hearing. Front Hum Neurosci 2023; 17:1125747. [PMID: 37850038 PMCID: PMC10577430 DOI: 10.3389/fnhum.2023.1125747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/08/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Residual hearing in cochlear implant (CI) candidates requires the functional integrity of the nerve in particular regions of the cochlea. Nerve activity can be elicited as electrically evoked compound action potentials (ECAP) after cochlear implantation. We hypothesize that ECAP thresholds depend on preoperative residual hearing ability. Materials and methods In a retrospective study, we analyzed 84 adult cochlear implant users who had received a Nucleus® CI632 Slim Modiolar Electrode and who preoperatively had had residual hearing. Inclusion criteria were severe to profound hearing loss with preoperative measurable hearing in the ear to receive the implant, postlingual hearing loss, German as native language and correct placement of the electrode, inserted completely into the scala tympani. Electrically evoked compound action potential (ECAP) was recorded intraoperatively. The angular insertion was measured for each electrode contact from postoperative computed tomography to estimate the corresponding spiral ganglion frequency. Pure-tone audiometry and allocated ECAP thresholds were tested to investigate possible correlation. Results The average of hearing thresholds, tested at 0.5, 1, 2, and 4 kHz (4FPTA) was 82 ± 18 (range 47-129) dB HL. The success rate for recording ECAP thresholds was 96.9%. For all comparable pure-tone frequencies (1, 2, 4, and 8 kHz), there was significant correlation between preoperative hearing levels and intraoperative ECAP thresholds (p < 0.001). Higher hearing thresholds are associated with increased ECAP thresholds. Conclusion In CI candidates with adequate residual hearing, intraoperative electrophysiological measurement records lower thresholds. This outcome may be explained by the neural survival density of the peripheral system, with less neural degeneration.
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Affiliation(s)
- Tim Liebscher
- ENT-Clinic, Department of Audiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Dziemba OC, Merz S, Hocke T. [Evaluative audiometry after cochlear implant provision. German Version]. HNO 2023; 71:669-677. [PMID: 37450021 PMCID: PMC10520209 DOI: 10.1007/s00106-023-01316-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND One of the main treatment goals in cochlear implant (CI) patients is to improve speech perception. One of the target parameters is speech intelligibility in quiet. However, treatment results show a high variability, which has not been sufficiently explained so far. The aim of this noninterventional retrospective study was to elucidate this variability using a selected population of patients in whom etiology was not expected to have a negative impact on postoperative speech intelligibility. MATERIALS AND METHODS Audiometric findings of the CI follow-up of 28 adult patients after 6 months of CI experience were evaluated. These were related to the preoperative audiometric examination and evaluated with respect to a recently published predictive model for the postoperative monosyllabic score. RESULTS Inclusion of postoperative categorical loudness scaling and hearing loss for Freiburg numbers in the model explained 55% of the variability in fitting outcomes with respect to monosyllabic comprehension. CONCLUSION The results of this study suggest that much of the cause of variability in fitting outcomes can be captured by systematic postoperative audiometric checks. Immediate conclusions for CI system adjustments may be drawn from these results. However, the extent to which these are accepted by individual patients and thus lead to an improvement in outcome must be subject to further study, preferably prospective.
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Affiliation(s)
- Oliver C Dziemba
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenkrankheiten, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland.
| | | | - Thomas Hocke
- Cochlear Deutschland GmbH & Co. KG, Hannover, Deutschland
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Oh M, Oh EJ, Jung B, Yoo MH, Yoo SY, Jung DJ, Lee KY. Cochlear Implantation in the Elderly: Speech Performance, Associated Factor, Complication, and Surgical Safety. J Audiol Otol 2023; 27:205-211. [PMID: 37872754 PMCID: PMC10603278 DOI: 10.7874/jao.2023.00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The guidelines for cochlear implantation (CIs) are expanding, and the number of CI procedures performed on the elderly is increasing. The purpose of this study was to analyze the results and safety of cochlear implantation in the elderly, as well as to evaluate the predictive factors on CI outcomes. SUBJECTS AND METHODS The study included 56 patients aged ≥40 years, who received CIs between 2009 and 2020. They were divided into two groups: 27 younger adults (40-64 years) and 29 elderly (>64 years). The study compared their pre- and postoperative speech perception and category of auditory performance (CAP) scores, surgical complications, and hospitalization periods. It also evaluated associated factors in the elderly group by examining categorical and continuous variables and postoperative CAP score. RESULTS There was a significant improvement in speech recognition tests (both word and sentence) and CAP scores in both groups compared to the pre-implantation scores (p<0.001). Postoperative results were slightly lower in the elderly group than in younger adults for sentence recognition and CAP scores, except for word recognition. No significant associated factors were found on postoperative CAP scores, except for etiology. Postoperative CAP significantly improved in the sudden hearing loss group compared to the groups with other etiologies (p=0.045). The elderly group had more comorbidities than that in the younger adult group (p=0.026), but there were no significant differences in postoperative complications and hospitalization periods. CONCLUSIONS While speech recognition and CAP scores were relatively lower in the elderly group compared to the younger adults, the elderly group showed significant improvements in audiological results after CI. Moreover, CI was safe and well tolerated in elderly patients.
