Cochlear Implant Users Research Articles

Investigating the Effect of Blurring and Focusing Current in Cochlear Implant Users with the Panoramic ECAP Method.

For some cochlear implants (CIs), it is possible to focus electrical stimulation by partially returning current from the active electrode to nearby, intra-cochlear electrodes (partial tripolar (pTP) stimulation). Another method achieves the opposite: "blurring" by stimulating multiple electrodes simultaneously. The Panoramic ECAP (PECAP) method provides a platform to investigate their effects in detail by measuring electrically evoked compound action potentials and estimating current spread and neural responsiveness along the length of the CI electrode array. We investigate how sharpening and broadening the electrical current spread are reflected in PECAP estimates. PECAP measurements were recorded at most comfortable level in 12 ears of Advanced Bionics CI users. Focused thresholds were also determined. For the electrodes with the highest and lowest focused thresholds, additional PECAP measurements were recorded while stimulating in pTP mode and in "blurred" mode with 3 or 5 adjacent electrodes simultaneously stimulated. Current spread and neural responsiveness were then estimated along the electrode array using PECAP. PECAP revealed increased current spread estimates across participants for blurred stimulation of the targeted electrodes towards the apex of the cochlea. Variable results for pTP stimulation were found, with two of eight ears appearing to drive a small group-level effect of increased current spread. When stimulating multiple electrodes simultaneously, PECAP detected localized increases in current spread towards the apex (but not the base) of the cochlea. pTP stimulation showed mixed effects on PECAP current spread estimates. These findings are in line with behavioral speech perception studies and have implications for cochlear implant optimization.

The Effects of Home Language Use on Spanish Speech Measures in Bilingual Children With Hearing Loss Who Use Cochlear Implants and Their Peers With Normal Hearing.

The purpose of this study was to investigate how the amount of home language use between the primary caregiver and bilingual Spanish- and English-speaking children with hearing loss who use cochlear implants (CIs) versus their bilingual age-matched peers with normal hearing (NH) can impact speech outcomes in the home language. Thirty-four bilingual Spanish- and English-speaking children (17 CI users and 17 with NH) between the ages of 5;3 and 7;9 (years;months) participated in this study. Independent variables were the amount of home language use with the primary caregiver and hearing status, and dependent variables were vowels and consonants correctly produced and occurrence of selected phonological processes. The amount of home language use was ascertained from surveys, and the dependent measures were based on a single-word picture elicitation task. Bilingual children with CIs who are exposed to Spanish for more than 80% of the time via their primary caregiver performed better on Spanish segmental accuracy measures than those who are exposed to Spanish from only 20% to 50% of the time, specifically on vowels (partial η2 = .31) and consonants (partial η2 = .025). Children with NH outperformed children with CIs on all accuracy measures in Spanish. Preliminary results suggest the importance of language exposure through interactions with the primary caregiver for speech development in bilingual children. Future studies should investigate strategies to facilitate home language development in bilingual children with CIs, enabling them to reach their full potential.

Evaluation of VOR function with vHIT in unilateral pediatric cochlear implant users

ObjectiveThe changes in the inner ear affect both the cochlea and the vestibule and these effects are observed after cochlear implantation surgery. The aim of the current study is to evaluate the effect of unilateral cochlear implant use on vestibulo-ocular reflex (VOR) in children. MethodsIn the current study, 29 cochlear implanted children, aged 7–18 years, were include as the study group and 32 children, in the same age range, were included with normal-hearing as the control group. vHIT was used to evaluate VOR and the results of unilateral CI users were compared with the control group. The study group was evaluated in two different situations: cochlear implant sound processor on (CI-ON) and cochlear implant sound processor off (CI-OFF). The data obtained in the evaluations were compared between the implanted ear and the non-implanted ear between the CI-ON and CI-OFF states within the study group and between the study group and the control group. ResultsWhen the CI-ON and CI-OFF conditions in the study group were compared, no significant difference was found (p > 0.05). Similarly, no significant difference was found between the implanted ear and the non-implanted ear (p > 0.05). Also, there was no significant difference in the comparisons between the study group and the control group (p > 0.05). ConclusionvHIT is a functional test method that can be used in children to test vestibular function after cochlear implant. vHIT is a comfortable test to use after cochlear implantation to demonstrate the functionality of the vestibular system. And it provides consistent results regardless of whether the speech processor is on or off.

