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Wu SS, Dunn-Johnson C, Zeitler DM, Schwartz S, Sutliff S, Appachi S, Jamis C, Petter K, Vovos R, Goldberg D, Anne S. Auditory Outcomes Following Cochlear Implantation in Children with Unilateral Hearing Loss. Otol Neurotol 2024; 45:513-520. [PMID: 38511263 PMCID: PMC11087191 DOI: 10.1097/mao.0000000000004169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Unilateral hearing loss (UHL) in children is associated with speech and language delays. Cochlear implantation (CI) is currently the only rehabilitative option that restores binaural hearing. This study aims to describe auditory outcomes in children who underwent CI for UHL and to determine the association between duration of hearing loss and auditory outcomes. STUDY DESIGN Retrospective case series. SETTING Three tertiary-level, academic institutions. PATIENTS Children <18 years with UHL who underwent CI between 2018 and 2021. INTERVENTION Cochlear implantation. MAIN OUTCOME MEASURES Speech perception and Speech, Spatial and Qualities of Hearing Scale (SSQ) were assessed postimplantation. Scores >50% on speech perception and SSQ scores >8 points were considered satisfactory. Associations between duration of UHL and implantation age and outcomes were assessed using Spearman's rank correlation. RESULTS Of the 38 children included, mean age at CI was 7.9 ± 3.2 years and mean UHL duration was 5.0 ± 2.8 years. Mean datalogging was 8.1 ± 3.1 hours/day. Mean auditory testing scores were SSQ, 7.9 ± 1.2; BABY BIO, 68.1 ± 30.2%; CNC, 38.4 ± 28.4%; WIPI, 52.5 ± 23.1%. Scores >50% on CNC testing were achieved by 40% of patients. SSQ scores >8 points were reported by 78% (7/9) of patients. There were no significant correlations between UHL duration and auditory outcomes. CONCLUSION Overall, children with UHL who undergo CI can achieve satisfactory speech perception scores and SSQ scores. There were no associations between duration of hearing loss and age at implantation with auditory outcomes. Multiple variables may impact auditory outcomes, including motivation, family support, access to technology, and consistent isolated auditory training postactivation and should be taken into consideration in addition to age at implantation and duration of UHL in determination of CI candidacy.
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Affiliation(s)
- Shannon S. Wu
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Camille Dunn-Johnson
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daniel M. Zeitler
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington
| | - Seth Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington
| | - Suzanne Sutliff
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Swathi Appachi
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carmen Jamis
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karen Petter
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rachel Vovos
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Donald Goldberg
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samantha Anne
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Schauwecker N, Patro A, Holder JT, Bennett ML, Perkins E, Moberly AC. Cochlear Implant Qualification in Noise Versus Quiet: Do Patients Demonstrate Similar Postoperative Benefits? Otolaryngol Head Neck Surg 2024; 170:1411-1420. [PMID: 38353294 DOI: 10.1002/ohn.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 04/30/2024]
Abstract
OBJECTIVE To assess patient factors, audiometric performance, and patient-reported outcomes in cochlear implant (CI) patients who would not have qualified with in-quiet testing alone. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. METHODS Adult CI recipients implanted between 2012 and 2022 were identified. Patients with preoperative AzBio Quiet > 60% in the implanted ear, requiring multitalker babble to qualify, comprised the in-noise qualifying (NQ) group. NQ postoperative performance was compared with the in-quiet qualifying (QQ) group using CNC, AzBio Quiet, and AzBio +5 dB signal-to-noise ratio. Speech, Spatial and Qualities of Hearing Scale (SSQ), Cochlear Implant Quality of Life scale (CIQOL-10), and daily device usage were also compared between the groups. RESULTS The QQ group (n = 771) and NQ group (n = 67) were similar in age and hearing loss duration. NQ had higher average preoperative and postoperative speech recognition scores. A larger proportion of QQ saw significant improvement in CNC and AzBio Quiet scores in the CI-only listening condition (eg, CI-only AzBio Quiet: 88% QQ vs 51% NQ, P < .001). Improvement in CI-only AzBio +5 dB and in all open set testing in the best-aided binaural listening condition was similar between groups (eg, Binaural AzBio Quiet 73% QQ vs 59% NQ, P = .345). Postoperative SSQ ratings, CIQOL scores, and device usage were also equivalent between both groups. CONCLUSION Patients who require in-noise testing to meet CI candidacy demonstrate similar improvements in best-aided speech perception and patient-reported outcomes as in-QQ, supporting the use of in-noise testing to determine CI qualification for borderline CI candidates.
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Affiliation(s)
- Natalie Schauwecker
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Hamed N, Alajmi N, Alkoblan FI, Alghtani YA, Abdelsamad Y, Alhussien A, Alhajress RI, Alhabib SF. The Chronological Evolution of Cochlear Implant Contraindications: A Comprehensive Review. J Clin Med 2024; 13:2337. [PMID: 38673610 PMCID: PMC11050773 DOI: 10.3390/jcm13082337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Cochlear implantation has emerged as a transformative intervention in addressing profound hearing loss, offering a paradigm shift in auditory rehabilitation for individuals with restricted auditory function. Throughout its history, the understanding of contraindications for cochlear implant (CI) surgery has evolved significantly. This review comprehensively analyzes the chronological advancements in the understanding of CI contraindications, examining studies conducted from historical timelines to the present. Recent research has revealed significant developments in the field, prompting a reevaluation of established criteria and resulting in expanded indications for CI. The chronological evolution of contraindications underscores the transformative nature of the field, offering potential improvements in outcomes and enhancing the quality of life for individuals with profound hearing loss. In conclusion, this narrative review emphasizes the dynamic nature of the field, where the reevaluation of contraindications has created new opportunities and broader indications for CI. The emerging prospects, including improved outcomes and enhanced quality of life, hold promise for individuals with profound hearing loss.
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Affiliation(s)
- Nezar Hamed
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Norah Alajmi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Faisal Ibrahim Alkoblan
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Yazeed Abdullah Alghtani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Yassin Abdelsamad
- Research Department, MED-EL GmbH, P.O. Box 245, Riyadh 11411, Saudi Arabia;
| | - Ahmed Alhussien
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Rafeef Ibrahim Alhajress
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Salman F. Alhabib
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
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Homans NC, van der Toom HFE, Pauw RJ, Vroegop JL. Patient and clinician experiences with the multidisciplinary single-day cochlear implant selection (MSCS) protocol. Am J Otolaryngol 2024; 45:104277. [PMID: 38636172 DOI: 10.1016/j.amjoto.2024.104277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE This study assessed the MSCS (Multidisciplinary Single-day Cochlear Implant Selection) protocol with a primary focus on sustaining or enhancing patient satisfaction throughout the cochlear implant selection process. MATERIALS AND METHODS Following the implementation of the new selection protocol, where all selection appointments take place on the same day, we surveyed 37 individuals who underwent the process. Twenty adhered to the standard procedure, while 17 followed the MSCS protocol. We also gathered feedback from seven out of eight involved healthcare providers. This method enabled us to evaluate the protocol's effectiveness in maintaining patient satisfaction and ensuring staff contentment with care delivery within a condensed timeframe. RESULTS Patient responses showed slight variations in average scores without statistical significant differences, indicating comparable satisfaction between the MSCS pathway and the standard protocol. The majority of patients preferred the MSCS protocol, with none of the MSCS participants opting for appointments spread over multiple days. Healthcare practitioners of the CI center also displayed similar or increased satisfaction levels with the MSCS protocol. CONCLUSION The adoption of the MSCS in daily clinical care has led to a decrease in patient appointment times without sacrificing patient satisfaction. Additionally, the majority of individuals actively choose the MSCS protocol. Among those who have directly experienced it, there is unanimous preference for the consolidated appointments over spreading them across multiple days. Professionals within the CI team express equal satisfaction with both the new and old protocols, indicating that the reduction in patient time does not diminish overall satisfaction.
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Affiliation(s)
- Nienke C Homans
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, the Netherlands.
| | - Hylke F E van der Toom
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, the Netherlands
| | - Robert J Pauw
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, the Netherlands
| | - Jantien L Vroegop
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, the Netherlands
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Kim EY, Seol HY. Comparison of Speech Perception Performance According to Prosody Change Between People With Normal Hearing and Cochlear Implant Users. J Audiol Otol 2024; 28:119-125. [PMID: 38052522 PMCID: PMC11065548 DOI: 10.7874/jao.2023.00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/13/2023] [Accepted: 07/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cochlear implants (CIs) are well known to improve audibility and speech recognition in individuals with hearing loss, but some individuals still struggle with many aspects in communication, such as prosody. This study explores how prosodic elements are perceived by those with normal hearing (NH) and CIs. SUBJECTS AND METHODS Thirteen individuals with NH and thirteen CI users participated in this study and completed speech perception, speech prosody perception, speech prosody production, pitch difference discrimination, and melodic contour perception testing. RESULTS NH listeners performed significantly better than CI users on speech perception, speech prosody perception (except for words with neutral meaning and a negative prosody change and when words were repeated twice), pitch difference discrimination, and melodic contour perception testing. No statistical significance was observed for speech prosody production for both groups. CONCLUSIONS Compared to NH listeners, CI users had limited ability to recognize prosodic elements. The study findings highlight the necessity of an assessment tool and signal processing algorithm for CIs, specifically targeting prosodic elements in clinical settings.