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Affiliation(s)
- Minji Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Jung Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Boseung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Hoon Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | | | - Da Jung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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van der Straaten TFK, Burger AVM, Briaire JJ, Boermans PPBM, Vickers D, Frijns JHM. Diagnostic value of preoperative measures in selecting post-lingually deafened candidates for cochlear implantation - a different approach. Int J Audiol 2023; 62:983-991. [PMID: 35997570 DOI: 10.1080/14992027.2022.2106453] [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: 09/29/2021] [Accepted: 07/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We examined which preoperative diagnostic measure is most suited to serve as a selection criterion to determine adult cochlear implantation (CI) candidacy. DESIGN Preoperative diagnostic measures included pure tone audiometry (PTA; 0.5, 1, 2, 4 kHz), speech perception tests (SPT) unaided with headphones and with best-aided hearing aids (in quiet and in noise). Gain in speech perception was used as outcome measure. Performance of preoperative measures was analysed using the area under the curve (AUC) of receiver operating characteristic (ROC) curves. STUDY SAMPLE This retrospective longitudinal cohort study included 552 post-lingually deafened adults with CI in a tertiary referral centre in the Netherlands. RESULTS Best-aided SPT in quiet was the most accurate in defining which CI candidates improved their speech perception in quiet postoperatively. For an improvement in speech perception in noise, the best-aided SPT in noise was the most accurate in defining which adult would benefit from CI. PTA measures performed lower compared to the SPT measures. CONCLUSIONS SPT is better than PTA for selecting CI candidates who will benefit in terms of speech perception. Best-aided SPT in noise was the most accurate for indicating an improvement of speech perception in noise but was only evaluated in high performers with residual hearing. These insights will assist in formulating more effective selection criteria for CI.
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Affiliation(s)
- Tirza F K van der Straaten
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anouk V M Burger
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Briaire
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Paul B M Boermans
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Deborah Vickers
- Clinical Neurosciences, University of Cambridge, Cambridge, The United Kingdom
| | - Johan H M Frijns
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
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Heuninck E, Van de Heyning P, Van Rompaey V, Mertens G, Topsakal V. Audiological outcomes of robot-assisted cochlear implant surgery. Eur Arch Otorhinolaryngol 2023; 280:4433-4444. [PMID: 37043021 DOI: 10.1007/s00405-023-07961-7] [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: 11/23/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE The main objective of this study is to evaluate the short-term and long-term audiological outcomes in patients who underwent cochlear implantation with a robot-assisted system to enable access to the cochlea, and to compare outcomes with a matched control group of patients who underwent cochlear implantation with conventional access to the cochlea. METHODS In total, 23 patients were implanted by robot-assisted cochlear implant surgery (RACIS). To evaluate the effectiveness of robotic surgery in terms of audiological outcomes, a statistically balanced control group of conventionally implanted patients was created. Minimal outcome measures (MOM), consisting of pure-tone audiometry, speech understanding in quiet and speech understanding in noise were performed pre-operatively and at 3 months, 6 months, 12 months and 2 years post-activation of the audioprocessor. RESULTS There was no statistically significant difference in pure-tone audiometry, speech perception in quiet and speech perception in noise between robotically implanted and conventionally implanted patients pre-operatively, 3 months, 6 months, 12 months and 2 years post-activation. A significant improvement in pure-tone hearing thresholds, speech understanding in quiet and speech understanding in noise with the cochlear implant has been quantified as of the first measurements at 3 months and this significant improvement remained stable over a time period of 2 years for HEARO implanted patients. CONCLUSION Clinical outcomes in robot-assisted cochlear implant surgery are comparable to conventional cochlear implantation. CLINICALTRAILS. GOV TRAIL REGISTRATION NUMBERS NCT03746613 (date of registration: 19/11/2018), NCT04102215 (date of registration: 25/09/2019).
