Audiologist perspectives on a regional telehealth model for cochlear implant follow-up care: a qualitative study

Cochlear implantation (CI) is used for rehabilitation of children with bilateral severe to profound sensorineural hearing loss. Recently, treatment of such children has been influenced by diagnostic technological advances. Infants and toddlers are now increasingly included for CI. The primary aim of this study was to determine the effects of 'age at CI' on CI outcome. The primary aim of this study was to determine the effects of 'age at CI' on CI outcome. In this prospective study at a tertiary care centre, we evaluated 50 cochlear implanted children from October 2011 to March 2013. The case group consists of 15 (30%) children who underwent CI at more than 5years of age and control group consisted of 35 (70%) children who underwent CI at less than or equal to 5years age. All patients received auditory and speech rehabilitation and we evaluated their auditory perception outcomes 1year post CI, the children were assessed by categories of auditory performance (CAP) and meaningful auditory integration scale (MAIS) tests. There were significantly improved mean auditory perception outcomes (increase of 12.29% in CAP, and 14.05% in MAIS scores) at 1year post CI in CI recipients of age group '5years or less' in comparison to those who underwent CI at 'more than 5years of age'. However, children of 'more than 5years' age at CI, mean CAP and MAIS scores were still more than 80% of maximum achievable CAP and MAIS scores. In this study, CI recipient children who were implanted at less than or equal to 5years of age were found to have significantly improved auditory perception outcome at 1year post CI. Hence, it appears preferable to provide CI early. However, even in children who underwent CI at more than 5years of age, there was substantial improvement in auditory perception outcomes and CI was still helpful in these children. Hence, knowledge of 'age at CI' can provide reasonable help in predicting the auditory perception outcome and optimal counselling of families of CI candidates.

Impact of room acoustic parameters on speech and music perception among participants with cochlear implants

Objectives − To assess the effect of auditory and speech rehabilitation according to the revised Category of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) score in patients who underwent Cochlear Implant (CI) surgery at a tertiary care centre in Central India.Patients and Methods − This was a retrospective interventional study conducted at the Department of Pediatrics and Otorhinolaryngology of Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, during the period from 2014 to 2018, to assess the hearing and speech of the patients who underwent CI, and was approved by the Institutional Ethical Committee.Results − A total of 114 patients underwent surgery using the mastoidectomy-posterior tympanotomy (MPTA) approach at our centre. Of these, 61 (54%) were males and 53 (47%) were females, with a mean average age of 24.66 months. The number of patients with a right ear defect was 107 (93%) whereas with left ear defect there were only 7 (6%). Six patients were lost to follow-up. The majority of children fell into the 4th category followed by the 2nd category of CAP scoring, and in SIR scoring the majority of children fell into the 4th category, followed by the 3rd and 2ndcategories, which is statistically significant.Conclusion − CI surgery is the gold standard for prelingual deafness. Early detection and early implantation of a CI is highly recommended for patients to enable them to live a healthier life. The study also indicated that early CI reduces the discrepancies between physical and expressive age. The CAP and SIR questionnaires were relevant and apt for assessment of hearing and speech development after CI.

Cochlear implantation (CI) is used in management of children with bilateral severe to profound sensorineural hearing loss (SNHL). Recently, due to technological advancements, more and more infants and toddlers are undertaking the CI. The age at implantation may have an impact on CI outcomes. The primary aim of this study was to determine the long-term impact of 'age at implantation' on Health Related Quality of Life (HRQoL) outcome post-CI. In this prospective study at a tertiary care centre, we evaluated 50 CI recipient children from 2011 to 2018. Group A consisted of 35 (70%) children who received CI at less than or equal to 5years of age and Group B with 15 (30%) children who underwent CI at more than 5years of age. Following CI, all children received auditory-verbal therapy and thereafter we evaluated their long-term HRQoL outcomes at 5years post-CI. Children were assessed by Nijmegen Cochlear Implant Questionnaire (NCIQ) and Children with cochlear implants: parental perspectives-questionnaire (CCIPPQ). There were significantly improved HRQoL outcomes (with an increase of 11.7% in mean NCIQ and 11.4% in mean CCIPPQ scores) at 5years post-CI in CI recipients of age group '5years or less' as compared to those who underwent CI at 'more than 5years' age [P value < 0.05 for both the mean NCIQ scores and mean CCIPPQ scores respectively]. However, for children with 'more than 5years' age at implantation, mean NCIQ and CCIPPQ scores were still more than 80% of maximum achievable NCIQ and CCIPPQ scores. In this study, CI recipient children who were implanted at less than or equal to 5years of age were found to have significantly improved HRQoL outcomes at 5years post-CI. Hence, it seems desirable to provide CI at an early age. However, even in children who received CI at more than 5years of age, there was a substantial enhancement in HRQoL outcomes and CI was still effective in these children. Hence, knowledge of 'age at implantation' may provide reasonable assistance in predicting the HRQoL outcomes and optimal counseling of parents and families of CI candidates.

