Adult Cochlear Implant Patients Research Articles

Changes in Outcomes Expectations During the Cochlear Implant Evaluation Process.

Patient expectations are a critical factor in determining cochlear implant (CI) candidacy. However, minimal data are available on how potential CI recipients develop their expectations and if expectations can be modified by providers. In addition, there is little insight into the resources patients use to inform their decision to undergo implantation. This project aims to assess (1) the role of the CI evaluation (CIE) process on patients' expectations, (2) the extent to which patients' pre-CI outcome expectations can be modified, (3) the information patients use to inform their expectations, and patients' preferences for the discussion/display of potential CI outcomes. Prospective mixed methods study of 32 adult CI patients undergoing CIEs. Outcome measures included: pre-CI Cochlear Implant Quality of Life-35 Profile scores (CIQOL-35 Profile); pre-CIE/post-CIE/day of surgery CIQOL-Expectations scores; post-CIE/day of surgery Decisional Conflict Scale (DCS) scores; and pre-CI aided CNC-word and AzBio sentence scores. Thematic analyses of key informant interviews with 19 potential CI recipients were also performed. In aim 1, CI CIQOL-Expectation domain scores remained essentially unchanged following the CIE when averaged across all participants (d = 0.01 to 0.17). However, changes in expectations were observed for many participants at the individual level. Regarding the second aim, participants with higher pre-CIE expectations showed a decrease in expectations following the CIE for all CIQOL domains except emotional and social (d = -0.27 to -0.77). In contrast, the only significant change in participants with lower expectations was an increase in expectations in the environment score from pre-CIE to the day of surgery (d = 0.76). Expectations remained essentially unchanged or continued to change in the same direction between the post-CIE and the day of surgery, narrowing the gap between participants with higher and lower expectations. Overall, participants demonstrated low overall conflict related to their decision to proceed with cochlear implantation (mean DCS of 11.4 post-CIE and 14.2 at time of surgery out of 100) but DCS scores were higher for participants with lower pre-CIE expectations (d = 0.71). In aim 3, key informant interviews demonstrated no differences between the low- and high expectation cohorts regarding resources used to develop their perception of CI outcomes. Potential CI recipients placed high value in talking with patients who had previously received a CI, and preferred discussing CI functional abilities via clinical vignettes described in the CIQOL Functional Staging System rather than by discussing speech recognition or CIQOL-35 Profile scores. The results of the present study suggest that, although overall expectations averaged across the cohort remained essentially unchanged, individual participants' pre-CI expectations can be modified and there is value in measuring these expectations using the CIQOL-Expectations tool to determine if they are realistic. This information can then be utilized during personalized counseling to present a more accurate representation of likely CI outcomes for each patient. Discussions between potential CI recipients and current CI users may also provide valuable information to inform their expectations. In addition, communicating potential CI benefits using CIQOL functional stages and associated clinical vignettes may result in more realistic patient expectations and support shared decision-making related to CI surgery.

Patient-related outcome measures (PROM) in adult cochlear implant patients

Cochlear implants (CI) provide individuals with severe sensorineural hearing loss the opportunity for artificial auditory perception. The standardized documentation of speech intelligibility tests is widespread, while the systematic capture of patient-related outcome measures (PROMs) remains inconsistent. Relevant PROM instruments were evaluated and selected based on the criteria of dissemination, clarity, and relevance, integrated into routine clinical practice, and tested at longitudinal time points. A total of three PROM instruments were selected and successfully integrated into the clinical routine. The comparison of 2measurement points from 25individuals showed improvements in subjective speech comprehension and tinnitus perception. This study demonstrates the clinical implementation and integration of PROMs in adult CI candidates and patients. The PROMs are apromising tool to support various phases of treatment, both as adecision aid for potential CI candidates and for monitoring after implantation.

Discrepancies Between Expected and Actual Cochlear Implant-Related Functional Outcomes.

