Candidates For Cochlear Implantation Research Articles

The Effect of Bimodal Hearing on Post-Operative Quality of Life.

To examine how bimodal stimulation affects quality of life (QOL) during the post operative period following cochlear implantation (CI). This data could potentially provide evidence to encourage more bimodal candidates to continue hearing aid (HA) use after CI. In this prospective study, patients completed preoperative, and 1-, 3- and 6-months post-activation QOL surveys on listening effort, speech perception, sound quality/localization, and hearing handicap. 15 HA users who were candidates for contralateral CI completed the study (mean age 65.6 years). Patients used both devices a median rate of 97%, 97% and 98% of the time at 1, 3, and 6 months respectively. On average, patients' hearing handicap score decreased by 16% at 1 month, 36% at 3 months, and 30% at 6 months. Patients' listening effort scores decreased by a mean of 10.8% at 1 month, 12.6% at 3 months and 18.7% at 6 months. Localization improved by 24.3% at 1 month and remained steady. There was no significant improvement in sound quality scores. Bimodal listeners should expect QOL to improve, and listening effort and localization is generally optimized using CI and HA compared to CI alone. Some scores improved at earlier time points than others, suggesting bimodal auditory skills may develop at different rates.

Vestibular Hypofunction Screening in Older Cochlear Implant Candidates.

Vestibular loss is associated with increasing age and hearing loss. Cochlear implantation (CI) may be performed in these patients; however, CI can induce vestibular hypofunction (VH) postoperatively. If CI is performed in the "better balancing ear," patients may experience vestibulopathy from new bilateral VH. The objective of this study was to evaluate the rates of VH in older CI candidates, thereby helping to identify patients at increased risk for bilateral VH after CI. Retrospective cohort study from 2019 to 2022 of patients age 60 to 80 years old who underwent videonystagmography (VNG). Tertiary care neurotology practice. VNG, including spontaneous nystagmus, cervical vestibular evoked myogenic potential (cVEMP), caloric stimulation, and rotary chair, was reviewed and stratified by CI candidacy. Patients with prior CI or known vestibular diagnosis were excluded. Thirty-three patients were CI candidates and 184 patients were controls. cVEMP demonstrated a significantly greater rate of unilateral VH in CI candidates (P = .018). Caloric stimulation demonstrated an elevated rate of bilateral VH and presbyvestibulopathy in CI candidates (P = .057 and P = .036, respectively). Rotary chair demonstrated a significantly higher rate of bilateral VH and incomplete vestibular compensation based on reduced gain and gain asymmetry, respectively, in CI candidates (P < .001 and P = .043, respectively). Mean bithermal slow phase velocity sum and rotary chair gain were significantly lower in the CI candidate group (P = .002 and P < .001, respectively). Preoperative identification of VH determined the side of implantation in 4 patients (15%). VH and incomplete vestibular compensation are common and more frequently seen in CI candidates compared to age-matched controls. Vestibular screening can play a role in surgical counseling and planning, and should be considered in older patients undergoing CI.

Clinical Practice Guideline: Age-Related Hearing Loss Executive Summary.

Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with an explanation of the support in the literature, the evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the Guideline Development Group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life. (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related quality of life at a subsequent health care encounter or within 1 year. The GDG offered the following KASas an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.

The (in)visibility of deafness: Identity, stigma, quality of lifeand the potential role of totally implantable cochlear implants.

The disclosure of deafness is complex, given the historic and on-going stigma associated with being deaf. The aim of this study was to explore how identity, stigma, and quality of life may be impacted when using cochlear implants (CIs) and totally implantable cochlear implants (TICIs). The physical difference between these two assistive listening devices is significant, given many CI users opt to hide their sound processor behind hair or headwear, in contrast to TICIs (an emerging technology) whereby all components are implanted internally and thus invisible. This qualitative study involved semistructured interviews and demographic questionnaires with 12 adult participants with more than 1 year of experience using their CI. Participants were recruited Australia-wide through community organisations that support deaf and hard-of-hearing individuals. Interview transcripts were analysed thematically, with the themes generated through an inductive process, with consensus generated through group working with three members from the research team. Four major themes were identified: (1) CI challenges; (2) The importance of social and support networks; (3) Identity and disclosure and (4) Concerns about TICIs. The underlying finding was centred around the construction of deaf identity. Participant attitudes were generally categorised as 'Loud and proud', with the recognition that displaying the CI was an extension of self, something to be proud of, and a means to normalise deafness; or 'Out of sight and out of mind', which sought to minimise the visibility of deafness. While both identities differed in how deafness is disclosed, they are fundamentally related to the same ideas of self-agency and empowerment. TICIs present a novel opportunity-the ability for CI users to control the visibility of their deafness and thus control disclosure. This study explored the impact of stigma and categorised two core identities that CI users construct. Future directions include investigating potential CI candidates, to explore if TICIs may be a facilitator to CI uptake. The semistructured interview guide was developed in consultation with adults with CIs. Feedback led to adjustments and improvement to the interview guide. In addition, F. R. has a lived experience with hearing loss, and C. Y. L. is an executive committee member for a nonprofit charity organisation that supports families that are D/deaf and hard-of-hearing.

