Residual Hearing Research Articles

Hybrid cochlear implant:a scoping review

Cochlear implants (CIs) restore the perception of sound for individuals with severe to profound hearing loss by employing electrical stimulation to directly activate the remaining auditory neurons. Post-implantation ipsilateral hearing loss has been observed in every patient series involving hearing preservation cochlear implantation. Patients with residual hearing in the low-pitched area of the cochlea but severe to profound hearing loss in the middle and high-frequency range can be inserted with a shorter electrode array which preserves the residual hearing. The Hybrid CI, also referred to as electro-acoustic stimulation (EAS), is a type of cochlear implant designed to preserve residual acoustic hearing. It allows for the simultaneous use of a cochlear implant and a hearing aid in the same ear. Expanding electrical speech processing to individuals with more remaining acoustic hearing using a less invasive and shorter cochlear implant marks a significant milestone in cochlear implant technology. In Hybrid CI, the integration of electrical and acoustic hearing often leads to notable improvements in word recognition for the majority of cases. There is a distinct advantage of combining acoustic and electric hearing over relying solely on electrical stimulation, particularly in understanding speech in noisy environments and appreciating music. In general, patients who undergo Hybrid CI express high levels of satisfaction with their outcomes. This review's goal is to discuss Hybrid CI with its history, principles, design, candidacy, advantages, and limitations.

EXPRESS: Vocal and musical emotion perception, voice cue discrimination, and quality of life in cochlear implant users with and without acoustic hearing.

This study aims to provide a comprehensive picture of auditory emotion perception in cochlear implant (CI) users by (1) investigating emotion categorization in both vocal (pseud-ospeech) and musical domains, and (2) how individual differences in residual acoustic hearing, sensitivity to voice cues (voice pitch, vocal tract length), and quality of life (QoL) might be associated with vocal emotion perception, and, going a step further, also with musical emotion perception. In 28 adult CI users, with or without self-reported acoustic hearing, we showed that sensitivity (d') scores for emotion categorization varied largely across the participants, in line with previous research. However, within participants, the d' scores for vocal and musical emotion categorization were significantly correlated, indicating similar processing of auditory emotional cues across the pseudo-speech and music domains and robustness of the tests. Only for musical emotion perception, emotion d' scores were higher in implant users with residual acoustic hearing compared to no acoustic hearing. The voice pitch perception did not significantly correlate with emotion categorization in either domain, while the vocal tract length significantly correlated in both domains. For QoL, only the subdomain of Sspeech production ability, but not the overall QoL scores, correlated with vocal emotion categorization, partially supporting previous findings. Taken together, results indicate that auditory emotion perception is challenging for some CI users, possibly a consequence of how available the emotion-related cues are via electric hearing. Improving these cues, either via rehabilitation or training, may also help auditory emotion perception in CI users.

Does the audiogram shape influence the intracochlear recording of Electrocochleography during and after cochlear implantation?

During cochlear implant (CI) surgery, it is desirable to perform intraoperative measurements such as Electrocochleography (ECochG) to monitor the inner ear function and thereby to support the preservation of residual hearing. However, a significant challenge arises as the recording location of intracochlear ECochG via the CI electrode changes during electrode insertion. This study aimed to investigate the relationships between intracochlear ECochG recordings, the position of the recording contact within the cochlea relative to its anatomy, and the implications for frequency and residual hearing preservation. Intraoperative ECochG recordings were conducted using the CI electrode (MED-EL) during the insertion of hearing preservation electrodes and after the insertion process. Recordings were continuously conducted using the most apical electrode (contact 1) during insertion. After insertion, the recordings were performed on all different electrode contacts. The electrode location in the cochlea during insertion was estimated using mathematical models and preoperative clinical imaging, while the postoperative electrode position was determined using postoperative clinical imaging. The study involved 10 adult CI recipients. In those with good low-frequency hearing, an increase in signal amplitude was observed, with the highest amplitudes closest to the stimulation frequency generators, and no phase change was observed. Conversely, patients with flat hearing loss exhibited a second peak with an opposite phase in the medial area of the cochlea. This study is the first to suggest that the pattern of the preoperative audiogram may influence the ECochG outcomes measured intraoperatively. Specifically, the ECochG responses during insertion appeared to behave as expected with good low-frequency hearing, while with flat hearing loss there appear to be further effects. These findings indicate that this approach can provide valuable information for the interpretation of intracochlearly recorded ECochG signals.