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Affiliation(s)
- Eun Yeon Kim
- Department of Speech Language Pathology, Graduate School of Interdisciplinary Therapy, Myongji University, Seoul, Korea
| | - Hye Yoon Seol
- Department of Communication Disorders, Ewha Womans University, Seoul, Korea
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Homans NC, van der Toom HFE, Pauw RJ, Vroegop JL. Pilot study of a multidisciplinary single-day cochlear implant selection protocol. Am J Otolaryngol 2024; 45:104190. [PMID: 38101132 DOI: 10.1016/j.amjoto.2023.104190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE This study aimed to explore and introduce the potential of a MSCS (Multidisciplinary Single-day Cochlear Implant Selection) protocol. The primary objectives of this pilot were to reduce the duration between referral and surgery, minimize hospital visits and decrease the time healthcare professionals dedicate to the cochlear implant (CI) selection process. MATERIALS AND METHODS We established a pilot program at the CI center of the Erasmus MC, a tertiary referral center in the Netherlands, with the goal of improving and shorten the selection process. We evaluated our pilot, including 15 CI candidates, and conducted a retrospective analysis for time and cost savings. RESULTS The results showed that the pilot of the MSCS protocol significantly reduced the length of the CI selection phase (84 days vs 1; standard intake vs MSCS protocol) and the number of hospital visits (6 vs 2 visits; standard vs MSCS protocol), resulting in less travel time and lower costs for the CI candidates. The total time of professionals spend on patients was also reduced with 27 %. CONCLUSION This study highlights the potential benefits of the MSCS protocol in terms of reducing the burden on patients and healthcare providers and improving the efficiency of the CI selection process.
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Affiliation(s)
- Nienke C Homans
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, the Netherlands.
| | - Hylke F E van der Toom
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, the Netherlands
| | - Robert J Pauw
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, the Netherlands
| | - Jantien L Vroegop
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, the Netherlands
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Na E, Toupin-April K, Olds J, Chen J, Fitzpatrick EM. Benefits and risks related to cochlear implantation for children with residual hearing: a systematic review. Int J Audiol 2024; 63:75-86. [PMID: 36524877 DOI: 10.1080/14992027.2022.2155879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to synthesise information concerning the potential benefits and risks related to cochlear implants (CIs) versus hearing aids (HAs) in children with residual hearing. DESIGN A systematic review of articles published from January 2003 to January 2019 was conducted. STUDY SAMPLE Our review included studies that compared the benefits and risks of CIs versus HAs in children (≤18 years old) with residual hearing. A total of 3265 citations were identified; 8 studies met inclusion criteria. RESULTS Children with CIs showed significantly better speech perception scores post-CI than pre-CI. There was limited evidence related to improvement in everyday auditory performance, and the results showed non-significant improvement in speech intelligibility. One study on social-emotional functioning suggested benefits from CIs. In four studies, 37.2% (16/43) of children showed loss of residual hearing and 14.0% (8/57) had discontinued or limited use of their device. CONCLUSIONS Children with CIs showed improvement in speech perception outcomes compared to those with HAs. However, due to the limited number of studies and information to guide decision-making related to other areas of development, it will be important to conduct further research of both benefits and risks of CIs in this specific population to facilitate decision-making.
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Affiliation(s)
- Eunjung Na
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Janet Olds
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Jianyong Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Elizabeth M Fitzpatrick
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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Geerardyn A, Zhu M, Klabbers T, Huinck W, Mylanus E, Nadol JB, Verhaert N, Quesnel AM. Human Histology after Structure Preservation Cochlear Implantation via Round Window Insertion. Laryngoscope 2024; 134:945-953. [PMID: 37493203 DOI: 10.1002/lary.30900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/22/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Current surgical techniques aim to preserve intracochlear structures during cochlear implant (CI) insertion to maintain residual cochlear function. The optimal technique to minimize damage, however, is still under debate. The aim of this study is to histologically compare insertional trauma and intracochlear tissue formation in humans with a CI implanted via different insertion techniques. METHODS One recent temporal bone from a donor who underwent implantation of a full-length CI (576°) via round window (RW) insertion was compared with nine cases implanted via cochleostomy (CO) or extended round window (ERW) approach. Insertional trauma was assessed on H&E-stained histological sections. 3D reconstructions were generated and virtually re-sectioned to measure intracochlear volumes of fibrosis and neo-ossification. RESULTS The RW insertion case showed electrode translocation via the spiral ligament. 2/9 CO/ERW cases showed no insertional trauma. The total volume of the cochlea occupied by fibro-osseous tissue was 10.8% in the RW case compared with a mean of 30.6% (range 8.7%-44.8%, N = 9) in the CO/ERW cases. The difference in tissue formation in the basal 5 mm of scala tympani, however, was even more pronounced when the RW case (12.3%) was compared with the cases with a CO/ERW approach (mean of 93.8%, range 81% to 100%, N = 9). CONCLUSIONS Full-length CI insertions via the RW can be minimally traumatic at the cochlear base without inducing extensive fibro-osseous tissue formation locally. The current study further supports the hypothesis that drilling of the cochleostomy with damage to the endosteum incites a local tissue reaction. LEVEL OF EVIDENCE 4: Case-control study Laryngoscope, 134:945-953, 2024.
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Affiliation(s)
- Alexander Geerardyn
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - MengYu Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Tim Klabbers
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Joseph B Nadol
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Nicolas Verhaert
- ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Alicia M Quesnel
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Pignac S, Sygal N, Biglari M, Olds J, Fitzpatrick EM. Determining cochlear implant candidacy in children with residual hearing: A scoping review. Int J Pediatr Otorhinolaryngol 2024; 177:111855. [PMID: 38190764 DOI: 10.1016/j.ijporl.2024.111855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/20/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVES The purpose of this review was to summarize what is known about criteria, assessments, and recommendations for evaluating cochlear implant (CI) candidacy in children with residual hearing. METHODS Peer-reviewed studies were identified through a systematic search in five electronic databases. Articles were screened and assessed for eligibility. From the eligible studies, data were extracted to summarize and present a narrative synthesis of the findings. RESULTS A total of seven articles (two reviews and five primary studies) were included in the final analysis. Hearing levels better than the moderately severe to severe range (65-90 dB HL) tend to be supported as audiological candidacy criteria for pediatric CI. Recommendations for candidacy consideration based on audiologic thresholds range from 65 to 80 dB Hl pure-tone average as the lower boundary. Our review did not identify any specific assessment protocols. However, additional decision-making considerations related to borderline hearing loss configurations and assessment tools (the Speech Intelligibility Index and the Pediatric Minimum Speech Test Battery) were identified. Supplementary assessment considerations were also reported. CONCLUSION There is limited information regarding specific assessment protocols for children with residual hearing. The literature is primarily focused on guidelines related to audiologic criteria, although it is widely recommended that other areas of functioning should also be considered. Most recommendations appear to be based on expert opinion, clinical expertise, and evidence from overall pediatric CI outcomes rather than empirical evidence targeting children with residual hearing. There is an ongoing need for research to further develop protocols and tools that can assist clinicians and families in making cochlear implantation decisions for children with residual hearing.
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Affiliation(s)
- Sarah Pignac
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada
| | - Ninell Sygal
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada
| | - Maryam Biglari
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada
| | - Janet Olds
- Child Hearing Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa, Ontario, K1N 8L1, Canada
| | - Elizabeth M Fitzpatrick
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada; Child Hearing Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa, Ontario, K1N 8L1, Canada.
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Kanji A, Mirkin L, Casoojee A. Experiences of parents of children with cochlear implants in South Africa: an exploratory study. Disabil Rehabil 2023:1-8. [PMID: 38149802 DOI: 10.1080/09638288.2023.2297924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/16/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Cochlear implantation is a well-established option for early intervention. Children with hearing impairment and their parents are users of intervention services, with parents being more suited to provide insight into their experiences. The purpose of the current study was to describe the experiences of parents of children with cochlear implants (CIs) in the South African context. METHODS A qualitative research design was employed. Non-probability, purposive sampling was used. Seven, online semi-structured interviews were conducted with parents of children with CIs. Data were analysed using inductive thematic analysis. RESULTS Participants expressed feelings of certainty and assurance in the CI journey. Participants extended gratitude to the healthcare professionals involved in their children's CI journey. Feelings of doubt and stress were noted when coming to terms with the decision of cochlear implantation and financial stressors were noted as a challenge. Many participants found it challenging transitioning their children into school. CONCLUSIONS Parents conveyed having no regrets with their decision of cochlear implantation for their child and were grateful for the support provided by healthcare professionals. However, financial, and educational challenges remain. Findings suggest the need for more financial support for cochlear implantation in South Africa, and for adequate inclusive educational settings.
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Affiliation(s)
- Amisha Kanji
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Lori Mirkin
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Aisha Casoojee
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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12
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Almasri NA, Garadat SN. Psychometric properties of the Arabic version of the meaningful use of speech scale (Arabic MUSS). Disabil Rehabil 2023; 45:4296-4302. [PMID: 36448753 DOI: 10.1080/09638288.2022.2148299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/12/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE To examine the construct, discriminative, and predictive validity, and the test-retest reliability of the Arabic Meaningful Use of Speech Scale (MUSS). METHODS Parents of 102 children with cochlear implantation (CI) with a matching control group of 102 children with normal hearing completed the Arabic-MUSS scale. A random subsample of 30 parents was interviewed after two weeks to examine the test-retest reliability. RESULTS the construct validity of the Arabic-MUSS was established by exploratory factor analysis that yielded a unidimensional scale and explained a total of 92.48% of the variance in the total score of the Arabic-MUSS. The internal consistency of the scale was excellent with Cronbach's alpha = 0.975. The Arabic-MUSS discriminative validity was supported by the significant difference between the total score of children with CI and children with normal hearing (p < 0.0001). The Arabic-MUSS has a moderate predictive validity as demonstrated by the moderate correlation between the total score and the time since cochlear implantation (p < 0.001). The Arabic-MUSS has excellent test-retest reliability. CONCLUSION The Arabic-MUSS is a valid and reliable measure that can be used to guide plans for auditory rehabilitation and monitor the progress of children with cochlear implantation over time.IMPLICATIONS FOR REHABILITATIONThe Arabic-Meaningful Use of Speech Scale is a valid and reliable parent-report assessment.The Arabic-Meaningful Use of Speech Scale evaluates functional speech in children with cochlear implantation.Clinicians can use the Arabic- Meaningful Use of Speech Scale to plan and monitor the progress of auditory rehabilitation programs.
