The Risk of Becoming a Cochlear Implant Non-user or Minimal-user in a Patient Cohort From Denmark 2010-2022.

Present Electrically Evoked Compound Action Potentials and Lack of Auditory Sensation Through a Cochlear Implant After Vestibular Schwannoma Resection.

To determine the prevalence of vestibular dysfunction in children with sensorineural hearing loss (SNHL) undergoing cochlear implantation (CI), and to assess postoperative changes in vestibular function in the implanted ear. This retrospective study included all children with SNHL who underwent CI at Aarhus University Hospital between 2020 and 2024 and received preoperative vestibular testing. Vestibular assessment comprised video head impulse testing (vHIT/HIT) and cervical vestibular evoked myogenic potentials (cVEMP). Paired pre- and postoperative data were available for a subset of children, in whom within-subject changes were analysed using McNemar's test. A total of 171 children completed preoperative vestibular testing. Preoperatively, 26.9% showed abnormalities on at least one vestibular modality, with otolith dysfunction on cVEMP being most frequent (31.2%). Paired pre- and postoperative assessments were available for 47 children. In the implanted ear, vestibular dysfunction increased from 8.5% preoperatively to 25.5% postoperatively. Otolith function deteriorated in 21.9% (9/41) of children with available cVEMP data (p=0.0156), whereas semicircular canal changes on vHIT/HIT were infrequent and not statistically significant. Postoperative findings in the non-implanted ear were sparse and showed no systematic pattern. Vestibular dysfunction is common among children with SNHL prior to cochlear implantation. In the subgroup with paired data, CI was associated with a significant postoperative decline in otolith function, while semicircular canal responses remained largely stable. These findings highlight the importance of implementing systematic vestibular assessment in both the preoperative and postoperative CI work-up to support surgical planning and early rehabilitation.

The linguistic resources employed to discuss sensory experiences and phenomena can vary considerably between different cultural, disciplinary and socio-political contexts. Whilst questions about the discourses of sound have long been explored in some fields, within the field of cochlear implant research, such questions have received limited attention. This article draws together literature from diverse fields, highlighting the various complexities inherent in talking about “sound” in different contexts. The results of a collocation analysis of “sound” within the CIRCorpus - (a purpose-built 3-million-word corpus comprised of scientific research articles about cochlear implants published between 1960 and 2024) are then reported. The collocation analysis highlights a discursive environment in which sound is predominantly framed within a language of testing and abilit y, suggesting that discussions of sound within CI research have become distinctly psychologized and increasingly technicalized and homogenized over time. The implications of these patterns for informing future CI research agendas are discussed.

This study aimed to evaluate long-term cochlear implant (CI) outcomes in elderly patients aged ≥65 years, with a particular focus on the impact of implantation age and chronological age at testing on auditory performance. We conducted a retrospective study of 53 postlingually deafened adults aged ≥65 years at the time of outcome evaluation who underwent unilateral CI at our institute between 1987 and 2019. Patients were divided into two groups according to age at implantation: the Younger-elderly group (<75 years; n = 36) and the Older-elderly group (≥75 years; n = 17). Postoperative aided thresholds and monosyllabic speech discrimination scores in quiet were collected annually up to 10 years postoperatively. CI-aided thresholds remained stable over 10 years after implantation and did not differ between groups (p = 0.40). In contrast, speech discrimination scores were significantly poorer in the Older-elderly group compared with the Younger-elderly group (p = 0.020). Regression analyses confirmed that chronological age at testing, but not age at implantation, was a significant predictor of speech outcomes (p < 0.0001). Notably, patients aged ≥80 years exhibited mean CI-aided speech discrimination below 50 %. CI effectively restored hearing thresholds in elderly patients, independent of implantation age. However, speech perception declined progressively with advancing test age, particularly in those ≥80 years, suggesting that central auditory and cognitive aging are the primary constraints on long-term outcomes. Candidacy criteria should therefore be applied cautiously in this age group, with thorough preoperative counseling to establish realistic expectations.

The Effect of Steroids on Cochlear Impedance in Humans: A Systematic Review.