Cochlear implant usage in single sided deafness and factors affecting usage

Objectives The primary objective was to examine duration of daily cochlear implant (CI) usage at 12 and 24 months post-operatively in single sided deafness (SSD). The secondary objective was to examine factors that could affect CI usage. Methods Retrospective cohort of patients with SSD who received CI from January 2015 to March 2020. CI usage was evaluated at 12 and 24 months. Hearing loss duration, tinnitus scores and signal-to-noise ratio (SNR) were correlated with CI usage at 12 months. Results Usage data was available for 54 patients at 12 months and 38 patients at 24 months. The mean usage was 8.2 h/day (SD 4.2) at 12 months, 7.0 h/day (SD 5.1) at 24 months. 5 out of 54 (9.3%) and 7 out of 38 patients (18.4%) were non-users at 12 and 24 months post-operatively. An improved mean SNR score from pre-operative 4.4 dB (SD 2.8) to – 0.70 dB (SD 4.2) at 12 months post-operative was positively correlated with CI usage at 12 and 24 months. Hearing loss duration and tinnitus scores were not associated with CI usage. Conclusions 18.4% of our patients were non-users at 24 months. Mean usage at 24 months was 7.0 h/day. Improved hearing in noise at 12 months was correlated with better usage.

Changes in Outcomes Expectations During the Cochlear Implant Evaluation Process.

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

When to Start Computer-Based Auditory Training After Cochlear Implantation: Effects on Quality of Life and Speech Recognition.

Computer-based auditory training (CBAT) has been shown to improve outcomes in adult cochlear implant (CI) users. This study evaluates in new CI users whether starting CBAT within 3 months of activation or later impacts CI outcomes. Prospective natural experiment. Tertiary academic medical center. Sixty-five new adult CI users. CBAT use over the first-year postactivation. Speech recognition scores and CIQOL-35 Profile score improvements between CI recipients who started CBAT resources early (<3 mo) and late (3-12 mo) postactivation. A total of 43 CI recipients started using CBAT within 3 months postactivation (early) and 22 after 3 months (late). Patients who used CBAT within 3 months postactivation showed significantly greater improvement in consonant-nucleus-consonant words (CNCw) (48.3 ± 24.2% vs 27.8 ± 24.9%; d = 0.84), AzBio Sentences in quiet (55.1 ± 28.0% vs 35.7 ± 36.5%; d = 0.62), and CIQOL-35 listening domain scores (18.2 ± 16.3 vs 6.9 ± 12.9, d = 0.73 [0.023, 1.43]), at 3 months postactivation, compared to those who had not yet initiated CBAT. However, by 12 months postactivation, after which all CI recipients had started CBAT, there were no differences observed between patients who started CBAT early or late in speech recognition scores (CNCw: d = 0.26 [-0.35, 0.88]; AzBio: d = 0.37 [-0.23, 0.97]) or in any CIQOL global or domain score (d-range = 0.014-0.47). Auditory training with self-directed computer software (CBAT) may yield speech recognition and quality-of-life benefits for new adult CI recipients. While early users showed greater improvement in outcomes at 3 months postactivation than users who started later, both groups achieved similar benefits by 12 months postactivation.

Perception of voice cues and speech-in-speech by children with prelingual single-sided deafness and a cochlear implant