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Affiliation(s)
- Nihad A Almasri
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Soha N Garadat
- Department of Hearing and Speech Sciences, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
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Adams JK, Marinelli JP, DeJong RW, Spear SA, Erbele ID. National Trends in Cochlear Implantation Across the Department of the Defense: A Case for Inclusion as a General Otolaryngology Core Competency. Otol Neurotol 2023; 44:e710-e714. [PMID: 37733998 DOI: 10.1097/mao.0000000000004020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE With ongoing national expansions in cochlear implantation (CI) candidacy criteria, more patients qualify for CI today than ever before. Among US veterans and military service members, the prevalence of qualifying degrees of hearing loss secondary to occupational noise exposure exceeds the general population. The primary aim of the current work was to evaluate CI trends across the military health system. STUDY DESIGN Database review. SETTING Military and civilian practices. PATIENTS Department of Defense (DoD) beneficiaries who underwent CI. MAIN OUTCOME MEASURES CI rates between 2010 and 2019. RESULTS A total of 3,573 cochlear implant operations were performed among DoD beneficiaries from 2010 to 2019. A majority of patients (55%) were older than 64 years, with the next most commonly implanted age group being 0 to 4 years of age (14%). From 2010 to 2019, annual CI increased at a rate of 7.9% per year for all implantation over the study period ( r = 0.97, p < 0.0001); there was a statistically significant difference of this rate compared with tympanoplasty, which was used as a reference procedure (rate, -1.9%; p = 0.03). This trend was similar for beneficiaries implanted both in military (11.9% per year, r = 0.77, p = 0.009) and civilian facilities (7.7% per year, r = 0.96, p < 0.0001); there was no statistically significant difference between the annual growth rates of these groups ( p = 0.68). CONCLUSIONS Although the number of devices implanted is rapidly increasing among DoD beneficiaries, reported national utilization rates remain low. This disparity likely exists in the general public, considering the aging demographic in the West and continual expansions in US Federal Drug Administration labeling. These data suggest that widespread expansion of the procedure to general otolaryngology practices will be required to meet current and future demands for CI. For this reason, CI should be considered for "key indicator" designation among residency training programs.
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Affiliation(s)
- Jason K Adams
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium
| | - John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium
| | - Russell W DeJong
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium
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Porps SL, Bennett DM, Gilden J, Ravelo K, Buck B, Reinhart P, Hong RS. Effects of an evidence-based model for cochlear implant aftercare delivery on clinical efficiency and patient outcomes. Cochlear Implants Int 2023; 24:325-334. [PMID: 36927486 DOI: 10.1080/14670100.2023.2188007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVES To assess an evidence-based model (EBM) approach to cochlear implant (CI) aftercare that includes a modified, reduced treatment schedule for newly-implanted adult CI recipients consisting of four appointments (initial activation, 1-, 3- and 6- months postactivation) in the first year post-surgery. METHOD This prospective multicenter proof-of-concept study was conducted across three clinics in the United States by five experienced CI clinicians. Seventeen newly-implanted adult patients with postlingual hearing loss enrolled in the study. Hearing outcomes were measured using objective speech testing and subjective self-report measures. RESULTS Most recipients (14/17; 82%) were able to follow the four-appointment EBM schedule. The reduced number of visits translated into an average time savings of 3 hours per patient. Significant improvements in speech perception were observed at both 3- and 6-months postactivation, as measured by CNC words in quiet and AzBio sentences at +10 dB SNR, consistent with published results achieved by traditional practices. Recipients were significantly satisfied with telephone, music, small group conversation, and television listening at 6 months postactivation. Recipient satisfaction with overall service was rated as "excellent" by 14/14 (100%) respondents. CONCLUSION The four-appointment EBM approach delivered efficient and effective audiological aftercare to CI recipients in the first year following CI implantation.
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Affiliation(s)
| | | | - Jan Gilden
- Cochlear Hearing Center, Bellaire, TX, USA
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15
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Tzvi-Minker E, Keck A. How Can We Compare Cochlear Implant Systems across Manufacturers? A Scoping Review of Recent Literature. Audiol Res 2023; 13:753-766. [PMID: 37887848 PMCID: PMC10604631 DOI: 10.3390/audiolres13050067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
Electric stimulation via a cochlear implant (CI) enables people with severe-to-profound sensorineural hearing loss to regain speech understanding and music appreciation and, thus, allow them to actively engage in social life. Three main manufacturers (CochlearTM, MED-ELTM, and Advanced BionicsTM "AB") have been offering CI systems, thus challenging CI recipients and otolaryngologists with a difficult decision as currently no comprehensive overview or meta-analysis on performance outcomes following CI implantation is available. The main goals of this scoping review were to (1) map the literature on speech and music performance outcomes and to (2) find whether studies have performed outcome comparisons between devices of different manufacturers. To this end, a literature search was conducted to find studies that address speech and music outcomes in CI recipients. From a total of 1592 papers, 188 paper abstracts were analyzed and 147 articles were found suitable for an examination of full text. From these, 42 studies were included for synthesis. A total of 16 studies used the consonant-nucleus-consonant (CNC) word recognition test in quiet at 60 db SPL. We found that aside from technical comparisons, very few publications compared speech outcomes across manufacturers of CI systems. However, evidence suggests that these data are available in large CI centers in Germany and the US. Future studies should therefore leverage large data cohorts to perform such comparisons, which could provide critical evaluation criteria and assist both CI recipients and otolaryngologists to make informed performance-based decisions.
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16
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Quimby AE, Venkatesh S, Corsten M, McDonald JT, Hwa TP, Bigelow DC, Ruckenstein MJ, Johnson-Obaseki S, Brant JA. Socioeconomic Status Among Cochlear Implant Candidates and Association With Surgical Pursuance. JAMA Otolaryngol Head Neck Surg 2023; 149:891-898. [PMID: 37615991 PMCID: PMC10450586 DOI: 10.1001/jamaoto.2023.2217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 08/25/2023]
Abstract
Importance Despite the sizeable global burden of hearing loss, cochlear implants have poor penetrance among eligible hearing-impaired individuals. Identifying populations who may benefit from a cochlear implant but among whom penetrance is poor is an important aim in reducing the health-related and economic effects of hearing loss on both individuals and society. Objectives To explore the association of socioeconomic status (SES) with cochlear implant candidacy and the decision to undergo cochlear implantation. Design, Setting, and Participants This retrospective cohort study was performed in a tertiary academic center. All adult patients evaluated for cochlear implant candidacy from January 1, 1999, through December 31, 2022, were included in the analysis. Exposures Household income quintile and rural or urban residence were used as proxies for SES based on zip code linkage to US Census and US Department of Agriculture data. Main Outcomes and Measures Odds of cochlear implant candidacy and surgery. Results A total of 754 individuals underwent candidacy evaluations and were included in the analysis (386 [51.2%] women; mean [SD] age, 64.0 [15.7] years). Of these, 693 (91.9%) were cochlear implant candidates, and 623 candidates (89.9%) underwent cochlear implantation. Multivariable analyses demonstrated that individuals in the highest income quintile had lower odds of cochlear implant candidacy compared with those in the lowest income quintile (odds ratio [OR], 0.26 [95% CI, 0.08-0.91]), and candidates in the highest income quintile had greater odds of undergoing cochlear implant surgery compared with those in the lowest quintile (OR, 2.59 [95% CI, 1.14-5.86]). Living in a small town or a micropolitan or rural area was associated with lower odds of undergoing cochlear implant surgery compared with living in a metropolitan core (OR, 0.18 [95% CI, 0.04-0.83]) after controlling for distance to the primary implant center. Conclusions and Relevance The findings of this cohort study suggest that individuals with higher SES are less likely to qualify for a cochlear implant; however, those who qualify are more likely to undergo surgery compared with those with lower SES. These findings highlight a hearing health care disparity that should be addressed through further studies to guide population-based initiatives.
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Affiliation(s)
- Alexandra E. Quimby
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
| | - Sanjena Venkatesh
- currently a medical student at Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Martin Corsten
- Department of Surgery, Division of Otolaryngology–Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - James Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Tiffany P. Hwa
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
- Department of Otolaryngology–Head & Neck Surgery, Temple University, Philadelphia, Pennsylvania
| | - Douglas C. Bigelow
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
| | - Michael J. Ruckenstein
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
| | | | - Jason A. Brant
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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17
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Geerardyn A, De Voecht K, Wouters J, Verhaert N. Electro-vibrational stimulation results in improved speech perception in noise for cochlear implant users with bilateral residual hearing. Sci Rep 2023; 13:11251. [PMID: 37438474 DOI: 10.1038/s41598-023-38468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023] Open
Abstract
A cochlear implant is a neuroprosthetic device that can restore speech perception for people with severe to profound hearing loss. Because of recent evolutions, a growing number of people with a cochlear implant have useful residual acoustic hearing. While combined electro-acoustic stimulation has been shown to improve speech perception for this group of people, some studies report limited adoption rates. Here, we present electro-vibrational stimulation as an alternative combined stimulation strategy that similarly targets the full cochlear reserve. This novel strategy combines the electrical stimulation by the cochlear implant with low-frequency bone conduction stimulation. In a first evaluation of electro-vibrational stimulation, speech perception in noise was assessed in 9 subjects with a CI and symmetrical residual hearing. We demonstrate a statistically significant and clinically relevant improvement for speech perception in noise of 1.9 dB signal-to-noise ratio. This effect was observed with a first prototype that provides vibrational stimulation to both ears with limited transcranial attenuation. Future integration of electro-vibrational stimulation into one single implantable device could ultimately allow cochlear implant users to benefit from their low-frequency residual hearing without the need for an additional insert earphone.
