Improvements in Hearing and in Quality of Life after Sequential Bilateral Cochlear Implantation in a Consecutive Sample of Adult Patients with Severe-to-Profound Hearing Loss

Late Bilateral Sequential Cochlear Implant and Quality of Life

Introduction  Hearing impairment is one of the main disorders that can interfere with the development of speech and language. In an individual, it can cause significant communication difficulties, social isolation, negative feelings, and depressive disorders. The hearing aids (HAs) and cochlear implant (CI) are options for profound and severe hearing loss, and the CI can be indicated for individuals who do not obtain benefits from HAs. Objective  To evaluate the quality of life of individuals who underwent sequential bilateral CIs with a long surgical interval between procedures. Methods  Fifteen patients, aged 8 to 70 years old, who underwent sequential bilateral CI, with an interval ≥ 4 years between surgeries, were evaluated. Quality of life was evaluated using three questionnaires: WHOQOL-BREF, SSQ-12 and HHIA in Portuguese. Results  The WHOQOL-BREF questionnaire showed that the study participants had a good quality of life in all domains assessed. According to the SSQ-12, few reported inability to listen in communication situations. Most individuals were classified as having medium disability by the HHIA, but the social and emotional effects did not significantly affect the quality of life. Conclusion  The use of questionnaires to assess the quality of life of patients with hearing impairment is a valuable tool to measure adaptation to CI. Patients undergoing bilateral sequential CI, even with a long interval between procedures, presented high indices of quality of life.

Speech Understanding and Subjective Listening Effort in Noise With Different OTEs and Sound Processing Technologies

OBJECTIVE

To determine speech reception thresholds (SRTs) in noise and subjective listening effort (LE) in cochlear implant (CI) recipients for application of three sound processing (SP) technologies with two off-the-ear (OTE) CI sound processors, a fixed moderately directional microphone (Standard), an adaptive directional microphone (Beam), and the spatial noise-reduction setting ForwardFocus, with the Kanso 2 (OTE2), and Beam with the Kanso (OTE1).

STUDY DESIGN

Prospective repeated measures, within-subject design.

SETTING

Single tertiary-referral center.

PATIENTS

Twenty CI recipients with bilateral severe-to-profound sensorineural hearing loss.

MAIN OUTCOME MEASURES

SRTs were assessed in two spatial configurations with frontal speech and noise from 90-180-270 degrees (S0N90-180-270) or from the CI side (S0NCI). SRTs were obtained for sentences of the Oldenburg sentence test presented in International Collegium of Rehabilitative Audiology (ICRA) noise ICRA5-250. LE for speech understanding in noise was evaluated in S0N90-180-270 and assessed in effort scale categorical units (ESCUs) by using Adaptive Categorical Listening Effort Scaling (ACALES). LEs at 5-dB signal-to-noise ratio (SNR) were calculated from fitted psychometric curves.

RESULTS

With OTE2 in S0N90-180-270, SRT with ForwardFocus (-4.28 dB SNR) was better than with Beam (-3.13 dB SNR) and Standard (0.43 dB SNR). ForwardFocus showed lower LE5dB (2.61 ESCU) compared with Beam (4.60 ESCU) and Standard (5.32 ESCU). In a comparison of both OTEs in S0N90-180-270 regarding best-performing SP technology, ForwardFocus with OTE2 yielded a better SRT and better LE5dB than Beam with OTE1 (SRT: -1.70 dB SNR; LE5dB: 4.00 ESCU). With OTE2 in S0NCI, SRT was improved with ForwardFocus (-2.78 dB SNR) compared with Beam (-1.23 dB SNR) and Standard (1.83 dB SNR).

CONCLUSION

With respect to SP technology and OTE, CI recipients experience best SRT and lowest LE in S0N90-180-270 when using ForwardFocus with OTE2. ACALES is feasible for assessing subjective LE in CI recipients.