Voice cues, such as fundamental frequency (F0) and vocal tract length (VTL), help listeners identify the speaker's gender, perceive the linguistic and emotional prosody, and segregate competing talkers. Postlingually implanted adult cochlear implant (CI) users seem to have difficulty in perceiving and making use of voice cues, especially of VTL. Early implanted child CI users, in contrast, perceive and make use of both voice cues better than CI adults, and in patterns similar to their peers with normal hearing (NH).In our study, we investigated the perception and use of voice cues in children with single-sided deafness (SSD) who received their CI at an early age (SSD+CI), in an attempt to bridge the gap between these two groups. The SSD+CI children have access to bilateral auditory information and often receive their CI at an early age, similar to CI children. They may also have dominant acoustic representations, similar to CI adults who acquired hearing loss at a later age. As such, the current study aimed to investigate the perception and use of voice cues by a group of nine early-implanted children with prelingual SSD. The study consisted of three experiments: F0 and VTL discrimination, voice gender categorization, and speech-in-speech perception. In each experiment, the results of the SSD group are compared to children and adults with CIs (for their CI ear) and with typical hearing (for their NH ear).Overall, the SSD+CI children had poorer VTL detection thresholds with their CI compared to their NH ear, while their F0 perception was similar across ears. Detection thresholds for both F0 and VTL with their CI ear was comparable to those of bilaterally implanted CI children, suggesting that SSD+CI children do not only rely on their NH ear, but actually make use of their CI. SSD+CI children relied more heavily on F0 cues than on VTL cues for voice gender categorization, with cue weighting patterns comparable to those of CI adults. In contrast to CI children, the SSD+CI children showed limited speech perception benefit based on F0 and VTL differences between the target and masker speaker, which again corresponded to the results of CI adults. Altogether, the SSD+CI children make good use of their CI, despite a good-hearing ear, however, the perceptual patterns seem to fall in-between those of CI children and CI adults. Perhaps a combination of childhood neuroplasticity, limited experience with relying only on the CI, and a dominant acoustic representation of voice gender explain these results.

EVALUATION OF REMOTE CHECK IN CHILDREN WITH COCHLEAR IMPLANTS

ObjectiveThis study evaluates the feasibility of reducing in-person appointments by utilizing Remote Check (RC) in pediatric cochlear implant (CI) recipients and investigates the most suitable age range for implementing RC. MethodsFifty-eight pediatric CI recipients, aged 1 to 17 years, were evaluated using a web-based RC application by audiologists. Most (84.5%) used verbal communication. Inclusion criteria required stable map status, caregiver tech proficiency, and a compatible phone. ResultsRemote assessments were beneficial, with 89.7% of participants successfully completing RC. Aided threshold tests (ATT) were completed in 73.2% of participants, while speech-in-noise tests (Digit Triplet Test, DTT) were completed in 47.3%. Children as young as 4 successfully completed ATT, while a minimum age of 7 was required for DTT. A significant relationship between age and test success was demonstrated. Verbally communicative children had higher completion success rates. Parental education was significantly correlated with DTT success, with higher success rates in children whose parents had undergraduate degrees. With RC use, 69% of children did not need clinic visits, emphasizing the need for personalized and remote support for optimal cochlear implant performance. In-person appointments were primarily required due to concerns about the duration of device usage. ConclusionThe study confirms the effectiveness and feasibility of using RC in pediatric CI users, even as young as one year old with stable aided hearing. The findings advocate for the integration of RC into routine follow-up protocols, offering a more accessible option for enhanced patient care.

Validity and reliability of the Turkish version of the hearing implant sound quality index questionnaire (HISQUI19)

Objectives The aim was to construct validity and reliability of the Hearing Implant Sound Quality Index Questionnaire (HISQUI19) in Turkish. Methods This study was a methodologic study to validate HISQUI19 in Turkish. The study included 62 cochlear implant users. Guttman’s split half-coefficient and Cronbach’s alpha tests were used for construct validity and internal consistency. Pearson correlation test was used to assess the relationship of the HISQUI19 total score to the SSQ49 scales for CI users and to show test – retest reliability. Results The Cronbach’s α value was 0.94 overall score with high internal consistency (Guttman’s split-half-coefficient: 0.912). Test-retest reliability results showed high repeatability and consistency of the measure across time (r = 0.708; P = 0.002). Support for conducting factor analysis was provided by the KMO test, with a value of 0.876, which is ‘great’. Discussion Subjective evaluation of cochlear implant users’ daily life experiences is a useful tool to reveal the auditory benefits of cochlear implant usage. Conclusion Turkish version of the HISQUI19 is a reliable and valid assessment tool for adults with CIs. This questionnaire provides clinicians with a valuable, reliable, and valid tool for determining the subjective benefit of CI for patients.

Increased listening effort and decreased speech discrimination at high presentation sound levels in acoustic hearing listeners and cochlear implant users.