Leveraging eCAP thresholds in a logistic model to predict speech outcomes after implantation in anomalous cochlea

Background Pediatric cochlear implant (CI) recipients with cochlear malformations face challenges due to variable speech recognition outcomes. Aims/objectives This study assesses the predictive value of intraoperative electrically evoked compound action potential (eCAP) thresholds, residual hearing, age at implantation, Intelligent Quotient (IQ), and malformation type for speech recognition outcomes. Material and methods A prospective cohort of 52 children (aged 1–4 years) with cochlear malformations who underwent CI between 2016 and 2024 was analyzed. Intraoperative eCAP thresholds were recorded, and disyllable word recognition scores (WRS) were evaluated 24 months postoperatively. Results Patients included incomplete partition (IP-II, 46.2%), cochlear hypoplasia (30.8%), IP-I (13.5%), and common cavity (9.6%). IP-II cases had higher mean eCAP thresholds (18.85 µV) compared to cochlear hypoplasia and common cavity cases. Higher eCAP thresholds correlated with better WRS outcomes (p < 0.001). Logistic regression revealed eCAP thresholds, residual hearing, age, IQ, and malformation type as significant predictors, with an AUC of 0.92. Conclusions and significance Intraoperative eCAP thresholds and residual hearing strongly predict auditory outcomes in children with cochlear malformations. Tailored CI strategies based on individual profiles can optimize speech recognition outcomes.

Improving Real-Time Feedback During Cochlear Implantation: The Auditory Nerve Neurophonic/Cochlear Microphonic Ratio.

Real-time monitoring of cochlear function to predict the loss of residual hearing after cochlear implantation is now possible. Current approaches monitor the cochlear microphonic (CM) during implantation from the electrode at the tip of the implant. A drop in CM response of >30% is associated with poorer hearing outcomes. However, there is prior evidence that CM amplitude can fluctuate in a manner unrelated to hearing trauma, leading to false positives. By monitoring another cochlear response, the auditory nerve neurophonic (ANN), a differentiation between CM drops that result in reduced cochlear output from false positives may be possible. The hypothesis tested in the present work was that ANN/CM ratios measured during a CM drop will increase during drops not associated with postoperative hearing loss. Twenty-eight adult participants with known CM drops during implantation were taken from a larger data set. This contains adult cochlear implant candidates scheduled to receive a Cochlear Nucleus cochlear implant with either the slim-straight or slim-modiolar electrode array with preoperative audiometric low-frequency average thresholds of ≤80 dB HL at 500, 750, and 1000 Hz in the ear to be implanted. Patients were recruited from eight international implant sites. Pure-tone audiometry was measured postoperatively and 4 to 6 weeks after implantation. Electrocochleography was measured during and immediately after the implantation of the array in response to a 500-Hz, 6-msec pure-tone pip at 110 dB HL. The ANN/CM ratio rose during CM drops in 19 of these patients and decreased in 9. At the follow-up timepoint, patients with a decreasing ANN/CM ratio had a median hearing loss of 29.0 dB, significantly worse than the group with increasing ratio at 13.3 dB (p = 0.004). Considering only the change in ANN amplitude during a CM drop led to smaller groups (ANN drop during CM drop N = 17, ANN increasing during CM drop N = 6) due to 5 patients having undetectable ANN during the CM drop. Using the ANN alone also led to as poorer prediction of hearing preservation, with median hearing preservation in the ANN increasing group of 12.9 dB, significantly better than the ANN decreasing group of 25 dB (p = 0.02). The group with a decreasing ANN/CM ratio had maximum CM amplitude immediately after insertion lower than the maximum amplitude reached during insertion (mean maximum postinsertion amplitude of 98% of during-insertion amplitude). In comparison, the ANN/CM ratio increasing group tended to have a larger CM amplitude immediately after insertion (mean maximum CM amplitude postinsertion of 164% of the maximum during-insertion amplitude). These data show that the ANN/CM ratio is a measure that can differentiate between patients with CM drops that lead to a loss of residual hearing and those that do not. The ANN/CM ratio is easily measured and responds rapidly during a CM drop, showing clinical promise for improving current and developing approaches to intraoperative monitoring.

