Monosyllabic Word Recognition Scores Research Articles

Disproportionately high loss in speech intelligibility

The influence of hearing impairment on everyday hearing can be estimated by speech audiometry. There is agreat deal of variability in the dependence of word recognition scores on pure-tone hearing loss. Alarge clinical database of 28,261records with complete tone and speech audiometry data was analyzed. The maximum monosyllabic word recognition score was evaluated as afunction of hearing loss. Its distribution was analyzed in detail. In arank analysis, the distribution of percentiles was determined as afunction of pure-tone hearing loss up to 80 dBHL. The percentiles of the distribution of maximum word recognition scores for agiven pure-tone hearing loss derived here can be used as reference values for adisproportionately high loss of speech recognition.

Evaluation of safety and effectiveness of the LISTENT LCI-20PI cochlear implant in prelingually deafened children

ObjectivesThis prospective multicenter clinical trial was to evaluate the safety and effectiveness of a novel cochlear implant (CI) system, the LISTENT LCI-20PI device in prelingually deafened children (<6 years old). DesignThe LCI-20PI CI system was implanted in 70 prelingually deafened children (<6 years old). The median age (interquartile range) at implantation was 3 years old (2–4 years old). The status of the LCI-20PI devices was evaluated through CI device testing and fitting including measurement of electrically evoked compound action potential (ECAP), electrode impedances, subjective thresholds (T levels), and subjective comfort levels (C levels). The safety and effectiveness of the devices were evaluated during 1-year follow-up. The clinical trial registration number is ChiCTR2200067092. ResultsECAPs were successfully measured in 92.8% (64/70) recipients intraoperatively and in 94.3% (66/70) recipients during device activation. Most of the impedances (99.7%) were within normal limits of 0.7–20 kOhm. The median (interquartile ranges) Meaningful Auditory Integration Scale/Infant-Toddler Meaningful Auditory Integration Scale (MAIS/IT-MAIS) was 95% (85%–97.5%) at 12-month post-activation testing. Median (interquartile range) close-set monosyllabic-word recognition score (MRS) and disyllabic-word recognition score (DRS) in children 3–6 years old at 12-month post-activation testing were 86% (77%–97%) and 90% (70%–100%), respectively. ConclusionsThe new developed LCI-20PI CI device proved safe and effective in prelingually deafened children (<6 years old) in the clinical trial. This CI system could be a cost-effective alternative for prelingually deafened children.

Role of prior intratympanic gentamicin and corticosteroids therapy on speech understanding in patients with Menière's disease after cochlear implantation

AimIntratympanic injection of corticosteroids (ITC) and gentamicin therapy (ITG) are widely used treatments for vertigo in Meniere’s disease (MD). Even though studies show good results after cochlea implantation (CI) in MD patients when compared to non-MD groups, there is no indication on the effect of ITC and ITG prior to CI on hearing after CI. This study compares the post-operative hearing of CI patients with and without MD and patients who have received ITG or ITC prior to CI.MethodsIn a retrospective case control study, adult patients with MD who received CI from 2002 till 2021 were compared to a matched control group of CI patients without MD. Patients with prior ITC/ITG were extracted from MD group. Pre-operative audiological results were measured and trends across post-operative monosyllabic word recognition score at 65 decibels (WRS65CI) at switch-on, 3–6 months, 1 year and last yearly value were analyzed across all groups.Results28 MD ears were compared with 33 control ears. From MD ears 9 had received ITG and 6 ITC prior to CI. WRS65CI increased significantly with time within MD and control groups, but no difference in WRS65CI was found between these 2 groups. ITG ears showed fluctuating WRS65CI after CI with no change across time, while ITC ears showed significant increase in trend of WRS65CI values across time.ConclusionMD and non-MD patients showed comparable hearing results after CI. Prior ITC might positively influence hearing preservation after CI in MD patients whereas ITG group showed fluctuating hearing.

Development of an Optimized Protocol for Cochlear Implant Care to Increase Cochlear Implant Access.

