Cochlear Implant Recipients Research Articles

Cochlear Implant Artifacts Removal in EEG-Based Objective Auditory Rehabilitation Assessment.

Cochlear implant (CI) is a neural prosthesis that can restore hearing for patients with severe to profound hearing loss. Observed variability in auditory rehabilitation outcomes following cochlear implantation may be due to cerebral reorganization. Electroencephalography (EEG), favored for its CI compatibility and non-invasiveness, has become a staple in clinical objective assessments of cerebral plasticity post-implantation. However, the electrical activity of CI distorts neural responses, and EEG susceptibility to these artifacts presents significant challenges in obtaining reliable neural responses. Despite the use of various artifact removal techniques in previous studies, the automatic identification and reduction of CI artifacts while minimizing information loss or damage remains a pressing issue in objectively assessing advanced auditory functions in CI recipients. To address this problem, we propose an approach that combines machine learning algorithms-specifically, Support Vector Machines (SVM)-along with Independent Component Analysis (ICA) and Ensemble Empirical Mode Decomposition (EEMD) to automatically detect and minimize electrical artifacts in EEG data. The innovation of this research is the automatic detection of CI artifacts using the temporal properties of EEG signals. By applying EEMD and ICA, we can process and remove the identified CI artifacts from the affected EEG channels, yielding a refined signal. Comparative analysis in the temporal, frequency, and spatial domains suggests that the corrected EEG recordings of CI recipients closely align with those of peers with normal hearing, signifying the restoration of reliable neural responses across the entire scalp while eliminating CI artifacts.

Relationships Between Speech, Spatial and Qualities of Hearing Short Form SSQ12 Item Scores and their Use in Guiding Rehabilitation for Cochlear Implant Recipients.

Cochlear implantation successfully improves hearing in most adult recipients. However, in rare cases, post-implant rehabilitation is required to maximize benefit. The primary aim of this investigation was to test if self-reports by cochlear implant users indicate the need for post-implant rehabilitation. Listening performance was assessed with the Speech, Spatial and Qualities short-form SSQ12, which was self-administered via a web-based survey. Subjects included over 2000 adult bilateral or unilateral cochlear implant users with at least one year of experience. A novel application of regression tree analysis identified core SSQ12 items that serve as first steps in establishing a plan for further rehabilitation: items 1, 8, and 11 dealing with single-talker situations, loudness perception, and clarity, respectively. Further regression and classification tree analyses revealed that SSQ12 item scores were weakly related to age, degree of tinnitus, and use of bilateral versus unilateral implants. Conversely, SSQ12 scores were strongly associated with self-rated satisfaction and confidence in using their cochlear implant. The SSQ12 total scores did not vary significantly over 1-9 or more years' experience. These findings suggest that the SSQ12 may be a useful tool to guide rehabilitation at any time after cochlear implantation. Identification of poor performance may have implications for timely management to improve the outcomes, through various techniques such as device fitting adjustments, counseling, active sound exposure, and training spatial hearing.

Intracochlear Recording of Electrocochleography During and After Cochlear Implant Insertion Dependent on the Location in the Cochlea.

To preserve residual hearing during cochlear implant (CI) surgery it is desirable to use intraoperative monitoring of inner ear function (cochlear monitoring). A promising method is electrocochleography (ECochG). Within this project the relations between intracochlear ECochG recordings, position of the recording contact in the cochlea with respect to anatomy and frequency and preservation of residual hearing were investigated. The aim was to better understand the changes in ECochG signals and whether these are due to the electrode position in the cochlea or to trauma generated during insertion. During and after insertion of hearing preservation electrodes, intraoperative ECochG recordings were performed using the CI electrode (MED-EL). During insertion, the recordings were performed at discrete insertion steps on electrode contact 1. After insertion as well as postoperatively the recordings were performed at different electrode contacts. The electrode location in the cochlea during insertion was estimated by mathematical models using preoperative clinical imaging, the postoperative location was measured using postoperative clinical imaging. The recordings were analyzed from six adult CI recipients. In the four patients with good residual hearing in the low frequencies the signal amplitude rose with largest amplitudes being recorded closest to the generators of the stimulation frequency, while in both cases with severe pantonal hearing losses the amplitude initially rose and then dropped. This might be due to various reasons as discussed in the following. Our results indicate that this approach can provide valuable information for the interpretation of intracochlearly recorded ECochG signals.