To identify trends in timing of pediatric cochlear implant (CI) care during COVID-19. Retrospective cohort. Tertiary care center. Patients under 18 years of age who underwent CI between 1/1/2016 and 2/29/2020 were included in the pre-COVID-19 group, and patients implanted between 3/1/2020 and 12/31/2021 comprised the COVID-19 group. Revision and sequential surgeries were excluded. Time intervals between care milestones including severe-to-profound hearing loss diagnosis, initial CI candidacy evaluation, and surgery were compared among groups, as were the number and type of postoperative visits. A total of 98 patients met criteria; 70 were implanted pre-COVID-19 and 28 during COVID-19. A significant increase in the interval between CI candidacy evaluation and surgery was seen among patients with prelingual deafness during COVID-19 compared with pre-COVID-19 (µ = 47.3 weeks, 95% confidence interval [CI]: 34.8-59.9 vs µ = 20.5 weeks, 95% CI: 13.1-27.9; p < .001). Patients in the COVID-19 group attended fewer in-person rehabilitation visits in the 12 months after surgery (µ = 14.9 visits, 95% CI: 9.7-20.1 vs µ = 20.9, 95% CI: 18.1-23.7; p = .04). Average age at implantation in the COVID-19 group was 5.7 years (95% CI: 4.0-7.5) versus 3.7 years in the pre-COVID-19 group (95% CI: 2.9-4.6; p = .05). The time interval between hearing loss confirmation and CI surgery was on average 99.7 weeks for patients implanted during COVID-19 (95% CI: 48.8-150) versus 54.2 weeks for patients implanted pre-COVID (95% CI: 39.6-68.8), which was not a statistically significant difference (p = .1). During the COVID-19 pandemic patients with prelingual deafness experienced delays in care relative to patients implanted before the pandemic.

The objectives of this study are to identify and describe the characteristics of dental underserved geographic areas. Understanding these characteristics is an important step in addressing access to dental care barriers. Dental underserved areas were identified from the Health Resources and Services Administration (HRSA) database and converted to census tracts for analysis. Characteristics of dental underserved geographic areas were compared with areas not designated as underserved. Dental practices included in the Dun & Bradstreet Business information database were geocoded and analyzed according to the underserved designation of their location and census demographic data. Thus, the relationships between dental underserved status, practice, and population characteristics were evaluated. Dental underserved areas are more likely to comprise individuals with lower socio-economic status (income and education levels), higher levels of underrepresented population groups, and have lower population densities than non-underserved areas. The populations living in dental underserved areas are more likely to experience geographic, financial, and educational barriers to dental care. The study identifies the geographic and financial barriers to dental care access. These findings suggest that the likelihood of a market-driven solution to dental underserved geographic areas is low and support public sector interventions to improve the status quo.

Cochlear implantation has become a standard practice for adults with severe to profound hearing loss who demonstrate limited benefit from hearing aids. Despite the substantial auditory benefits provided by cochlear implants, many adults experience difficulty understanding speech in noisy environments and in other challenging listening conditions such as television. Remote microphone technology may provide some benefit in these situations; however, little is known about whether these systems are effective in improving speech understanding in difficult acoustic environments for this population. This study was undertaken with adult cochlear implant recipients to assess the potential benefits of remote microphone technology. The objectives were to examine the measurable and perceived benefit of remote microphone devices during television viewing and to assess the benefits of a frequency-modulated system for speech understanding in noise. Fifteen adult unilateral cochlear implant users were fit with remote microphone devices in a clinical environment. The study used a combination of direct measurements and patient perceptions to assess speech understanding with and without remote microphone technology. The direct measures involved a within-subject repeated-measures design. Direct measures of patients' speech understanding during television viewing were collected using their cochlear implant alone and with their implant device coupled to an assistive listening device. Questionnaires were administered to document patients' perceptions of benefits during the television-listening tasks. Speech recognition tests of open-set sentences in noise with and without remote microphone technology were also administered. Participants showed improved speech understanding for television listening when using remote microphone devices coupled to their cochlear implant compared with a cochlear implant alone. This benefit was documented both when listening to news and talk show recordings. Questionnaire results also showed statistically significant differences between listening with a cochlear implant alone and listening with a remote microphone device. Participants judged that remote microphone technology provided them with better comprehension, more confidence, and greater ease of listening. Use of a frequency-modulated system coupled to a cochlear implant also showed significant improvement over a cochlear implant alone for open-set sentence recognition in +10 and +5 dB signal to noise ratios. Benefits were measured during remote microphone use in focused-listening situations in a clinical setting, for both television viewing and speech understanding in noise in the audiometric sound suite. The results suggest that adult cochlear implant users should be counseled regarding the potential for enhanced speech understanding in difficult listening environments through the use of remote microphone technology.

