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Dhanasingh A, Nielsen SB, Beal F, Schilp S, Hessler R, Jolly C, Hochmair I. Cochlear implant electrode design for safe and effective treatment. Front Neurol 2024; 15:1348439. [PMID: 38756216 PMCID: PMC11096578 DOI: 10.3389/fneur.2024.1348439] [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: 12/02/2023] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
The optimal placement of a cochlear implant (CI) electrode inside the scala tympani compartment to create an effective electrode-neural interface is the base for a successful CI treatment. The characteristics of an effective electrode design include (a) electrode matching every possible variation in the inner ear size, shape, and anatomy, (b) electrically covering most of the neuronal elements, and (c) preserving intra-cochlear structures, even in non-hearing preservation surgeries. Flexible electrode arrays of various lengths are required to reach an angular insertion depth of 680° to which neuronal cell bodies are angularly distributed and to minimize the rate of electrode scalar deviation. At the time of writing this article, the current scientific evidence indicates that straight lateral wall electrode outperforms perimodiolar electrode by preventing electrode tip fold-over and scalar deviation. Most of the available literature on electrode insertion depth and hearing outcomes supports the practice of physically placing an electrode to cover both the basal and middle turns of the cochlea. This is only achievable with longer straight lateral wall electrodes as single-sized and pre-shaped perimodiolar electrodes have limitations in reaching beyond the basal turn of the cochlea and in offering consistent modiolar hugging placement in every cochlea. For malformed inner ear anatomies that lack a central modiolar trunk, the perimodiolar electrode is not an effective electrode choice. Most of the literature has failed to demonstrate superiority in hearing outcomes when comparing perimodiolar electrodes with straight lateral wall electrodes from single CI manufacturers. In summary, flexible and straight lateral wall electrode type is reported to be gentle to intra-cochlear structures and has the potential to electrically stimulate most of the neuronal elements, which are necessary in bringing full benefit of the CI device to recipients.
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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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Rader T, Schrank L, Spiegel JL, Nachtigäller P, Spiro JE, Hempel JM, Canis M, Mueller J. Comparison of speech perception in bimodal cochlear implant patients with respect to the cochlear coverage. HNO 2024; 72:17-24. [PMID: 37608133 PMCID: PMC10799137 DOI: 10.1007/s00106-023-01327-5] [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] [Accepted: 06/13/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The hearing success of patients with bimodal fitting, utilizing both a cochlear implant (CI) and a hearing aid (HA), varies considerably: While some patients benefit from bimodal CI and HA, others do not. OBJECTIVES This retrospective study aimed to investigate speech perception in bimodally fitted patients and compare it with the cochlear coverage (CC). METHODS The CC was calculated with the OTOPLAN software, measuring the cochlear duct length on temporal bone CT scans of 39 patients retrospectively. The patients were categorized into two groups: CC ≤ 65% (CC500) and CC > 65% (CC600). Monaural speech intelligibility for monosyllables at a sound pressure level (SPL) of 65 dB in a free-field setting was assessed before and after CI at various time points. The two groups, one with preoperative HA and one with postoperative CI, were compared. Additionally, speech intelligibility was correlated with CC in the entire cohort before CI and at the last available follow-up (last observation time, LOT). RESULTS Overall, there was no significant difference in speech intelligibility between CC500 and CC600 patients, with both groups demonstrating a consistent improvement after implantation. While CC600 patients tended to exhibit earlier improvement in speech intelligibility, CC500 patients showed a slower initial improvement within the first 3 months but demonstrated a steeper learning curve thereafter. At LOT, the two patient groups converged, with no significant differences in expected speech intelligibility. There was no significant relationship between unimodal/unilateral free-field speech intelligibility and CC. Interestingly, patients with a CC of 70-75% achieved the highest speech intelligibility. CONCLUSION Despite of the lack of a significant correlation between CC and speech perception, patients appeared to reach their maximum in unimodal/unilateral speech perception primarily at a coverage level of 70-75%. Nevertheless, further investigation is warranted, as CC500 was associated with shorter cochlear duct length, and different types of electrodes were used in both groups.