Psychosocial and auditory factors that influence successful music-based auditory training in pediatric cochlear implant recipients.

Cochlear implants (CIs), which are designed to support spoken communication of persons with severe to profound hearing loss, can provide improved hearing capability through passive exposure. However, auditory training may optimize perception of spectrally complex sounds such as music or speech. Reviews of music-based training for pediatric CI users have reported modest though variable benefits, as well as problems with attrition. It is presumed that more substantial changes may result from longer, more intensive training; however, the development of protocols sufficiently motivating for sustained intensity is challenging. This article examined the experiences of star pediatric CI users, whose years of music training have yielded exceptional auditory benefits. Greater understanding of their experiences and attitudes may suggest best practices for music-based training. Research aims included: (a) characterizing the musical behaviors and perceptual learning processes of music-centric (Music-centric, for purposes of this paper, refers to CI users who engage in sustained and successful music making such as music lessons and ensembles and focused music listening over a period of years, and who derive deep satisfaction from those experiences.) pediatric CI users, and (b) identifying psychosocial and auditory factors that motivated persistence in auditory training. We used qualitative and patient-engaged research methodologies, gathering data through questionnaires with open-ended questions. The participants, six music-centric CI users and five parents, described their experiences and attitudes regarding music training, and factors that supported or undermined those experiences. Data were analyzed using reflexive thematic analysis. The codes were consolidated into five themes and organized into a Model of Music-Based Learning for Pediatric Cochlear Implant Recipients. Sustained participation in music training was perceived as a dynamic process including varied musical stimuli, and moderated by intrinsic (attitude, perceived behavioral control) and extrinsic (parents, teachers, peers) influences, hearing status, sound access and background factors. These themes highlighted motivational factors that pediatric CI users and parents considered important to sustained, intensive and successful music learning throughout childhood and adolescence. These factors should be considered in the development of music-based training for pediatric CI recipients.

Are children with unilateral sensorineural hearing loss receiving cochlear implants?

IntroductionThe US Food and Drug Administration (FDA) granted its first approval for cochlear implants (CI) in children with bilateral sensorineural hearing loss (SNHL) in 1990. In 2019, the FDA expanded CI indications to include children with unilateral SNHL. ObjectiveThe aim of this study was to assess the prevalence of children with unilateral SNHL in the population of new pediatric CI recipients between 2012 and 2021. MethodsA retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Pediatric database examined patients under 18 years of age with bilateral or unilateral SNHL who underwent CI between 2012 and 2021. Current Procedural Terminology code 69930 identified patients with ‘cochlear device implantation, with or without mastoidectomy.’ The percentage of children undergoing CI for unilateral versus bilateral SNHL during the study period was calculated and subjected to statistical analysis. Results9863 pediatric CI patients were included with a mean age of 5.1 (95 % CI 5.1–5.2) years at the time of implantation. 7.5 % (N = 739) of patients had unilateral SNHL and 92.5 % (N = 9124) had bilateral SNHL. Children with bilateral SNHL undergoing CI were significantly younger (5.0 years versus 6.9 years for those with unilateral SNHL, p < .001). There was a statistically significant difference in the percentage of children receiving CI for unilateral versus bilateral SNHL (3.3 % in 2012 to 14.3 % in 2021, p < .001) before and after the FDA changes. ConclusionsThe proportion of CIs placed for unilateral SNHL has increased annually even before 2019 when the FDA expanded its CI indications to include children with unilateral SNHL for the first time.

Preparation, characterization, and in vitro/vivo evaluation of a multifunctional electrode coating for cochlear implants

Cochlear implantation (CI) is the primary intervention for patients with sensorineural hearing loss to restore their hearing. However, approximately 90 % of CI recipients experience unexpected fibrosis around the inserted electrode arrays due to acute and chronic inflammation. This fibrosis leads to progressive residual hearing loss. Addressing this complication is crucial for enhancing CI outcomes, yet an effective treatment has not yet been found. In this study, we developed a multifunctional dexamethasone (DXM)-loaded polytrimethylene carbonate (PTMC) electrode coating to mitigate inflammatory reactions and fibrosis after CI. This thin and flexible coating could preserve the mechanical performance of the electrode and reduce the implantation resistance for CI. The in vitro release studies demonstrated the DXM-PTMC coating's efficient drug loading and sustained release capability over 90 days. DXM-PTMC also showed long-term stability, high biocompatibility, and effective anti-inflammatory effects in vitro and in vivo. Compared with the uncoated group, DXM-PTMC coating significantly inhibited the expression of inflammatory factors, such as NO, TNF-α, IL-1β, and IL-6. DXM-PTMC coating suppressed fibrosis in rat implantation models for 3 weeks by reducing both acute and chronic inflammation. Our findings suggest that DXM-PTMC coating is a novel strategy to improve the outcomes of CI.