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Affiliation(s)
- Emilie Heuninck
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Brussels, Vrije Universiteit Brussel, Brussels Health Campus, Brussels, Belgium.
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Brussels, Vrije Universiteit Brussel, Brussels Health Campus, Brussels, Belgium
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Barda A, Shapira Y, Fostick L. Individual Differences in Auditory Training Benefits for Hearing Aid Users. Clin Pract 2023; 13:1196-1206. [PMID: 37887083 PMCID: PMC10605281 DOI: 10.3390/clinpract13050107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
The present study aimed to examine whether individual differences in baseline speech perception could serve as predictors for the effectiveness and generalization of auditory training (AT) to non-trained tasks. Twelve adults, aged 60-75 years with bilateral hearing loss, completed a two-month, home-based, computerized AT program, involving sessions four times per week. Training tasks included the identification of vowel frontal, height, manner of articulation, point of articulation, voicing, and open-set consonant-vowel-consonant (CVC) words. Non-trained speech perception tests were conducted one month before AT, prior to training, after one and two months of training, and during a two-month follow-up. The results showed that one month of AT improved performance in most trained tasks, with generalization observed in the CVC words test and HeBio sentences with speech-shaped noise (SSN). No evidence of spontaneous learning or added benefit from an extra month of training was found. Most importantly, baseline speech perception predicted improvements in both training and post-training generalization tasks. This emphasizes the significance of adopting an individualized approach when determining the potential effectiveness of AT, applicable in both clinical and research contexts.
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Affiliation(s)
- Ayelet Barda
- Department of Health Management, Ariel University, Ariel 40700, Israel; (A.B.); (Y.S.)
| | - Yair Shapira
- Department of Health Management, Ariel University, Ariel 40700, Israel; (A.B.); (Y.S.)
| | - Leah Fostick
- Department of Communication Disorders, Auditory Perception Lab in the Name of Laurent Levy, Ariel University, Ariel 40700, Israel
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Hoppe U, Hast A, Hornung J, Hocke T. Evolving a Model for Cochlear Implant Outcome. J Clin Med 2023; 12:6215. [PMID: 37834857 PMCID: PMC10573840 DOI: 10.3390/jcm12196215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Cochlear implantation is an efficient treatment for postlingually deafened adults who do not benefit sufficiently from acoustic amplification. Implantation is indicated when it can be foreseen that speech recognition with a cochlear implant (CI) is superior to that with a hearing aid. Especially for subjects with residual speech recognition, it is desirable to predict CI outcome on the basis of preoperative audiological tests. PURPOSE The purpose of the study was to extend and refine a previously developed model for CI outcome prediction for subjects with preoperative word recognition to include subjects with no residual hearing by incorporating additional results of routine examinations. RESULTS By introducing the duration of unaided hearing loss (DuHL), the median absolute error (MAE) of the prediction was reduced. While for subjects with preoperative speech recognition, the model modification did not change the MAE, for subjects with no residual speech recognition before surgery, the MAE decreased from 23.7% with the previous model to 17.2% with the extended model. CONCLUSIONS Prediction of word recognition with CI is possible within clinically relevant limits. Outcome prediction is particularly important for preoperative counseling and in CI aftercare to support systematic monitoring of CI fitting.
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Affiliation(s)
- Ulrich Hoppe
- Cochlear Implant Center CICERO, Department of Otorhinolaryngology-Head and Neck Surgery, Uniklinikum Erlangen, Waldstr. 1, D-91054 Erlangen, Germany; (A.H.); (J.H.)
| | - Anne Hast
- Cochlear Implant Center CICERO, Department of Otorhinolaryngology-Head and Neck Surgery, Uniklinikum Erlangen, Waldstr. 1, D-91054 Erlangen, Germany; (A.H.); (J.H.)