Previous research has demonstrated that realistic patient expectations are a critical factor in determining cochlear implant (CI) candidacy. The current study uses the validated Cochlear Implant Quality of Life-Expectations (CIQOL-Expectations) instrument to determine expectations of potential CI users and the degree to which their pre-CI expectations are met after implantation. Prospective cohort study. Tertiary medical center. Sixty adult CI patients. Pre-CI aided and post-CI consonant-nucleus-consonant word and AzBio sentence scores, pre-CI CIQOL-Expectations, and pre-CI and 3/6/12-month post-CI CIQOL-35 Profile scores. Mean pre-CI CIQOL-Expectations exceeded 12-month mean CIQOL-35 Profile scores for the global measure and the communication, environment, and listening effort domains ( d = 0.65-0.97). The communication and listening effort domain scores had the largest discrepancy between expected and actual post-CI improvement (actual scores, 15.1 and 16.3 points lower than expected [ d = 0.93-0.97], respectively). For 42% of patients, pre-CI global expectations exceeded 12-month post-CI CIQOL-35 Profile global scores, 49% met their expectations, and actual scores exceeded expectations for only 10% of patients. Similar patterns were seen for all CIQOL domains except emotional. Post-CI functional abilities seem to fall short of pre-CI expectations for a substantial percentage of CI users, which was most apparent for the communication and listening effort CIQOL domains. These results may help clinicians direct personalized counseling toward common misconceptions, which can aid shared decision making and potentially minimize the mismatch between expected and realized outcomes.Level of Evidence: III.IRB Pro00073019, approved December 20, 2017 (Medical University of South Carolina).

Preliminary Evidence to Support a De-Escalated Cochlear Implant Programming Paradigm for New Adult Recipients: A Systematic Review.

Background: No standard schedule for cochlear implant (CI) programming has been developed, and common practices may have CI recipients seen in excess of what is necessary. The objective of this study was to review evidence for a de-escalated, evidence-based schedule for adult CI programming. Methods: Systematic review was undertaken in March 2023 of PubMed, Scopus, and CINAHL databases using the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if (1) they evaluated an evidence-based programming/follow-up schedule in new adult CI patients or (2) they evaluated programming or outcomes in a longitudinal fashion such that they could inform CI follow-up strategies. Level of evidence was evaluated using the LEGEND evidence assessment tool. Results: Our review identified 940 studies. After screening with a priori inclusion criteria, 18 studies were ultimately included in this review. Of these, 2 demonstrated feasibility of de-escalated approaches to new adult CI programming. The remainder presented longitudinal speech and programming parameter data that demonstrated relative stability of both categories by 3 to 6 months post-activation. Conclusions: Overall, there is a paucity of literature evaluating any form of evidence-based CI programming or follow-up. Most applicable data derive from longitudinal outcomes featured in studies of other CI features, with only a handful of studies directly evaluating CI programming strategies over time. However, stability in outcomes and programming detailed in the available data supports consideration of a de-escalated programming paradigm that could primarily limit programming to the very early post-activation period (before 3 to 6 months) to enhance patient care and reduce operational strains on cochlear implant programs.

Early Datalogging Predicts Cochlear Implant Performance: Building a Recommendation for Daily Device Usage.

To quantify the effect of datalogging on speech recognition scores and time to achievement for a "benchmark" level of performance within the first year, and to provide a data-driven recommendation for minimum daily cochlear implant (CI) device usage to better guide patient counseling and future outcomes. Retrospective cohort. Tertiary referral center. Three hundred thirty-seven adult CI patients with data logging and speech recognition outcome data who were implanted between August 2015 and August 2020. Processor datalogging, speech recognition scores, achievement of "benchmark speech recognition performance" defined as 80% of the median score for speech recognition outcomes at our institution. The 1-month datalogging measure correlated positively with word and sentences scores at 1, 3, 6, and 12 months postactivation. Compared with age, sex, and preoperative performance, datalogging was the largest predictive factor of benchmark achievement on multivariate analysis. Each hour/day increase of device usage at 1 month resulted in a higher likelihood of achieving benchmark consonant-nucleus-consonant and AzBio scores within the first year (odds ratio = 1.21, p < 0.001) as well as earlier benchmark achievement. Receiver operating characteristic curve analysis identified the optimal data logging threshold at an average of 12 hours/day. Early CI device usage, as measured by 1-month datalogging, predicts benchmark speech recognition achievement in adults. Datalogging is an important predictor of CI performance within the first year postimplantation. These data support the recommended daily CI processor utilization of at least 12 hours/day to achieve optimal speech recognition performance for most patients.