To develop an evidence-based protocol for audiology-based, cochlear implant (CI) programming in the first year after activation. Retrospective case review. CI program at a tertiary medical center. One-hundred seventy-one patients (178 ears; mean age at implantation, 62.3 yr; 44.4% female) implanted between 2016 and 2021 with postlingual onset of deafness and no history of CI revision surgery. Patients included here had confirmed CI programming optimization based on CI-aided thresholds in the 20- to 30-dB-HL range as well as upper stimulation levels guided by electrically evoked stapedial reflex thresholds. Consonant-nucleus-consonant monosyllabic word recognition scores in the CI-alone and bilateral best-aided conditions at five time points: preoperative evaluation, and 1, 3, 6, and 12 months after activation. For both the CI-alone and bilateral best-aided conditions, consonant-nucleus-consonant word recognition significantly improved from preoperative evaluation to all postactivation time points. For the CI-alone condition, no significant differences were observed between 3 and 6 months, or from 6 to 12 months after activation. In contrast, for the bilateral best-aided condition, significant differences were observed between 1 and 3 months, and 3 and 6 months, but no difference in scores between 6 and 12 months. Based on the current data set and associated analyses, CI centers programming adult patients could eliminate either the 3- or 6-month visit from their clinical follow-up schedule if patient mapping of lower and upper stimulation levels is validated via CI-aided audiometric thresholds and electrically evoked stapedial reflex thresholds, respectively.

Matching the pitch perception of the cochlear implanted ear with the contralateral ear in patients with single-sided deafness: a novel approach.

Single-sided deaf patients following cochlear implantation often compare the sound quality of their implanted ear with normal hearing. The interaural differences can result in dissatisfaction with speech comprehension and reduced time of usage of the speech processor; hence, prolonging auditory adaptation time. The proposed calibration method presented in this study demonstrates how the frequency distribution of the cochlear implant can be set to adequately approximate the pitch perception of the contralateral normal hearing ear towards improving speech intelligibility in a noisy environment. In 12 postlingual single-sided deaf patients, subjective interaural pitch-matching was carried out to determine new central frequencies for the reallocation of the frequency bands of their speech processor (CP910, CP950 or CP1000, Cochlear, Australia). The patients were asked to compare the pitch of the tones presented to their normal hearing ear to the pitch of individual channels of their cochlear implant (CI522 or CI622, Cochlear, Australia). A third-degree polynomial curve was fit to the acquired matching frequencies to create the new frequency allocation table. Audiological measurements (free-field aided thresholds, speech reception thresholds, and monosyllabic word recognition score) in noise, together with a Speech, Spatial and Qualities of Hearing Scale (SSQ12) questionnaire (short version of the original SSQ) results were evaluated prior to the pitch-matching procedure, and again, 2 weeks later. The free-field aided thresholds of the patients showed no greater shift than ± 5dB following the procedure; however, their monosyllabic word recognition score in noise improved significantly (mean - 9.58%, SD 4.98%, matched pairs t test comparison: p < 0.001). The results of the SSQ12 questionnaire also showed significant improvement in speech intelligibility, sound localization, and sound quality (mean 0.96 points, SD 0.45 points, matched pairs t test comparison: p < 0.001). Matching the pitch perception of the implanted cochlea with the sensation of the normal hearing contralateral ear, resulted in significant changes in the quality of hearing in patients with single-sided deafness. It is plausible the procedure can usher positive results in bimodal patients or following sequential bilateral cochlear implantation.

Speech Perception Performance in Cochlear Implant Recipients Correlates to the Number and Synchrony of Excited Auditory Nerve Fibers Derived From Electrically Evoked Compound Action Potentials.