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Affiliation(s)
- Alexander Geerardyn
- ExpORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Katleen De Voecht
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jan Wouters
- ExpORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Nicolas Verhaert
- ExpORL, Department of Neurosciences, KU Leuven, Leuven, Belgium.
- Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium.
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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18
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Kurz A, Herrmann D, Hagen R, Rak K. Using Anatomy-Based Fitting to Reduce Frequency-to-Place Mismatch in Experienced Bilateral Cochlear Implant Users: A Promising Concept. J Pers Med 2023; 13:1109. [PMID: 37511722 PMCID: PMC10381201 DOI: 10.3390/jpm13071109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Fitting cochlear implant (CI) users can be challenging. Anatomy-based fitting (ABF) maps may have the potential to lead to better objective and subjective outcomes than conventional clinically based fitting (CBF) methods. ABF maps were created via information derived from exact electrode contact positions, which were determined via post-operative high-resolution flat panel volume computer tomography and clinical fitting software. The outcome measures were speech understanding in quiet and noise and self-perceived sound quality with the CBF map and with the ABF map. Participants were 10 experienced bilateral CI users. The ABF map provided better speech understanding in quiet and noisy environments compared to the CBF map. Additionally, two approaches of reducing the frequency-to-place mismatch revealed that participants are more likely to accept the ABF map if their electrode array is inserted deep enough to stimulate the apical region of their cochlea. This suggests an Angular Insertion Depth of the most apical contact of around 720°-620°. Participants had better speech understanding in quiet and noise with the ABF map. The maps' self-perceived sound quality was similar. ABF mapping may be an effective tool for compensating the frequency-to-place mismatch in experienced bilateral CI users.
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Affiliation(s)
- Anja Kurz
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - David Herrmann
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Kristen Rak
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
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19
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Nassiri AM, Marinelli JP, Lohse CM, Carlson ML. Age and Incidence of Cochlear Implantation in the Pediatric Population With Congenital Bilateral Profound Hearing Loss. Otol Neurotol 2023; Publish Ahead of Print:00129492-990000000-00319. [PMID: 37367698 DOI: 10.1097/mao.0000000000003932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVES The current study characterizes age and incidence of cochlear implantation among qualifying children with congenital bilateral profound hearing loss in the U.S. STUDY DESIGN Deidentified cochlear implantation data were acquired from prospectively collected patient registries from two cochlear implant (CI) manufacturers (Cochlear Americas and Advanced Bionics). Children <36 months old were assumed to have congenital bilateral profound sensorineural hearing loss. SETTING U.S. CI centers. PATIENTS Children <36 months old who received CIs. INTERVENTIONS Cochlear implantation. MAIN OUTCOME MEASURES Age at implantation and incidence. RESULTS A total of 4,236 children <36 months old underwent cochlear implantation from 2015 to 2019. The median age at implantation was 16 months (interquartile range, 12-24 mo) and did not change significantly during the 5-year study period (p = 0.09). Patients residing closer to CI centers (p = 0.03) and treated at higher-volume centers (p = 0.008) underwent implantation at a younger age. Bilateral simultaneous implantation increased from 38% to 53% of CI surgeries in 2015 and 2019, respectively. Children who received bilateral simultaneous CIs were younger compared with those receiving unilateral or bilateral sequential CIs (median, 14 versus 18 mo; p < 0.001). The incidence of cochlear implantation increased from 7,648 per 100,000 person-years in 2015 to 9,344 in 2019 (p < 0.001). CONCLUSION Although the incidence of pediatric CI recipients and the frequency of bilateral simultaneous implantation increased over the study period, age at implantation did not change significantly and far exceeded current Food and Drug Administration (9 mo) and American Academy of Otolaryngology and Head and Neck Surgery position statement (6-12 mo) guidelines.
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Affiliation(s)
- Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO
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20
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Koirala N, Deroche MLD, Wolfe J, Neumann S, Bien AG, Doan D, Goldbeck M, Muthuraman M, Gracco VL. Dynamic networks differentiate the language ability of children with cochlear implants. Front Neurosci 2023; 17:1141886. [PMID: 37409105 PMCID: PMC10318154 DOI: 10.3389/fnins.2023.1141886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
Background Cochlear implantation (CI) in prelingually deafened children has been shown to be an effective intervention for developing language and reading skill. However, there is a substantial proportion of the children receiving CI who struggle with language and reading. The current study-one of the first to implement electrical source imaging in CI population was designed to identify the neural underpinnings in two groups of CI children with good and poor language and reading skill. Methods Data using high density electroencephalography (EEG) under a resting state condition was obtained from 75 children, 50 with CIs having good (HL) or poor language skills (LL) and 25 normal hearing (NH) children. We identified coherent sources using dynamic imaging of coherent sources (DICS) and their effective connectivity computing time-frequency causality estimation based on temporal partial directed coherence (TPDC) in the two CI groups compared to a cohort of age and gender matched NH children. Findings Sources with higher coherence amplitude were observed in three frequency bands (alpha, beta and gamma) for the CI groups when compared to normal hearing children. The two groups of CI children with good (HL) and poor (LL) language ability exhibited not only different cortical and subcortical source profiles but also distinct effective connectivity between them. Additionally, a support vector machine (SVM) algorithm using these sources and their connectivity patterns for each CI group across the three frequency bands was able to predict the language and reading scores with high accuracy. Interpretation Increased coherence in the CI groups suggest overall that the oscillatory activity in some brain areas become more strongly coupled compared to the NH group. Moreover, the different sources and their connectivity patterns and their association to language and reading skill in both groups, suggest a compensatory adaptation that either facilitated or impeded language and reading development. The neural differences in the two groups of CI children may reflect potential biomarkers for predicting outcome success in CI children.
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Affiliation(s)
- Nabin Koirala
- Child Study Center, Yale School of Medicine, Yale University, New Haven, CT, United States
| | | | - Jace Wolfe
- Hearts for Hearing Foundation, Oklahoma City, OK, United States
| | - Sara Neumann
- Hearts for Hearing Foundation, Oklahoma City, OK, United States
| | - Alexander G. Bien
- Department of Otolaryngology – Head and Neck Surgery, University of Oklahoma Medical Center, Oklahoma City, OK, United States
| | - Derek Doan
- University of Oklahoma College of Medicine, Oklahoma City, OK, United States
| | - Michael Goldbeck
- University of Oklahoma College of Medicine, Oklahoma City, OK, United States
| | - Muthuraman Muthuraman
- Department of Neurology, Neural Engineering with Signal Analytics and Artificial Intelligence (NESA-AI), Universitätsklinikum Würzburg, Würzburg, Germany
| | - Vincent L. Gracco
- Child Study Center, Yale School of Medicine, Yale University, New Haven, CT, United States
- School of Communication Sciences and Disorders, McGill University, Montreal, QC, Canada
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21
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Buhle AC, McCrary HC, Gordon SA, Johnson KM, Babajanian EE, Patel NS. Expanding Understanding of Electrocochleography in Cochlear Implantation: Auditory Neuropathy Spectrum Disorder With Normal Pure Tone Average. Otol Neurotol Open 2023; 3:e035. [PMID: 38516124 PMCID: PMC10950127 DOI: 10.1097/ono.0000000000000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/11/2023] [Indexed: 03/23/2024]
Abstract
Objective Describe the preoperative decision-making, intraoperative electrocochleographic (ECoG) findings, and outcome of cochlear implantation (CI) in a patient with auditory neuropathy spectrum disorder (ANSD) and normal pure-tone thresholds. Patients A 19-year-old with a history of hypoxic ischemic encephalopathy and seizures was referred for hearing rehabilitation in the setting of typical hearing by pure tone audiometry but poor speech understanding. A diagnosis of ANSD was made based on acoustic brainstem response (ABR), distortion product otoacoustic emission, and acoustic reflex testing. Imaging revealed no central cause of hearing impairment. Interventions Right-sided CI. Main Outcome Measures Preoperative and postoperative audiometric data. Intraoperative ECoG. Results Preoperatively the patient underwent comprehensive audiologic testing with behavioral audiometry, ABR testing, and CI candidacy evaluation. In the right ear, the pure tone average (PTA) was 15 dB and word recognition score was 36%. ABR confirmed ANSD. Preoperative CNC and AzBio in quiet were 8% and 0%, respectively. Intraoperative ECoG amplitudes and audiometry showed responses in the 100 uV range and estimated PTA of 42 dB HL. Postoperative testing at 1-month post-initial activation revealed PTA of 45 dB HL and unchanged word and sentence scores. However, the patient cites an improved ability to communicate and increased confidence and averages over 14 hours of device use daily. Conclusions To our knowledge, this is the first reported case of CI in an ear with normal PTA. Given that nearly all presently available ECoG data comes from patients with greater degrees of hearing loss, this unique case adds to our understanding of hearing preservation in CI.
