To evaluate long-term functional hearing preservation (FHP) in pediatric cochlear implant recipients and identify key predictors, including electrode array length, preoperative thresholds, and presence of inner ear malformations. Retrospective case review. Tertiary referral center. We reviewed 113 ears of children with preoperative acoustic hearing (≤65dB HL at 250Hz) who received a cochlear implant (CI) from a single manufacturer. Data were collected over a mean follow-up of 4 years (range: 0.2 to 8.7y). Functional hearing preservation (FHP), was defined as an unaided threshold of ≤80dB HL at 250Hz. The percentage of FHP was calculated for each patient. Outcomes were analyzed using Kaplan-Meier survival analysis and mixed-effects modeling to evaluate short-term (1y) and long-term (5y) predictors of FHP. Across all ears, survival estimates for FHP were 0.70 at 1 year and 0.57 at 5 years. Children with EVA demonstrated poor durability of residual hearing, with a survival probability of 0.36 at 1 year and no probability of retaining functional hearing beyond 2 years. In contrast, ears without EVA showed greater potential for preservation: 0.76 at both 6 months and 1 year, 0.72 at 2 years, and 0.62 at 5 years. Hearing preservation was significantly influenced by electrode array length, preoperative thresholds (short-term), presence of EVA, and time since surgery. Short-term and long-term hearing preservation was not significantly influenced by age at implantation. Functional hearing preservation is achievable in a substantial proportion of children, particularly with 24mm arrays and in the absence of inner ear malformation. Outcomes decline progressively over time, particularly for cases of EVA. This study underscores the need for tailored surgical and rehabilitation strategies and long-term monitoring in this population.

Examine the incidence of one or more electrode contacts placed within the region of functional acoustic hearing and the potential influence of electrode positioning on speech recognition for pediatric cochlear implant (CI) recipients. A retrospective review for pediatric CI recipients of straight electrode arrays with preserved low-frequency hearing (an unaided threshold of ≤ 80 dB HL at 250 Hz) was conducted at a tertiary referral center. Intraoperative X-rays were used to determine the angular insertion depth (AID) of each electrode. Proximity of contacts to the functional acoustic hearing region was calculated using AID and postoperative unaided thresholds. For electric-acoustic stimulation (EAS) users, the association between proximity values and CNC word recognition in quiet was reviewed at 3-, 6-, and 12-months post-activation. Among 69 ears, 90% had at least one electrode contact within the functional acoustic hearing region. Proximity values ranged from -131° to 450° (mean: 100°, SD: 120°). For EAS users with speech recognition data (n = 29), proximity values were not significantly associated with post-activation CNC scores (p ≥ 0.212). Most pediatric CI recipients with hearing preservation had at least one electrode contact in the region of functional acoustic hearing. Proximity was not significantly associated with word recognition in quiet for EAS users, though this subgroup was limited in sample size. Further studies in pediatric EAS users are needed to understand the potential relationship with speech recognition in noise and to determine the benefits of individualizing array selection and/or EAS mapping.

Background/Objectives: Frequency-to-place mismatch between cochlear implant (CI) electrodes and cochlear tonotopy has been suggested to affect postoperative speech perception. This study aimed to examine the associations between frequency-to-place mismatch and speech perception outcomes across multiple linguistic levels in patients with CI and to assess how these associations change over time using postoperative computed tomography. Methods: This retrospective cohort study included 44 postlingually deafened adults who underwent unilateral cochlear implantation with a Flex28 electrode by a single surgeon at a tertiary care hospital. Speech perception was assessed using CI-2004, a Japanese speech perception test consisting of monosyllables, consonants, words, and sentences, in quiet settings at 3, 6, and 12 months after CI activation. Partial correlation analyses between frequency-to-place mismatch and postoperative speech perception scores were performed in 35 of the 44 patients, controlling for age and mean preoperative pure-tone thresholds. Results: Negative associations were observed between frequency-to-place mismatch and CI-2004 scores, particularly for monosyllable and consonant perception in uncorrected analyses. After correction for multiple comparisons, only consonant perception at 3 months after CI activation remained significant (r = -0.52, p = 0.002). Similar patterns were observed for other speech measures and at later time points, although these did not remain significant after correction. Conclusions: Frequency-to-place mismatch was associated with postoperative speech perception outcomes, particularly those involving phoneme-level recognition. After correction for multiple comparisons, only consonant perception at 3 months after CI activation remained significant.