Objectives To assess functional language performance on paediatric cochlear implant patients in Malawi. Methods Sixteen patients who received cochlear implantation before the age of 18 years from a single site were invited for an interview. Parents or guardians of twelve of these participated in the PEACH and BAPP questionnaires, whilst four others who had become adults answered independently. The PEACH scale is a 13-question survey with a maximum score of 52. The BAPP score has four domains with a total score of 16. Results Most patients acquired profound hearing loss through either mumps, meningitis, malaria or a combination (15/16). The mean age of onset of profound deafness was 8.8 years of age (range = 4–16 years) and implantation was 10.6 years (range = 4–18 years). The mean ‘Quiet Sounds’ questions were 23.56/24 (sd +/–1.75) and ‘Loud Sounds’ were 27.06/28 (sd +/–1.57). The mean total PEACH score was 50.63/52 (sd +/–2.73). There was no correlation with age of implant and PEACH score. The BAPP score was 16/16 for each patient. Conclusion Despite a very low socio-economic environment, this cohort shows cochlear implantation has a strong perceived benefit from the parents and guardians of post-lingually profoundly deaf children.

Background Vestibular involvement in CDH23-related nonsyndromic hearing loss remains incompletely understood, particularly prior to cochlear implantation. Aims/Objectives To evaluate vestibular function prior to cochlear implantation in patients with severe to profound non-syndromic hearing loss caused by CDH23 mutations. Material and Methods We retrospectively evaluated vestibular function in seven patients with severe to profound non-syndromic hearing loss caused by CDH23 mutations who were scheduled for cochlear implantation. Vestibular assessment included caloric testing, ACS-cVEMP, BCV-oVEMP, and damped rotation testing, depending on age. Results Six patients had homozygous missense mutations, and one had compound heterozygous mutations in CDH23. Caloric testing revealed unilateral reduced responses in two patients (28.6%). Damped rotation testing, performed in four pediatric patients, showed a unilateral reduced response in one patient (25%). ACS-cVEMP demonstrated a unilateral reduced response in one patient (14.3%) and an absent response in another (14.3%). BCV-oVEMP, conducted in three patients, revealed a unilateral absent response in one patient (33.3%). Overall, unilateral vestibular dysfunction was identified in four of seven patients (57.1%). Conclusions and Significance More than half of patients with CDH23-related non-syndromic deafness exhibited unilateral vestibular dysfunction prior to cochlear implantation, suggesting that preoperative vestibular assessment may be clinically relevant in this population.

Advancements in cochlear implant (CI) and hearing aid (HA) technology enabled the combining of acoustic and electric stimulation for bimodal hearing and electro-acoustic stimulation (EAS) among listeners with hearing loss. While some users experience benefits such as enhanced speech or music perception and improved localization, others face interference between CI and HA, potentially leading to HA discontinuation. Our study aims to explore the underlying causes of interference, map existing evidence, and identify potential research gaps. The insights gained on interference will help foresee and mitigate such scenarios, improving speech and music perception in bimodal and EAS users. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines, and it was registered on protocols.io (access online at dx.doi.org/10.17504/protocols.io.dm6gp37xdvzp/v2). Inclusion criteria were peer-reviewed articles written in English and published between 2000 and May 2024, and articles reported adverse performance outcomes with combined CI and HA use in adults or children compared to CI or HA alone. Relevant articles were searched using specific key words and Boolean operators across multiple databases. The final scoping review included 15 articles published across 13 scientific journals. These articles originated from nine countries and underwent narrative analysis to extract insights on interference in combined CI and HA use. The study offers valuable insights into the prevalence, causes, and assessment of interference in the combined use of CI and HA. Our review suggests that bimodal interference is individualized or listener-specific, with various factors affecting the utility of bimodal and EAS. Thus, a mixed-methods approach should be implemented in the future to gain a more comprehensive understanding of interference. Customized strategies can also be explored and applied to reduce interference through HA programming, CI mapping, counseling, and training to enhance the benefits for bimodal and EAS users.

An Adult Cochlear Implant Aural Rehabilitation Special Interest Group was formed in 2023. Members represent interdisciplinary collaborators, including audiologists, speech-language pathologists, surgeons, nonclinical administrators, manufacturer/industry representatives, and researchers. Current perspectives of adult cochlear implant (CI) recipients regarding aural rehabilitation (AR) remain unknown and understudied. The aim of this study is to survey adult CI recipients to determine their perspectives on the AR process. A web-based national survey was sent to adult CI recipients through multiple channels. The survey asked recipients about their demographics, state of residence, hearing loss history, and device configuration. Questions probed recipients' experiences of learning about AR options, services used, definitions of AR, and perceived value of services received. Questions were also asked about barriers to AR services, preoperative counseling, and satisfaction with their decision to pursue a CI. A total of 115 CI recipients responded to the survey. Results revealed a relative lack of information provided to many CI recipients regarding AR services. Many CI recipients reported wishing they had received additional resources in the areas of music training and equipment troubleshooting. Most participants reported that both one-on-one clinician-guided AR and independent listening practice were effective methods of AR. Findings shed light on current gaps in providing the most effective AR services, which will need to be addressed to optimize hearing health care and outcomes for adult CI recipients. Future work should include outreach to a broader representation of CI users to expand our understanding of AR resources, education, and limitations.