Many studies have assessed the performance of individuals with cochlear implants (CIs) with electrically evoked compound action potentials (eCAPs). These eCAP-based studies have focused on the amplitude information of the response, without considering the temporal firing properties of the excited auditory nerve fibers (ANFs), such as neural latency and synchrony. These temporal features have been associated with neural health in animal studies and, consequently, could be of importance to clinical CI outcomes. With a deconvolution method, combined with a unitary response, the eCAP can be mathematically unraveled into the compound discharge latency distribution (CDLD). The CDLD reflects both the number and the temporal firing properties of excited ANFs. The present study aimed to determine to what extent the CDLD derived from intraoperatively recorded eCAPs is related to speech perception in individuals with CIs. This retrospective study acquired data on monosyllabic word recognition scores and intraoperative eCAP amplitude growth functions from 124 adult patients with postlingual deafness that received the Advanced Bionics HiRes 90K device. The CDLD was determined for each recorded eCAP waveform by deconvolution. Each of the two Gaussian components of the CDLD was described by three parameters: the amplitude, the firing latency (the average latency of each component of the CDLD), and the variance of the CDLD components (an indication of the synchronicity of excited ANFs). Apart from these six CDLD parameters, the area under the CDLD curve (AUCD) and the slope of the AUCD growth function were determined as well. The AUCD was indicative of the total number of excited ANFs over time. The slope of the AUCD growth function indicated the increases in the number of excited ANFs with stimulus level. Associations between speech perception and each of these eight CDLD-related parameters were investigated with linear mixed modeling. In individuals with CIs, larger amplitudes of the two CDLD components, greater AUCD, and steeper slopes of the AUCD growth function were all significantly associated with better speech perception. In addition, a smaller latency variance in the early CDLD component, but not in the late, was significantly associated with better speech recognition scores. Speech recognition was not significantly dependent on CDLD latencies. The AUCD and the slope of the AUCD growth function provided a similar explanation of the variance in speech perception (R 2 ) as the eCAP amplitude, the slope of the amplitude growth function, the amplitude, and variance of the first CDLD component. The results demonstrate that both the number and the neural synchrony of excited ANFs, as revealed by CDLDs, are indicative of postimplantation speech perception in individuals with a CI. Because the CDLD-based parameters yielded a higher significance than the eCAP amplitude or the AGF slope, the authors conclude that CDLDs can serve as a clinical predictor of the survival of ANFs and that they have predictive value for postoperative speech perception performance. Thus, it would be worthwhile to incorporate the CDLD into eCAP measures in future clinical applications.

Effect of Electrode Insertion Angle on Cochlear Implantation Outcomes in Adult and Children Patients with Sensorineural Hearing Loss.

Purpose To determine the role played by electrode insertion angle in cochlear implantation (CI) outcomes in adult and children patients with sensorineural hearing loss (SNHL). Methods Adults (n = 10) and children (n = 19) with SNHL undergoing CI in a tertiary specialized hospital were retrospectively enrolled. The measurements were evaluated before and after CI surgery using sound field audiometry and speech recognition tests. Questionnaires were used to assess subjective benefits. Electrode insertion angles were determined using postoperative X-rays. Results Both adult and children patients showed significant improvements in hearing, speech performance, and audiology and speech-related quality of life after CI. The angular insertion depths of adult and children group were 323.70 ± 43.57° and 341.53 ± 57.07°, respectively, showing no significant difference. In the adult group, deeper insertion depths were found to be strongly linked to lower postoperative pure tone thresholds at 12 months and higher postoperative disyllabic Word Recognition and Sentence Recognition Scores at 6 months (all P < 0.05). In the children group, deeper insertion depth had a positive correlation with postoperative monosyllabic Word Recognition Scores 6 and 12 months after CI surgery (both P < 0.05). Multiple linear regression models were constructed to predict disyllabic Word Recognition Scores at 6 and 12 months postoperatively in the children group, in which insertion angle, duration of hearing loss, and preoperative questionnaire result were identified as dependent variables. Conclusions Greater angular insertion depths resulted in improved hearing and speech performances after CI. The benefits of greater angular insertion depths can be found in both adult and children patients and last for at least 12 months. Clinicians are expected to determine the optimal implantation direction during CI and ensure the insertion depth to improve the speech rehabilitation of patients.