To report the outcomes on a large series of elderly patients who underwent cochlear implantation (CI) surgery under local anesthesia with conscious sedation (LA-CS). Retrospective chart review on 100 consecutive elderly patients (> 65 years) who underwent CI with LA-CS at a tertiary care center between August 2013 and January 2020. An age-matched control group of 50 patients who underwent CI with general anesthesia (GA) are used for comparison. Outcomes measured included time in the operating room, time in the postanesthesia care unit (PACU), and rate of adverse events. Cochlear implant surgery under LA-CS was successfully performed in 99 (99%) patients. One patient requiring conversion to GA intraoperatively. No patients in the LA-CS group experienced cardiopulmonary adverse events; however, three patients (6%) in the GA group experienced minor events including atrial fibrillation and/or demand ischemia. Overnight observation in the hospital due to postoperative medical concerns or prolonged wake-up from anesthesia was required in one patient (1%) from the LA-CS cohort and 12 patients (24%) from the GA cohort. Perioperative adverse events exclusive to the LA-CS group included severe intraoperative vertigo (8%), temporary facial nerve paresis (3%), and wound infection (1%). The average amount of time spent in the operating room was 37 minutes less for procedures performed under LA-CS compared to GA (P < .05). The average amount of time in recovery was similar for both groups (P > .05). Cochlear implant surgery under LA-CS offers many benefits and is a safe, feasible, and cost-effective alternative to GA when performed by experienced CI surgeons. 3 Laryngoscope, 131:E946-E951, 2021.

Cochlear implant (CI) users frequently complain about speech quality perception (SQP). In patients undergoing cochlear implantation for single-sided deafness, there is concern that poor SQP from the implanted ear will negatively impact binaural (CI + normal hearing [NH]) SQP. In this study, we investigate if binaural SQP is measurably different than unimplanted NH alone. Cross-sectional study. Tertiary care center. Fifteen unilateral CI users with NH in the contralateral ear completed the validated Columbia Speech Quality Instrument. This instrument consists of 9 audio clips rated across 14 specific speech qualities using a 10-point visual analog scale. SQP was assessed in 3 conditions: CI only, NH only, and CI + NH. Median speech quality scores were worse in the CI only condition compared to the NH only (50.0 vs 72.6, P = .0003) and binaural (50.0 vs 71.0, P = .007) conditions. Median speech quality scores were not significantly different between the NH only and binaural conditions (72.6 vs 71, P = .8). Compared to NH, CI speech quality sounded less clear, less natural, and more mechanical. Compared to NH, SQP is poorer with a CI alone. However, in contrast to expectation, there is no significant difference between NH and binaural SQP. This suggests poorer CI speech perception does not negatively impact binaural SQP in patients undergoing cochlear implantation for single-sided deafness.