Considerable variability in auditory and speech outcomes among pediatric cochlear implant (CI) recipients has raised ongoing debate regarding whether early auditory perception directly determines later speech intelligibility, particularly in tonal language environments where pitch cues are critical for communication. This longitudinal study evaluated 64 prelingually deaf children aged 1-5 years over 12 months following unilateral implantation, integrating four standardized behavioral scales-the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), Categories of Auditory Performance (CAP), Monosyllabic-Trochee-Polysyllabic Word Test (MESP), and Speech Intelligibility Rating (SIR)-together with cortical auditory evoked potentials (CAEP). All measures demonstrated significant time-dependent improvement (p < 0.001): IT-MAIS and CAP increased rapidly within 3 months post-activation, followed by progressive gains in MESP and SIR reflecting enhanced speech perception and intelligibility. Multiple regression analysis showed that CAP at 3 months was significantly associated with SIR outcomes at 12 months (β = 0.201, p = 0.010), explaining 26.6% of the variance, supporting a hierarchical relationship between early auditory comprehension and later expressive language development. Furthermore, P1 latency shortening on CAEP correlated with higher SIR scores (r = 0.275, p = 0.028), supporting cortical plasticity as a neural mechanism underlying behavioral recovery. No significant between-group differences were observed for most auditory and speech perception measures. However, SIR scores at 12 months were modestly higher in children with normal cochlear anatomy. Overall developmental trajectories remained comparable between groups, suggesting that functional auditory experience plays a major role in rehabilitation outcomes. These findings provide longitudinal behavioral and electrophysiological evidence suggesting that early auditory integration is associated with later speech production outcomes. The proposed multimodal framework offers a reproducible, evidence-based approach for monitoring auditory-speech trajectories and guiding individualized rehabilitation in pediatric CI 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.

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.

To investigate the trajectory of spectral resolution in adult cochlear implant (CI) recipients and determine whether early spectral resolution measures can predict later speech recognition outcomes. Prospective, longitudinal study of 531 postlingually deafened adult CI recipients. Spectral resolution (EasyQSMD) and speech recognition (CNC words, AzBio sentences in quiet and noise) were evaluated from activation through 1-year post-activation. Growth curve models were fit to EasyQSMD thresholds across all timepoints to generate mode-based estimates of early spectral resolution at 1-month post-activation. These model-derived early thresholds were then used to predict later speech recognition outcomes (best of 6-months and 1-year) through linear regression analyses. EasyQSMD thresholds improved from activation to 1-week post-activation, then stabilized through the first year. Model-derived early EasyQSMD thresholds significantly predicted later speech recognition outcomes, explaining 3%-8% of the variance in performance. Spectral resolution rapidly stabilizes, reaching asymptotic performance by 1-week post-activation. The EasyQSMD provides a non-linguistic assessment tool that demonstrates significant predictive value for subsequent speech recognition outcomes. This early predictive capability enables the identification of poor performers during a critical window when speech recognition skills are still developing and the brain's neuroplasticity is at peak potential. Integrating spectral resolution assessment into early post-activation clinical protocols could improve individualized realistic expectations counseling and guide targeted interventions-potentially leading to improved overall CI adoption rates. The brief administration time and independence from linguistic content make the EasyQSMD particularly valuable for multilingual populations and during the earliest stages of auditory rehabilitation post-CI.

There remain large variations in cochlear implant auditory-speech perception ability, which are poorly explained by patient history factors. This study aims to better understand how combinations of speech processing limitations, identified using psychophysical and functional brain imaging measures, are associated with long-term speech understanding outcomes of new cochlear implant recipients. Forty-three cochlear implant recipients (44 ears) were recruited to participate in a longitudinal study to evaluate limitations at various locations along the auditory processing pathway. At the periphery, intra-cochlear neural health was estimated using focused psychophysical thresholds. Higher-order across-electrode intensity discrimination ability was assessed using psychophysical "spectral tilt." At the cortical level, cross-modal activation of the auditory cortex was assessed using functional near-infrared spectroscopy. Speech understanding outcomes were evaluated in competing multi-talker babble noise at 1-year post-device switch-on. We found that greater abilities to discriminate smaller across-electrode stimulation intensities ( R2 = 0.138, p = 0.047) and smaller cross-modal activations of the auditory cortex ( R2 = 0.216, p = 0.01) were significantly associated with better speech understanding outcomes in cochlear implant recipients. Furthermore, both measures contributed significantly to better predict speech understanding outcomes in a multiple regression model (Adj R2 = 0.312, p = 0.009). The results suggest that recipient-specific psychophysical and functional brain imaging metrics contribute significantly toward individual differences in speech understanding outcomes. Different recipients can be affected by different limitations, which can be identified using these tests, and therefore lead to potential patient-specific methods to improve their speech understanding.