Changes in visually and auditory attended audiovisual speech processing in cochlear implant users: A longitudinal ERP study

Limited auditory input, whether caused by hearing loss or by electrical stimulation through a cochlear implant (CI), can be compensated by the remaining senses. Specifically for CI users, previous studies reported not only improved visual skills, but also altered cortical processing of unisensory visual and auditory stimuli. However, in multisensory scenarios, it is still unclear how auditory deprivation (before implantation) and electrical hearing experience (after implantation) affect cortical audiovisual speech processing.Here, we present a prospective longitudinal electroencephalography (EEG) study which systematically examined the deprivation- and CI-induced alterations of cortical processing of audiovisual words by comparing event-related potentials (ERPs) in postlingually deafened CI users before and after implantation (five weeks and six months of CI use). A group of matched normal-hearing (NH) listeners served as controls. The participants performed a word-identification task with congruent and incongruent audiovisual words, focusing their attention on either the visual (lip movement) or the auditory speech signal. This allowed us to study the (top-down) attention effect on the (bottom-up) sensory cortical processing of audiovisual speech.When compared to the NH listeners, the CI candidates (before implantation) and the CI users (after implantation) exhibited enhanced lipreading abilities and an altered cortical response at the N1 latency range (90–150 ms) that was characterized by a decreased theta oscillation power (4–8 Hz) and a smaller amplitude in the auditory cortex. After implantation, however, the auditory-cortex response gradually increased and developed a stronger intra-modal connectivity. Nevertheless, task efficiency and activation in the visual cortex was significantly modulated in both groups by focusing attention on the visual as compared to the auditory speech signal, with the NH listeners additionally showing an attention-dependent decrease in beta oscillation power (13–30 Hz).In sum, these results suggest remarkable deprivation effects on audiovisual speech processing in the auditory cortex, which partially reverse after implantation. Although even experienced CI users still show distinct audiovisual speech processing compared to NH listeners, pronounced effects of (top-down) direction of attention on (bottom-up) audiovisual processing can be observed in both groups. However, NH listeners but not CI users appear to show enhanced allocation of cognitive resources in visually as compared to auditory attended audiovisual speech conditions, which supports our behavioural observations of poorer lipreading abilities and reduced visual influence on audition in NH listeners as compared to CI users.

Cochlear implantation in patients with Streptococcus suis meningitis: clinical characteristics and postoperative evaluation

Background Hearing loss is a common sequala of Streptococcus suis (S. suis) meningitis, but few have addressed cochlear implantation (CI) candidates with S. suis meningitis. Objectives To assess the clinical characteristics and CI postoperative outcomes in S. suis meningitis patients. Material and methods Eight S. suis meningitis patients underwent CI at Sun Yat-sen Memorial Hospital between 2020 and 2023. Control groups included (1) non-Suis meningitis patients (n = 12) and (2) non-meningitis patients (n = 35). Electrode impedances and neural response telemetry (NRT) thresholds were recorded at one month after surgery. The auditory performance-II (CAP) and speech intelligibility rating (SIR) were recorded at the last visit. Results CAP scores of S. suis meningitis patients were significantly lower than those of non-Suis meningitis and non-meningitis patients (p = .019; p<.001). And NRT thresholds of S. suis meningitis patients were higher than those of non-Suis meningitis and non-meningitis patients (p = .006; p = .027). Conclusions and significance It is recommended for S. suis meningitis CI candidates to undergo CI promptly after controlling infection, preferably within four to six weeks. CI users with S. suis meningitis tend to exhibit suboptimal hearing rehabilitation outcomes, possibly associated with the more severe damage on spiral ganglion cells after S. suis meningitis.

"To implant or not to implant": electrically evoked auditory brainstem response audiometry for decision-making in vestibular schwannoma resection with CI.