Objectives: Simultaneous removal and cochlear implantation (CI) have been reported in intralabyrinthine and intracochlear schwannoma. A wide range of postoperative hearing outcomes have been reported after CI in these cases. This study evaluated the outcomes of performing a simultaneous resection of Schwannoma in cochlea and cochlear implantation (CI), aiming to assess the effectiveness of this combined surgical approach for hearing rehabilitation with CI. Methods: This retrospective case series was conducted at a tertiary care center. The study included four consecutive patients with profound sensorineural hearing loss due to a mass inside the cochlea. These patients underwent simultaneous single-sided CI and tumor resection performed by the same surgeon. Preoperative and postoperative audiological assessments were conducted to evaluate the patients' hearing outcomes before and after the surgical intervention. Results: Simultaneous CI with tumor resection was successful in all cases. Two of the four patients had a unilateral tumor, while the other two had a bilateral tumor with the involvement of the internal auditory canal and cerebellopontine angle (neurofibromatosis type 2 (NF2)). In two cases of unilateral tumor, aided free-field pure tone average (PTA) was 26 dB, and 46 dB hearing level (HL), and word recognition score (WRS) at 65 dB was 40% and 68%, respectively, 3 months after surgery. In two cases of tumor with NF2, aided free-field PTA was 36 dB and 60 dB HL, and both cases showed 0% WRS at 65 dB 3 months after surgery. Conclusions: Simultaneous schwannoma excision and CI in patients with Schwannoma inside cochlea are surgically practical and safe. Postoperatively, there was a notable improvement in hearing in cases of sporadic schwannoma, regardless of the type of CI used. However, there was 0% WRS in the two NF2 patients with a mass in the internal auditory canal.

Introduction: Cochlear implantation (CI) is used for rehabilitation of children with bilateral severe-to-profound sensorineural hearing loss. Recently, treatment of such children has been influenced by diagnostic technological advances. Multiple radiological abnormalities detected in temporal bone and brain are now increasingly included for CI. The primary aim of this study was to determine the effects of "radiological abnormalities in temporal bone or brain" on CI outcome. Aim: The primary aim of this study was to determine the effects of "radiological abnormalities in high-resolution computed tomography (HRCT) temporal bone or magnetic resonance imaging (MRI) brain" on CI outcome. Study Design: Prospective study. Setting: Tertiary care center. Materials and Methods: In this study, we evaluated fifty cochlear-implanted children from October 2011 to March 2013. The case group consisted of 15 (30%) children with radiological abnormalities and control group consisted of 35 (70%) children with no radiological abnormalities in HRCT temporal bone or MRI brain. All patients received auditory and speech rehabilitation, and their auditory perception outcomes 1 year after CI were evaluated. The children were assessed by categories of auditory perception (CAP) and Meaningful Auditory Integration Scale (MAIS) tests. Results: There was significant reduction in mean auditory perception outcomes (decreased 6.9% mean CAP and 5.4% mean MAIS scores) at 1 year post-CI in CI recipients who had radiological abnormalities, in comparison to those who had no radiological abnormalities in temporal bone or brain (P < 0.05). Conclusion: In this study, presence of radiological abnormalities in temporal bone or brain was found to have a significant deleterious effect on auditory perception outcome at 1 year after CI surgery in children. However, CI was still helpful in these children. Hence, knowledge of "radiological abnormalities in temporal bone or brain" can provide reasonable help in predicting the auditory perception outcome for CI candidates.

IntroductionPre-operative assessments before cochlear implantation (CI) includes the examination of both tone hearing, and the level of the cochlear reserve indicated by speech understanding. The goal of this study was to explore the predictive influence of tone hearing and cochlear reserve in CI.MethodsWe did a retrospective cohort study, which included adult patients who had undergone CI between January 2012 and December 2019 in a tertiary care center. The pre-operative tone hearing, unaided maximum monosyllabic word recognition score (WRSmax), aided hearing gain, aided monosyllabic word recognition score at 65 dB (WRS65(HA)), and speech perception gap (SPG) were measured. The duration of unaided hearing loss (UHL) was also assessed. These variables were compared with post-operative monosyllabic word recognition score after CI at 65 dB (WRS65(CI)).Results103 patients and 128 ears were included in this study. Regardless of tone hearing, patients with better pre-operative WRSmax and WRS65(HA) performed better post-operatively. WRSmax was found to be the most important factor that was statistically significantly associated with WRS65(CI). SPG was statistically significantly associated with WRSmax and SPG ≥ 20% group performed better post-operatively. Any duration of unaided hearing loss was statistically significantly inversely associated with WRSmax above 0%.ConclusionCochlear reserve represented by WRSmax may play the most important role as a predictive factor in outcomes after CI. SPG should be considered for indicating CI in patients, when WRS65(HA) does not reach WRSmax. Early rehabilitation with hearing aids and duration of hearing aid usage might play an important role in preserving cochlear reserve in adults.