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Affiliation(s)
- Tobias Rader
- Division of Audiology, Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Leonhard Schrank
- Division of Audiology, Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Pascal Nachtigäller
- Division of Audiology, Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Judith E Spiro
- Department for Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - John-Martin Hempel
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joachim Mueller
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, 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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Eitutis ST, Vickers DA, Tebbutt K, Thomas T, Jiang D, de Klerk A, Clemesha J, Chung M, Bance ML. A Multicenter Comparison of 1-yr Functional Outcomes and Programming Differences Between the Advanced Bionics Mid-Scala and SlimJ Electrode Arrays. Otol Neurotol 2023; 44:e730-e738. [PMID: 37889939 PMCID: PMC10662583 DOI: 10.1097/mao.0000000000004048] [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: 10/29/2023]
Abstract
OBJECTIVE To determine if there is a difference in hearing outcomes or stimulation levels between Advanced Bionics straight and precurved arrays. STUDY DESIGN Retrospective chart review across three implant centers. SETTING Tertiary centers for cochlear and auditory brainstem implantation. PATIENTS One hundred fifteen pediatric and 205 adult cochlear implants (CIs) were reviewed. All patients were implanted under the National Institute for Health and Care Excellence 2009 guidelines with a HiRes Ultra SlimJ or Mid-Scala electrode array. MAIN OUTCOME MEASURES Hearing preservation after implantation, as well as CI-only listening scores for Bamford-Kowal-Bench sentences were compared 1 year after implantation. Stimulation levels for threshold and comfort levels were also compared 1 year after implantation. RESULTS Hearing preservation was significantly better with the SlimJ compared with the Mid-Scala electrode array. Bamford-Kowal-Bench outcomes were not significantly different between the two arrays in any listening condition. Stimulation levels were not different between arrays but did vary across electrode contacts. At least one electrode was deactivated in 33% of implants but was more common for the SlimJ device. CONCLUSION Modern straight and precurved arrays from Advanced Bionics did not differ in hearing performance or current requirements. Although hearing preservation was possible with both devices, the SlimJ array would still be the preferred electrode in cases where hearing preservation was a priority. Unfortunately, the SlimJ device was also prone to poor sound perception on basal electrodes. Further investigation is needed to determine if deactivated electrodes are associated with electrode position/migration, and if programming changes are needed to optimize the use of these high-frequency channels.
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Affiliation(s)
- Susan T. Eitutis
- Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust
- Cambridge Hearing Group, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge
| | - Deborah A. Vickers
- Sound Laboratory, Cambridge Hearing Group, Clinical Neurosciences, University of Cambridge, Cambridge
| | | | | | - Dan Jiang
- Guy's and St. Thomas' NHS Foundation Trust
| | | | - Jennifer Clemesha
- Auditory Implant Department, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mark Chung
- Auditory Implant Department, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Manohar L. Bance
- Cambridge Hearing Group, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge
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Rader T, Schrank L, Spiegel JL, Nachtigäller P, Spiro JE, Hempel JM, Canis M, Müller J. [Speech perception as a function of cochlear coverage-comparison in bimodally hearing cochlear implant patients. German version]. HNO 2023:10.1007/s00106-023-01330-w. [PMID: 37450020 PMCID: PMC10403407 DOI: 10.1007/s00106-023-01330-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Hearing success in bimodally hearing patients with a cochlear implant (CI) and a hearing aid (HA) exhibits different results: while some benefit from bimodal CI and HA, others do not. OBJECTIVE The aim of this study was to investigate hearing success in terms of speech perception in bimodally fitted patients in relation to the cochlear coverage (CC) of the CI electrodes. MATERIALS AND METHODS Using the OTOPLAN software (CAScination AG, Bern, Switzerland), CC was retrospectively measured from CT scans of the temporal bone of 39 patients, who were then categorized into two groups: CC ≤ 65% (CC500) and CC > 65% (CC600). Monaural speech intelligibility for monosyllables at a sound pressure level (SPL) of 65 dB in open field was assessed at various timepoints, preoperatively with HA and postoperatively with CI, and compared between the groups. In addition, speech intelligibility was correlated with CC in the entire cohort before surgery and during follow-up (FU). RESULTS Overall, no significant differences in speech intelligibility were found between CC500 and CC600 patients at any of the FU timepoints. However, both CC500 and CC600 patients showed a steady improvement in speech intelligibility after implantation. While CC600 patients tended to show an earlier improvement in speech intelligibility, CC500 patients tended to show a slower improvement during the first 3 months and a steeper learning curve thereafter. The two patient groups converged during FU, with no significant differences in speech intelligibility. There was no significant relationship between unimodal/unilateral free-field speech intelligibility and CC. However, patients with a CC of 70-75% achieved maximum speech intelligibility. CONCLUSION Despite a nonsignificant correlation between CC and speech discrimination, patients seem to reach their maximum in unimodal/unilateral speech understanding mainly at 70-75% coverage. However, there is room for further investigation, as CC500 was associated with a shorter cochlear duct length (CDL), and long and very long electrodes were used in both groups.