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Affiliation(s)
- Anna C. Buhle
- Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Hilary C. McCrary
- Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT
| | - Steven A. Gordon
- Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT
| | - Kathryn M. Johnson
- Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT
| | - Eric E. Babajanian
- Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT
| | - Neil S. Patel
- Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT
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22
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Na E, Toupin-April K, Olds J, Noll D, Fitzpatrick EM. Cochlear Implant Decision Making for Children With Residual Hearing: Perspectives of Practitioners. Am J Audiol 2023:1-13. [PMID: 36989158 DOI: 10.1044/2023_aja-22-00091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
PURPOSE Cochlear implants (CIs) are increasingly considered for children with residual hearing who benefit from hearing aids (HAs). However, the decision-making process for families of these children and for practitioners is particularly challenging because there is no clear audiological cut point for CI candidacy. This study aimed to understand Canadian practitioners' perspectives of the CI decision-making process and how they guide families of children with residual hearing. METHOD Semistructured interviews were conducted with a total of 17 practitioners through four focus groups and one individual interview. Interviews were transcribed verbatim, and a thematic analysis was carried out. RESULTS Data were organized into five broad domains: candidacy issues for children with residual hearing, practitioners' roles in decision support, additional considerations affecting decision making, factors facilitating decision making, and practitioners' needs. CONCLUSIONS This study found that practitioners' confidence in determining candidacy and supporting parents has increased due to their experiences with positive outcomes for these children. Practitioners indicated that there was a need for more research to guide the decision-making process.
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Affiliation(s)
- Eunjung Na
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Janet Olds
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Dorie Noll
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Elizabeth M Fitzpatrick
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ontario, Canada
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Mitton TJ, Yancey KL, Isaacson B, Kutz W, Whitson J, Hunter JB. Audiometric and Patient-Reported Outcomes in Single-Sided Deafness Cochlear Implant Recipients Using the CIQOL-35. Otolaryngol Head Neck Surg 2023; 168:1156-1163. [PMID: 36871181 DOI: 10.1002/ohn.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Describe the effect that cochlear implantation (CI) has on audiometric outcomes and quality of life (QOL) in patients with single-sided deafness (SSD). STUDY DESIGN Retrospective case review. SETTING Tertiary university hospital system. METHODS Preoperative and postoperative AzBio performance and Cochlear Implant Quality of Life-35 (CIQOL-35) Profile scores in CI patients with SSD were compared, and postoperative measures were compared to those from CI patients without SSD. RESULTS Seventeen patients with unilateral CI and contralateral unaided pure-tone averages ≤30 dB were included. The median age was 60.2 (interquartile range [IQR], 50.9-64.9 years), and 7/17 (41%) were women. Median daily use was 8.2 hour (IQR, 5.4-11.9 h). The median preoperative AzBio quiet score in the ear to be implanted was 3% (IQR, 0%-6%). After a median follow-up of 12.0 months, the median postoperative AzBio quiet score was 76% (IQR, 47%-86%) (p < .01). SSD subjects demonstrated statistically significant improvements in median scores on the following CIQOL-35 subdomains following implantation: Entertainment (17 preoperatively vs 21 postoperatively), Listening Effort (12 vs 14), Social (17 vs 22), and Global (28 vs 35; p < .05). SSD patients achieved equal or higher postoperative CIQOL-35 scores in most subdomains (6/7) compared to an age-matched group of non-SSD CI recipients who underwent unilaterally (N = 19) or sequential (N = 6) implantation. CONCLUSION SSD CI patients not only demonstrate significant improvements in speech perception testing in the implanted ear but also exhibit improvement in multiple QOL subdomains on the CIQOL-35, the only validated cochlear implant QOL instrument.
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Affiliation(s)
- Tanner J Mitton
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Johanna Whitson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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24
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Schvartz-Leyzac KC, Colesa DJ, Swiderski DL, Raphael Y, Pfingst BE. Cochlear Health and Cochlear-implant Function. J Assoc Res Otolaryngol 2023; 24:5-29. [PMID: 36600147 PMCID: PMC9971430 DOI: 10.1007/s10162-022-00882-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
The cochlear implant (CI) is widely considered to be one of the most innovative and successful neuroprosthetic treatments developed to date. Although outcomes vary, CIs are able to effectively improve hearing in nearly all recipients and can substantially improve speech understanding and quality of life for patients with significant hearing loss. A wealth of research has focused on underlying factors that contribute to success with a CI, and recent evidence suggests that the overall health of the cochlea could potentially play a larger role than previously recognized. This article defines and reviews attributes of cochlear health and describes procedures to evaluate cochlear health in humans and animal models in order to examine the effects of cochlear health on performance with a CI. Lastly, we describe how future biologic approaches can be used to preserve and/or enhance cochlear health in order to maximize performance for individual CI recipients.
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Affiliation(s)
- Kara C Schvartz-Leyzac
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA
| | - Deborah J Colesa
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Donald L Swiderski
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Yehoash Raphael
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Bryan E Pfingst
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA.
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25
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Sunwoo W. Neonatal Deafening Selectively Degrades the Sensitivity to Interaural Time Differences of Electrical Stimuli in Low-Frequency Pathways in Rats. eNeuro 2023; 10:ENEURO. [PMID: 36609304 DOI: 10.1523/ENEURO.0437-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/07/2023] Open
Abstract
We examined the effect of neonatal deafening on frequency-specific pathways for processing of interaural time differences (ITDs) in cochlear-implant stimuli. Animal studies have demonstrated differences in neural ITD sensitivity in the inferior colliculus (IC) depending on the intracochlear location of intracochlear stimulating electrodes. We used neonatally deafened (ND) rats of both sexes and recorded the responses of single neurons in the IC to electrical stimuli with ITDs delivered to the apical or basal cochlea and compared them with acutely deafened (AD) rats of both sexes with normal hearing (NH) during development. We found that neonatal deafness significantly impacted the ITD sensitivity and the ITD tuning patterns restricted to apically driven IC neurons. In ND rats, the ITD sensitivity of apically driven neurons is reduced to values similar to basally driven neurons. The prevalence of ITD-sensitive apical neurons with a peak-shaped ITD tuning curve, which may reflect predominant input from the medial superior olivary (MSO) complex, in ND rats was diminished compared with that in AD rats (67%, AD vs 40%, ND). Conversely, monotonic-type responses rarely occurred in AD rats (14%) but were approximately equally as prevalent as peak-type tuning curves in ND rats (42%). Nevertheless, in ND rats, the ITD at the maximum slope of the ITD tuning curve was still more concentrated within the physiological ITD range in apically driven than in basally driven neurons. These results indicate that the development of high ITD sensitivity processed by low-frequency pathways depends on normal auditory experience and associated biases in ITD tuning strategies.
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Garadat SN, Almasri NA. Translation, adaptation, and validation of the Arabic version of the meaningful auditory integration scale. Cochlear Implants Int 2023; 24:35-42. [PMID: 36369726 DOI: 10.1080/14670100.2022.2141417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The main objectives of this study were to translate and adapt the infant-toddler meaningful integration scale (IT-MAIS) into Arabic and to establish the psychometric properties of the translated scale in children with a cochlear implant. METHODS The translation and cross-cultural adaptation of this questionnaire were completed in multiple steps and following standard translation protocols. In total, twenty-eight parents of young cochlear implant recipients completed IT-MAIS. Data were collected postoperatively and at 3-, 6-, 9-, and 12-month post-device activation. Data were examined for the validity and reliability of the scale. The internal consistency and reliability of the scale were analyzed using Cronbach α, split-half reliability, and the corrected item-total correlation coefficients. RESULTS Findings demonstrated that the scale exhibited good face and content validity, suggesting that the scale is a one-dimensional measure. Additionally, the reliability analysis for the scale indicated high reliability and correlation among test items. IT-MAIS scores consistently improved over time for all participants and this improvement. correlated negatively with the duration of deafness. CONCLUSION Current findings indicated that the translated Arabic version of the IT-MAIS scale could serve as a valid instrument for assessing the development of auditory skills in Arabic-speaking children with cochlear implants.
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Affiliation(s)
- Soha N Garadat
- Department of Hearing and Speech Sciences, The University of Jordan, Amman, Jordan
| | - Nihad A Almasri
- Department of Physiotherapy, The University of Jordan, Amman, Jordan
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27
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Wathour J, Govaerts PJ, Derue L, Vanderbemden S, Huaux H, Lacroix E, Deggouj N. Prospective Comparison Between Manual and Computer-Assisted (FOX) Cochlear Implant Fitting in Newly Implanted Patients. Ear Hear 2022. [PMID: 36607743 DOI: 10.1097/AUD.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE A prospective, longitudinal, randomized controlled trial with an original crossover design for 1 year was conducted to compare manual fitting to artificial intelligence-based fitting in newly implanted patients. DESIGN Twenty-four patients who received their first cochlear implant (CI) were randomly assigned to the manual or Fitting to Outcome eXpert (FOX) arm; they followed the corresponding fitting procedures for 1 year. After 1 year, each patient was switched to another arm. The number of fittings, auditory outcomes (pure-tone thresholds, loudness scaling curves, spectral discrimination scores, bisyllabic word recognition in quiet and noise, and speech tracking), fitting session questionnaire, and CI parameters (T level, C level, Threshold Sound Pressure Level (T-SPL), Comfortable Sound Pressure Level (C-SPL), and loudness growth value) were compared between the two groups. Differences between the two groups were analyzed using the Mann-Whitney test, and Holm corrections were applied for multiple statistical tests. At the end of the crossover session, patients were offered the choice to continue with their old or new map. RESULTS As early as 3 mo postactivation, the FOX group showed less variability and significantly better speech intelligibility in quiet conditions at 40 and 55 dB SPL and noise ( p < 0.05) with median phoneme scores of 50%, 70%, and 50% at 55, 70, and 85 dB SPL compared with 45%, 50%, and 40%, respectively. This group showed better results at 12 mo postactivation ( p < 0.05). In the manual group, 100% of the patients decided to keep the new FOX map, and 82% performed better with the FOX map. In the FOX group, 63% of the patients decided to keep the manual map, although the measurable outcome had not improved. In this group, participants reported to prefer the manual map because it felt more comfortable, even if the FOX map gave better measured outcome. CONCLUSION Although the study size remains relatively small, the AI-FOX approach was equivalent to or even outperformed the manual approach in hearing performance, comfort, and resources. Furthermore, FOX is a tool capable of continuous improvement by comparing its predictions with observed results and is continuously learning from clinicians' practice, which is why this technology promises major advances in the future.