The sounds we experience in our everyday communication can vary greatly in terms of level and background noise depending on the environment. Paradoxically, increasing the sound intensity may lead to worsened speech understanding, especially in noise. This is known as the "Rollover" phenomenon. There have been limited studies on rollover and how it is experienced differentially across aging groups, for those with and without hearing loss, as well as cochlear implant (CI) users. There is also mounting evidence that listening effort plays an important role in challenging listening conditions and can be directly quantified with objective measures such as pupil dilation. We found that listening effort was modulated by sound level and that rollover occurred primarily in the presence of background noise. The effect on listening effort was exacerbated by age and hearing loss in acoustic listeners, with greatest effect in older listeners with hearing loss, while there was no effect in CI users. The age- and hearing-dependent effects of rollover highlight the potential negative impact of amplification to high sound levels and therefore has implications for effective treatment of age-related hearing loss.

Designing audio processing strategies to enhance cochlear implant users' music enjoyment

Cochlear implants (CIs) provide hundreds of thousands of users with increased access to sound, particularly speech, but experiences of music are more varied. Can greater engagement by CI users in the music mixing process mutually benefit them as well as audio engineers? This paper presents an exploratory mixed-methods study that leverages insights from CI users and professional audio engineers (AEs) in the investigation of techniques to enhance CI user music enjoyment and promote empathetic practices in AEs. Analysis of data collected over a multi-step process of surveys, interviews, and iterative cycles of sound mixing and feedback revealed two mixing strategies—namely essentializing and exaggeration of musical elements—common among mixes preferred by CI users. Participant responses also highlighted systemic ableism and audism in the music industry—an industry from which CI users report feeling excluded. Specifically, AEs felt inadequately trained around aural diversity considerations and experienced anxiety around their own aural diversity. In sum, this work contributes to insights into CI user music listening preferences; how AEs approach mixing for an aurally diverse audience; and discussion around the efficacy of CI simulation, user feedback, and AE peer feedback on mix enjoyment by CI users. Based on these findings, we offer several design insights that emphasize the need for customizable music listening tools centered around user agency and enjoyment.

Anatomy-based fitting improves speech perception in noise for cochlear implant recipients with single-sided deafness

Abstract Objective To evaluate objective and subjective hearing outcomes in experienced cochlear implant users with single sided deafness (SSD CI) who used fitting maps created via anatomy-based fitting (ABF) and clinically-based fitting (CBF). Participants Twelve SSD CI users with postlingual hearing loss. Intervention OTOPLAN (Version 3. (MED-EL) was used to determine intracochlear electrode contact positions using post-operative high-resolution flat panel volume computed tomography. From these positions, the corresponding center frequencies and bandwidths were derived for each channel. These were implemented in the clinical fitting software MAESTRO to yield an ABF map individualized to each user. Main Outcome Measures ABF and CBF maps were compared. Objective speech perception in quiet and in noise, binaural effects, and self-perceived sound quality were evaluated. Results Significantly higher speech perception in noise scores were observed with the ABF map compared to the CBF map (mean SRT50: -6.49 vs. -4.8 dB SNR for the S0NCI configuration and − 3.85 vs. -2.75 dB SNR for the S0N0 configuration). Summation and squelch effects were significantly increased with the ABF map (0.86 vs. 0.21 dB SNR for summation and 0.85 vs. -0.09 dB SNR for squelch). No improvement in speech perception in quiet or spatial release from masking were observed with the ABF map. A similar level of self-perceived sound quality was reported for each map. Upon the end of the study, all users opted to keep the ABF map. This preference was independent of the angular insertion depth of the electrode array. Conclusions Experienced SSD CI users preferred using the ABF map, which gave them significant improvements in binaural hearing and some aspects of speech perception.

Investigation of Deficits in Auditory Emotional Content Recognition by Adult Cochlear Implant Users through the Study of Electroencephalographic Gamma and Alpha Asymmetry and Alexithymia Assessment.