Stable long-term outcomes after cochlear implantation in subjects with TMPRSS3 associated hearing loss: a retrospective multicentre study

BackgroundThe spiral ganglion hypothesis suggests that pathogenic variants in genes preferentially expressed in the spiral ganglion nerves (SGN), may lead to poor cochlear implant (CI) performance. It was long thought that TMPRSS3 was particularly expressed in the SGNs. However, this is not in line with recent reviews evaluating CI performance in subjects with TMPRSS3-associated sensorineural hearing loss (SNHL) reporting overall beneficial outcomes. These outcomes are, however, based on variable follow-up times of, in general, 1 year or less. Therefore, we aimed to 1. evaluate long-term outcomes after CI implantation of speech recognition in quiet in subjects with TMPRSS3-associated SNHL, and 2. test the spiral ganglion hypothesis using the TMPRSS3-group.MethodsThis retrospective, multicentre study evaluated long-term CI performance in a Dutch population with TMPRSS3-associated SNHL. The phoneme scores at 70 dB with CI in the TMPRSS3-group were compared to a control group of fully genotyped cochlear implant users with post-lingual SNHL without genes affecting the SGN, or severe anatomical inner ear malformations. CI-recipients with a phoneme score ≤ 70% at least 1-year post-implantation were considered poor performers and were evaluated in more detail.ResultsThe TMPRSS3 group consisted of 29 subjects (N = 33 ears), and the control group of 62 subjects (N = 67 ears). For the TMPRSS3-group, we found an average phoneme score of 89% after 5 years, which remained stable up to 10 years post-implantation. At both 5 and 10-year follow-up, no difference was found in speech recognition in quiet between both groups (p = 0.830 and p = 0.987, respectively). Despite these overall adequate CI outcomes, six CI recipients had a phoneme score of ≤ 70% and were considered poor performers. The latter was observed in subjects with residual hearing post-implantation or older age at implantation.ConclusionSubjects with TMPRSS3-associated SNHL have adequate and stable long-term outcomes after cochlear implantation, equal to the performance of genotyped patient with affected genes not expressed in the SGN. These findings are not in line with the spiral ganglion hypothesis. However, more recent studies showed that TMPRSS3 is mainly expressed in the hair cells with only limited SGN expression. Therefore, we cannot confirm nor refute the spiral ganglion hypothesis.

Barriers for Audiology, Speech, and Language Therapy Services to Cochlear Implant Recipients

Background: With the rise in cochlear implant use among children with hearing impairments, understanding the challenges in providing effective audiology, speech, and language therapy services is crucial. These services are vital for the successful integration of cochlear implant recipients into mainstream society, particularly in terms of language acquisition and social-educational outcomes. Objective: This study aimed to find out Barriers of audiology, speech, and language therapy services to cochlear implant. Methods: A cross-sectional survey design was employed, involving 74 participants selected through non-probability convenience sampling. The study utilized a structured questionnaire covering demographics, availability of audiology, speech, and language therapy services, and specific issues related to cochlear implant use. Data were analysed using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Results: Among participants, 58.1% were aged 25-35 years; 67.6% were female. Educational levels varied, with 33.8% holding graduate degrees. Key barriers identified included distance to services, cost, and scheduling difficulties. 66.2% agreed that health insurance was a significant challenge, and 52.7% faced difficulties due to the unavailability of nearby speech therapists. Conclusion: The study highlights the critical need for accessible and tailored speech and language therapy services for cochlear implant recipients, especially in rural areas. Addressing these barriers requires concerted efforts from healthcare providers, policymakers, and community leaders to enhance the rehabilitation outcomes for cochlear implant recipients.