Objective To compare replacement hearing aids (HA) with a cochlear implant (CI) and a HA in the bimodal solution using the Signal to Noise Ratio (SNR) at 70% correct Speech Reception Threshold (SRT70) measured with the Hearing in Noise Test (HINT), Word Recognition Scores (WRS) in quiet and noise and patient reported outcome using Speech Spatial and Quality (SSQ-12) questionnaire. Design/Study Sample Prospective randomised controlled trial between bimodal use and continuous HA use for additional three months. Study Sample Sixty-three CI candidates (mean age: 63.4, range: 23–83 years) with asymmetric hearing loss (AHL) fulfilling CI candidacy criteria on one ear. Results No difference was found between the original and new replacement HAs after one month. However, comparing the bimodal solution with new replacement HAs mean SRT70 improved by −10.26 dB SNR (95%CI:−15.38;−5.13), WRS in quiet by 18.56% (95%CI:9.48;27.64), WRS in noise by 18.18% (95%CI:8.84;27.53), and SSQ12 total scores improved by 2.67 scale points (95%CI:1.81;3.53). Conclusion Extended use of HAs offers no additional benefit; CI surgery can proceed once one month of acclimatisation is achieved as the addition of a CI outperforms new replacement HAs in CI candidates with AHL.

Machine Learning to Characterize Speech Recognition and Quality of Life Outcomes in Adult Cochlear Implant Users.

Objective Speech understanding outcomes after cochlear implantation (CI) exhibit considerable variability. Speech understanding is a bi-modal and bi-directional process, involving also visual and cognitive functions. Therefore, follow-up for CI candidates should consider a broader range of factors beyond auditory factors. The current study aimed to evaluate the auditory, visual, and cognitive abilities of adults with a severe-to-profound hearing loss before and after implantation. Design and Study sample Twenty-six CI-candidates were assessed before implantation, and at three, six, and twelve months post-implantation. The auditory abilities were evaluated using pure-tone audiometry, speech audiometry in quiet and in noise. For assessing the (audio-)visual speech processing abilities the Test for (Audio-) Visual Speech Perception (TAUVIS) was used. The cognitive tests included the Letter-number sequencing task, the Letter Detection Test, and an auditory Stroop test. Linear Mixed Models were used to investigate the effect of test moment statistically. Results Findings show improvement in auditory, visual, and cognitive abilities post-implantation, with the most significant gains observed at three months post-implantation. Conclusions This study underscores the importance of evaluating CI outcomes comprehensively, considering auditory, visual, and cognitive abilities involved in speech understanding. These results could provide useful information for the counselling and rehabilitation before and after implantation.

An increasing number of children and adultswho are deaf are receiving cochlear implants in both ears (bilateral CIs or BiCIs), promoting the possibility of access to binaural cues. However, their effectiveness remains limited, as they do not adequately restore key acoustic cues for sound localization, particularly interaural time differences (ITDs) at low frequencies. The cochlea, the auditory sensory organ, typically transmits information for encoding ITDs more effectively at the apical region, which is specifically "tuned" to low frequencies. However, sensitivity to electrically-stimulated ITDs does not necessarily follow the non-implanted anatomy. We hypothesized that effective restoration of robust ITD perception through electrical stimulation with BiCIs depends on targeting cochlear locations that transmit information most effectively. We created a personalized sound-coding strategy that delivered ITDs to each participant's single "best" cochlear location. We then evaluated the spatial hearing of 14 BiCI listeners using this "Best" strategy and compared it with three control strategies. Here, we show an improvement in perception of ITDs with a tone stimulus with the "Best" strategy. However, this benefit does not seem to translate to speech stimuli. This suggests that restoration of ITD sensitivity requires targeting more than one good cochlear location for redundancy when it comes to more complex sounds such as speech.

