Self-assessment of unilateral and bimodal cochlear implant experiences in daily life

The Effect of Contralateral Routing of Signal Devices on the Quality of Life of Unilateral Cochlear Implant Recipients and Their Frequent Communication Partners

PURPOSE

Unilateral cochlear implant (CI) recipients with limited hearing in the contralateral ear are deprived of the advantages of binaural hearing. To address speech recognition challenges arising from the head shadow effect, a contralateral routing of signal (CROS) device can be used; however, less is known of the broader impact of a CROS device on an individual's quality of life (QoL) or that of their frequent communication partners (FCPs). This preliminary study aimed to evaluate the impact of CROS on speech recognition in noise and its influence on the QoL of unilateral CI recipients and their FCPs.

METHOD

This preliminary study enrolled seven adult unilateral CI recipients and their FCPs. All CI recipients were fitted with CROS devices during their initial appointments. Speech recognition testing was conducted in noise with and without the CROS device in a sound booth before a take-home trial. Participants used the CROS devices for approximately 1 year, with device fitting occurring before and continuing during the COVID-19 pandemic. Participants completed two QoL questionnaires, the Auditory Performance and Satisfaction Scale for Single-Sided Deafness (APS-SSD) and the Nijmegen Cochlear Implant Questionnaire (NCIQ), twice: once prior to CROS device use and once after the take-home trial. Additionally, the FCPs of each CI recipient completed the Significant Other Scale of Hearing Disability (SOS-HEAR) Questionnaire twice, once before and once after extended CROS device use.

RESULTS

When noise was directed toward the CI ear and speech toward the non-CI ear, speech recognition improved by 32% with the CROS device (p = .001). CI recipients reported significant median improvement in the "general" domain of the APS-SSD after the take-home trial (Wilcoxon Z = 12.0, p < .05). FCPs reported a significant median reduction in concerns related to their partner's hearing when the CI recipient used the CROS device (Wilcoxon Z = 2.0, p < .05).

CONCLUSIONS

This preliminary study demonstrates the benefit of CROS devices for unilateral CI recipients in noisy environments. Additionally, it highlights the positive impact of CROS devices on the QoL of both CI recipients and their FCPs. These findings emphasize the importance of considering CROS devices as a valuable solution for unilateral CI recipients to enhance their hearing experience, overall well-being, and that of their FCPs.

Integrated bimodal fitting and binaural streaming technology outcomes for unilateral cochlear implant users

OBJECTIVE

Adults typically receive only one cochlear implant (CI) due to cost constraints, with a contralateral hearing aid recommended when there is aidable hearing. Standard hearing aids differ from a CI in terms of processing strategy and function as a separate entity, requiring the user to integrate the disparate signals. Integrated bimodal technology has recently been introduced to address this challenge. The aim of the study was to investigate the performance of unilateral CI users with and without an integrated bimodal fitting and determine whether binaural streaming technology offers additional benefit.

STUDY SAMPLE

Twenty-six CI users using integrated bimodal technology.

DESIGN

Repeated measures where outcomes and user experience were assessed using a functional test battery more representative of real life listening (speech perception in noise tests, localisation test, tracking test) and the speech, spatial and qualities-of-hearing scale (SSQ).

RESULTS

Bimodal outcomes were significantly better than for CI alone. Speech perception in noise improvements ranged from 1.4 dB to 3.5 dB depending on the location of speech and noise. The localisation and tracking tests, and the SSQ also showed significant improvements. Binaural streaming offered additional improvement (1.2 dB to 6.1 dB on the different speech tests).

CONCLUSIONS

Integrated bimodal and binaural streaming technology improved the performance of unilateral CI users.

Contralateral hearing aid use in adult cochlear implant recipients: retrospective analysis of auditory outcomes

OBJECTIVE

To investigate retrospectively the frequency of usage of bimodal stimulation among cochlear implant (CI) users, as well its clinical benefit relative to unilateral use.

DESIGN

All subjects had been monitored with the clinical Minimal Outcome Measurements test battery.

STUDY SAMPLES

103 adults with bilateral postlingual profound sensorineural hearing loss and unilateral CI use were extracted from the local database. These were divided into two groups: those who only used a CI and those who used bimodal stimulation.

RESULTS

The preoperative contralateral residual hearing in the bimodal group was significantly better than that of the CI-only group. In both groups, speech perception in quiet and in noise improved after CI, with no significant difference between postoperative unimodal conditions. For the bimodal group, an additional significant improvement was found for the bimodal condition compared to the unimodal.