Robust online drop detection for cochlear implant surgery

AbstractHearing loss is an impairment that affects a large population worldwide. Cochlear implant (CI) surgery is an effective solution, especially in patients with residual, natural hearing. However, the risk of intracochlear damage during CI surgery, which impairs residual hearing, remains as a concern. It has been shown that intra-operative monitoring (using electrocochleography, specifically the cochlear microphonic) during CI surgery can detect drops that are associated with such trauma, resulting in its potential prevention. Researchers have attempted to automate the process of drop detection by implementing supervised models. However, these have so far failed to achieve good reliability and generalizability. To address these issues, we develop an unsupervised model based on the Bayesian method with a scoring function derived from the logistic function. The proposed model, as a data-driven method, directly learns from data without the need for any supervision which enhances its adaptability to diverse patient populations. Empirical results demonstrate the proposed model’s high accuracy with a low false alarm rate (18 extra detection against 146 in previous work), as well as its robustness when processing new data. This indicates its potential for real-world application to improve safety during CI surgery.

Auditory Brainstem Response (ABR) Recording of Simultaneous Electric-Acoustic Stimulation between Round Window Membrane and Basal Part of Cochlear Bone in guinea Pigs.

Extracochlear electric-acoustic stimulation (EAS) between the round window membrane and the basal part of the cochlear bone exhibits distinct auditory brainstem response (ABR) characteristics. The use of EAS in individuals with residual hearing is becoming increasingly common in clinical settings. Ongoing research has explored the characteristics of EAS-induced responses in hearing cochleae. This study explored a novel extracochlear EAS approach using round window membrane-cochlear bone stimulation to maintain cochlear integrity. The electrodes stimulate the basal part of the cochlea and spare the apex, making the model ideal for EAS candidates with profound high-frequency hearing loss and residual low-frequency hearing. ABR analyses of EAS were conducted to compare responses to acoustic, electrical, and combined stimulations. The threshold of EAS was higher than that of acoustic stimulation (AS) or electric stimulation (ES). The maximum peak height of the amplitude (MPHA) in the EAS showed sound pressure level (SPL)- and electric current-dependent changes, with superior performance at higher SPLs. The MPHA latency shift index analysis demonstrated significant differences between the EAS and the AS or ES only. In the context of EAS, neural responses occurring before 4 ms are defined as early responses, which are related to the stimulus. Late responses, occurring after 4 ms, suggest distinct physiological mechanisms that may involve synaptic actions or specific interactions within the EAS. Extracochlear EAS provides insights into its physiological implications, proposes a method for clinical application, and offers a potential avenue for improving hearing preservation and performance.

Amplitude and Phase Changes in Electrocochleographic Real-Time Recordings During Cochlear Implantation and Its Relation to Pre- and Postoperative Hearing.

The aim of this study was to relate response patterns of electrocochleography (ECochG) recordings during cochlear implantation to pre- and postoperative hearing. Thirty subjects with either flat (FA, n = 9) or sloping (SA, n = 21) audiograms before cochlear implantation were prospectively included. Real-time ECochG recordings were conducted via the cochlear implant. The difference curve (DIF) signal of the ECochG recordings was analyzed regarding alteration of the waveform, amplitude changes, and relative phase shifts during insertion. Five subjects (56%) with FA and 13 (62%) with SA exhibited DIF signal drops in the early phase of the insertion. In subjects with FA, alterations of the DIF signal waveform in the early phase of the insertion occurred in 8 subjects (90%), whereas such changes were detectable in only 2 out of 21 subjects (10%) with SA (p < 0.001). DIF signal drops with relative phase shifts of >0.7 radians but without alterations of the waveform occurred in 5 subjects (56%) with FA and 11 (52%) with SA. Such drops were associated with larger postoperative hearing losses than DIF signal drops without phase changes in both groups (FA: 43 versus 20 dB, p = 0.045; SA: 30 versus 14 dB, p = 0.001). Residual cochlear function in basal regions leads to alteration of the DIF signal waveform during insertion, probably not associated with cochlear injury. A decrease of the DIF signal amplitude with a simultaneous relative phase shift but no alteration of the waveform is associated with greater loss of residual hearing independent from the preoperative hearing.