Cognitive Assessment in Elderly Cochlear Implant Recipients: Long-Term Analysis.

To examine long-term speech and cognition outcomes in older adult cochlear implant (CI) recipients. First, by evaluating if CI performance was maintained over an extended follow-up period regardless of preoperative cognitive status. Secondly, by evaluating if there was a difference in the rate of cognitive decline between preoperative mild and normal cognition following CI over an extended period of time. Retrospective cohort study. CI recipients ≥65 years of age implanted between 2009 and 2014 with 4+ years follow up. Pre- and postoperative audiometric and speech outcome assessments were collected. Cognitive status was measured using the mini mental status examination (MMSE) at numerous time points. Fifty-three patients met inclusion. Patients were divided into two groups based on preoperative MMSE with scores considered normal (28-30) and those with mildly impaired cognition (MIC, scores 25-27). Audiometric and speech performance improved significantly at one-year post implantation and this was maintained without significant change at 4+ years, regardless of cognitive status. Mixed modeling analysis controlling for age demonstrated no significant difference in the rate of cognitive decline at 4+ years post implantation between the normal cognition cohort (1.74; 95%CI 0.89-2.6) and MIC (2.9; 95%1.91-3.88). Speech performance was significantly improved and sustained after CI in both normal cognition and MIC patients. The rate of cognitive decline in older adult CI patients appears to be similar regardless of preoperative cognitive status. Although results demonstrate rates of cognitive decline following CI did not differ between cognition groups over 4+ years, future studies will need to further investigate this over extended time periods with a more comprehensive cognitive testing battery. 4 Laryngoscope, 133:2379-2387, 2023.

Role of Preoperative Patient Expectations in Adult Cochlear Implant Outcomes.

Preoperative expectations affect patient outcomes in many health conditions, but expectations are rarely assessed in adult cochlear implant (CI) users. This study is a first step in assessing the contribution of preoperative expectations to postoperative CI outcomes, including speech recognition, CI quality of life (CIQOL), and CI satisfaction. Cross-sectional study. Tertiary medical center. Fourty one adult CI patients. Preoperative expectation questionnaire results, pre- and postoperative speech recognition (CNC and AzBio) scores, postoperative CIQOL domain scores and global scores, and CI satisfaction scores using a visual analog scale (VAS). Cohen's d was used to express effect size. Overall, patients with lower preoperative CI performance expectations showed higher postoperative QOL. This effect was large for the emotional, entertainment, and social domains (d = 0.85-1.02) of the CIQOL-35 and medium for the communication, listening effort domains, and the Global score (d = 0.55-0.63). Preoperative performance expectations showed minimal associations with preoperative versus postoperative change in CNC (d = -0.26; -0.69-0.18) or AzBio scores (d = -0.28; -0.72-0.15). Determining the extent to which preoperative expectations played a role in postoperative satisfaction with CIs was limited by the clustering of satisfaction scores in the upper range of the scale (VAS mean 81.1). This study provides preliminary evidence that patients' expectations before cochlear implantation may influence their postoperative quality of life and other outcomes, but not postoperative speech recognition. This suggests that an increased emphasis should be placed on measuring and counseling expectations in CI candidates. This assumption needs to be confirmed with additional research with larger sample sizes, more sensitive satisfaction measures, and a prospective design.

Pupillometry Assessment of Speech Recognition and Listening Experience in Adult Cochlear Implant Patients.