CONCLUSION

Given the observed auditory benefit of bimodal stimulation in comparison to unimodal stimulation and given the finding that degree of residual hearing is not correlated with bimodal benefits, it is recommended to encourage CI recipients to continue contralateral HA use after CI. As a result of expanding CI criteria worldwide, the population of bimodal users is expected to grow in the near future.

Evaluating Listening Effort in Unilateral, Bimodal, and Bilateral Cochlear Implant Users

OBJECTIVE

Evaluate listening effort (LE) in unilateral, bilateral, and bimodal cochlear implant (CI) users. Establish an easy-to-implement task of LE that could be useful for clinical decision making.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary neurotology center.

METHODS

The Sentence Final Word Identification and Recall Task, an established measure of LE, was modified to include challenging listening conditions (multitalker babble, gender, and emotional variation; test), in addition to single-talker sentences (control). Participants listened to lists of sentences in each condition and recalled the last word of each sentence. LE was quantified by percentage of words correctly recalled and was compared across conditions, across CI groups, and within subjects (best aided vs monaural).

RESULTS

A total of 24 adults between the ages of 37 and 82 years enrolled, including 4 unilateral CI users (CI), 10 bilateral CI users (CICI), and 10 bimodal CI users (CIHA). Task condition impacted LE (P < .001), but hearing configuration and listener group did not (P = .90). Working memory capacity and contralateral hearing contributed to individual performance.

CONCLUSION

This study adds to the growing body of literature on LE in challenging listening conditions for CI users and demonstrates feasibility of a simple behavioral task that could be implemented clinically to assess LE. This study also highlights the potential benefits of bimodal hearing and individual hearing and cognitive factors in understanding individual differences in performance, which will be evaluated through further research.

Relationships Between Speech, Spatial and Qualities of Hearing Short Form SSQ12 Item Scores and their Use in Guiding Rehabilitation for Cochlear Implant Recipients

Cochlear implantation successfully improves hearing in most adult recipients. However, in rare cases, post-implant rehabilitation is required to maximize benefit. The primary aim of this investigation was to test if self-reports by cochlear implant users indicate the need for post-implant rehabilitation. Listening performance was assessed with the Speech, Spatial and Qualities short-form SSQ12, which was self-administered via a web-based survey. Subjects included over 2000 adult bilateral or unilateral cochlear implant users with at least one year of experience. A novel application of regression tree analysis identified core SSQ12 items that serve as first steps in establishing a plan for further rehabilitation: items 1, 8, and 11 dealing with single-talker situations, loudness perception, and clarity, respectively. Further regression and classification tree analyses revealed that SSQ12 item scores were weakly related to age, degree of tinnitus, and use of bilateral versus unilateral implants. Conversely, SSQ12 scores were strongly associated with self-rated satisfaction and confidence in using their cochlear implant. The SSQ12 total scores did not vary significantly over 1-9 or more years' experience. These findings suggest that the SSQ12 may be a useful tool to guide rehabilitation at any time after cochlear implantation. Identification of poor performance may have implications for timely management to improve the outcomes, through various techniques such as device fitting adjustments, counseling, active sound exposure, and training spatial hearing.

Determining Cochlear Implant Candidacy in Adults: Limitations, Expansions, and Opportunities for Improvement

The safety, efficacy, and success of cochlear implants (CIs) are well established and have led to changes in criteria used by clinicians to determine who should receive a CI. Such changes in clinical decision-making have out-paced the slower-occurring changes that have taken place with regulatory bodies' and insurers' indications. We review the historical development of indications for CIs, including those of the U.S. Food and Drug Administration (FDA), Medicare, Medicaid, and private insurers. We report on expansion to include patients with greater residual hearing, such as those who receive Hybrid and EAS devices, and report on recent FDA approvals that place less emphasis on the patient's best-aided condition and greater emphasis on the ear to be treated. This includes expansion of CIs to patients with single-side deafness and asymmetric hearing loss. We review changes in the test materials used to determine candidacy, including transition from sentences in quiet to sentences in noise to the recent use of monosyllabic words and cognitive screening measures. Importantly, we discuss the recent trend to recommend CIs despite a patient not meeting FDA or insurers' indications (a practice known as “off-label”), which serves as attestation that current indications need to be updated.