Role of cochlear reserve in adults with cochlear implants following post-lingual hearing loss

IntroductionPre-operative assessments before cochlear implantation (CI) includes the examination of both tone hearing, and the level of the cochlear reserve indicated by speech understanding. The goal of this study was to explore the predictive influence of tone hearing and cochlear reserve in CI.MethodsWe did a retrospective cohort study, which included adult patients who had undergone CI between January 2012 and December 2019 in a tertiary care center. The pre-operative tone hearing, unaided maximum monosyllabic word recognition score (WRSmax), aided hearing gain, aided monosyllabic word recognition score at 65 dB (WRS65(HA)), and speech perception gap (SPG) were measured. The duration of unaided hearing loss (UHL) was also assessed. These variables were compared with post-operative monosyllabic word recognition score after CI at 65 dB (WRS65(CI)).Results103 patients and 128 ears were included in this study. Regardless of tone hearing, patients with better pre-operative WRSmax and WRS65(HA) performed better post-operatively. WRSmax was found to be the most important factor that was statistically significantly associated with WRS65(CI). SPG was statistically significantly associated with WRSmax and SPG ≥ 20% group performed better post-operatively. Any duration of unaided hearing loss was statistically significantly inversely associated with WRSmax above 0%.ConclusionCochlear reserve represented by WRSmax may play the most important role as a predictive factor in outcomes after CI. SPG should be considered for indicating CI in patients, when WRS65(HA) does not reach WRSmax. Early rehabilitation with hearing aids and duration of hearing aid usage might play an important role in preserving cochlear reserve in adults.

Using Clinical Audiologic Measures to Determine Cochlear Implant Candidacy

Introduction: Only a small percentage (6–10%) of patients who are candidates receive cochlear implants (CIs). One potential reason contributing to low usage rates may be confusion regarding which patients to refer for CI evaluation. The extent to which information provided by standard clinical audiologic assessments is sufficient for selecting appropriate CI evaluation referrals is uncertain. The objective of this study is to evaluate the capacity of standard clinical audiologic measures to differentiate CI candidates from noncandidates. Method: The study design is a retrospective review of a prospectively maintained CI database from a university-based tertiary medical center of 518 patients undergoing CI evaluations from 2012 to 2020. Each ear of each patient was treated as an independent value. Receiver operating characteristic (ROCs) curves were constructed using aided AzBio sentence recognition scores in quiet and aided AzBio +10 dB signal-to-noise ratio scores <60% as binary classifiers for CI candidacy. For each ROC, we examined the capacity of multiple pure-tone thresholds, pure-tone average (PTA), and CNC word recognition scores (WRSs) measured under earphones to determine CI candidacy. Area under the curve ROC (AUC-ROC) values were calculated to demonstrate the capacity of each model to differentiate CI candidates from noncandidates. Results: Variables with the greatest capacity to accurately differentiate CI candidates from noncandidates using aided AzBio in quiet scores were earphone CNC WRS, earphone pure-tone threshold at 1,000 Hz, and earphone PTA (AUC-ROC values = 0.86–0.88). Using aided AzBio +10 scores as the measure for candidacy, only CNC word recognition had a fair capacity to identify candidates (AUC-ROC value = 0.73). Based on the ROCs, a 1,000 Hz pure-tone threshold >50 dB HL, PTA >57 dB HL, and a monosyllabic WRS <60% can each serve as individual indicators for referral for CI evaluations. Conclusion: The current study provides initial indicators for referral and a first step at developing evidence-based criteria for CI evaluation referral using standard audiologic assessments.

The Relationship Between Impedance, Programming and Word Recognition in a Large Clinical Dataset of Cochlear Implant Recipients.

Cochlear implant programming typically involves measuring electrode impedance, selecting a speech processing strategy and fitting the dynamic range of electrical stimulation. This study retrospectively analyzed a clinical dataset of adult cochlear implant recipients to understand how these variables relate to speech recognition. Data from 425 implanted post-lingually deafened ears with Advanced Bionics devices were analyzed. A linear mixed-effects model was used to infer how impedance, programming and patient factors were associated with monosyllabic word recognition scores measured in quiet. Additional analyses were conducted on subsets of data to examine the role of speech processing strategy on scores, and the time taken for the scores of unilaterally implanted patients to plateau. Variation in basal impedance was negatively associated with word score, suggesting importance in evaluating the profile of impedance. While there were small, negative bivariate correlations between programming level metrics and word scores, these relationships were not clearly supported by the model that accounted for other factors. Age at implantation was negatively associated with word score, and duration of implant experience was positively associated with word score, which could help to inform candidature and guide expectations. Electrode array type was also associated with word score. Word scores measured with traditional continuous interleaved sampling and current steering speech processing strategies were similar. The word scores of unilaterally implanted patients largely plateaued within 6-months of activation. However, there was individual variation which was not related to initially measured impedance and programming levels.