Given the importance of emotion recognition for communication purposes, and the impairment for such skill in CI users despite impressive language performances, the aim of the present study was to investigate the neural correlates of emotion recognition skills, apart from language, in adult unilateral CI (UCI) users during a music in noise (happy/sad) recognition task. Furthermore, asymmetry was investigated through electroencephalographic (EEG) rhythm, given the traditional concept of hemispheric lateralization for emotional processing, and the intrinsic asymmetry due to the clinical UCI condition. Twenty adult UCI users and eight normal hearing (NH) controls were recruited. EEG gamma and alpha band power was assessed as there is evidence of a relationship between gamma and emotional response and between alpha asymmetry and tendency to approach or withdraw from stimuli. The TAS-20 questionnaire (alexithymia) was completed by the participants. The results showed no effect of background noise, while supporting that gamma activity related to emotion processing shows alterations in the UCI group compared to the NH group, and that these alterations are also modulated by the etiology of deafness. In particular, relative higher gamma activity in the CI side corresponds to positive processes, correlated with higher emotion recognition abilities, whereas gamma activity in the non-CI side may be related to positive processes inversely correlated with alexithymia and also inversely correlated with age; a correlation between TAS-20 scores and age was found only in the NH group. EEG gamma activity appears to be fundamental to the processing of the emotional aspect of music and also to the psychocognitive emotion-related component in adults with CI.

How differ eCAP types in cochlear implants users with and without inner ear malformations: amplitude growth function, spread of excitation, refractory recovery function.

Inner ear malformations (IEMs) may result in differences in outcomes of cochlear implant user. These differences could be observed in both behavioral and objective tests. eCAP is the most common used objective test in cochlear implants and have different presence rate in cochlear implant users with and without IEMs. This study aims to evaluate eCAP results from CI user with and without IEMs through different recoding methods; amplitude growth function, spreads of excitation and refractory recovery. There were 42 CI users (20 IEM&22 normal) above five-years old and with at least one year experience. Three different eCAP measurement was conducted at several intracochlear electrodes. Presence rate, threshold levels and amplitude were compared between groups. For Amplitude growth function measurement, when the percentage of detected eCAP thresholds was analyzed between groups, there was a significant difference only for basal electrode and no significant difference for apical and middle electrodes. Similarly, the presence rate of RecF-eCAP for both groups were in a downward trend from apical to basal. However, there was no significant difference in AGF-eCAP and RecF-eCAP amplitudes between groups for the cochlea's apical, middle and basal region. Although the presence rate of SOE-eCAP was lower for IEM group, there was no significant difference in ECAP amplitudes for all maskers. It could be inferred that even though the observable eCAP rate differed between these two groups when the observable eCAP was recorded, the IEM group produced eCAP with similar amplitudes to normal cochlea group.

Music Perception and Music-Related Quality of Life in Adult Cochlear Implant Users: Exploring the Need for Music Rehabilitation.

Cochlear implant (CI) users face difficulties in accurately perceiving basic musical elements such as pitch, melody, and timbre. Music significantly affects the quality of life (QoL) of CI users. Individually and culturally influenced music perception exceeds psychophysical measures in capturing the subjective music enjoyment of CI users. Understanding the music perception, enjoyment, and habits of CI users is crucial for approaches to improve music-related QoL (MuRQoL). Therefore, this study aims to investigate music perception skills, experiences, and participation in music activities in a large group of adult CI users, and to understand the importance of these factors and their impact on QoL of CI users. This study included 214 CI recipients with diverse auditory experiences who were aged between 18 and 65 years and were unilateral, bimodal, or bilateral users for at least 1 year and 193 normal hearing (NH) controls. All participants completed the information forms and the MuRQoL questionnaire. To assess the impact of music on QoL and identify personalized rehabilitation needs, the scores for each question in both parts of the questionnaire were intersected on a matrix. Data were presented in detail for the CI group and compared between CI and NH groups. A statistically significant difference was found between the matched CI and NH groups in favor of the NH group in terms of music perception and music engagement. Participants who received music education at any point in their lives had significantly higher MuRQoL questionnaire scores. There was no significant relationship found between the duration of auditory rehabilitation, pre-CI hearing aid usage, music listening modality, and MuRQoL questionnaire scores. Unilateral CI users had significantly lower scores in music perception and music engagement subsections compared with bimodal and bilateral CI users. Also, it was found that music had a strong negative impact on QoL in 67/214 of the CI users. Although CI users scored significantly lower than NH individuals on the first part of the questionnaire, which asked about musical skills, enjoyment, and participation in musical activities, findings suggest that CI users value music and music enjoyment just as much. The study reveals the influence of factors such as education level, age, music education, type of hearing loss and auditory rehabilitation on music perception, music enjoyment, and participation in music activities through self-report. The results indicate that for many CI users, music has a strong negative impact on QoL, highlighting the need for personalized music interventions, the inclusion of self-report questionnaires, and music perception tests in clinical evaluations.