The association between electrode impedance and short-term outcomes in cochlear implant recipients of slim modiolar and slim straight electrode arrays

Objectives Electrode impedance measurements from cochlear implants (CI) reflect the status of the electrode array as well as the surrounding cochlear environment, and could provide a clinical index of functional changes with the CI. The goals of this study were to examine (1) the impact of electrode array type on electrode impedance, and (2) the relationship between electrode impedance and short-term hearing preservation and speech recognition outcomes. Methods Retrospective study of 115 adult hearing preservation CI recipients of a slim modiolar or slim straight array. Common ground electrode impedances, pre- and post-operative hearing thresholds and CNC word recognition scores were retrieved. Results Electrode impedances were significantly higher for recipients of the straight electrode array. Within individuals, electrode impedances were stable after the first week post-activation. However, increased standard deviation of electrode impedances was associated with greater loss of low frequency hearing at initial activation, and with poorer speech recognition at 6 months post-implantation. Conclusions Results demonstrate that electrode impedances depend on the type of implanted array. Findings also suggest that there may be a role for the variability in electrode impedance across electrodes as an indicator of changes in the intracochlear environment that contribute to outcomes with a CI.

Factors Affecting Early and Late Cochlear Implantation.

This study aimed to describe the factors affecting early and late cochlear implantation. A total of 159 patients from the Hospital Canselor Tuanku Muhriz (HCTM) Cochlear Implant Programme were recruited in this retrospective cross-sectional study. All paediatric Cochlear Implant (CI) recipients with pre-lingual deafness were included in this retrospective study. The study was conducted from January 2019 until December 2020. The pre-lingual cochlear implant recipients' data were analysed based on demographics and interval from diagnosis to hearing aid fitting and implantation. The association between the dependent variables with early and late cochlear implantation was compared. A total of 83 (52%) patients were female. Chinese race constituted most of the patients, which was 90/159 (57%). The majority were from middle-income families (M40); 89 (56%). The most common aetiology of Hearing Loss (HL) was idiopathic; 139 (87%), followed by intrauterine infections, which comprised of congenital CMV; 8 (5%) and congenital Rubella; 1 (1%) and nonspecific intrauterine infection 2 (1%). The relationship between the universal neonatal hearing screening and the interval between diagnosis to implantation was significant (p=0.033). Other variables were not significant. UNHS was a significant factor contributing to early and late implantation. The median age of diagnosis of hearing loss was 18 months (interquartile range; 15); the age of CI was 34 months (interquartile range; 24); the interval from diagnosis to hearing aid was 2 months (interquartile range; 5), and the interval from diagnosis to CI was 16 months (interquartile range; 14).

Caloric function as a predictor of cochlear implant performance

Objectives Changes in vestibular function have been demonstrated following cochlear implantation (CI). The functional impact of these changes on CI performance has not been well-studied. We sought to assess whether caloric changes postimplantation could predict CI performance. Methods Retrospective review of a prospectively collected database at a tertiary care hospital. Patients who underwent CI over a 22-year period (1999–2021) and had videonystagmography (VNG) testing pre- and postimplantation were included. Caloric responses were compared pre- versus post-implantation, and assessed for their ability to predict CI performance as evaluated using AzBio +10 decibels signal-to-noise ratio (dB S/N) scores. Results 43 CI recipients were included. There was a significant difference in the average maximal slow-phase velocity in response to caloric irrigation in the implanted ear pre- versus post-operatively (21.2 vs. 18.5 deg/s; p = 0.02). Controlling for age and pre-implantation speech recognition performance, pre- and post-implantation caloric responses in the implanted ear significantly predicted CI performance at 0–6 months and >6 months post-implantation. Caloric changes following implantation were not significantly correlated with CI performance. Conclusion CI impacts vestibular function as evidenced by changes in caloric responses. Vestibular function pre- and possibly post-CI may be clinically useful metrics for predicting some proportion of CI performance variability.

The Effects of Stimulus Repetition Rate on Electrically Evoked Auditory Brainstem Potentials in Postlingually Deafened Adult Cochlear Implant Recipients.