ABSTRACT Objectives To evaluate the clinical impact of anatomy‐based fitting (ABF) in cochlear implants for patients with asymmetric hearing loss. Study Design Prospective cohort study. Setting Tertiary referral center specializing in hearing disorders. Methods Fifteen adult patients with asymmetric severe‐to‐profound sensorineural hearing loss or anacusis in the implanted ear, and residual low‐frequency hearing (≤ 65 dB HL at 125–500 Hz) in the better ear, were enrolled. All underwent cochlear implantation with bimodal rehabilitation (cochlear implant + hearing aid) and completed a 12‐month follow‐up. Cochlear duct length was measured preoperatively using OTOPLAN software to select the appropriate electrode array. Postoperative CT scans were analyzed with OTOPLAN to verify electrode positioning and generate the ABF map. Speech intelligibility in noise was assessed using the Italian Matrix sentence test in three listening conditions, comparing outcomes between the ABF and the default MAESTRO fitting maps. Results No statistically significant differences were found in speech perception scores between ABF and MAESTRO maps across test conditions. However, 86.7% of patients (13/15) preferred the ABF map for daily use, citing improved sound quality and listening comfort. Conclusion ABF, which aligns electrical stimulation with the patient's cochlear tonotopy by individualizing electrode selection and programming, may enhance the subjective auditory experience. While objective speech outcomes were comparable, patient preference strongly favored ABF, supporting its clinical relevance for optimizing cochlear implant performance in bimodal users.

It is unknown how electrode array position in the cochlea influences long-term hearing preservation for cochlear implant (CI) recipients with preserved low-frequency hearing after surgery. The aim of this study was to evaluate the influence of electrode insertion depth relative to regions of post-operative acoustic hearing and hearing preservation ≥ 1 year after CI activation. A retrospective review of adult CI recipients of a straight electrode array from 2017 to 2022 with functional acoustic hearing preservation (≤ 80 dB HL at 250 Hz) at device activation was performed. Proximity was quantified as the angular insertion depth (AID) of the most apical contact relative to the region of preserved functional acoustic hearing. Positive values indicate placement within the functional acoustic region; negative values indicate placement basal to the functional acoustic region. Low-frequency pure tone average (LFPTA) was queried from the preoperative, device activation, and annual post-activation visits. Stepwise regression analyzed whether proximity, AID, age, biological sex, and pre-operative LFPTA were significant predictors for change in unaided hearing thresholds. One hundred and six CI recipients met inclusion criteria. AID ranged from 330° to 717° (mean 513°, SD 79°). Proximity values ranged from -183° to 442° (mean 35°, SD 110°). None of the reviewed independent variables, including proximity, significantly predicted unaided hearing threshold shifts at the 1-year or the ≥ 3-year visits (p ≥ 0.128). Deeper insertion depths and electrode array placement within the functional acoustic hearing region did not predispose CI recipients to delayed loss of residual hearing.

ABSTRACT Objectives To understand the sociodemographic, audiologic, and performance variables that influence participant attrition in long‐term, repeated‐measures clinical research. Methods A retrospective review was completed for adult cochlear implant (CI) recipients who enrolled in an ongoing, repeated‐measures clinical research study investigating outcomes between two mapping procedures. The sample was stratified into those who completed the 12‐month study and those who withdrew prior to the study endpoint. The groups were compared for sociodemographic variables (age at consent, race, ethnicity, biological sex, drive time to the clinic, socioeconomic position, and rurality), cognition, and audiologic variables (device type, ipsilateral and contralateral hearing, device wear‐time, and tonotopic mismatch). Early performance on CNC word recognition was analyzed between groups. Results Of the 118 research participants, the attrition rate for the sample was 21%. Sociodemographic variables were at parity between the completed and withdrawal groups. Of the reviewed audiologic variables, the withdrawal group had poorer low‐frequency acoustic hearing thresholds, was less likely to be electric‐acoustic stimulation users than CI alone users (likely due to unaided thresholds), and had greater tonotopic mismatch. Early CNC word recognition was significantly different between the two groups, with the completed group having better early performance than the withdrawal group. Conclusion The present findings serve as a reminder of the need for reflection on clinical research study attrition patterns and a call for intentionally designed study inclusion criteria and procedures to support enrollment and retention of a representative sample. Level of Evidence 3.