Vestibular schwannomas (VS) are often associated with debilitating hearing loss. Therefore, preservation and rehabilitation of hearing have become major therapeutic goals of VS management. Recently, cochlear implantation (CI) has been established as an effective treatment option for VS-associated hearing loss. Nevertheless, the integrity and proper function of the cochlear nerve must be evaluated before conducting CI to ensure optimal CI outcomes. Various methods to determine cochlear nerve integrity and functionality have emerged in the last few years. Of these, the use of electrically evoked auditory brainstem response audiometry (eABR) in particular has been proven to be ameaningful tool for monitoring cochlear nerve health during VS surgery. Here, the cochlear nerve can be electrically stimulated using an intracochlear test electrode before, during, and after tumor extirpation. Subsequently, the resulting brainstem responses can be measured and interpreted accordingly to obtain direct information on the cochlear nerve function. This allows for continuous monitoring of cochlear nerve function throughout the course of VS surgery and aids in the decision-making for CI candidacy. Finally, in the case of preserved brainstem responses, CI can be performed instantly after VS extirpation. This simultaneous approach offers several advantages over two-staged procedures and has been shown to be an efficient and safe procedure for restoring hearing after VS removal.

Impact of unilateral vs. bilateral evaluation on cochlear implant candidacy

Background The indication criteria for cochlear implantation differ considerably across regions. Objectives To estimate the effects of different candidacy criteria on the number of cochlear implant (CI) candidates. Methods We analysed a very large clinical audiological database comprising pure-tone thresholds and speech-audiometric data in order to identify CI candidates on the basis of different audiometric candidacy criteria. In particular, we simulated the effects of three different CI candidacy criteria. Results The bilateral evaluation of CI candidacy has the strongest influence on the number of potential CI candidates. Additionally, the cut-off criteria for middle-ear implants have a large effect on numbers of candidates when air conduction has deteriorated. Conclusions and Significance: Expanding the indication criteria opens up the possibility of improving the accurate identification of individual cases suitable for cochlear-implant provision.

Application of Genetic Information to Cochlear Implantation in Clinical Practice.

Cochlear implantation is currently the treatment of choice for children with severe-to-profound sensorineural hearing impairment (SNHI). However, the outcomes with cochlear implant (CI) vary significantly among recipients. Genetic diagnosis offers direct clues regarding the pathogenesis of SNHI, which facilitates the development of personalized medicine for potential candidates for CI. In this article, I present a comprehensive overview of the usefulness of genetic information in clinical decision-making for CI. Genetically confirmed diagnosis enables clinicians to: 1) monitor the evolution of SNHI and determine the optimal surgical timing, 2) predict the potential benefits of CI in patients with identified genetic etiology, and 3) select CI devices/electrodes tailored to patients with specific genetic mutations.

Intraoperative assessment of cochlear nerve functionality in various vestibular schwannoma scenarios: Lessons learned

The use of cochlear implants (CIs) is on the rise for patients with vestibular schwannoma (VS). Besides CI following tumor resection, new scenarios such as implantation in observed and/or irradiated tumors are becoming increasingly common. A significant emerging trend is the need of intraoperative evaluation of the functionality of the cochlear nerve in order to decide if a CI would be placed. The purpose of this paper is to explore the experience of a tertiary center with the application of the Auditory Nerve Test System (ANTS) in various scenarios regarding VS patients. The results are compared to that of the studies that have previously used the ANTS in this condition.Patients with unilateral or bilateral VS (NF2) who were evaluated with the ANTS prior to considering CI in a tertiary center between 2021 and 2023 were analyzed. The presence of a robust wave V was chosen to define a positive electrical auditory brainstem response (EABR). Two patients underwent promontory stimulation (PromStim) EABR previous to ANTS evaluation.Seven patients, 2 NF-2 and 5 with sporadic VS were included. The initial scenario was simultaneous translabyrinthine (TL) tumor resection and CI in 3 cases while a CI placement without tumor resection was planned in 4 cases. The ANTS was positive in 4 cases, negative in 2 cases, and uncertain in one case. Two patients underwent simultaneous TL and CI, 1 patient simultaneous TL and auditory brainstem implant, 3 patients posterior tympanotomy with CI, and 1 patient had no implant placement. In the 5 patients undergoing CI, sound detection was present. There was a good correlation between the PromStim and ANTS EABR. The literature research yielded 35 patients with complete information about EABR response. There was one false negative and one false positive case; that is, the 28 implanted cases with a present wave V following tumor resection had some degree of auditory perception in all but one case.The ANTS is a useful intraoperative tool to asses CI candidacy in VS patients undergoing observation, irradiation or surgery. A positive strongly predicts at least sound detection with the CI.