ObjectiveThe aim of the present study was to investigate the pupillary response to word identification in cochlear implant (CI) patients. Authors hypothesized that when task difficulty (i.e., addition of background noise) increased, pupil dilation markers such as the peak dilation or the latency of the peak dilation would increase in CI users, as already observed in normal-hearing and hearing-impaired subjects.MethodsPupillometric measures in 10 CI patients were combined to standard speech recognition scores used to evaluate CI outcomes, namely, speech audiometry in quiet and in noise at +10 dB signal-to-noise ratio (SNR). The main outcome measures of pupillometry were mean pupil dilation, maximal pupil dilation, dilation latency, and mean dilation during return to baseline or retention interval. Subjective hearing quality was evaluated by means of one self-reported fatigue questionnaire, and the Speech, Spatial, and Qualities (SSQ) of Hearing scale.ResultsAll pupil dilation data were transformed to percent change in event-related pupil dilation (ERPD, %). Analyses show that the peak amplitudes for both mean pupil dilation and maximal pupil dilation were higher during the speech-in-noise test. Mean peak dilation was measured at 3.47 ± 2.29% noise vs. 2.19 ± 2.46 in quiet and maximal peak value was detected at 9.17 ± 3.25% in noise vs. 8.72 ± 2.93% in quiet. Concerning the questionnaires, the mean pupil dilation during the retention interval was significantly correlated with the spatial subscale score of the SSQ Hearing scale [r(8) = −0.84, p = 0.0023], and with the global score [r(8) = −0.78, p = 0.0018].ConclusionThe analysis of pupillometric traces, obtained during speech audiometry in quiet and in noise in CI users, provided interesting information about the different processes engaged in this task. Pupillometric measures could be indicative of listening difficulty, phoneme intelligibility, and were correlated with general hearing experience as evaluated by the SSQ of Hearing scale. These preliminary results show that pupillometry constitutes a promising tool to improve objective quantification of CI performance in clinical settings.

An Application of eHealth Technology Toward the Digitization of the Health Records of Older Patients With Cochlear Implants.

Purpose Despite the current legislative indications toward the digitization of patient health records, 80% of health data are unstructured and in a format that cannot be used in electronic archives or in registries of diseases. An innovative automated system is here proposed to efficiently retrieve and digitize clinical information from original unstructured ear, nose, and throat (ENT) medical records, in order to reduce the manual workload in the retrieval and digitization process. Method The system, based on an eHealth technology named cognitive computing, interprets medical reports to transform unstructured clinical data (e.g., narrative text) into a structured digital format. The system has been tailored to handle the reports of aged cochlear implant (CI) patients by digitizing the information typically requested in electronic CI registries and by the current ENT/audiology guidelines. Results were obtained from the reports generated by an outpatient ENT care service from 52 older adult CI patients. Results The system allowed a quick and automated interpretation and retrieval of all the information required, such as the patient's medical history, risk factors, examination outcomes, communicative performances before and after CI implantation, and CI settings. The accuracy of the system in correctly interpreting and retrieving the above information from the original unstructured medical reports was very good (recall = 0.78; precision = 0.95). The system allowed to reduce the time needed to manually digitize the information from 20-30 min/report to only 20 s/report. Conclusion The proposed system is a viable solution for the automated digitization of unstructured health data as recommended by the ENT/audiology clinical best practices.

Development of the Cochlear Implant Quality of Life Item Bank.

Functional outcomes following cochlear implantation have traditionally been focused on word and sentence recognition, which, although important, do not capture the varied communication and other experiences of adult cochlear implant (CI) users. Although the inadequacies of speech recognition to quantify CI user benefits are widely acknowledged, rarely have adult CI user outcomes been comprehensively assessed beyond these conventional measures. An important limitation in addressing this knowledge gap is that patient-reported outcome measures have not been developed and validated in adult CI patients using rigorous scientific methods. The purpose of the present study is to build on our previous work and create an item bank that can be used to develop new patient-reported outcome measures that assess CI quality of life (QOL) in the adult CI population. An online questionnaire was made available to 500 adult CI users who represented the adult CI population and were recruited through a consortium of 20 CI centers in the United States. The questionnaire included the 101 question CIQOL item pool and additional questions related to demographics, hearing and CI history, and speech recognition scores. In accordance with the Patient-Reported Outcomes Measurement Information System, responses were psychometrically analyzed using confirmatory factor analysis and item response theory. Of the 500 questionnaires sent, 371 (74.2%) subjects completed the questionnaire. Subjects represented the full range of age, durations of CI use, speech recognition abilities, and listening modalities of the adult CI population; subjects were implanted with each of the three CI manufacturers' devices. The initial item pool consisted of the following domain constructs: communication, emotional, entertainment, environment, independence, listening effort, and social. Through psychometric analysis, after removing locally dependent and misfitting items, all of the domains were found to have sound psychometric properties, with the exception of the independence domain. This resulted in a final CIQOL item bank of 81 items in 6 domains with good psychometric properties. Our findings reveal that hypothesis-driven quantitative analyses result in a psychometrically sound CIQOL item bank, organized into unique domains comprised of independent items which measure the full ability range of the adult CI population. The final item bank will now be used to develop new instruments that evaluate and differentiate adult CIQOL across the patient ability spectrum.