| | - Joachim Hornung
- Cochlear Implant Center CICERO, Department of Otorhinolaryngology-Head and Neck Surgery, Uniklinikum Erlangen, Waldstr. 1, D-91054 Erlangen, Germany; (A.H.); (J.H.)
| | - Thomas Hocke
- Cochlear Deutschland GmbH & Co. KG, Mailänder Str. 4a, D-30539 Hannover, Germany;
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Cottrell J, Dixon P, Cao X, Kiss A, Smilsky K, Kaminskas K, Ng A, Shipp D, Dimitrijevic A, Chen J, Lin V, Kyriakopoulou L, Le T. Gene mutations as a non-invasive measure of adult cochlear implant performance: Variable outcomes in patients with select TMPRSS3 mutations. PLoS One 2023; 18:e0291600. [PMID: 37713394 PMCID: PMC10503761 DOI: 10.1371/journal.pone.0291600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The cochlear implant (CI) has proven to be a successful treatment for patients with severe-to-profound sensorineural hearing loss, however outcome variance exists. We sought to evaluate particular mutations discovered in previously established sensory and neural partition genes and compare post-operative CI outcomes. MATERIALS AND METHODS Utilizing a prospective cohort study design, blood samples collected from adult patients with non-syndromic hearing loss undergoing CI were tested for 54 genes of interest with high-throughput sequencing. Patients were categorized as having a pathogenic variant in the sensory partition, pathogenic variant in the neural partition, pathogenic variant in both sensory and neural partition, or with no variant identified. Speech perception performance was assessed pre- and 12 months post-operatively. Performance measures were compared to genetic mutation and variant status utilizing a Wilcoxon rank sum test, with P<0.05 considered statistically significant. RESULTS Thirty-six cochlear implant patients underwent genetic testing and speech understanding measurements. Of the 54 genes that were interrogated, three patients (8.3%) demonstrated a pathogenic mutation in the neural partition (within TMPRSS3 genes), one patient (2.8%) demonstrated a pathogenic mutation in the sensory partition (within the POU4F3 genes). In addition, 3 patients (8.3%) had an isolated neural partition variance of unknown significance (VUS), 5 patients (13.9%) had an isolated sensory partition VUS, 1 patient (2.8%) had a variant in both neural and sensory partition, and 23 patients (63.9%) had no mutation or variant identified. There was no statistically significant difference in speech perception scores between patients with sensory or neural partition pathogenic mutations or VUS. Variable performance was found within patients with TMPRSS3 gene mutations. CONCLUSION The impact of genetic mutations on post-operative outcomes in CI patients was heterogenous. Future research and dissemination of mutations and subsequent CI performance is warranted to elucidate exact mutations within target genes providing the best non-invasive prognostic capability.
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Affiliation(s)
- Justin Cottrell
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter Dixon
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Xingshan Cao
- Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kari Smilsky
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kassandra Kaminskas
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amy Ng
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Shipp
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Dimitrijevic
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Chen
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Lin
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lianna Kyriakopoulou
- Department of Laboratory Medicine & Pathology–Clinical Chemistry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Trung Le
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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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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Berger JI, Gander PE, Kim S, Schwalje AT, Woo J, Na YM, Holmes A, Hong JM, Dunn CC, Hansen MR, Gantz BJ, McMurray B, Griffiths TD, Choi I. Neural Correlates of Individual Differences in Speech-in-Noise Performance in a Large Cohort of Cochlear Implant Users. Ear Hear 2023; 44:1107-1120. [PMID: 37144890 PMCID: PMC10426791 DOI: 10.1097/aud.0000000000001357] [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: 04/23/2021] [Accepted: 01/11/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Understanding speech-in-noise (SiN) is a complex task that recruits multiple cortical subsystems. Individuals vary in their ability to understand SiN. This cannot be explained by simple peripheral hearing profiles, but recent work by our group ( Kim et al. 2021 , Neuroimage ) highlighted central neural factors underlying the variance in SiN ability in normal hearing (NH) subjects. The present study examined neural predictors of SiN ability in a large cohort of cochlear-implant (CI) users. DESIGN We recorded electroencephalography in 114 postlingually deafened CI users while they completed the California consonant test: a word-in-noise task. In many subjects, data were also collected on two other commonly used clinical measures of speech perception: a word-in-quiet task (consonant-nucleus-consonant) word and a sentence-in-noise task (AzBio sentences). Neural activity was assessed at a vertex electrode (Cz), which could help maximize eventual generalizability to clinical situations. The N1-P2 complex of event-related potentials (ERPs) at this