Audiological results and subjective benefit of an active transcutaneous bone-conduction device in patients with congenital aural atresia.

PurposeTo review functional and subjective benefit after implantation of an active transcutaneous bone conduction device (BCD) in patients with congenital microtia with atresia or stenosis of the external auditory canal.MethodsRetrospective chart analysis and questionnaire on the subjective impression of hearing ( Speech, Spatial and Qualities of Hearing Scale (SSQ-B) of patients treated between 2012 and 2015.ResultsResults18 patients (24 ears) with conductive or mixed hearing loss in unilateral (n = 10) or bilateral (n = 8) atresia were implanted with a BCD. No major complications occurred after implantation. Preoperative unaided air conduction pure tone average at 0.5, 1, 2 and 4 kHz (PTA 4 ) was 69.2 ± 11.7 dB, while postoperative aided PTA 4 was 33.4 ± 6.3 dB, resulting in a mean functional hearing gain of 35.9 +/- 15.6 dB. Preoperatively, the mean monosyllabic word recognition score was 22.9 % ± 22.3 %, which increased to 87.1 % +/- 15.1 % in the aided condition. The Oldenburger Sentence Test at S0N0 revealed a decrease in signal-to-noise-ratio from − 0.58 ± 4.40 dB in the unaided to − 5.67 ± 3.21 dB in the postoperative aided condition for all patients investigated. 15 of 18 patients had a subjective benefit showing a positive SSQ-B score (mean 1.7).ConclusionThe implantation of an active bone conduction device brings along subjective and functional benefit for patients with conductive or combined hearing loss.

High-frequency Cochlear Nerve Deficit Region: Relationship With Deaf Duration and Cochlear Implantation Performance in Postlingual Deaf Adults.

To analyze the changes of cochlear nerve diameter and the presence of a cochlear nerve deficit at a high-frequency region and investigate their effects on cochlear implant (CI) performance in postlingual deaf adults. Retrospective. Tertiary care academic center. Eighty-three postlingual deaf adults with no labyrinthine anomalies or cognitive deficits who received a CI with perimodiolar electrodes from a single manufacturer. We evaluated the changes of cochlear nerve diameter and the presence of a "tail sign," defined as identifiable nerve fibers originating from the far basal turn of the cochlea, which represents the presence of cochlear nerve at a high-frequency region in magnetic resonance imaging, on monosyllabic word recognition scores. The cochlear nerve diameter showed a positive correlation with word recognition scores (maximum diameter, R2 = 0.26, p < 0.01; minimum diameter, R2 = 0.26, p < 0.01), but a negative correlation with deaf duration. Recipients with a positive tail sign performed better (73 ± 19%) than those without (45 ± 24%, p < 0.01). A positive tail sign was more commonly found in good performers (52 of 62, 84%) than in poor performers (5 of 21, 24%, p < 0.01). Favorable outcomes could be anticipated in postlingual deaf adults with a large cochlear nerve diameter and positive tail sign. A presence of cochlear nerve at a high-frequency region may be an imaging marker for predicting good CI performance.

Vestibular Function After Bilateral Simultaneous Cochlear Implantation.