Intracochlear Electrocochleography: Influence of Scalar Position of the Cochlear Implant Electrode on Postinsertion Results.

Electrocochleography (ECochG) recorded during cochlear implant (CI) insertion from the apical electrode in conjunction with postinsertion ECochG can identify electrophysiologic differences that exist between groups with and without a translocation of the array from the scala tympani (ST) into the scala vestibuli (SV). Translocation of the CI electrode from ST into SV can limit performance postoperatively. ECochG markers of trauma may be able to aid in the ability to detect electrode array-induced trauma/scalar translocation intraoperatively. Twenty-one adult CI patients were included. Subjects were postoperatively parsed into two groups based on analysis of postoperative imaging: 1) ST (n = 14) insertion; 2) SV (n = 7) insertion, indicating translocation of the electrode. The ECochG response elicited from a 500 Hz acoustic stimulus was recorded from the lead electrode during insertion when the distal electrode marker was at the round window, and was compared to the response recorded from a basal electrode (e13) after complete insertion. No statistically significant change in mean ECochG magnitude was found in either group between recording intervals. There was a mean loss of preoperative pure-tone average of 52% for the nontranslocation group and 94% for the translocation group. Intraoperative intracochlear ECochG through the CI array provides a unique opportunity to explore the impact of the CI electrode on the inner ear. Specifically, a translocation of the array from ST to SV does not seem to change the biomechanics of the cochlear region that lies basal to the area of translocation in the acute period.

Brain Plasticity Can Predict the Cochlear Implant Outcome in Adult-Onset Deafness.

Sensory plasticity, which is associated with deafness, has not been as thoroughly investigated in the adult brain as it has in the developing brain. In this study, we examined the brain reorganization induced by auditory deprivation in people with adult-onset deafness and its clinical relevance by measuring glucose metabolism before cochlear implant (CI) surgery. F-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) scans were performed in 37 postlingually deafened patients during the preoperative workup period, and in 39 normal-hearing (NH) controls. Behavioral CI outcomes were measured at 1 year after implantation using a phoneme identification test with auditory cueing only. In the deaf individuals, areas involved in the auditory pathway such as the inferior colliculus and bilateral superior temporal gyri were hypometabolic compared to the NH controls. The hypometabolism observed in the deaf auditory cortices gradually returned to levels similar to the controls as the duration of deafness increased. However, contrary to our previous findings in congenitally deaf children, this metabolic recovery failed to have a significant prognostic value for the recovery of the speech perception ability in adult CI patients. In a broad occipital area centered on the primary visual cortices, glucose metabolism was higher in the deaf patients than the controls, suggesting that the area had become visually hyperactive for sensory compensation immediately after the onset of deafness. In addition, a negative correlation between the metabolic activity and behavioral speech perception outcomes was observed in the visual association areas. In the medial frontal cortices, cortical metabolism in most patients decreased, but patients who had preserved metabolic activities showed better speech performance. These results suggest that the auditory cortex in people with adult-onset deafness is relatively resistant to cross-modal plasticity, and instead, individual traits in late-stage visual processing and cognitive control seem to be more reliable prognostic markers for adult-onset deafness.