location were included in multiple linear regression analyses, along with several other demographic and hearing factors as predictors of SiN performance. RESULTS In general, there was a good agreement between the scores on the three speech perception tasks. ERP amplitudes did not predict AzBio performance, which was predicted by the duration of device use, low-frequency hearing thresholds, and age. However, ERP amplitudes were strong predictors for performance for both word recognition tasks: the California consonant test (which was conducted simultaneously with electroencephalography recording) and the consonant-nucleus-consonant (conducted offline). These correlations held even after accounting for known predictors of performance including residual low-frequency hearing thresholds. In CI-users, better performance was predicted by an increased cortical response to the target word, in contrast to previous reports in normal-hearing subjects in whom speech perception ability was accounted for by the ability to suppress noise. CONCLUSIONS These data indicate a neurophysiological correlate of SiN performance, thereby revealing a richer profile of an individual's hearing performance than shown by psychoacoustic measures alone. These results also highlight important differences between sentence and word recognition measures of performance and suggest that individual differences in these measures may be underwritten by different mechanisms. Finally, the contrast with prior reports of NH listeners in the same task suggests CI-users performance may be explained by a different weighting of neural processes than NH listeners.
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Affiliation(s)
- Joel I. Berger
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Phillip E. Gander
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Subong Kim
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Adam T. Schwalje
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jihwan Woo
- Department of Biomedical Engineering, University of Ulsan, Ulsan, South Korea
| | - Young-min Na
- Department of Biomedical Engineering, University of Ulsan, Ulsan, South Korea
| | - Ann Holmes
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Jean M. Hong
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Camille C. Dunn
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Marlan R. Hansen
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Bruce J. Gantz
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Bob McMurray
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
| | - Timothy D. Griffiths
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Inyong Choi
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
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48
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Panario J, Bester C, O'Leary SJ. Characteristics of the Summating Potential Measured Across a Cochlear Implant Array as an Indicator of Cochlear Function. Ear Hear 2023; 44:1088-1106. [PMID: 36935398 PMCID: PMC10426787 DOI: 10.1097/aud.0000000000001347] [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: 01/13/2022] [Accepted: 01/13/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES The underlying state of cochlear and neural tissue function is known to affect postoperative speech perception following cochlear implantation. The ability to assess these tissues in patients can be performed using intracochlear electrocochleography (IC ECochG). One component of ECochG is the summating potential (SP) that appears to be generated by multiple cochlear tissues. Its qualities may be able to detect the presence of functional inner hair cells, but evidence for this is limited in human cochleae. This study aimed to examine the IC SP characteristics in cochlear implantation recipients, its relationship to preoperative speech perception and audiometric thresholds, and to other IC ECochG components. DESIGN This is a retrospective analysis of 113 patients' IC ECochG recordings across the array in response to a 500 Hz tone burst stimulus. Responses to condensation and rarefaction stimuli were then subtracted from one another to emphasize the cochlear microphonic and added to one another to emphasize the SP, auditory nerve neurophonic, and compound action potential. Patients were grouped based on their maximum SP deflection being large and positive (+SP), large and negative (-SP), or minimal (0 SP) to further investigate these relationships. RESULTS Patients in the +SP group had better preoperative speech perception (mean consonant-vowel-consonant phoneme score 46%) compared to the -SP and 0 SP groups (consonant-vowel-consonant phoneme scores 34% and 36%, respectively, difference to +SP: p < 0.05). Audiometric thresholds were lowest for +SP (mean pure-tone average 50 dB HL), then -SP (65 dB HL), and highest for 0 SP patients (70 dB HL), but there was not a statistical significance between +SP and -SP groups ( p > 0.1). There were also distinct differences between SP groups in the qualities of their other ECochG components. These included the +SP patients having larger cochlear microphonic maximum amplitude, more apical SP peak electrode locations, and a more spatially specific SP magnitude growth pattern across the array. CONCLUSIONS Patients with large positive SP deflection in IC ECochG have preoperatively better speech perception and lower audiometric thresholds than those without. Patterns in other ECochG components suggest its positive deflection may be an indicator of cochlear function.