(1) Evaluate tinnitus outcomes in adults after cochlear implantation, (2) examine the impact of demographic/audiologic factors on tinnitus outcomes, and (3) determine the relationship between early tinnitus outcomes and long-term hearing-related quality of life (QoL). Retrospective review of prospectively collected data. Adult cochlear implant (CI) center. Eighty-three adult CI recipients aged 20 to 84 years old (mean=66.2, SD 16.4). Patient-reported outcome measures before and after cochlear implantation. Tinnitus Handicap Inventory (THI); Speech, Spatial, and Qualities of Hearing Scale-12 (SSQ-12); and the Cochlear Implant Quality of Life-10 measure (CIQOL-10) pre-CI and post-CI. (1) THI scores significantly improved from pre-CI to early (1 to 3mo) post-CI, with no additional gains by long-term (6 to 2mo) post-CI. Early post-CI, 77.2% of patients reported a clinically significant improvement in their tinnitus-induced distress from pre-CI to post-CI. (2) Patients with early clinical THI improvement had shorter durations of deafness and greater CI usage than those with a lack of improvement. (3) Early post-CI THI scores were negatively correlated with long-term overall SSQ-12 scores. Long-term post-CI THI scores were also negatively correlated with long-term CIQOL-10 scores and overall SSQ-12 scores. Adult CI recipients reported improved tinnitus-induced distress at early post-CI and maintained this improvement long-term. Patients with shorter durations of deafness and greater CI usage were more likely to report relief in tinnitus-induced distress. Early THI outcomes post-CI were associated with long-term QoL. Clinicians should consider early evaluation of tinnitus outcomes to inform patient counseling regarding long-term CI outcomes. Level IV-historical cohort or case-controlled studies. 24087.

To compare hearing preservation (HP) outcomes between ears for adult sequential bilateral cochlear implant (CI) recipients. Within-subject, retrospective cohort. Tertiary referral CI center. Sixty adults with preoperative functional acoustic hearing [low-frequency pure-tone average (LFPTA; 125, 250, and 500 Hz) ≤80 dB HL] were implanted with the same electrode array in both ears. Sequential bilateral cochlear implantation from 2012 to 2022. Initial (1mo) and long-term (12mo) HP outcomes between ears were assessed by comparing the LFPTA shift in the first and second implanted ear. Correlations between LFPTA shift in the first and second implanted ear at 1 month ( rs = 0.221, P = 0.090) and 12 months ( rs = 0.234, P = 0.123) were weak and nonsignificant. However, a multilevel linear mixed-effects model demonstrated greater LFPTA shifts in the second implanted ear when compared with the first, with a mean difference of 6.3 dB HL (95% CI: 0.2-12.4, P = 0.048). In addition, the model showed that HP declined during the first 12 months following implantation, and younger patients had greater LFPTA shifts over time ( p interaction = 0.012). There were no significant associations between LFPTA shift and preoperative LFPTA, biological sex, electrode array design, or postoperative steroid use. In the present sample, HP in the first implanted ear was poorly predictive of the outcome in the second ear. Substantial variability in outcomes between ears could indicate that subtle differences in surgical technique and insertion dynamics have a relatively larger impact on HP than patient-specific factors.

To describe the clinical presentation and course of 2 cochlear implant (CI) recipients with a titanium allergy. A 66-year-old female and a 41-year-old female both underwent unilateral cochlear implantation, immediately after which they experienced otalgia that persisted and negatively impacted their ability to wear their CI external processor. Patch testing for cochlear implant allergy was performed. Surgical explantation of the CI with the exposed titanium to remove the allergen was recommended, with a subsequent surgery offered with implantation of a CI fully encased in silicone after resolution of otalgia. Clinical resolution of otalgia, including the ability to use a cochlear implant without discomfort. Both CI patients were confirmed to have a titanium allergy through patch testing. One patient experienced complete resolution of otalgia, while the second patient continued to have otalgia for at least 6 months following CI explantation. The first patient was subsequently implanted with a different CI in which the titanium components were fully encased in silicone and has remained pain-free and able to use her CI on an everyday basis 2 years post-implantation. A high index of suspicion for patient allergy to cochlear implants is warranted in CI recipients presenting with otherwise unexplained and persistent otalgia following CI surgery, and even more so in those with a prior history of hypersensitivity reactions.