Predicting Auditory Skill Outcomes After Pediatric Cochlear Implantation Using Preoperative Brain Imaging.

Our study used preoperative neuroanatomical features to predict auditory development in Chinese-learning children with cochlear implants (CIs). T1-weighted whole-brain magnetic resonance imaging (MRI) scans were obtained from 17 Chinese-learning pediatric CI candidates (12 females and five males, age at MRI = 23.0 ± 15.0 months). Voxel-based morphometry was applied to examine the children's whole-brain structure. Machine learning was employed using neuroanatomical features to predict children's auditory skills up to 24 months after CI. The whole-brain neural model and auditory/visual cortex neural model were compared with a nonneural model using gender, age at CI activation, and preoperative residual hearing as predictors. Model performance was quantified using the mean square error (MSE) between predicted values and observations. The model with preoperative neuroanatomical features showed a significantly smaller MSE than the nonneural model in predicting auditory skills in children with CIs. Specifically, the auditory-related area played an important role in predicting post-CI outcomes. The preoperative neuroanatomical features outperformed the nonneural features in predicting auditory skills in children with CIs. These results indicate that neural structure holds the potential to serve as an objective and effective feature for predicting post-CI outcomes. https://doi.org/10.23641/asha.28012046.

How Does Deep Neural Network-Based Noise Reduction in Hearing Aids Impact Cochlear Implant Candidacy?

Adult hearing-impaired patients qualifying for cochlear implants typically exhibit less than 60% sentence recognition under the best hearing aid conditions, either in quiet or noisy environments, with speech and noise presented through a single speaker. This study examines the influence of deep neural network-based (DNN-based) noise reduction on cochlear implant evaluation. Speech perception was assessed using AzBio sentences in both quiet and noisy conditions (multi-talker babble) at 5 and 10 dB signal-to-noise ratios (SNRs) through one loudspeaker. Sentence recognition scores were measured for 10 hearing-impaired patients using three hearing aid programs: calm situation, speech in noise, and spheric speech in loud noise (DNN-based noise reduction). Speech perception results were compared to bench analyses comprising the phase inversion technique, employed to predict SNR improvement, and the Hearing-Aid Speech Perception Index (HASPI v2), utilized to predict speech intelligibility. The spheric speech in loud noise program improved speech perception by 20 to 32% points as compared to the calm situation program. Thus, DNN-based noise reduction can improve speech perception in noisy environments, potentially reducing the need for cochlear implants in some cases. The phase inversion method showed a 4-5 dB SNR improvement for the DNN-based noise reduction program compared to the other two programs. HASPI v2 predicted slightly better speech intelligibility than was measured in this study. DNN-based noise reduction might make it difficult for some patients with significant residual hearing to qualify for cochlear implantation, potentially delaying its adoption or eliminating the need for it entirely.

Hearing preservation in pediatric cochlear implantation.

Pediatric cochlear implantation has evolved considerably over the past three decades to include more patients at earlier ages with greater degrees of residual hearing. As an extension, a significant focus of research over the past decade has surrounded preservation of existing acoustic hearing. Multiple studies published within the last 5 years demonstrate aidable acoustic hearing preservation in 60-90% of pediatric patients, with 40-60% experiencing complete hearing preservation following cochlear implantation. Durability of preserved hearing varies among patients, with some patients losing residual hearing within 1 year of surgery whereas others maintain acoustic hearing through at least 5 years of follow-up. Speech outcomes appear superior among patients with preserved acoustic hearing, particularly in the presence of background noise. Several recent studies suggest a music appreciation advantage in children with preserved acoustic hearing following cochlear implantation. Hearing preservation rates during cochlear implantation in children matches, if not often exceeds, hearing preservation rates observed among adults. Preservation of acoustic hearing during cochlear implantation confers multiple advantages for the pediatric population. Beyond improved speech understanding and music appreciation, minimizing intracochlear trauma and resultant scarring facilitates potential future regenerative treatments or revision surgery.