Auditory Outcomes Following Cochlear Implantation in Children with Unilateral Hearing Loss.

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. Retrospective case series. Three tertiary-level, academic institutions. Children <18 years with UHL who underwent CI between 2018 and 2021. Cochlear implantation. 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. 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. 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.

Awareness of Health Professionals about Candidacy of Cochlear Implant

Background: Cochlear implants serve as a transformative solution for individuals with sensorineural hearing loss, particularly benefiting children aged 12-24 months with bilateral profound deafness who find little to no benefit from traditional hearing aids. This advanced auditory technology converts acoustic signals into electrical stimuli, directly stimulating the auditory nerve and thereby providing an essential hearing function. The determination of candidacy for cochlear implants is a collaborative process involving ENT specialists, audiologists, and speech and language pathologists. These devices significantly impact the lives of profoundly deaf individuals by offering a means to access sound and develop communication skills, crucial for their integration into a hearing world.&#x0D; Objective: To assess the awareness of health professionals about candidacy of cochlear implant.&#x0D; Methods: This cross-sectional study was meticulously designed, adhering to standardized protocols for data collection and analysis to enhance the reliability and validity of findings. The research unfolded in various government and private hospitals across Lahore, focusing on a specific cohort of health professionals—ENT specialists and speech and language pathologists. A total of 55 participants, both male and female, aged between 29 to 52 years, were systematically selected through non-probability convenience sampling. The assessment of awareness among these professionals regarding the candidacy for cochlear implants was conducted using a carefully structured pediatric checklist. This tool encompassed multiple items directly relating to the core candidacy criteria, ensuring a comprehensive evaluation of professional knowledge and awareness. The analysis was performed using statistical methods appropriate for cross-sectional data, aiming to draw meaningful insights from the responses collected.&#x0D; Results: The study's participant pool consisted of 24 ENT specialists (43.6%) and 31 speech and language pathologists (56.4%), highlighting a diverse representation of the field. Among these professionals, a significant discrepancy in awareness was observed. Those who had practical experience working in cochlear implant centers demonstrated a higher level of awareness, with nuanced understanding of both audiometric and speech-based candidacy criteria. Conversely, participants lacking this practical exposure showed considerable gaps in their knowledge, particularly in applying these criteria to pediatric cases. The numerical data revealed that only a fraction of the respondents could accurately identify all key candidacy indicators, underscoring the need for targeted educational interventions.&#x0D; Conclusion: The findings of this study underline a palpable deficiency in the awareness and understanding of cochlear implant candidacy criteria among ENT specialists and speech and language pathologists. Despite the critical role these professionals play in the identification and management of potential implant candidates, a notable portion exhibited limited knowledge, especially in aspects beyond their immediate field of expertise. This gap was more pronounced among those without direct experience in cochlear implant centers, suggesting that hands-on involvement significantly contributes to a deeper comprehension of candidacy nuances. Therefore, there is an urgent need for comprehensive training programs and continued professional development opportunities to bridge these knowledge gaps, ensuring that all children who could benefit from cochlear implants are accurately identified and referred.

Predicting Early Cochlear Implant Performance: Can Cognitive Testing Help?

There is significant variability in speech recognition outcomes in adults who receive cochlear implants (CIs). Little is known regarding cognitive influences on very early CI performance, during which significant neural plasticity occurs. Prospective study of 15 postlingually deafened adult CI candidates tested preoperatively with a battery of cognitive assessments. The mini-mental state exam (MMSE), forward digit span, Stroop measure of inhibition-concentration, and test of word reading efficiency were utilized to assess cognition. consonant-nucleus-consonant words, AZBio sentences in quiet, and AZBio sentences in noise (+10 dB SNR) were utilized to assess speech recognition at 1- and 3-months of CI use. Performance in all speech measures at 1-month was moderately correlated with preoperative MMSE, but these correlations were not strongly correlated after correcting for multiple comparisons. There were large correlations of forward digit span with 1-month AzBio quiet (P ≤ 0.001, rho = 0.762) and AzBio noise (P ≤ 0.001, rho = 0.860), both of which were strong after correction. At 3 months, forward digit span was strongly predictive of AzBio noise (P ≤ 0.001, rho = 0.786), which was strongly correlated after correction. Changes in speech recognition scores were not correlated with preoperative cognitive test scores. Working memory capacity significantly predicted early CI sentence recognition performance in our small cohort, while other cognitive functions assessed did not. These results differ from prior studies predicting longer-term outcomes. Findings and further studies may lead to better preoperative counseling and help identify patients who require closer evaluation to ensure optimal CI performance.