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Biever A, Kelsall DC, Lupo JE, Haase GM. Evolution of the candidacy requirements and patient perioperative assessment protocols for cochlear implantation. J Acoust Soc Am 2022; 152:3346. [PMID: 36586869 DOI: 10.1121/10.0016446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Cochlear implantation as an approved clinical therapy ushered in an exciting era of innovation for the treatment of hearing loss. The U.S. Food and Drug Administration approved the use of cochlear implants as a treatment option for adults with profound sensorineural hearing loss in 1985. The landscape for treating adults and children with significant hearing loss has changed dramatically over the last three decades. The purpose of this paper is to examine the evolving regulatory process and changes to clinical care. A significant emerging trend in cochlear implantation is the consideration of steroids to preserve hearing during and following surgery. This parallels the quest for hearing preservation in noise-induced hearing disorders, especially considering the current interest in biological drug therapies in this population. The future will likely usher in an era of combination therapeutics utilizing drugs and cochlear implantation. For over 30+ years and following regulatory compliance, the Rocky Mountain Ear Center has developed an extensive candidacy and outcome assessment protocol. This systematic approach evaluates both unaided and aided auditory performance during candidacy stages and post-implantation. Adjunctive measures of cognition and quality-of-life augment the auditory assessment in specific populations. Practical insights into lessons learned have directed further clinical research and have resulted in beneficial changes to clinical care.
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Affiliation(s)
- Allison Biever
- Rocky Mountain Ear Center, Englewood, Colorado 80113, USA
| | | | - J Eric Lupo
- Rocky Mountain Ear Center, Englewood, Colorado 80113, USA
| | - Gerald M Haase
- University of Colorado, School of Medicine, Aurora, Colorado 80045, USA
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29
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Sbeih F, Bouzaher MH, Appachi S, Schwartz S, Cohen MS, Carvalho D, Yoon P, Liu YCC, Anne S. Safety of Cochlear Implantation in Children 12 Months or Younger: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2022; 167:912-922. [PMID: 34982600 DOI: 10.1177/01945998211067741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To systematically review the literature to determine safety of cochlear implantation in pediatric patients 12 months and younger. DATA SOURCE Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to March 20, 2021. REVIEW METHODS Studies that involved patients 12 months and younger with report of intraoperative or postoperative complication outcomes were included. Studies selected were reviewed for complications, explants, readmissions, and prolonged hospitalizations. Two independent reviewers screened all studies that were selected for the systematic review and meta-analysis. All studies included were assessed for quality and risk of bias. RESULTS The literature search yielded 269 studies, of which 53 studies underwent full-text screening, and 18 studies were selected for the systematic review and meta-analysis. A total of 449 patients and 625 cochlear implants were assessed. Across all included studies, major complications were noted in 3.1% of patients (95% CI, 0.8-7.1) and 2.3% of cochlear implantations (95% CI, 0.6-5.2), whereas minor complications were noted in 2.4% of patients (95% CI, 0.4-6.0) and 1.8% of cochlear implantations (95% CI, 0.4-4.3). There were no anesthetic complications reported across all included studies. CONCLUSION The results of this systematic review and meta-analysis suggest that cochlear implantation in patients 12 months and younger is safe with similar rates of complications to older cohorts.
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Affiliation(s)
- Firas Sbeih
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Malek H Bouzaher
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Swathi Appachi
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Seth Schwartz
- Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Daniela Carvalho
- Department of Otolaryngology-Head and Neck Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Patricia Yoon
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, The Children's Hospital, Denver, Colorado, USA
| | - Yi-Chun Carol Liu
- Texas Children's Hospital, Division of Pediatric Otolaryngology, Houston, Texas, USA
| | - Samantha Anne
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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30
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Fan T, Xiang M, Li Y, Gong J, Wu T, Wang Y, Xu J, Wang Y, Li J, Liang S. Effect of Electrode Insertion Angle on Cochlear Implantation Outcomes in Adult and Children Patients with Sensorineural Hearing Loss. Oxidative Medicine and Cellular Longevity 2022; 2022:1-11. [PMID: 36052159 PMCID: PMC9427248 DOI: 10.1155/2022/9914716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
Purpose To determine the role played by electrode insertion angle in cochlear implantation (CI) outcomes in adult and children patients with sensorineural hearing loss (SNHL). Methods Adults (n = 10) and children (n = 19) with SNHL undergoing CI in a tertiary specialized hospital were retrospectively enrolled. The measurements were evaluated before and after CI surgery using sound field audiometry and speech recognition tests. Questionnaires were used to assess subjective benefits. Electrode insertion angles were determined using postoperative X-rays. Results Both adult and children patients showed significant improvements in hearing, speech performance, and audiology and speech-related quality of life after CI. The angular insertion depths of adult and children group were 323.70 ± 43.57° and 341.53 ± 57.07°, respectively, showing no significant difference. In the adult group, deeper insertion depths were found to be strongly linked to lower postoperative pure tone thresholds at 12 months and higher postoperative disyllabic Word Recognition and Sentence Recognition Scores at 6 months (all P < 0.05). In the children group, deeper insertion depth had a positive correlation with postoperative monosyllabic Word Recognition Scores 6 and 12 months after CI surgery (both P < 0.05). Multiple linear regression models were constructed to predict disyllabic Word Recognition Scores at 6 and 12 months postoperatively in the children group, in which insertion angle, duration of hearing loss, and preoperative questionnaire result were identified as dependent variables. Conclusions Greater angular insertion depths resulted in improved hearing and speech performances after CI. The benefits of greater angular insertion depths can be found in both adult and children patients and last for at least 12 months. Clinicians are expected to determine the optimal implantation direction during CI and ensure the insertion depth to improve the speech rehabilitation of patients.
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31
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Allen TE, Morere DA. Psychometric Characteristics of the Visual Communication and Sign Language Checklist. J Deaf Stud Deaf Educ 2022; 27:297-309. [PMID: 35589092 DOI: 10.1093/deafed/enac011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
Since its publication in 2013, the Visual Communication and Sign Language (VCSL) Checklist has been widely utilized to assess the development of early American Sign Language skills of deaf children from birth to age 5. However, little research has been published using the results of VCSL assessments. Notably, no psychometric analyses have been conducted to verify the validity of the VCSL in a population whose characteristics are different from those of the small sample of native signing children from whom the published norms were created. The current paper, using data from the online version of the VCSL (VCSL:O), addresses this shortcoming. Ratings of the 114 VCSL items from 562 evaluations were analyzed using a partial-credit Rasch model. Results indicate that the underlying skill across the age range comprises an adequate single dimension. Within the items' age groupings, however, the dimensionality is not so clear. Item ordering, as well as item fit, is explored in detail. In addition, the paper reports the benefits of using the resulting Rasch scale scores, which, unlike the published scoring strategy that focuses on basal and ceiling performance, makes use of the ratings of partial credit, or emerging, skills. Strategies for revising the VCSL are recommended.
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Affiliation(s)
- Thomas E Allen
- Educational Neuroscience Program, Gallaudet University, Washington, DC, USA
| | - Donna A Morere
- Department of Psychology, Gallaudet University, Washington, DC, USA
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32
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Kecman E. Research About Parents of Children with Cochlear Implants: A Scoping Review. J Deaf Stud Deaf Educ 2022; 27:214-233. [PMID: 35894552 DOI: 10.1093/deafed/enac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 06/15/2023]
Abstract
Parents of children who are deaf or hard of hearing have long attracted interest from researchers, though, since the 1990s, published research about this population has increasingly gravitated toward issues surrounding pediatric cochlear implantation. This scoping review was undertaken to map the nature, extent, and range of three decades of research about parents of children with cochlear implants, and reports on (1) publication characteristics, (2) sampling characteristics, and (3) study design characteristics within 80 peer-reviewed articles published between 1990 and 2020. The results indicate several gaps and gluts within the field, including a lack of diversity within (and detail about) study samples, a disproportionate focus on evaluating parents' personal characteristics and (presupposed) psycho-emotional problems, and a scarcity of participatory or co-constructed projects. The results may inform future research, ensuring a wider range of perspectives and experiences are recorded and issues of highest priority and relevance to families are investigated.
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Affiliation(s)
- Emily Kecman
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
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33
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Gustafson SJ, Newsome E, Flores AN. Narrative Review of Loudness Perception Measures in Children. Ear Hear 2022; Publish Ahead of Print. [DOI: 10.1097/aud.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Kim YS, Kim Y, Lee SJ, Han JH, Yi N, Yoo HS, Carandang M, Lee SY, Kim BJ, Choi BY. Efficacy of cochlear implants in children with borderline hearing who have already achieved significant language development with hearing aids. PLoS One 2022; 17:e0267898. [PMID: 35648744 PMCID: PMC9159549 DOI: 10.1371/journal.pone.0267898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
There are still debates about timing and effectiveness of cochlear implants (CI) in pediatric subjects with significant residual hearing who do not belong to traditional indication of CI. In this study, we aimed to investigate the outcomes of CI, specifically on improvement of pronunciation, among hearing-impaired children already with a substantial degree of language skills as evaluated by Categories of Auditory Perception (CAP) scores or sentence score. Our cohort comprised pediatric CI recipients from July 2018 through October 2020. Among them, cases with CAP scores of 5 or 6 preoperatively were defined as "borderline cases". We investigated prevalence and etiologies, and compared speech evaluation data preoperatively and postoperatively at three time points (3, 6 and 9-12 months after implantation). Among 86 pediatric CI recipients, 13 subjects (15.12%) had language development that reached CAP scores of 5 or 6 before implantation. Postoperative speech evaluation data 6 months after implantation revealed significant improvement of pronunciation (Urimal Test of Articulation and Phonation scores: UTAP), Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and word perception scores, but not of CAP and sentence perception scores. Notably, the significant improvement of pronunciation based on UTAP scores outstripped that of other speech parameters and this continued steadily up to one-year postoperatively. The result of the study serves as evidence for what to expect from cochlear implantation in hearing-impaired children who have already achieved a substantial degree of language development in terms of CAP scores or sentence perception scores, preoperatively.