Introduction: Cochlear implantation is the treatment of choice for severe hearing loss and deafness. Cholesteatomas can cause this deafness. A frequently used procedure in the course of surgical rehabilitation is a subtotal petrosectomy combined with a cochlear implant. The clinical follow-up of residual cholesteatomas is related to the blind sac closure difficult. Cholesteatoma MRI sequence-related CI magnet artefacts make follow-up challenging. Recent developments in combining cochlear implants and necessary MRI examinations enable the assessment of the internal auditory canal and cochlea. The study aimed to develop a procedure for detecting cholesteatomas in patients with cochlear implants using magnetic resonance imaging (MRI). Methods: Ex vivo MRI examinations were performed on five volunteers with fixed cochlear implants (Medel Synchrony) and swim caps. MRI examinations were performed at 1.5 T and 3 T using EPI, HASTE, and RESOLVE sequences (Siemens). The position of the implant was 12 cm distal to the external auditory canal, with anteversional head position of the volunteers in the MRI. Results: Due to artefact effects, assessment of the ipsilateral and contralateral mastoid is not possible with EPI sequences and a cochlear implant. The combination of cholesteatoma-detecting MARS sequences (HASTE, RESOLVE), a distal implant position, and a specific head position allows the assessment of the ipsilateral mastoid. Conclusions: Postoperative cholesteatoma assessment after CI implantation and subtotal petrosectomy appears to be possible under 1.5 T and 3 T, considering the MRI sequence, implant position, and head position.

This study reports the effects of stimulation level and stimulation rate on the phase locking value (PLV)-an index quantifying neural synchrony of the cochlear nerve (CN)-in postlingually deafened adult cochlear implant users. PLVs were measured at three to four electrode locations at five stimulation levels or at six stimulation rates in 17 participants. Linear mixed-effects models were used to assess the effects of these two parameters on the PLV. Smaller PLVs were measured at the base compared with more apical electrodes across stimulation levels and stimulation rates. The PLV increased with stimulation level but was not affected by stimulation rate up to 120 Hz. In human cochlear implant users, neural synchrony of the CN increases with stimulation level and is not affected by stimulation rate up to 120 Hz. In electrical hearing, these parametric effects are not altered by the pathological changes in the CN.

Cochlear Implant Recipients and Functional Hearing Preservation: Candidacy Criteria, Management Considerations, and Device Fitting

BackgroundThe National Cochlear Implant Program (NCIP) is a national program that addresses the increasing prevalence of hearing loss, especially in the pediatric population here in the Philippines. In its pilot implementation, it included three tertiary hospitals to represent Luzon, Visayas, and Mindanao, and was able to enroll 20 patients who successfully underwent cochlear implantation (CI).ObjectivesThe aim of this study is to evaluate the auditory outcomes of the patients who underwent cochlear implantation under the NCIP using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) Questionnaire and Categories of Auditory Performance (CAP) score questionnaire.MethodsThis is a retrospective cohort study including all recipients of the cochlear implants, under NCIP from December 2019 to December 2021, except one with incomplete data during the course of his follow up. The outcomes measured included the PEACH Questionnaire score and CAP Questionnaire score and were compared on various factors which included patient's sex and age, parents' socioeconomic status, duration of hearing aid use prior to CI, pre-CI imaging findings, and CI electrode placement using nonparametric statistical tests.ResultsThe mean PEACH score of the 19 patients was 53.59% ± 12.76% (range: 30% - 75%) while the mean CAP score was 3.16 ± 1.04 (range: 1 - 4.3). Parents of the included patients who have a higher educational background and those in which the electrode was located on the ideal location, scala tympani, have a statistically significant higher PEACH score (p-value of 0.017 and 0.012, respectively). In comparing the CAP scores, those who have unremarkable or normal preoperative imaging have a statistically significant higher score (p-value 0.013).ConclusionPatients who had normal preoperative imaging, proper placement of electrodes, and those patients with parents belonging to a higher educational background had statistically significant better auditory outcomes after cochlear implantation. Patients who had the cochlear implantation before 36 months of age and hearing aid use of 7 to 18 months prior to cochlear implantation had higher PEACH and CAP scores, however these were not statistically significant. Further studies with a larger sample size is recommended.

Music Enjoyment and Listening Time in Cochlear Implant Recipients: The Role of Audiometric Performance.