Impact of Reverberation on Speech Perception in Noise in Bimodal/Bilateral Cochlear Implant Users with and without Residual Hearing.

(1) Background: The aim of the present study was to assess the impact of reverberation on speech perception in noise and spatial release from masking (SRM) in bimodal or bilateral cochlear implant (CI) users and CI subjects with low-frequency residual hearing using combined electric-acoustic stimulation (EAS). (2) Methods: In total, 10 bimodal, 14 bilateral CI users and 14 EAS users, and 17 normal hearing (NH) controls, took part in the study. Speech reception thresholds (SRTs) in unmodulated noise were assessed in co-located masker condition (S0N0) with a spatial separation of speech and noise (S0N60) in both free-field and loudspeaker-based room simulation for two different reverberation times. (3) Results: There was a significant detrimental effect of reverberation on SRTs and SRM in all subject groups. A significant difference between the NH group and all the CI/EAS groups was found. There was no significant difference in SRTs between any CI and EAS group. Only NH subjects achieved spatial release from masking in reverberation, whereas no beneficial effect of spatial separation of speech and noise was found in any CI/EAS group. (4) Conclusions: The subject group with electric-acoustic stimulation did not yield a superior outcome in terms of speech perception in noise under reverberation when the noise was presented towards the better hearing ear.

Needs analysis for self-help training in the context of cochlear implant rehabilitation

Despite cochlear implantation, CI users experience difficulties in challenging listening situations. In German-speaking countries, there are no interventions to promote specific coping strategies for such situations. The present study examines persistent everyday limitations and the relevance of potential intervention content in order to develop a self-help program for CI rehabilitation. 56 CI users from three German CI centers were recruited and completed an online survey on demographic data, hearing biography, hearing handicap and potentially relevant intervention content. The intervention content presented included the following categories: Medical Aspects, Communication Improvement Aspects, Psychosocial Aspects, Technical Aspects, Specific Aspects. The hearing handicap was moderate to severe in this sample. The content categories presented for the design of a self-help program were all rated as "important". The duration of CI provision correlated significantly negatively with the assessment of the relevance of psychosocial aspects. Further significant correlations were found between the severity of the hearing handicap and the rating of the relevance of aspects for improving communication, psychosocial and technical aspects. A self-help program that takes into account the contents examined could provide promising support for the CI rehabilitation process and will be developed and evaluated subsequently.

Audiological outcome of bimodal CI users over time and depending on different influencing factors

Hearing-impaired persons with asymmetric hearing loss and aunilateral indication for acochlear implant (CI) generally benefit from abimodal hearing solution. The influence of bimodal fitting on speech comprehension (SC) over time has not yet been sufficiently investigated. The present study examines the influence of bimodal fitting on SC in bimodally fitted CI users with postlingual deafness at least 36months after implantation and analyzes possible influencing factors. Included in this retrospective longitudinal study were 54bimodally fitted speech-competent CI users with at least 36months of CI experience. Audiometric data of these CI users at predefined timepoints were compared. The change in the results of the Freiburg monosyllabic test (FT) over 36months was significant (p < 5%) for the deafness group at <10years for both the 65 dB sound pressure level (SPL) and at 80 dB SPL and also significant for the deafness group ≥10years for 65 dB SPL. In the Oldenburg sentence test (OlSa) there was ahighly significant change (p < 0.1%) for S0, S0N0, and S0NCI configurations and avery significant change (p < 1%) for S0NHA (HA: hearing aid). Age at implantation as apossible influencing factor could not be confirmed in the FT. In contrast, the duration of deafness was anegative influencing factor for SC with CI in the FT, whereas alonger duration of deafness was associated with worse results in the FT. The degree of hearing loss in the ear fitted with an HA did not influence SC. The median bimodal benefit (here: difference in SC with bimodal fitting compared to unilateral HA fitting for FT at 65 dB SPL) was 10% over the total study period. For amedian of 79% of the test subjects, the bimodal benefit was found over the entire period of 36months. Over time, SC improves significantly with aCI for the bimodal test subjects. The investigated influencing factors (age, duration of deafness, and degree of hearing loss in the contralateral ear) support the indication for bimodal provision in accordance with the guideline in Germany for cochlear implantation-regardless of age, duration of deafness, and hearing ability of the contralateral ear.