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Affiliation(s)
- Young Seok Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yehree Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Jae Lee
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin Hee Han
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Nayoung Yi
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo Soon Yoo
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, South Korea
| | - Marge Carandang
- Department of Otorhinolaryngology-Head and Neck Surgery, East Avenue Medical Center, Metro Manila, Philippines
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, South Korea
| | - Bong Jik Kim
- Department of Otorhinolaryngology, Chungnam National University Sejong Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
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35
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Misztal C, Peña S, Martinez D, Velandia S, Goncalves S, Ma R, Holcomb M, Angeli S, Telischi F, Dinh CT. Comparison of Speech Test Outcomes After Cochlear Implantation in Patients With and Without Asymmetric Hearing Loss. Otol Neurotol 2022; 43:559-66. [PMID: 35261377 DOI: 10.1097/MAO.0000000000003515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Determine whether asymmetric hearing loss (AHL) affects postoperative speech outcomes in cochlear implant (CI) patients. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care hospital. PATIENTS Adult English-speaking patients with unilateral CIs implanted between 2014 and 2018 were stratified into NonAHL and AHL groups based on preoperative AzBio scores in quiet from the nonimplanted ear (0-50% vs. 51-100%, respectively). INTERVENTIONS CI surgery in the poorer performing ear. MAIN OUTCOME MEASURES Postoperative consonant-nucleusconsonant (CNC) word and AzBio sentence test scores in quiet and/or noise at +5 dB signal-to-noise ratio (SNR). RESULTS Of 512 patients, 33 non-AHL and 27 AHL patients were included. Average ages were 65.6 and 63.6 years, respectively. As expected, preoperative AzBio scores in quiet from the nonimplanted ear were higher in the AHL group (95% confidence interval [95%CI]: 66.4-76.4%) than the non-AHL group at baseline (95%CI: 12.3-23.6%). In both cohorts, AzBio scores in quiet from the implanted ear improved from baseline, with 24-month scores (95%CI: 73.8 - 84.9%) being higher than preoperative scores (95%CI: 13.2-23.1%). There were also significant differences in AzBio scores in quiet between cohorts overall (p = 0.0120) on mixed model analysis, with the AHL group performing ∼6.4% better than the non-AHL group; however, differences were not significant when scores were stratified by time. In addition, there were no significant differences in CNC in quiet and AzBio scores in noise at +5 dB SNR between cohorts (p = 0.1786 and p = 0.6215, respectively). CONCLUSIONS After CI, patients with AHL can achieve scores on word and sentence tests at least comparable to traditional CI candidates, supporting the expansion of CI candidacy to include patients with AHL.
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Abstract
The market for hearing technology is evolving—with the emergence of hearables, it now extends beyond hearing aids and includes any ear-level devices with wireless connectivity (i.e., wireless earbuds). However, will this evolving marketplace bring forth opportunities or challenges to individuals’ hearing health care and the profession of audiology and otolaryngology? The debate has been ongoing. This study explores the wide spectrum of hearables available in the market and discusses the necessity of high-quality clinical evidence prior to the implementation of over-the-counter devices into clinical practice.
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Park LR, Griffin AM, Sladen DP, Neumann S, Young NM. American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Cochlear Implantation in Children With Single-Sided Deafness. Ear Hear 2022; 43:255-267. [PMID: 35213890 PMCID: PMC8862768 DOI: 10.1097/aud.0000000000001204] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shafiro V, Luzum N, Moberly AC, Harris MS. Perception of Environmental Sounds in Cochlear Implant Users: A Systematic Review. Front Neurosci 2022; 15:788899. [PMID: 35082595 PMCID: PMC8785216 DOI: 10.3389/fnins.2021.788899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives: Improved perception of environmental sounds (PES) is one of the primary benefits of cochlear implantation (CI). However, past research contains mixed findings on PES ability in contemporary CI users, which at times contrast with anecdotal clinical reports. The present review examined extant PES research to provide an evidence basis for clinical counseling, identify knowledge gaps, and suggest directions for future work in this area of CI outcome assessment. Methods: Six electronic databases were searched using medical subject headings (MeSH) and keywords broadly identified to reference CI and environmental sounds. Records published between 2000 and 2021 were screened by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to identify studies that met the inclusion criteria. Data were subsequently extracted and evaluated according to synthesis without-meta-analysis (SWiM) guidelines. Results: Nineteen studies met the inclusion criteria. Most examined PES in post-lingually implanted adults, with one study focused on pre/perilingual adults. Environmental sound identification (ESI) in quiet using open- or closed-set response format was most commonly used in PES assessment, included in all selected studies. ESI accuracy in CI children (3 studies) and adults (16 studies), was highly variable but generally mediocre (means range: 31–87%). Only two studies evaluated ESI performance prospectively before and after CI, while most studies were cross-sectional. Overall, CI performance was consistently lower than that of normal-hearing peers. No significant differences in identification accuracy were reported between CI candidates and CI users. Environmental sound identification correlated in CI users with measures of speech perception, music and spectro-temporal processing. Conclusion: The findings of this systematic review indicate considerable limitations in the current knowledge of PES in contemporary CI users, especially in pre/perilingual late-implanted adults and children. Although no overall improvement in PES following implantation was found, large individual variability and existing methodological limitations in PES assessment may potentially obscure potential CI benefits for PES. Further research in this ecologically relevant area of assessment is needed to establish a stronger evidence basis, identify CI users with significant deficits, and improve CI users' safety and satisfaction through targeted PES rehabilitation.
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Affiliation(s)
- Valeriy Shafiro
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL, United States
- *Correspondence: Valeriy Shafiro
| | - Nathan Luzum
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Aaron C. Moberly
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Michael S. Harris
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
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Abstract
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.
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Affiliation(s)
- Teresa A Zwolan
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Gregory Basura
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan
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Casazza GC, Kesser BW, Strumpf AM, Gurgel RK, Hashisaki GT. Otology-Neurotology 2020 US Workforce Distribution. Otol Neurotol Open 2021; 1:e007. [PMID: 38550357 PMCID: PMC10969502 DOI: 10.1097/ono.0000000000000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/05/2021] [Indexed: 04/05/2024]
Abstract
Objective Determine the geographic and per capita distribution of otology-neurotology physician-surgeons within the United States. Study Design National database review. Setting United States. Methods The American Neurotology Society and ENThealth.org membership databases were queried to identify otology-neurotology physician-surgeons within the United States. Physician-surgeons were divided by regional national census areas, state, and by largest population statistical area based on 2019 US Census population estimates. The number of otology-neurotology physician-surgeons per 1 million persons was calculated for each population designation. Results Four-hundred eighty-two physician-surgeons were identified, representing 49 states and the District of Columbia. The New England division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island) was the most concentrated region (1.89), whereas the West-South-Central (Texas, Oklahoma, Arkansas, Louisiana) was the least concentrated region (1.23) per million persons. The highest concentration of physician-surgeons by state is within the District of Columbia (4.25), Vermont (3.21), North Dakota (2.62), Massachusetts (2.61), and New York (2.21) (per million), whereas Mississippi (0.67), Georgia (0.66), Idaho (0.56), New Mexico (0.48), and Wyoming (0.0) were the least concentrated per million persons. Increasing number of physician-surgeons was significantly correlated by state (r2 = 0.9; P < 0.0001), largest statistical area (r2 = 0.88; P < 0.0001), and census region (r2 = 0.95; P < 0.0005). Conclusions Otology-neurotology physician-surgeons are evenly distributed across the United States; however, certain areas are likely underrepresented. Variability in clinical practice may account for under or overrepresentation not captured in this analysis.
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Affiliation(s)
- Geoffrey C. Casazza
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Bradley W. Kesser
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA
| | - Andrew M. Strumpf
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA
| | - Richard K. Gurgel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT
| | - George T. Hashisaki
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA
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Foreman RM, Zappas MP, Lavell J. Children With Hearing Impairment and Cochlear Implants. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nassiri AM, Marinelli JP, Sorkin DL, Carlson ML. Barriers to Adult Cochlear Implant Care in the United States: An Analysis of Health Care Delivery. Semin Hear 2021; 42:311-320. [PMID: 34912159 PMCID: PMC8660164 DOI: 10.1055/s-0041-1739281] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Persistent underutilization of cochlear implants (CIs) in the United States is in part a reflection of a lack of hearing health knowledge and the complexities of care delivery in the treatment of sensorineural hearing loss. An evaluation of the patient experience through the CI health care delivery process systematically exposes barriers that must be overcome to undergo treatment for moderate-to-severe hearing loss. This review analyzes patient-facing obstacles including diagnosis of hearing loss, CI candidate identification and referral to surgeon, CI evaluation and candidacy criteria interpretation, and lastly CI surgery and rehabilitation. Pervasive throughout the process are several themes which demand attention in addressing inequities in hearing health disparities in the United States.