Revisional Cochlear Implant Surgeries in Adults

Introduction: Cochlear implant (CI) surgery allows hearing reestablishment among individuals with severe to profound hearing loss. However, only few patients will need a surgical reassessment. Objectives: To verify the incidence of surgical reassessment among adult patients; to verify the reasons that led the second surgery to be performed; to verify the efficacy—and audiological outcomes—of revisional surgery. Method: A longitudinal retrospective cohort study was carried out with the review of medical records, of adult patients, with bilateral severe to profound sensorineural hearing loss who underwent to revisional surgery, from 2004 to 2016 at a CI Center, in Brazil. Results: One hundred fifty-eight CI surgeries were performed among 137 adult patients. Fourteen revisional surgeries were performed among 10 patients: five surgeries were due by displacement of the internal unit; one because of having excessive subcutaneous tissue; one due to non-progression of the electrodes during the initial surgery, one late tympanic membrane perforation, one late facial palsy and, one due to a suture dehiscence in the surgical incision with exposure of the internal unit. Conclusions: The incidence of surgical reassessment among adult CI patients was 8.9%. All implanted patients that underwent a new surgical approach maintained an improved auditory threshold after revisional CI surgery.

Interaction between speech variations and background noise on speech intelligibility by Mandarin-speaking cochlear implant patients

Cochlear implant (CI) users have been shown to be more susceptible to the variations in speech production encountered in everyday listening, in which speaking rate, amplitude, duration, and voice pitch information may be quite variable, depending on the production context. Such variations may be further enlarged by the background noise, especially dynamic noise. The limited spectral resolution provided by the CI limits perception of voice pitch, which is an important cue for speech prosody and for tonal languages such as Mandarin Chinese. In this study, the effect of varying speaking rates and styles and background noise on speech understanding was investigated in Mandarin-speaking CI and normal-hearing (NH) listeners. Thirteen (5 male and 8 female, age 19–62 years) Mandarin-speaking, post-lingually deafened adult CI patients using their clinical processors and 9 (5 male and 4 female, age 23–59 years) NH subjects listening to unprocessed speech. Five different types of speech variations, including 3 speaking rates (slow, normal, fast) and 2 speaking styles (emotional, shouted) were presented with two masking noises (speech-shaped steady state noise-SSN or six-talker babble). Speech reception threshold, defined as the signal-to-noise ratio producing 50% correct word-in-sentence recognition using Mandarin Speech Perception materials was measured. NH listeners performed significantly better (16.7 dB) than CI patients across all conditions regardless of speech variations and noise types. CI patients’ performance deficit was highly dependent on speech rate and noise type; the deficit was smallest (11.7 dB) when slowly-spoken speech was presented in SSN and largest (20.6 dB) when shouted speech was presented in six-talker speech babble. NH listeners performed significantly better in speech babble than in SSN for all speech variations, while CI patients performed similarly in both noise types. The use of clear and slowly-spoken speech in the laboratory setting may largely underestimate CI patients’ performance deficits in real-world listening conditions, where acoustic variations introduced by speech variations and dynamic noise may present additional challenges.

Cortical reorganization after cochlear implantation for adults with single-sided deafness.

BackgroundAdults with single sided deafness (SSD) have lost binaural function, which limits sound source localization, speech understanding in noise, and quality of life. For SSD patients, restoration of bilateral auditory input is possible only with a cochlear implant (CI). In this study, cortical auditory evoked potentials (CAEPs) and behavioral performance were measured in left-implanted (SSD-CI-L) and right-implanted (SSD-CI-R) patients before and after cochlear implantation. We hypothesized that improvements in behavioral performance would be accompanied by changes in CAEPs after cochlear implantation.DesignProspective longitudinal study.SettingTertiary referral center.MethodNine right-handed adult SSD CI patients participated in the study. CAEPs were recorded before cochlear implantation and at 6 and 12 months post-implantation. CAEPs were elicited using speech stimuli (/ba/) delivered in sound field at 70 dBA. Global field power (GFP) latency and amplitude were calculated for P1, N1 and P2 peaks at each test session. CAEP were analyzed at frontocentral (Cz) and temporal (P7, P8, T7 and T8) and mastoid electrodes (M1 and M2) contralateral to the CI ear. Behavioral measures (sentence recognition in noise, with and without spatial cues) were collected at the same test sessions as for CAEPs. Speech performance and CAEPs were also measured in a control group of normal-hearing (NH) subjects.ResultsWhile increased N1 amplitude was observed in the scalp potential maps for GFP and Cz for SSD-CI-L patients after implantation, the changes were not statistically significant. Peak CAEP amplitude at electrodes to contralateral to the CI ear increased after cochlear implantation for all SSD-CI patients, but significant increases were observed only for mastoid sites. Peak latencies for some components at temporal and mastoid sites remained significantly longer than for the NH control group, even after cochlear implantation. For SSD-CI-R patients, P2 peak amplitude for baseline GFP and Cz was significantly lower than for the NH control group. A significant improvement for speech understanding in noise was observed at 12 months post-implantation when speech was presented to the CI ear and noise to the non-implanted ear.ConclusionAfter cochlear implantation, speech understanding significantly improved when speech and noise were spatially separated. The increased N1 amplitude for SSD-CI-L patients and the increased bilateral activation for all SSD-CI patients may reflect cortical reorganization and restoration of binaural function after one year of experience with the CI. However, because of the limited number of SSD patients, significant changes in cortical activity after cochlear implantation were often difficult to observe.