Background: By using outcome prediction scores, it is possible to distinguish between good and poor performers with cochlear implants (CI) after CI implantation. The reasons for poor performance, despite good basic conditions, can be manifold. On the one hand, the postoperative fitting may be inadequate; on the other, neurophysiological disease processes may impair speech understanding with a CI. These disease processes are not yet fully understood. In acoustics, it is known that the auditory brainstem responses (ABR) and their latencies and amplitudes allow differential diagnosis based on reference values for normal-hearing individuals. The aim of this study was to provide reference values for electrically evoked brainstem responses (EABRs) in terms of rate-dependent latencies and amplitudes. Methods: 20 ears of 18 experienced adult CI recipients with a predicted and measured good postoperative word recognition score were recruited from the clinic's patient pool. In the same stimulation mode and intensity we measured latencies and interpeak-latencies of EABRs and electrically evoked compound action potentials (ECAPs). With a defined supra-threshold stimulation intensity above the individual ECAP threshold, we applied stimulation at several rates between 11 and 91 stimuli per second. Results: We found rate dependences for EABR latency t3 and t5 in the order of 0.19 ms and 0.37 ms, respectively, while ECAP was not affected by rate. Correspondingly, the interpeak intervals' rate dependences for t5-t1, t5-t3 and t3-t1 were of the order of 0.37 ms, 0.18 ms and 0.19 ms. Comparing the EABR amplitudes between the stimulation rates 11/s and 81/s, we found that at 81/s the amplitudes were significantly reduced down: to 73% for A3 and 81% for A5. These rate dependences of latency and amplitude in EABR have characteristics comparable to those of acoustic ABR. Conclusions: These data may serve to provide reference values for EABR and ECAP latencies, interpeak intervals and amplitudes with respect to stimulation rate. Altered response patterns of ECAPs and EABRs to normalised stimulation modes could be used in the future to describe and classify neuropathological processes in a better-differentiated way.

Developmental Auditory and Speech-Language Performance in Pediatric Cochlear Implantation Recipients with Stable White Matter Lesions.

To analyze the association between stable asymptomatic white matter lesions (WMLs) and the cochlear implantation (CI) effect in congenitally deaf children, 43 CI children with stable asymptomatic WMLs determined via preoperative assessments and 86 peers with normal white matter were included. Outcome measurements included closed-set Mandarin Chinese (tone, disyllable, and sentence) recognition tests; categories of auditory performance (CAPs); and speech intelligibility rating (SIR) scales at 1, 12, and 24 months post-CI. Generalized estimating equation (GEE) models were used to analyze the association between WML and outcomes. In the WML group (control group), median CAP and SIR scores were 5 (5) and 4 (4) with mean rates of tone, disyllable, and sentence recognition of 84.8% (89.0%), 87.9% (89.7%), and 85.8% (88.0%) at 24 months post-CI, respectively. Auditory and speech performance improved significantly with implant use. Compared to their peers in the control group, for the participants with stable asymptomatic WMLs, auditory and speech abilities were not significantly different (p > 0.05). Stable asymptomatic WMLs might not be associated with poor auditory and speech intelligibility post-CI, which indicates that it is feasible to use comprehensive assessments to screen suitable candidates with WMLs who are likely to present with a good prognosis.

How Can We Compare Cochlear Implant Systems across Manufacturers? A Scoping Review of Recent Literature.

Electric stimulation via a cochlear implant (CI) enables people with severe-to-profound sensorineural hearing loss to regain speech understanding and music appreciation and, thus, allow them to actively engage in social life. Three main manufacturers (CochlearTM, MED-ELTM, and Advanced BionicsTM "AB") have been offering CI systems, thus challenging CI recipients and otolaryngologists with a difficult decision as currently no comprehensive overview or meta-analysis on performance outcomes following CI implantation is available. The main goals of this scoping review were to (1) map the literature on speech and music performance outcomes and to (2) find whether studies have performed outcome comparisons between devices of different manufacturers. To this end, a literature search was conducted to find studies that address speech and music outcomes in CI recipients. From a total of 1592 papers, 188 paper abstracts were analyzed and 147 articles were found suitable for an examination of full text. From these, 42 studies were included for synthesis. A total of 16 studies used the consonant-nucleus-consonant (CNC) word recognition test in quiet at 60 db SPL. We found that aside from technical comparisons, very few publications compared speech outcomes across manufacturers of CI systems. However, evidence suggests that these data are available in large CI centers in Germany and the US. Future studies should therefore leverage large data cohorts to perform such comparisons, which could provide critical evaluation criteria and assist both CI recipients and otolaryngologists to make informed performance-based decisions.