Thanks to the advantages of hearing-in-noise and spatial orientation, currently bilateral cochlear implantation (CI) became popular for patients with profound hearing loss. The aim of this study was to investigate vestibular function in bilateral simultaneous CI recipients. Retrospective analysis. University hospital. Sixteen patients with profound hearing loss were included. Bilateral simultaneous CI with flexible electrode using round window approach. Vestibular function was evaluated using both objective and subjective measures in the subjects preoperatively and 4 months postoperatively. Differences were analyzed preoperatively and postoperatively. Preoperative vestibular tests revealed that 8 subjects (50%) had abnormal caloric test results, 11 ears (34.4%) had abnormal ocular vestibular-evoked myogenic potential results, 6 ears (18.8%) had abnormal cervical vestibular-evoked myogenic potential results, 7 ears (21.9%) in the anterior semicircular canal, and 6 ears (18.8%) in the posterior semicircular canal had gain loss. However, surgery significantly decreased the sums of the maximal slow-phase velocities evidenced by caloric test (p ‹ 0.05). Cervical vestibular-evoked myogenic potential abnormal rate significantly increased to 53.1% after surgery (p ‹ 0.05). The postoperative changes regarding ocular vestibular-evoked myogenic potential, video head impulse test (vHIT), and Dizziness Handicap Inventory (DHI) were not significant among all the patients. Patients diagnosed as large vestibular aqueduct syndrome showed significantly higher DHI scores than others (p ‹ 0.05). Spearman's correlation analysis revealed that DHI moderately correlated with the dysfunction of semicircular canals evidenced by vHIT (r = 0.702; p < 0.001), weakly correlated with caloric (r = 0.352; p = 0.048). However, no correlation was found between DHI and VEMPs. The monosyllabic and disyllabic word recognition score significantly improved from 0 to 60.4 ± 14.3% (p < 0.05) and from 0 to 63.3 ± 14.5% (p < 0.05) respectively. There was no correlation between the improvement of word recognition score and the change of vestibular tests. The study showed preservation of utricle function, vestibular function at high frequency after bilateral simultaneous CI. However, operation significantly affected vestibular function at low frequency and saccule function. Patients with large vestibular aqueduct syndrome showed dramatically higher DHI scores than others. DHI moderately correlated with vHIT and weakly correlated with caloric.

Surgical and audiological results of bone-anchored hearing aids: comparison of two surgical techniques

IntroductionThe bone-anchored hearing system has become the most viable treatment option for subjects with conductive or mixed hearing loss, who are unable to benefit from conventional hearing aids or middle ear surgery. ObjectiveTo compare the surgical and audiological outcomes between the minimally-invasive Ponto surgery and a linear incision with soft tissue preservation techniques in bone-anchored hearing system recipients. MethodsA retrospective study was carried out from January 2017 to June 2018. Forty-two adult patients eligible for unilateral bone-anchored hearing system surgery with the Ponto system were included in the study. The implant and abutment lengths used varied from 3 to 4mm and from 6 to 14mm, according to the bone and skin thickness of the participants, respectively. ResultsTwenty-two surgeries were performed using the minimally invasive Ponto surgery technique (52.4%) and 20 (47.6%) using the linear incision. The mean age of the subjects implanted with minimally invasive Ponto surgery and linear incision techniques were 42.0 and 33.3 years old, respectively. Ten male (45,5%) and 14 (70%) female patients were implanted using minimally invasive Ponto surgery and the linear incision techniques, respectively. There were no differences between pure tone audiometric thresholds and monosyllabic word recognition scores of the subjects, when comparing both surgical techniques. The minimally invasive Ponto surgery technique significantly reduced the surgical time compared to the linear incision technique. There were no differences between both surgical techniques for skin-related complications; (Holgers 3 and 4) which occurred in 18.8% for MIPS and in 25% for linear incision. Subjects included in the minimally invasive Ponto surgery technique group showed a superior cosmetic outcome, with no surgical scar or additional sutures. ConclusionThe surgical and audiological outcomes were satisfactory and were not correlated to the surgical technique selected in all subjects. When compared to the linear incision, the minimally invasive Ponto surgery technique showed reduced surgical time and superior esthetic outcomes in the postoperative follow-up.

Depressive symptoms affect short- and long-term speech recognition outcome in cochlear implant users

PurposeTo investigate the impact of the amount of depressive symptoms in cochlear implant (CI) recipients on the development of speech recognition after CI-activation up to 2 years.DesignRetrospective data analysis of a German short form of the Beck Depression Inventory given at initial activation of the implant in relation to monosyllabic word recognition score at conversational level at initial activation and at 3 months, 1 and 2-year follow-up measurements.Study sampleThirty-one CI-patients (11 female, 20 male) aged between 41 and 83 (M = 64.77, SD = 10.43) who were German native speakers, postlingually deafened, with severe hearing loss in both sides but unilaterally implanted (19 right-sided, 12 left-sided).ResultsThe amount of depressive symptoms at initial activation was negatively correlated with the monosyllabic recognition score after 3 months and after 1 year of implant use.ConclusionThe psychological status in terms of depressive symptoms is an important parameter regarding the rehabilitative outcome of CI-patients. Care staff and CI-users should be sensitized to the link between depressive symptoms and the development of speech recognition with CI.