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Affiliation(s)
- Ashley M. Nassiri
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - John P. Marinelli
- Department of Otolaryngology - Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | | | - Matthew L. Carlson
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Dhondt C, Maes L, Vanaudenaerde S, Martens S, Rombaut L, Van Hecke R, Valette R, Swinnen F, Dhooge I. Changes in Vestibular Function Following Pediatric Cochlear Implantation: a Prospective Study. Ear Hear 2021. [PMID: 34593688 DOI: 10.1097/AUD.0000000000001125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Given the close interconnection between the auditory and vestibular end organs, the increasingly broad application of (bilateral) cochlear implantation (CI) in children raises concern about its impact on the vestibular function. Unfortunately, literature on this matter is inconclusive and subject to several limitations. Therefore, this study aimed to elucidate the impact of pediatric CI on the vestibular function in a large sample of children, representative for the current CI population. DESIGN Fifty hearing-impaired children followed in the Ghent University Hospital were included in this prospective study. Twenty-seven patients underwent unilateral CI, and 23 were bilaterally implanted (9 sequentially, 14 simultaneously), adding up to 73 implanted ears. Children's median age at first implantation was 29 (range 8 to 194) months. Vestibular assessment was scheduled on average 2.8 months (SD: 3.6) before and 4.6 (SD: 4.0) months after implantation and consisted of video Head Impulse Testing of the lateral semicircular canals, rotatory testing (0.16, 0.04, and 0.01 Hz) and cervical vestibular evoked myogenic potential (cVEMP) testing with bone conduction stimulation. Caloric testing was added in children older than 3 years of age. RESULTS Overall, group analysis in our sample of 73 CI-ears did not reveal any significant impact on the vestibular function, except for a significantly shortened ipsilateral N1 latency of the cVEMP responses (p = 0.027) after CI. Complete ipsilateral loss of function after implantation was seen in 5% (3/54) of all CI-ears on the video head impulse testing, in 0% (0/10) on the caloric test and in 2% (1/52) on the cVEMP, notably all patients deafened by a congenital cytomegalovirus infection. CONCLUSIONS The impact of CI on the vestibular function in our dataset was limited. Therefore, the many advantages of simultaneous bilateral implantation may outweigh the risk for vestibular damage postoperatively. However, the impact on the vestibular function may be dependent on various factors (e.g., etiology of the hearing loss), and the clinical outcome is still difficult to predict. Vestibular assessment remains thus an important aspect in the pediatric CI population; first because the vestibular function should be considered in the decision-making process on (simultaneous or sequential bilateral) CI and second because it is essential to reveal a possible additional sensory deficit, allowing an opportunity for rehabilitation to improve the overall outcome of these children.
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Pluta A, Krysztofiak M, Zgoda M, Wysocka J, Golec K, Wójcik J, Włodarczyk E, Haman M. False Belief Understanding in Deaf Children With Cochlear Implants. J Deaf Stud Deaf Educ 2021; 26:511-521. [PMID: 34179946 PMCID: PMC8448438 DOI: 10.1093/deafed/enab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 04/28/2021] [Accepted: 05/08/2021] [Indexed: 05/31/2023]
Abstract
Theory of mind (ToM) is crucial for social interactions. Previous research has indicated that deaf and hard-of-hearing children born into hearing families (DoH) are at risk of delayed ToM development. However, it is unclear whether this is the case for DoH children who receive cochlear implants (CIs) before and around the second year of life. The present study aimed to investigate false belief understanding (FBU) in DoH children with CIs. The relationships between false belief task (FBT) performance, sentence comprehension, age at implantation, duration of CI use, and Speech Recognition Threshold were explored. A total of 94 children with typical levels of hearing (TH) and 45 DoH children (age range: 3-8), who received their first CI between 6 and 27 months of age, were tested on the FBT and a sentence comprehension test. Results showed that 4- and 5-year-old children with CIs performed significantly worse than their peers with TH on the FBT; 6- to 8-year-old children with CIs performed similarly to age-matched children with TH. Age at implantation and duration of CI use were correlated with sentence comprehension but not with the FBT. The results indicated that FBU was delayed until the age of 6 years in most of children with CIs.
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Affiliation(s)
- Agnieszka Pluta
- Correspondence should be addressed to Agnieszka Pluta, Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland. E-mail:
| | | | - Małgorzata Zgoda
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Warsaw, Poland
| | - Joanna Wysocka
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Karolina Golec
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Joanna Wójcik
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Warsaw, Poland
| | - Elżbieta Włodarczyk
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Warsaw, Poland
| | - Maciej Haman
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
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Killan CF, Hoare DJ, Katiri R, Pierzycki RH, Adams B, Hartley DEH, Ropar D, Kitterick PT. A Scoping Review of Studies Comparing Outcomes for Children With Severe Hearing Loss Using Hearing Aids to Children With Cochlear Implants. Ear Hear 2021. [PMID: 34347660 DOI: 10.1097/AUD.0000000000001104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Clinical practice regarding children's candidature for cochlear implantation varies internationally, albeit with a recent global trend toward implanting children with more residual hearing than in the past. The provision of either hearing aids or cochlear implants can influence a wide range of children's outcomes. However, guidance on eligibility and suitability for implantation is often based on a small number of studies and a limited range of speech perception measures. No recent reviews have catalogued what is known about comparative outcomes for children with severe hearing-loss using hearing aids to children using cochlear implants. This article describes the findings of a scoping review that addressed the question "What research has been conducted comparing cochlear implant outcomes to outcomes in children using hearing aids with severe hearing-loss in the better-hearing ear?" The first objective was to catalogue the characteristics of studies pertinent to these children's candidature for cochlear implantation, to inform families, clinicians, researchers, and policy-makers. The second objective was to identify gaps in the evidence base, to inform future research projects and identify opportunities for evidence synthesis. DESIGN We included studies comparing separate groups of children using hearing aids to those using cochlear implants and also repeated measures studies comparing outcomes of children with severe hearing loss before and after cochlear implantation. We included any outcomes that might feasibly be influenced by the provision of hearing aids or cochlear implants. We searched the electronic databases Medline, PubMed, and CINAHL, for peer-reviewed journal articles with full-texts written in English, published from July 2007 to October 2019. The scoping methodology followed the approach recommended by the Joanna Briggs Institute regarding study selection, data extraction, and data presentation. RESULTS Twenty-one eligible studies were identified, conducted across 11 countries. The majority of children studied had either congenital or prelingual hearing loss, with typical cognitive function, experience of spoken language, and most implanted children used one implant. Speech and language development and speech perception were the most frequently assessed outcomes. However, some aspects of these outcomes were sparsely represented including voice, communication and pragmatic skills, and speech perception in complex background noise. Two studies compared literacy, two sound localization, one quality of life, and one psychosocial outcomes. None compared educational attainment, listening fatigue, balance, tinnitus, or music perception. CONCLUSIONS This scoping review provides a summary of the literature regarding comparative outcomes of children with severe hearing-loss using acoustic hearing aids and children using cochlear implants. Notable gaps in knowledge that could be addressed in future research includes children's quality of life, educational attainment, and complex listening and language outcomes, such as word and sentence understanding in background noise, spatial listening, communication and pragmatic skills. Clinician awareness of this sparse evidence base is important when making management decisions for children with more residual hearing than traditional implant candidates. This review also provides direction for researchers wishing to strengthen the evidence base upon which clinical decisions can be made.
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Fuentealba Bassaletti C, van Esch BF, Briaire JJ, van Benthem PPG, Hensen EF, Frijns JHM. Saccades Matter: Reduced Need for Caloric Testing of Cochlear Implant Candidates by Joint Analysis of v-HIT Gain and Corrective Saccades. Front Neurol 2021; 12:676812. [PMID: 34262523 PMCID: PMC8273162 DOI: 10.3389/fneur.2021.676812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Video head impulse test (v-HIT) is a quick, non-invasive and relatively cheap test to evaluate vestibular function compared to the caloric test. The latter is, however, needed to decide on the optimal side to perform cochlear implantation to avoid the risk on inducing a bilateral vestibular areflexia. This study evaluates the effectiveness of using the v-HIT to select cochlear implant (CI) candidates who require subsequent caloric testing before implantation, in that way reducing costs and patient burden at the same time. Study Design: Retrospective study using clinical data from 83 adult CI-candidates, between 2015 and 2020 at the Leiden University Medical Center. Materials and Methods: We used the v-HIT mean gain, MinGain_LR, the gain asymmetry (GA) and a newly defined parameter, MGS (Minimal Gain & Saccades) as different models to detect the group of patients that would need the caloric test to decide on the ear of implantation. The continuous model MGS was defined as the MinGain_LR, except for the cases with normal gain (both sides ≥0.8) where no corrective saccades were present. In the latter case MGS was defined to be 1.0 (the ideal gain value). Results: The receiver operating characteristics curve showed a very good diagnostic accuracy with and area under the curve (AUC) of 0.81 for the model MGS. The v-HIT mean gain, the minimal gain and GA had a lower diagnostic capacity with an AUC of 0.70, 0.72, and 0.73, respectively. Using MGS, caloric testing could be avoided in 38 cases (a reduction of 46%), with a test sensitivity of 0.9 (i.e., missing 3 of 28 cases). Conclusions: The newly developed model MGS balances the sensitivity and specificity of the v-HIT better than the more commonly evaluated parameters such as mean gain, MinGain_LR and GA. Therefore, taking the presence of corrective saccades into account in the evaluation of the v-HIT gain can considerably reduce the proportion of CI-candidates requiring additional caloric testing.
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Affiliation(s)
| | - Babette F van Esch
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen J Briaire
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Johan H M Frijns
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden, Netherlands
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