QoL, CIs, QALYs, and Individualized Rehabilitation: The Clinical and Practical Benefits of Regularly Assessing the Quality of Life of Adult Cochlear Implant Recipients.

This study aimed to report quality of life (QoL) scores in unilateral cochlear implant (CI) users and to generate guidance for clinicians on using QoL measures to individualize CI counselling and rehabilitation and to increase access to CIs as a mode of rehabilitation. Participants (n = 101) were unilateral CI users with single-sided deafness (SSD; n = 17), asymmetrical hearing loss (AHL; n = 26), or bilateral hearing loss (Uni; n = 58). Generic QoL was assessed via the Health Utilities Index (HUI-3), and disease-specific QoL was assessed via the Speech, Spatial, and Qualities of Hearing scale (SSQ12) and Nijmegen CI Questionnaire (NCIQ) at preimplantation and at 6 and 12 months of CI use. All groups had significantly increased HUI-3 scores at both intervals. The SSD group showed significant benefit on the SSQ12 at visit 3, the AHL group showed significant benefit on the SSQ12 and most NCIQ subdomains at both intervals, and the Uni group showed significant benefit with both tests at both intervals. Unilateral CI recipients demonstrate improved QoL within the first 12 months of device use. Regular assessment with generic and disease-specific questionnaires has the potential to play an important role in personalizing treatment and possibly in increasing access to CI provision.

Risk of Monopolar Electrosurgery in Cochlear Implant Recipients is Nominal: Evidence to Guide Clinical Practice.

Comprehensively assess the prevalence of monopolar electrosurgery-related device complications among cochlear implant (CI) recipients. Multifaceted retrospective review and survey. Tertiary medical center. Multifaceted approach including: (i) review of the current literature; (ii) historical review of institutional data from an academic, tertiary CI center; (iii) review of industry data provided by 3 Food and Drug Administration-approved CI manufacturers; and (iv) survey of high-volume CI centers. Literature review identified 9 human studies, detailing 84 devices with 199 episodes of device-cautery exposure. From studies reporting on patients records, no implant showed evidence of damage after exposure. One cadaveric study using dental cautery reported 1 episode of device damage. Review of institutional records did not identify any CI damage in 84 instances of exposure. Data from the 3 major implant manufacturers showed a single report of damage that could be reasonably linked to monopolar electrosurgery, out of a possible 689,426 CIs. Last, a survey of 8 high-volume CI centers did not identify any adverse events associated with monopolar cautery. These data estimate the risk of adverse device-related events or tissue injury to be extraordinarily low. Short of operating in immediate proximity to the CI (ie, the ipsilateral temporoparietal scalp), these data indicate that monopolar electrosurgery can be used in the body and the head-and-neck of CI recipients with nominal risk. These findings may guide decision-making in cases that are optimally or preferably performed with monopolar electrocautery and can be used to counsel CI patients following inadvertent exposures.

Predictors of Emotional Prosody Identification by School-Age Children With Cochlear Implants and Their Peers With Normal Hearing.

Children with cochlear implants (CIs) vary widely in their ability to identify emotions in speech. The causes of this variability are unknown, but this knowledge will be crucial if we are to design improvements in technological or rehabilitative interventions that are effective for individual patients. The objective of this study was to investigate how well factors such as age at implantation, duration of device experience (hearing age), nonverbal cognition, vocabulary, and socioeconomic status predict prosody-based emotion identification in children with CIs, and how the key predictors in this population compare to children with normal hearing who are listening to either normal emotional speech or to degraded speech. We measured vocal emotion identification in 47 school-age CI recipients aged 7 to 19 years in a single-interval, 5-alternative forced-choice task. None of the participants had usable residual hearing based on parent/caregiver report. Stimuli consisted of a set of semantically emotion-neutral sentences that were recorded by 4 talkers in child-directed and adult-directed prosody corresponding to five emotions: neutral, angry, happy, sad, and scared. Twenty-one children with normal hearing were also tested in the same tasks; they listened to both original speech and to versions that had been noise-vocoded to simulate CI information processing. Group comparison confirmed the expected deficit in CI participants' emotion identification relative to participants with normal hearing. Within the CI group, increasing hearing age (correlated with developmental age) and nonverbal cognition outcomes predicted emotion recognition scores. Stimulus-related factors such as talker and emotional category also influenced performance and were involved in interactions with hearing age and cognition. Age at implantation was not predictive of emotion identification. Unlike the CI participants, neither cognitive status nor vocabulary predicted outcomes in participants with normal hearing, whether listening to original speech or CI-simulated speech. Age-related improvements in outcomes were similar in the two groups. Participants with normal hearing listening to original speech showed the greatest differences in their scores for different talkers and emotions. Participants with normal hearing listening to CI-simulated speech showed significant deficits compared with their performance with original speech materials, and their scores also showed the least effect of talker- and emotion-based variability. CI participants showed more variation in their scores with different talkers and emotions than participants with normal hearing listening to CI-simulated speech, but less so than participants with normal hearing listening to original speech. Taken together, these results confirm previous findings that pediatric CI recipients have deficits in emotion identification based on prosodic cues, but they improve with age and experience at a rate that is similar to peers with normal hearing. Unlike participants with normal hearing, nonverbal cognition played a significant role in CI listeners' emotion identification. Specifically, nonverbal cognition predicted the extent to which individual CI users could benefit from some talkers being more expressive of emotions than others, and this effect was greater in CI users who had less experience with their device (or were younger) than CI users who had more experience with their device (or were older). Thus, in young prelingually deaf children with CIs performing an emotional prosody identification task, cognitive resources may be harnessed to a greater degree than in older prelingually deaf children with CIs or than children with normal hearing.