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Affiliation(s)
- Jared Panario
- Department Otolaryngology, University of Melbourne, Victoria, Australia
| | - Christofer Bester
- Department Otolaryngology, University of Melbourne, Victoria, Australia
| | - Stephen John O'Leary
- Department Otolaryngology, University of Melbourne, Victoria, Australia
- Royal Victorian Eye and Ear Hospital, Victoria, Australia
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Herzog JA, Buchman CA, Kallogjeri D, Chen S, Wick C, Durakovic N, Shew MA. Cognitive Assessment in Elderly Cochlear Implant Recipients: Long-Term Analysis. Laryngoscope 2023; 133:2379-2387. [PMID: 36300628 DOI: 10.1002/lary.30466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 08/11/2023]
Abstract
OBJECTIVES To examine long-term speech and cognition outcomes in older adult cochlear implant (CI) recipients. First, by evaluating if CI performance was maintained over an extended follow-up period regardless of preoperative cognitive status. Secondly, by evaluating if there was a difference in the rate of cognitive decline between preoperative mild and normal cognition following CI over an extended period of time. STUDY DESIGN AND SETTING Retrospective cohort study. METHODS CI recipients ≥65 years of age implanted between 2009 and 2014 with 4+ years follow up. Pre- and postoperative audiometric and speech outcome assessments were collected. Cognitive status was measured using the mini mental status examination (MMSE) at numerous time points. RESULTS Fifty-three patients met inclusion. Patients were divided into two groups based on preoperative MMSE with scores considered normal (28-30) and those with mildly impaired cognition (MIC, scores 25-27). Audiometric and speech performance improved significantly at one-year post implantation and this was maintained without significant change at 4+ years, regardless of cognitive status. Mixed modeling analysis controlling for age demonstrated no significant difference in the rate of cognitive decline at 4+ years post implantation between the normal cognition cohort (1.74; 95%CI 0.89-2.6) and MIC (2.9; 95%1.91-3.88). CONCLUSION Speech performance was significantly improved and sustained after CI in both normal cognition and MIC patients. The rate of cognitive decline in older adult CI patients appears to be similar regardless of preoperative cognitive status. Although results demonstrate rates of cognitive decline following CI did not differ between cognition groups over 4+ years, future studies will need to further investigate this over extended time periods with a more comprehensive cognitive testing battery. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2379-2387, 2023.
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Affiliation(s)
- 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
| | - Dorina Kallogjeri
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Stephanie Chen
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Cameron 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
| | - Matthew A Shew
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Madhukesh S, Gundmi A, K S H, Ramesh P, Jacob R. Assessing the Development and Viability of an Android App for Auditory Training in Older Adults with Hearing Impairments. Indian J Otolaryngol Head Neck Surg 2023; 75:1876-1883. [PMID: 37636618 PMCID: PMC10447351 DOI: 10.1007/s12070-023-03696-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/13/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose: This study aims to develop an android application that is more compatible and user-friendly for the older adult population with hearing impairment and validate the developed app. Method: The app's framework involved a training mode platform consisting of four levels with four sub-levels each. Every level includes stimuli of word-in-noise containing high and low-frequency words with three different noise types - traffic noise, competing for speech, and speech babble. The levels in the app increased in complexity to provide an efficient auditory training feature. The developed application was validated on older adults and professionals based on a questionnaire with both closed and open-ended questions. Results: Based on the validated responses of the participants, the app is a reliable tool for auditory training in older adults with hearing impairment. The app contains ease-of-use features for older adults and has been considered a platform for improvement in aural rehabilitation. Conclusion: The study marks as a tool in auditory training for older adults to provide the utmost benefit. Increase in the cases of the hearing-impaired population in a few years, a demand to set up a user-friendly management option is beneficiDigitizationtion of aural rehabilitation, especially for older adults, has thus been noted in the present study.
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Affiliation(s)
- Sanjana Madhukesh
- Department of Speech and Hearing, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education , Manipal, India
| | - Archana Gundmi
- Department of Speech and Hearing, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education , Manipal, India
| | - Harisha K S
- Department of Computer Applications, Manipal Institute of Technology, MAHE, Manipal, India
| | - Pramath Ramesh
- Department of Computer Applications, Manipal Institute of Technology, MAHE, Manipal, India
| | - Roshan Jacob
- Department of Computer Applications, Manipal Institute of Technology, MAHE, Manipal, India
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