The aim of the study was to evaluate the predictive value regarding postoperative hearing benefit of electrically evoked auditory brainstem response audiometry in sporadic vestibular schwannoma patients undergoing simultaneous tumor resection and cochlear implantation. Patients were included in a prospective study conducted between October 2016 and January 2019. The study was conducted at a tertiary care center. Subjects with unilateral sporadic vestibular schwannoma were screened for study participation. Patients underwent translabyrinthine vestibular schwannoma resection and cochlear implantation simultaneously. Electrically evoked brainstem response audiometry was performed during surgery before and after tumor removal using an intracochlear test electrode to objectively evaluate nerve conduction. Electrically evoked brainstem response audiometry results were correlated with postoperative sound field audiometry, word recognition tests, and speech reception thresholds. Quality of life was assessed before and 12 months after translabyrinthine tumor removal and cochlear implantation. Five patients, three male and two female, were included in the study and followed for at least 1 year after implantation. Three of the five patients are daily cochlear implant users with open set speech recognition. Two individuals with negative intraoperative electrically evoked auditory brainstem response results showed no auditory perception with cochlear implant. Simultaneous translabyrinthine vestibular schwannoma resection and cochlear implantation with intraoperative electrically evoked auditory brainstem response measurements is a feasible and promising option for sporadic vestibular schwannoma patients. Preservation of electrically evoked auditory brainstem responses seems to predict good subsequent hearing outcomes.

Background: The global consensus was established on newborn hearing screening for early identification and management of hearing loss, which is important in minimizing and preventing the negative impact of hearing loss in pediatric population. Aim and Objectives: This study was planned to assess the impact of universal neonatal hearing screening programme (UNHSP) on age of implantation, time takes for the process and candidacy evaluation for cochlear implantation (CI) in children with bilateral congenital profound sensorineural hearing loss (SNHL), who underwent CI at a tertiary care teaching hospital of India. Material and Methods: Children with congenital severe to profound SNHL, who underwent CI after thorough evaluation were included in the study. The date of birth (DOB), date of first hearing screening, date of registration and/or enrollment at the center for further workup and reporting to the CI candidacy committee, date of CI surgery was reviewed retrospectively. Results: A total of 250 children who underwent cochlear implantation at a tertiary care center were included in this study. Out of which, approximately 68% children were screened for hearing loss (HL) through UNHSP, rest of the 32% were not screened for HL during birth due to several reasons. The difference between both the groups with respect to the age of diagnosis of HL and age of cochlear implantation is significant. However, the time taken for the evaluation process was not substantial between both the groups. Conclusion: The implementation of UNHSP has several positive impacts in respect to the age at diagnosis of HL, age at the time of receiving CI and the overall growth of the recipient. So, the UNHSP has several positive impacts with respect to the age at diagnosis of HL, age at the time of receiving CI and the overall growth in children with congenital severe to profound SNHL and the proper execution of this programme is the need of the hour.

Cochlear implantation (CI) is used for rehabilitation of children with bilateral severe to profound permanent childhood hearing loss (PCHL). Recently, treatment of such children has been influenced by diagnostic technological advances. Children with perinatal risk factors associated with PCHL can undergo CI. The primary aim of this study was to determine the effects of 'perinatal risk factor associated with PCHL' on post-CI auditory outcomes. In this prospective study at a tertiary care centre we evaluated 50 cochlear implanted children from October 2011 to March 2013. The case group consisted of 6 (12%) children who had presence of 'perinatal risk factor associated with PCHL' and control group consisted of 44 (88%) children without any 'perinatal risk factor associated with PCHL'. All patients received auditory and speech rehabilitation and we evaluated their auditory perception outcomes by categories of auditory performance (CAP) and meaningful auditory integration scale (MAIS) scores at 1year post-CI. There were significantly decreased mean MAIS scores (decrease of 8.6%) and mean CAP scores (decrease of 6.7%) in CI recipient children with 'perinatal risk factor associated with PCHL' as compared to those who were without any 'perinatal risk factor associated with PCHL' at 1year after CI. However, in children with 'perinatal risk factor associated with PCHL', mean CAP & MAIS scores (auditory perception outcomes) were still more than 80% of maximum achievable CAP & MAIS scores. In this study, CI recipient children who were without any 'perinatal risk factor associated with PCHL' had significantly better mean MAIS & CAP scores (auditory perception outcomes) 1year post-CI. However, even in children who had 'perinatal risk factor associated with PCHL', there was substantial improvement in auditory perception outcomes at 1year post-CI and CI was still helpful in these children. Hence, knowledge of 'perinatal risk factor associated with PCHL' can provide reasonable help in predicting the auditory perception outcome and optimal counselling of families of CI candidates.