An Exploration of Quality of Life Perceptions of Cochlear Implant Recipients and Their Frequent Communication Partners

Purpose: Quality of life (QoL) after cochlear implantation has been investigated using a variety of QoL questionnaires. However, few studies have examined the perceived QoL of cochlear implant (CI) recipients compared between the recipient and a frequent communication partner (FCP) using both hearing-related (hearing-specific) and health-general (health-general) measures. Method: For this multiple case study, five participant pairs were recruited, consisting of five adult recipients who were implanted at least 6 months prior to the time of evaluation and five adult FCPs who lived with the recipient at the time of evaluation. All 10 participants (five pairs) completed a health-general questionnaire (Medical Outcome Study Short-Form Survey 12-Item [SF-12]), and eight participants (four pairs) completed a disease specific questionnaire (Nijmegen Cochlear Implant Questionnaire [NCIQ]). Results: Both recipients and partners tended to score similarly to each other on both measures. However, both groups scored higher on the SF-12 than the NCIQ. Results also revealed a better interrater agreement between pairs on the SF-12 compared to the NCIQ. Conclusions: Overall, scores for recipients and partners were higher for the health-general SF-12 compared to the hearing-related NCIQ. Additionally, rater agreement was better for the SF-12 compared to the NCIQ, suggesting that differences in QoL perceptions exist for more hearing-specific challenges. These results highlight potential differences in perception of recipient QoL postimplantation as illustrated through the use of multiple QoL measures. Results speak to the importance of open communication between recipients and partners.

Retracted: Change in Health-Related Quality of Life in Cochlear Implant Recipients in China.

[This retracts the article DOI: 10.1155/2022/1770580.].

Assessment of cochlear implant hearing outcomes using ecological momentary assessment in both controlled and real-world settings

Laboratory tests of speech understanding demonstrate high effectiveness of cochlear implants (CIs) for individuals with severe-to-profound hearing loss. However, understanding real-world benefits remains challenging. Retrospective questionnaires may be unreliable due to recall bias and limited acoustic information. To address this, we used an Ecological Momentary Assessment (EMA) smartphone app to collect subjective feedback and acoustic data from CI recipients in lab and real-world settings. We characterised challenging acoustic environments for CI users and the influence of internal factors on self-ratings of environmental noisiness, device benefit, and speech understanding. Twenty adults underwent cognitive tests, questionnaires, EMA, and the NAL Dynamic Conversation Test in the lab. Acoustic scenes were reproduced in an anechoic chamber to assess comprehension, familiarise participants with EMA, and establish benchmarks for real-world EMA data. Over four weeks, participants recorded experiences using the EMA app. Analysis of real-world EMA data revealed perceived noisiness was influenced by spectro-temporal properties and sound level. Self-reported communication factors were associated with environmental sound level and predictive of self-reported CI device benefit. Communication factors were also correlated with CI experience and cognitive performance. EMA offers valuable insights into CI recipients' real-world experiences, aiding customization and efficacy evaluation.