Listening-Related Fatigue in New and Experienced Adult Cochlear Implant Users.

Active listening in everyday settings is challenging and requires substantial mental effort, particularly in noisy settings. In some cases, effortful listening can lead to significant listening-related fatigue and negatively affect quality of life. However, our understanding of factors that affect the severity of fatigue is limited. Hearing aids and cochlear implants (CIs) can improve speech understanding and thus, potentially, reduce listening effort and fatigue. Some research supports this idea for adult hearing aid users with mild-to-moderate hearing loss, but similar work in CI users is very limited. This study examined (1) longitudinal changes in listening-related fatigue in new and established CI users, and (2) relationships between demographic and audiologic factors and preimplantation and postimplantation listening-related fatigue. Participants included an experimental group of 48 adult CI candidates receiving either a unilateral implant (n = 46) or simultaneous, bilateral implants (n = 2) and a control group of 96 experienced (>12 months experience) adult CI users (50 unilateral, 46 bilateral). Listening-related fatigue was evaluated using the 40-item version of the Vanderbilt Fatigue Scale for Adults. Experimental group ratings were obtained before implantation and again at 0.5-, 1-, 2-, 3-, 6-, and 12-month(s) postactivation. Control group participants completed the scale twice-upon study entry and approximately 3 months later. Additional measures, including a social isolation and disconnectedness questionnaire, hearing handicap inventory, and the Effort Assessment Scale, were also administered at multiple time points. The role of these measures and select demographic and audiologic factors on preimplant and postimplant fatigue ratings were examined. Adult CI candidates reported significantly more fatigue, greater self-perceived hearing handicap, greater listening effort, and more social isolation than experienced adult CI users. However, significant reductions in fatigue and effort were observed within 2 weeks postimplantation. By 3 months, there were no significant differences in fatigue, effort, hearing handicap, or social isolation between new CI recipients and experienced CI users. Secondary analyses revealed that age at onset of hearing loss (before or after 2 years of age) and subjective hearing handicap contributed significantly to the variance of preimplantation fatigue ratings (those with higher handicap reported higher fatigue). In contrast, variance in postimplantation fatigue ratings was not affected by age of hearing loss onset but was affected by gender (females reported more fatigue than males) and subjective ratings of effort, handicap, and isolation (those reporting more effort, handicap, and isolation reported more fatigue). Listening-related fatigue is a significant problem for many CI candidates, as well as for many experienced unilateral and bilateral CI users. Receipt of a CI significantly reduced listening-related fatigue (as well as listening effort, hearing handicap, and social isolation) as soon as 2 weeks post-CI activation. However, the magnitude of fatigue-related issues for both CI candidates and experienced CI users varies widely. Audiologic factors, such as hearing loss severity and aided speech recognition, were not predictive of individual differences in listening-related fatigue. In contrast, strong associations were observed between perceived hearing handicap and listening-related fatigue in all groups suggesting fatigue-related issues may be a component of perceived hearing handicap.

Changing Management of Intravestibular Schwannomas in the Era of Cochlear Implantation for Single-Sided Deafness.

Intralabyrinthine schwannomas (ILSs) are a rare cause of deafness. Patients with ILS confined to the semicircular canals and the vestibule (intravestibular schwannomas) are potential candidates for cochlear implantation for hearing rehabilitation, a new option for patients with unilateral hearing loss since the 2019 FDA approval of cochlear implant (CI) for single-sided deafness. In this report, we describe an evolving management approach for ILSs causing hearing loss. Adults (≥18 years) who underwent simultaneous ILS resection and CI between January 2019 and June 2023 (n = 3). Transmastoid labyrinthectomy with simultaneous cochlear implantation. Hearing performance with cochlear implantation measured as CNC Word Recognition scores and AzBio Sentence scores. Three patients with ILS confined to the semicircular canals and vestibule underwent simultaneous tumor resection via labyrinthectomy with CI placement. In all cases, complete tumor resection and full CI insertion were achieved. No patients experienced postoperative complications. Patients 1 and 2 underwent 6- and 9-month postactivation testing, respectively, with CNC scores 64% to 80% and AzBio 81% to 99% in the implanted ears. Patient 3 scored 0% on CNC and AzBio testing at 3 months and deferred her 6-month audiometry. Patients with ILS confined to the vestibule and semicircular canals can be considered for simultaneous tumor resection and CI placement.