To assess the S-value in pediatric cochlear implant (CI) patients using high-resolution CT images and examine its correlation with main cochlear parameters and angular insertion depth (AID). A retrospective review of preoperative CT images from pediatric CI recipients with normal cochlear anatomy was conducted at a referral hearing implant center. Cases involving congenital or acquired inner-ear abnormalities were excluded. Two independent reviewers with equivalent expertise used OTOPLAN to measure the main cochlear parameters, and the interrater reliability study revealed good agreement. S-values (the straight section of the cochlear basal turn) were measured and examined, and their correlation to electrode insertion angles and cochlear parameters (A- and B-values) was evaluated. The average cochlear duct length (CDL) of the included patients was 36.14 ± 0.26 mm, with an average S-value of 7.06 ± 0.40 mm, insertion angle of 598.20° ± 48.72°, and cochlear coverage of 77.49% ± 0.57. A statistically significant relationship was found between A- and the S-values (r = 0.65, p = 0.004). However, the B-value showed a moderate, non-significant correlation with the S-value (r = 0.43). Furthermore, a consistent negative, but not statistically significant, association was found between the S-value and the angular insertion depths of all electrode contacts(r = -0.28 to - 0.30). The S-value is a dependable anatomical parameter that correlates positively with the A-value. The evaluated lateral-wall array showed consistent insertion depths among patients with similar CDL, even when S-values differed. Further studies are needed to investigate the impact of greater variability in S-values on clinical outcomes and electrode-array position among CI users.

Neurocognitive factors contribute to heterogeneity in cochlear implant (CI) success. This study addresses three gaps: (1) whether long, low-redundancy sentences in quiet vs. short, high-redundancy sentences in noise recruit different cognitive involvement; (2) the methodological conflation of processing speed with inhibition-concentration; (3) the scarcity of tone language evidence in understanding the cognitive-speech relationship. Twenty-five postlingually deafened Mandarin CI users completed long-sentence recognition in quiet (Mandarin Chinese Adaptation of AzBio Sentence, CMnBio) and short-sentence recognition in four-talker babble noise (the BKB Sentences in Noise, BKB-SIN). Auditory input quality was assessed using the Spectral-Temporally Modulated Ripple Test (SMRT). The Shape Trail Test, a pencil-and-line task, was used to assess processing speed (STT-A/B), and inhibition-concentration (STT-B). Because STT-B reflects both processing speed and inhibition-concentration, the latter was isolated using STT-B.A (the residual of STT-B on STT-A). Independent contributions to recognition were assessed with hierarchical regression analyses. SMRT, STT-A, and STT-B showed correlations with both sentence outcomes, whereas STT-B.A correlated solely with BKB-SIN. In regression models controlling for SMRT, STT-A explained significant variance in CMnBio (β = -0.507, p = 0.001) and BKB-SIN (β = -0.371, p = 0.012). STT-B.A contributed only to BKB-SIN (β = -0.318, p = 0.014). Information processing speed shows a general association with sentence recognition in both quiet and noise, whereas inhibition-concentration shows a noise-specific association in Mandarin CI users. This study highlights the importance of methodological distinction separating these two cognitive functions and extends cognition-speech links to tonal languages.

Abstract Background Cochlear implant (CI) is a neuroprosthetic device that enables individuals with severe to profound hearing loss to hear and communicate. Selection of an appropriate CI manufacturer from amongst the three major global CI manufacturers, namely Advanced Bionics, Cochlear Corporation and MED-EL, can be a daunting and high-stakes decision for CI candidates. On this background, the present questionnaire-based, retrospective survey aimed to better understand the parental decision-making process regarding selection of CI manufacturer for their child. It examined the sources of information utilised by parents and the relative importance of the influencing factors in their decision-making. Results The survey incorporated 57 participants in all. It included parents of children who underwent cochlear implantation between January 2022 and January 2025, at the CI centre of a tertiary care hospital in Western India. Parents of children with cochlear deformity and those with cochlear implantation performed under government schemes were excluded from the study. The majority of the parents (68.42%) cited their auditory habilitationist as the most popular source of information when selecting a CI brand. Regardless of the CI manufacture chosen, parents ranked technology as the most important deciding factor while choosing the device. Conclusions Auditory habilitationist, audiologist and ENT Surgeon were the key sources of information for parents selecting CI manufacturer for their child. The majority of the parents prioritised technology and device construction during the selection process. Results of this study highlight the crucial role played by healthcare professionals in providing accurate, comprehensive and technology-focused guidance to support informed parental decision-making when selecting CI manufacturer.