Quality of Life and Audiological Benefits in Pediatric Cochlear Implant Users in Romania: Systematic Review and Cohort Study

Profound sensorineural hearing loss (SNHL) can be successfully treated with a cochlear implant (CI), and treatment is usually accompanied by increased quality of life (QoL). Therefore, the aim of this study was to investigate generic and health-related QoL, as well as the level of audiological outcomes, of CI users, in addition to whether Qol can be restored to the extent of those with normal hearing. Furthermore, different implantation timepoints were compared (early vs. late), and a possible correlation between health and generic QoL questionnaires was investigated. The outcomes from 93 pediatric CI users from Romania were analyzed in the study. Two QoL questionnaires (SSQ12, AQoL-6D), as well as the HSM sentence test and Soundfield measurements, were assessed. The outcomes revealed that the CI users were able to achieve the same QoL as their age- and-gender matched peers with normal hearing, and hearing was restored with good speech comprehension. No significant difference between early- and late-implanted children was detected, although a tendency of a better Word Recognition Score (+10%) in the early-implanted group was discovered. A moderate and significant correlation between the generic and health-related Qol questionnaire was observed. Audiological examinations are still the standard practice by which to measure the benefit of any hearing intervention; nonetheless, generic and health-related QoL should be assessed in order to provide a full picture of a successful and patient-satisfactory cochlear implant procedure.

Towards personalized and optimized fitting of cochlear implants

A cochlear implant (CI) is a neurotechnological device that restores total sensorineural hearing loss. It contains a sophisticated speech processor that analyzes and transforms the acoustic input. It distributes its time-enveloped spectral content to the auditory nerve as electrical pulsed stimulation trains of selected frequency channels on a multi-contact electrode that is surgically inserted in the cochlear duct. This remarkable brain interface enables the deaf to regain hearing and understand speech. However, tuning of the large (>50) number of parameters of the speech processor, so-called "device fitting," is a tedious and complex process, which is mainly carried out in the clinic through 'one-size-fits-all' procedures. Current fitting typically relies on limited and often subjective data that must be collected in limited time. Despite the success of the CI as a hearing-restoration device, variability in speech-recognition scores among users is still very large, and mostly unexplained. The major factors that underly this variability incorporate three levels: (i) variability in auditory-system malfunction of CI-users, (ii) variability in the selectivity of electrode-to-auditory nerve (EL-AN) activation, and (iii) lack of objective perceptual measures to optimize the fitting. We argue that variability in speech recognition can only be alleviated by using objective patient-specific data for an individualized fitting procedure, which incorporates knowledge from all three levels. In this paper, we propose a series of experiments, aimed at collecting a large amount of objective (i.e., quantitative, reproducible, and reliable) data that characterize the three processing levels of the user's auditory system. Machine-learning algorithms that process these data will eventually enable the clinician to derive reliable and personalized characteristics of the user's auditory system, the quality of EL-AN signal transfer, and predictions of the perceptual effects of changes in the current fitting.

Cross-cultural adaptation of the Nijmegen cochlear implant questionnaire into Turkish language: validity, reliability and effects of demographic variables

Purpose

The purpose of this study was to evaluate the validity and reliability of the Turkish version of the Nijmegen Cochlear Implant Questionnaire (Tr-NCIQ) and reveal the demographic factors contributing to the outcomes.

Methods

A group of 118 cochlear implant users aged between 18 and 70 years filled the Tr-NCIQ and the Turkish Hearing Handicapped Inventory for Adults (the Tr-HHI-Adult) via electronic survey. Cross-cultural adaptation of the Tr-NCIQ was performed. The reliability and validity of the questionnaire were evaluated utilizing internal consistency coefficient, split-half method, and predictive validity.

Results

The overall Cronbach’s alpha coefficient of the scale was 0.91, and the Spearman-Brown coefficient was 0.91. A moderately significant and negative correlation was present between the basic sound perception, speech production, self-esteem, activity, and social interactions subdomain scores and the HHI-Adult scores. Patients with post-lingual onset of hearing loss had significantly better results than those with pre-lingual onset, in the advanced sound perception subdomain. In addition, bilateral cochlear implant users had better results than the unilateral and bimodal users in the speech production subdomain and then the bimodal users in the self-esteem subdomain. There was no effect of age, duration of implant use, age at implantation, and the daily usage of cochlear implant (CI) on the quality-of-life outcomes.

Conclusion

The Tr-NCIQ is a reliable and valid tool to evaluate the subjective quality of life in CI users. In addition, as a standardized instrument, it can be easily self-administered both in clinical practice and for research purposes.