Assessing Cochlear Implant Outcomes in Older Adults Using HERMES: A National Web-based Database.

Cochlear implant (CI) outcomes research has been largely limited to retrospective or single-institution studies in the United States. The objective is to demonstrate the feasibility of using a novel, national, web-based CI database through evaluating CI outcomes in older adults. Analysis of a prospective, national, web-based database designed for CI outcome tracking (HERMES; HIPAA-secure, Encrypted, Research Management and Evaluation Solution). Multi-centered at 18 private practice and academic US medical centers. Older (age ≥75, n = 47) or younger (age <75, n = 103) adult CI patients (n = 150 total, n = 160 ears). Arizona Biomedical (AzBio), CI usage, postoperative complications. Older adults had slightly lower performance on most recent AzBio (56.0%, n = 26, 12.2 ± 6.5 mo postoperatively) compared with younger adults (74.0%, n = 52, 12.6 ± 6.5 mo postoperatively; p < 0.01, Mann-Whitney). However, on multiple regression, age was not a significant predictor of AzBio scores after controlling for sex, hearing loss duration, use, and postoperative follow-up duration. Most recent CI use was similar but significantly different (11.4 h/d in older, n = 24 versus 13.0 in younger, n = 45; p = 0.01). Usage also did not decline over time (p = 0.81 in older versus p = 0.46, in younger). The most common complications were similar (vertigo 25 versus 20%, p = 0.45; tinnitus 4 versus 4%, p = 0.93) in older and younger adults, respectively. We demonstrate the feasibility of a novel user-friendly, web-based, national CI database to analyze CI outcomes. Older age was not a significant predictor of AzBio scores after adjusting for multiple factors. Additionally, CI use did not decline over time.

Use of Adult Patient Focus Groups to Develop the Initial Item Bank for a Cochlear Implant Quality-of-Life Instrument

No instrument exists to assess quality of life (QOL) in adult cochlear implant (CI) users that has been developed and validated using accepted scientific standards. To develop a CI-specific QOL instrument for adults in accordance with the Patient Reported Outcomes Measurement Information System (PROMIS) guidelines. As required in the PROMIS guidelines, patient focus groups participated in creation of the initial item bank. Twenty-three adult CI users were divided into 1 of 3 focus groups stratified by word recognition ability. Three moderator-led focus groups were conducted based on grounded theory on December 3, 2016. Two reviewers independently analyzed focus group recordings and transcripts, with a third reviewer available to resolve discrepancies. All data were reviewed and reported according to the Consolidated Criteria for Reporting Qualitative Research. The setting was a tertiary referral center. Coded focus group data. The 23 focus group participants (10 [43%] female; mean [range] age, 68.1 [46.2-84.2] years) represented a wide range of income levels, education levels, listening modalities, CI device manufacturers, duration of CI use, and age at implantation. Data saturation was determined to be reached before the conclusion of each of the focus groups. After analysis of the transcripts, the central themes identified were communication, emotion, environmental sounds, independence and work function, listening effort, social isolation and ability to socialize, and sound clarity. Cognitive interviews were carried out on 20 adult CI patients who did not participate in the focus groups to ensure item clarity. Based on these results, the initial QOL item bank and prototype were developed. Patient focus groups drawn from the target population are the preferred method of identifying content areas and domains for developing the item bank for a CI-specific QOL instrument. Compared with previously used methods, the use of patient-centered item development for a CI-specific QOL instrument will more accurately reflect patient experience and increase our understanding of how CI use affects QOL.