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Affiliation(s)
- Tobias Rader
- Abteilung Audiologie, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Leonhard Schrank
- Abteilung Audiologie, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - Jennifer L Spiegel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Schwindel- und Gleichgewichtszentrum, LMU Klinikum der Universität München, München, Deutschland
| | - Pascal Nachtigäller
- Abteilung Audiologie, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - Judith E Spiro
- Klinik und Poliklinik für Radiologie, LMU Klinikum der Universität München, München, Deutschland
| | - John-Martin Hempel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, München, Deutschland
| | - Martin Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, München, Deutschland
| | - Joachim Müller
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, München, Deutschland
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Totten DJ, Saltagi A, Libich K, Pisoni DB, Nelson RF. Cochlear Implantation in US Military Veterans: A Single Institution Study. OTO Open 2023; 7:e53. [PMID: 37187572 PMCID: PMC10181857 DOI: 10.1002/oto2.53] [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: 03/16/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Objective Military veterans have high rates of noise-induced hearing loss (NIHL) which is associated with more significant spiral ganglion neuronal loss. This study explores the relationship between NIHL and cochlear implant (CI) outcomes in veterans. Study Design Retrospective case series of veterans who underwent CI between 2019 and 2021. Setting Veterans Health Administration hospital. Methods AzBio Sentence Test, Consonant-Nucleus-Consonant (CNC) scores, and Speech, Spatial, and Qualities of Hearing Scale (SSQ) were measured pre- and postoperatively. Linear regression assessed relationships between outcomes and noise exposure history, etiology of hearing loss, duration of hearing loss, and Self-Administered Gerocognitive Exam (SAGE) scores. Results Fifty-two male veterans were implanted at an average (standard deviation) age of 75.0 (9.2) years without major complications. The average duration of hearing loss was 36.0 (18.4) years. The average time of hearing aid use was 21.2 (15.4) years. Noise exposure was reported in 51.3% of patients. Objectively, AzBio and CNC scores 6 months postoperatively showed significant improvement of 48% and 39%, respectively. Subjectively, average 6-month SSQ scores showed significant improvement by 34 points (p < .0001). Younger age, SAGE score ≥17, and shorter duration of amplification were associated with higher postoperative AzBio scores. Greater improvement in AzBio and CNC scores was associated with lower preoperative scores. Noise exposure was not associated with any difference in CI performance. Conclusion Despite high levels of noise exposure and advanced age, veterans derive substantial benefits from cochlear implantation. SAGE score ≥17 may be predictive of overall CI outcomes. Noise exposure does not impact CI outcomes. Level of Evidence Level 4.
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Affiliation(s)
- Douglas J. Totten
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Abdul Saltagi
- College of Medicine, Indiana University School of MedicineIndianapolisIndianaUSA
| | - Karen Libich
- Department of AudiologyRoudebush Veterans' Administration Medical CenterIndianapolisIndianaUSA
| | - David B. Pisoni
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Psychological and Brain SciencesIndiana UniversityBloomingtonIndianaUSA
| | - Rick F. Nelson
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Neurological SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
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Herbert CJ, Pisoni DB, Kronenberger WG, Nelson RF. Exceptional Speech Recognition Outcomes After Cochlear Implantation: Lessons From Two Case Studies. Am J Audiol 2022; 31:552-566. [PMID: 35944073 PMCID: PMC9886164 DOI: 10.1044/2022_aja-21-00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Individual differences and variability in outcomes following cochlear implantation (CI) in patients with hearing loss remain significant unresolved clinical problems. Case reports of specific individuals allow for detailed examination of the information processing mechanisms underlying variability in outcomes. Two adults who displayed exceptionally good postoperative CI outcomes shortly after activation were administered a novel battery of auditory, speech recognition, and neurocognitive processing tests. METHOD A case study of two adult CI recipients with postlingually acquired hearing loss who displayed excellent postoperative speech recognition scores within 3 months of initial activation. Preoperative City University of New York sentence testing and a postoperative battery of sensitive speech recognition tests were combined with auditory and visual neurocognitive information processing tests to uncover their strengths, weaknesses, and milestones. RESULTS Preactivation CUNY auditory-only (A) scores were < 5% correct while the auditory + visual (A + V) scores were > 74%. Acoustically with their CIs, both participants' scores on speech recognition, environmental sound identification and speech in noise tests exceeded average CI users scores by 1-2 standard deviations. On nonacoustic visual measures of language and neurocognitive functioning, both participants achieved above average scores compared with normal hearing adults in vocabulary knowledge, rapid phonological coding of visually presented words and nonwords, verbal working memory, and executive functioning. CONCLUSIONS Measures of multisensory (A + V) speech recognition and visual neurocognitive functioning were associated with excellent speech recognition outcomes in two postlingual adult CI recipients. These neurocognitive information processing domains may underlie the exceptional speech recognition performance of these two patients and offer new directions for research explaining variability in postimplant outcomes. Results further suggest that current clinical outcome measures should be expanded beyond the conventional speech recognition measures to include more sensitive robust tests of speech recognition as well as neurocognitive measures of working memory, vocabulary, lexical access, and executive functioning.
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Affiliation(s)
- Carolyn J. Herbert
- DeVault Otologic Research Laboratory, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - David B. Pisoni
- DeVault Otologic Research Laboratory, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis,Department of Psychological and Brain Sciences, Indiana University Bloomington
| | - William G. Kronenberger
- DeVault Otologic Research Laboratory, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis,Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Rick F. Nelson
- DeVault Otologic Research Laboratory, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
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