Cochlear Implant Qualification in Noise Versus Quiet: Do Patients Demonstrate Similar Postoperative Benefits?

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. Retrospective chart review. Tertiary referral center. 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, Spatialand Qualities of Hearing Scale (SSQ), Cochlear Implant Quality of Life scale (CIQOL-10), and daily device usage were also compared between the groups. 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. 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.

Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures.

(1) Background: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data and a predictive model for postoperative speech perception in noise (SPiN) after CI provision. (2) Methods: CI candidates with substantial residual hearing (either in hearing threshold or in word recognition scores) were included in a retrospective analysis (n = 87). Speech perception scores in quiet 12 months post-surgery were compared with the predicted scores. A generalized linear model was fitted to speech reception thresholds (SRTs) after CI fitting to identify predictive variables for SPiN. (3) Results: About two-thirds of the recipients achieved the expected outcome in quiet or were better than expected. The mean absolute error of the prediction was 13.5 percentage points. Age at implantation was the only predictive factor for SPiN showing a significant correlation (r = 0.354; p = 0.007). (4) Conclusions: Outcome prediction accuracy for speech in quiet was comparable to previous studies. For CI recipients in the included study population, the SPiN outcome could be predicted only based on the factor age.

Radioclinical Assessment of Posterior Tympanotomy Difficulties during Ordinary Cochlear Implantation: A Prospective Case-Series Study.

This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI). It was a prospective case-series study. The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023. We included 73 CI candidates performed via the PT approach. The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery. We correlated this score with the intraoperative difficulty and surgical duration. The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001). Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.

Electrically evoked auditory brainstem responses in deaf children with cochlear nerve canal stenosis

Background Deaf children with cochlear nerve canal stenosis (CNCs) are always considered poor candidates for cochlear implantation. Objectives To investigate the function of the peripheral auditory pathway in deaf children with CNCs, as revealed by the electrically evoked auditory brainstem response (EABR), and postoperative cochlear implants (CIs) outcomes. Materials and Methods Thirteen children with CNCs and 13 children with no inner ear malformations (IEMs) who received CIs were recruited. The EABR evoked by electrical stimulation from the CI electrode was recorded. Postoperative CI outcomes were assessed using Categories of Auditory Performance (CAP) and Speech Intelligibility Rate (SIR). Results Compared with children with no IEMs, children with CNCs showed lower EABR extraction rates, higher thresholds, a longer wave V (eV) latency and lower CAP and SIR scores. The auditory and speech performance was positively correlated with the diameter of the cochlear nerve canal and the number of channels showing wave III (eIII) and eV in children with CNCs. Conclusions and Significance The physiological function of the peripheral auditory pathway in children with CNCs is poorer than that in children with no IEMs. Postoperative auditory and speech abilities may depend on the severity of cochlear nerve malformation and auditory conduction function.

Subjective visual vertical and postural control in patients following cochlear implantation.

Cochlear implantation (CI) is associated with changes in the histopathology of the inner ear and impairment of vestibular function. The objectives of our study were to evaluate patients for clinical manifestations of space perception and balance changes before surgery, compare them with asymptomatic subjects (controls), and report changes in posturography and subjective visual vertical (SVV) during the acute post-surgery period in patients. Examination was performed using static posturography and the SVV measurement. We examined 46 control subjects and 39 CI patients. Patients were examined pre-surgery (Pre), 2nd day (D2) and then 14th day (D14) after implantation. Baseline SVV was not different between patients and control group. There was a statistically significant difference (p < 0.001) in SVV between subgroups of right- and left-implanted patients at D2 (-1.36±3.02° and 2.71±2.36°, right and left side implanted respectively) but not Pre (0.76±1.07° and 0.31±1.82°) or D14 (0.72±1.83° and 1.29±1.60°). Baseline posturography parameters between patients and control group were statistically significantly different during stance on foam with eyes closed (p < 0.05). There was no statistically significant difference in posturography among Pre, D2 and D14. CI candidates have impaired postural control before surgery. CI surgery influences perception of subjective visual vertical in acute post-surgery period with SVV deviation contralateral to side of cochlear implantation, but not after two weeks.