Effects of Within-Talker Variability on Speech Intelligibility in Mandarin-Speaking Adult and Pediatric Cochlear Implant Patients.

Cochlear implant (CI) speech performance is typically evaluated using well-enunciated speech produced at a normal rate by a single talker. CI users often have greater difficulty with variations in speech production encountered in everyday listening. Within a single talker, speaking rate, amplitude, duration, and voice pitch information may be quite variable, depending on the production context. The coarse spectral resolution afforded by the CI limits perception of voice pitch, which is an important cue for speech prosody and for tonal languages such as Mandarin Chinese. In this study, sentence recognition from the Mandarin speech perception database was measured in adult and pediatric Mandarin-speaking CI listeners for a variety of speaking styles: voiced speech produced at slow, normal, and fast speaking rates; whispered speech; voiced emotional speech; and voiced shouted speech. Recognition of Mandarin Hearing in Noise Test sentences was also measured. Results showed that performance was significantly poorer with whispered speech relative to the other speaking styles and that performance was significantly better with slow speech than with fast or emotional speech. Results also showed that adult and pediatric performance was significantly poorer with Mandarin Hearing in Noise Test than with Mandarin speech perception sentences at the normal rate. The results suggest that adult and pediatric Mandarin-speaking CI patients are highly susceptible to whispered speech, due to the lack of lexically important voice pitch cues and perhaps other qualities associated with whispered speech. The results also suggest that test materials may contribute to differences in performance observed between adult and pediatric CI users.

Comparing the Performance Plateau in Adult Cochlear Implant Patients Using HINT and AzBio

This study aims to characterize the performance plateau in adult cochlear implant recipients after the initial postimplantation increase by using word recognition testing and an explicit definition of performance plateau. Retrospective review. Urban, tertiary referral center. One hundred twenty-five patients with 138 devices tested with AzBio were matched to 130 patients with 138 devices tested with HINT based on performed on CNC monosyllable tests. Patient's performance was measured overtime using AzBio and HINT tests to determine when and at what score their performance reached a plateau. Time from implantation to reach a performance plateau and plateau score with each test. Thirty-four devices reached a HINT plateau and 30 devices reached an AzBio plateau. Patients reached plateaus at similar times postoperatively using HINT and AzBio, 18.8 and 16.5 weeks, respectively (p = 0.476). Five patients tested with HINT plateaued at scores of 99% to 100%, whereas no patients plateaued above 92% with AzBio. Patients reached a plateau in performance at similar median times using AzBio and HINT, despite the ceiling effect of HINT in some patients. Most patients who reach a plateau did so within 4 months, but exactly when and if a patient's performance plateaus varies significantly among individuals. Further study is required to determine which test best reflects when a patient reaches his or her maximal performance in natural listening conditions.

Refractory effects of the N1 event-related potential in experienced cochlear implant patients

Objective: To determine if cochlear implant (CI) patients exhibit a temporal processing deficit for auditory stimuli, by examining refractory effects of the N1 event-related potential (ERP) component. Design: CI patients and normally-hearing controls were tested in an auditory refractory period paradigm while ERP recordings were collected across the scalp. Participants were presented with brief 500-Hz tones that were separated by inter-stimulus intervals (ISIs) of 500, 1000, or 3000 ms. The amplitude of the N1 was examined as a function of ISI within each group. Study sample: Ten adult CI patients and 13 age-matched normally-hearing controls were tested. Patients had long-lasting severe or profound sensorineural hearing loss prior to implantation, and a minimum of two years experience with CI activation. Results: Unlike normally-hearing controls, CI users showed no refractory effect for tones at 500 ms ISIs compared to 1000 ms. However, similar to controls, recovery from refractoriness was observed in anterior locations at 3000 ms. Conclusion: The refractory period threshold, defined as the minimum ISI where different N1 amplitudes are elicited, is greater than 1000 ms in CI patients; at least double that of normally-hearing controls.