Long-term Change in the Speech Perception Ability in Pediatric Cochlear Implants and the Effect of the Age at Implantation.

We analyzed the long-term changes in speech perception ability of pediatric cochlear implants (CIs) to evaluate the effect of the age at the time of surgery. Retrospective. Tertiary care academic center. One hundred fourteen prelingually deaf children with CI use duration >10 years. Categories of auditory performance (CAP) scores and monosyllabic word recognition scores using the Asan-Samsung Korean word list (ASK-WRS) and a conventional word list (KS-WRS) were the main outcomes. Outcomes were compared according to the age at surgery (group I, 1-2 yr; II, 2.1-3 yr; III, 3.1-7 yr; IV, 7.1-13 yr). CAP scores reached plateaus at 2.6 to 3.3 years post-CI; groups I to III showed better scores than group IV. The maximum CAP score was obtained in all children of groups I to III and in 65% of group IV. ASK-WRSs reached plateaus at 3.2 to 4.8 years post-CI. Younger patients at CI operation showed better ASK-WRSs (97, 93, 90, and 54% in groups I-IV, respectively), but the differences were not significant (I versus II and II versus III). Ceiling effect (perfect score) was observed in early groups (67, 44, 30, and 0% in groups I-IV). KS-WRSs, which is a challenging test, reached plateaus at 7.2 to 8.4 years postsurgery with no ceiling effect. Early implantees showed significantly better scores (88, 82, 73, and 46% in groups I-IV). Speech perception ability after CI showed audiological age-specific improvement evaluated by various test methods. The most challenging test demonstrated long-term performance differences by the age at CI operation.

Cochlear implantation in far-advanced otosclerosis: hearing results and complications.

SUMMARYSevere forms of otosclerosis known as far-advanced otosclerosis (FAO) can lead to severe to profound sensorineural hearing loss and can justify cochlear implantation. Because of the pathophysiology of otosclerosis, patients implanted for FAO may experience an increased rate of complications, such as facial nerve stimulation or electrode dislocation, and may have poorer hearing outcomes than expected. This retrospective study aimed to compare cochlear implantation hearing outcomes, surgical difficulties and complications in FAO patients versus non-FAO patients. Moreover, we evaluated whether high resolution computed tomography (CT scan) findings were predictive of perioperative problems, complications and hearing outcomes. FAO patients were diagnosed based on medical history, examination and CT scan. Thirty-five ears from FAO patients were compared to 38 control ears. Audiometric results were assessed at least 12 months after implantation by pure tone average, speech reception threshold, monosyllabic and disyllabic word recognition score (WRS) and Central Institute for the Deaf (CID) sentences test. Complications and surgical difficulties were compiled. CT scan findings were categorised within 3 grades of otosclerotic extension. No significant difference was found between FAO and non-FAO hearing outcomes, except that monosyllabic WRS were lower for FAO patients, especially those who underwent previous stapedotomy. Facial nerve symptomatology occurred in 8.6% of FAO patients; among these, one required explantation-reimplantation surgery. 86% of FAO implanted patients had retrofenestral extension on CT. These were associated with poorer disyllabic WRS (51% vs 68%, p < 0.05) than those with only fenestral involvement. Although not significant, high grade of severity on CT tended to be associated with surgical difficulties and complications. Cochlear implantation in FAO patients is an effective treatment technique. Though the overall complication rate is low, it tends to be higher in cases of severe extension on CT. Patient counselling should be adjusted accordingly.

Beyond Sentence Recognition in Quiet for Older Adults: Implications for Cochlear Implant Candidacy.