Inner ear malformations (IEMs) represent unique challenges in cochlear implantation, potentially influencing electrode placement during surgery and neural responsiveness. Thus, electrically evoked cortical auditory potentials (eCAEPs) were suggested to be performed as objective measures of higher-level auditory perception at the cortical level in assessing cochlear implant (CI) outcomes in this complex population. This study aims to evaluate preliminary findings of P1 latency in eCAEPs among CI recipients with several types of IEMs at different positions of electrodes, that is, apical, medial, and basal regions. A cohort of five CI recipients with IEMs was evaluated using postoperative eCAEPs recordings, and P1 latency was analyzed at different positions of electrodes. The mean age of the subjects was 14.01 ± 5.51 years, with common cavity malformations, incomplete partition type I (IP-I), incomplete partition type II (IP-II), and enlarged vestibular aqueduct. Early data suggest P1 responses were generally present in all IEM cases in this cohort, with the mean of P1 latency for the electrode at apical, medial, and basal regions of 108.2 ± 13.4, 124.0 ± 23.6, and 140.0 ± 41.5 ms, respectively. These findings may reflect differential cortical response across IEM types at multiple CI electrode locations.

Objective:This study investigated the impact of a contralateral routing of signal (CROS) device on subjective and objective listening effort and speech recognition in unilateral cochlear implant (CI) recipients.Study Design:A single-group, prospective, repeated measures design in 2 technology conditions (with CROS and without CROS), 3 talker locations (0°, 90°, and 270°), and 3 signal-to-noise ratio conditions (quiet, easy, and hard).Setting:Nonprofit audiology and speech language therapy (listening and spoken language) programParticipants:Unilateral adult CI recipients with limited functional hearing in their poorer performing ear or bilateral CI listeners willing to participate with their better hearing or preferred implanted ear for the duration of the testing (N = 15).Intervention:Participants were fitted with a CROS device on their poorer hearing ear.Main Outcome Measures:Objective listening effort measured via verbal response time, subjective listening effort and motivation measured via questionnaires, and speech recognition.Results:The CROS device reduced objective and subjective listening effort and improved speech recognition, particularly when speech was presented to the non-CI ear.Conclusions:The CROS device can reduce subjective and objective listening effort and improve speech recognition and motivation in certain situations.

Objectives:To evaluate the long-term audiometric and speech perception outcomes in Hybrid cochlear implant recipients meeting hybrid or electric-acoustic stimulation (EAS) indications, and to identify factors, including age, sex, and duration of hearing loss, that may contribute to outcome variability. Additionally, the study evaluates the impact of EAS on speech perception.Methods:Data from two clinical trials and retrospective data from the University of Iowa were combined for a total dataset of 150 Cochlear Nucleus Hybrid L24 (Cochlear Ltd., Sydney, Australia) cochlear implant recipients. Audiometric outcomes, as quantified by low-frequency pure-tone average (LFPTA; 125–500 Hz), and speech perception outcomes, including unilateral and bilateral CNC words in quiet and AzBio +5 dB SNR sentences in noise, were assessed preoperatively and postoperatively up to 5 years postactivation.Results:Functional low-frequency acoustic hearing (LFPTA < 80 dB HL) was preserved in 72.9% of Hybrid L24 recipients up to 5 years postactivation, with audiometric changes stabilizing around 1 year. Significant improvements were observed in speech perception both in quiet and in noise. Age at implantation was a significant predictor of both audiometric and speech outcomes, with younger recipients demonstrating greater speech-in-noise improvements and a greater likelihood of maintaining functionally aidable hearing. EAS users demonstrated superior speech outcomes compared to electric-only users.Conclusion:Cochlear implantation for EAS candidates provides long-term preservation of acoustic hearing and improved speech perception outcomes, particularly in younger recipients. These findings support the use of hybrid/EAS cochlear implantation in candidates with low-frequency hearing and highlight the benefit of EAS in enhancing speech understanding.

Cochlear implantation is considered a well-established treatment for severe-profound sensorineural hearing loss. Hearing loss often affects negatively to the quality of life (QOL). It may be associated with impaired speech, social isolation, psychological and professional development, and feelings of inferiority. These factors can result in emotional problems such as low self-esteem, loneliness, and depression. Bilateral profound hearing loss often results in impaired interpersonal relationships. After cochlear implantation, prelingual deafness patients’ QOL and speech recognition may have greatly improved. Despite this, there is little study on the satisfaction level in cochlear implantees who had long periods of hearing deprivation. Not much study has been done on the implantees’ QOL. This review article discusses the prevalence, cochlear implantation related comorbidities, factors of cochlear implant recipients affecting QOL, social acceptance, psychological acceptance, issues in the elderly age, complications associated with cochlear implantation, postcochlear implant status, and QOL assessment related to cochlear implant surgery.