P1 and N1 Characteristics in Individuals with Normal Hearing and Hearing Loss, and Cochlear Implant Users: A Pilot Study.

Background: It has been reported in many previous studies that the lack of auditory input due to hearing loss (HL) can induce changes in the brain. However, most of these studies have focused on individuals with pre-lingual HL and have predominantly compared the characteristics of those with normal hearing (NH) to cochlear implant (CI) users in children. This study examined the visual and auditory evoked potential characteristics in NH listeners, individuals with bilateral HL, and CI users, including those with single-sided deafness. Methods: A total of sixteen participants (seven NH listeners, four individuals with bilateral sensorineural HL, and five CI users) completed speech testing in quiet and noise and evoked potential testing. For speech testing, the Korean version of the Hearing in Noise Test was used to assess individuals' speech understanding ability in quiet and in noise (noise from the front, +90 degrees, and -90 degrees). For evoked potential testing, visual and auditory (1000 Hz, /ba/, and /da/) evoked potentials were measured. Results: The results showed that CI users understood speech better than those with HL in all conditions except for the noise from +90 and -90 degrees. In the CI group, a decrease in P1 amplitudes was noted across all channels after implantation. The NH group exhibited the highest amplitudes, followed by the HL group, with the CI group (post-CI) showing the lowest amplitudes. In terms of auditory evoked potentials, the smallest amplitude was observed in the pre-CI condition regardless of the type of stimulus. Conclusions: To the best of our knowledge, this is the first study that examined visual and auditory evoked potentials based on various hearing profiles. The characteristics of evoked potentials varied across participant groups, and further studies with CI users are necessary, as there are significant challenges in collecting and analyzing evoked potentials due to artifact issues on the CI side.

Experience with the cochlear implant enhances the neural tracking of spectrotemporal patterns in the Alberti bass

Cochlear implant (CI) users experience diminished music enjoyment due to the technical limitations of the CI. Nonetheless, behavioral studies have reported that rhythmic features are well-transmitted through the CI. Still, the gradual improvement of rhythm perception after the CI switch-on has not yet been determined using neurophysiological measures. To fill this gap, we here reanalyzed the electroencephalographic responses of participants from two previous mismatch negativity studies. These studies included eight recently implanted CI users measured twice, within the first six weeks after CI switch-on and approximately three months later; thirteen experienced CI users with a median experience of 7 years; and fourteen normally hearing (NH) controls. All participants listened to a repetitive four-tone pattern (known in music as Alberti bass) for 35 min. Applying frequency tagging, we aimed to estimate the neural activity synchronized to the periodicities of the Alberti bass. We hypothesized that longer experience with the CI would be reflected in stronger frequency-tagged neural responses approaching the responses of NH controls. We found an increase in the frequency-tagged amplitudes after only 3 months of CI use. This increase in neural synchronization may reflect an early adaptation to the CI stimulation. Moreover, the frequency-tagged amplitudes of experienced CI users were significantly greater than those of recently implanted CI users, but still smaller than those of NH controls. The frequency-tagged neural responses did not just reflect spectrotemporal changes in the stimuli (i.e., intensity or spectral content fluctuating over time), but also showed non-linear transformations that seemed to enhance relevant periodicities of the Alberti bass. Our findings provide neurophysiological evidence indicating a gradual adaptation to the CI, which is noticeable already after three months, resulting in close to NH brain processing of spectrotemporal features of musical rhythms after extended CI use.