To study postoperative hearing outcomes in older adult cochlear implant recipients who did not meet Medicare candidacy criteria by sentence testing in quiet. Case Control Series. University Based Tertiary Referral Cochlear Implant Center. Fifty-four patients age 60 or greater with bilateral moderate to profound sensorineural hearing loss who underwent cochlear implantation. Patients were divided into three groups by preoperative testing scores: 1) sentence recognition in quiet and monosyllabic word recognition scores ≤40%, 2) sentence recognition in quiet scores >40% and sentence recognition in noise scores ≤40%, and 3) sentence recognition in quiet scores >40% and monosyllabic word recognition scores ≤40% in the ear to be implanted. Cochlear implantation. Pre- versus postoperative sentence and word recognition scores. All three groups received a statistically significant benefit from their cochlear implant as measured by both postoperative sentence and word recognition. When comparing postoperative sentence recognition scores between groups, there were no statistically significant differences (Group 1: mean 83.1%, SD ± 17.4%; Group 2: mean 90.1%, SD ± 8.0%; Group 3: mean 90.6%, SD ± 6.9%). When comparing postoperative monosyllabic word recognition scores, there were no statistically significant differences between groups (Group 1: mean 60.3%, SD ± 19.6%; Group 2: mean 66.8%, SD ± 20.0%; Group 3: mean 70.0%, SD ± 18.8%). Results of this study demonstrate that older patients who do not meet current Medicare candidacy criteria derive significant long-term benefit from cochlear implantation when either sentence in noise or monosyllabic word recognition in quiet ≤40% is used to determine candidacy. Further research and greater numbers are needed to better characterize the role of monosyllabic word recognition in cochlear implant candidacy.

Effects of residual speech and auditory deprivation on speech perception of adult cochlear implant recipients

ObjectivePossible predictive factors of cochlear implant (CI) outcomes have been extensively reported in literature for different user groups such as prelingual pediatric or postlingual adult users. However, there remains unexplained outcome variability among adult CI users; therefore, research concerning these patients continues and many different variables have been reported. This study aimed at evaluating the relationship between preoperative speech reception capacity, residual hearing, duration of deafness, age of implantation, and postoperative monosyllabic word recognition scores (WRSs) in postlingual CI users. MethodsEffect of onset age of hearing loss, duration of hearing loss, cochlear implantation age, pre CI speech reception thresholds (SRT) and pre CI WRS on the post-CI WRS of 76 adults were analyzed. ResultsThere are statistically significant relationships between hearing loss duration, pre-CI WRS, residual hearing and the post CI WRS. We observed that patients with shorter auditory deprivation with measurable speech perceptions and residual hearing might perform better with CI. ConclusionEar selection in cases of unilateral CI should be considered on an individual basis with respect to the speech perception abilities.

Can routine office-based audiometry predict cochlear implant evaluation results?

Determining cochlear implant candidacy requires a specific sentence-level testing paradigm in best-aided conditions. Our objective was to determine if findings on routine audiometry could predict the results of a formal cochlear implant candidacy evaluation. We hypothesize that findings on routine audiometry will accurately predict cochlear implant evaluation results in the majority of candidates. Retrospective, observational, diagnostic study. The charts of all adult patients who were evaluated for implant candidacy at a tertiary care center from June 2008 through June 2013 were included. Routine, unaided audiologic measures (pure-tone hearing thresholds and recorded monosyllabic word recognition testing) were then correlated with best-aided sentence-level discrimination testing (using either the Hearing in Noise Test or AzBio sentences test). The degree of hearing loss at 250 to 4,000 Hz and monosyllabic word recognition scores significantly correlated with sentence-level word discrimination test results. Extrapolating from this association, we found that 86% of patients with monosyllabic word recognition scores at or below 32% (or 44% for patients with private insurance) would meet candidacy requirements for cochlear implantation. Routine audiometric findings can be used to identify patients who are likely to meet cochlear implant candidacy upon formal testing. For example, patients with pure-tone thresholds (250, 500, 1,000 Hz) of ≥75 dB and/or a monosyllabic word recognition test score of ≤40% have a high likelihood of meeting candidacy criteria. Utilization of these predictive patterns during routine audiometric evaluation may assist hearing health professionals in deciding when to refer patients for a formal cochlear implant evaluation. 4 Laryngoscope, 127:216-222, 2017.