Early Hearing Outcomes and Audiological Experiences With a Novel Fully Implanted Cochlear Implant.

To review audiological experiences and early hearing outcomes from the early feasibility study of a fully implanted cochlear implant. Prospective cohort. Tertiary academic medical center. Three adults (two-male, one female) with bilateral sensorineural hearing loss. Implantation with a fully implanted cochlear implant as part of an early feasibility study. Postoperative unaided and aided pure-tone audiometry, tympanometry, mapping parameters, speech perception, battery life, and quality-of-life assessment. All patients in the early feasibility study of this fully implanted cochlear implant now use their devices regularly. Preoperative and postoperative audiometric measurements showed that their residual hearing in the implanted ear decreased slightly after surgery but was preserved. All patients had type A tympanograms after their transient middle ear effusion resolved. Electrical stimulation levels were comparable to those routinely used in traditional cochlear implants. Two of the three patients use a hearing aid in the implanted ear for additional gain and show significant improvement in speech perception since implantation. Average battery life before recharging is 4 days. All patients are regular users with two showing improvement in quality-of-life metrics after receiving the fully implanted cochlear implant. The patient experience and hearing outcomes from the early feasibility study of a novel fully implanted cochlear implant are detailed in this study and demonstrate ease of operation and daily use by all participants. All patients obtained hearing, but two of three use a hearing aid with their device to overcome unanticipated implant circuitry noise and achieve improved speech perception scores. Current work is focused on reducing this system noise to allow for the device to be used as intended, without a hearing aid.

Barriers to Cochlear Implant Uptake in Adults: A Scoping Review.

Cochlear implants (CIs) provide access to sound and help mitigate the negative effects of hearing loss. As a field, we are successfully implanting more adults with greater amounts of residual hearing than ever before. Despite this, utilization remains low, which is thought to arise from barriers that are both intrinsic and extrinsic. A considerable body of literature has been published in the last 5 years on barriers to adult CI uptake, and understanding these barriers is critical to improving access and utilization. This scoping review aims to summarize the existing literature and provide a guide to understanding barriers to adult CI uptake. Inclusion criteria were limited to peer-reviewed articles involving adults, written in English, and accessible with a university library subscription. A cutoff of 20 years was used to limit the search. Barriers uncovered in this review were categorized into an ecological framework. The initial search revealed 2,315 items after duplicates were removed. One hundred thirty-one articles were reviewed under full-text, and 68 articles met the inclusion criteria. Race, ethnicity, and reimbursement are policy and structural barriers. Public awareness and education are societal barriers. Referral and geographical challenges are forms of organizational barriers. Living context and professional support are interpersonal barriers. At the individual level, sound quality, uncertainty of outcome, surgery, loss of residual hearing, and irreversibility are all barriers to CI uptake. By organizing barriers into an ecological framework, targeted interventions can be used to overcome such barriers.

The Influence of Vowels on the Identification of Spoken Disyllabic Words in the Malayalam Language for Individuals with Hearing Loss.

The present study investigates the reasons for better recognition of disyllabic words in Malayalam among individuals with hearing loss. This research was conducted in three experiments. Experiment 1 measured the psychometric properties (slope, intercept, and maximum scores) of disyllabic wordlists. Experiment 2 examined PBmax scores across varying degrees of sensorineural hearing loss (SNHL) and compared these findings with studies in other Indian and global languages. Experiment 3 analyzed the recognition performance of different vowel combinations across varying degrees of hearing loss. Experiment 1: Psychometric functions for disyllabic word recognition were derived from 45 individuals with normal hearing. Word recognition was tested in quiet at nine hearing levels ranging from -10 to +40 dB HL. Experiment 2: 1000 participants with SNHL were categorized by hearing loss severity (mild, moderate, moderately severe, severe, and profound). Word recognition scores, including PBmax, were analyzed and compared across severity levels. Experiment 3: Percent error scores for 17 vowel combinations were assessed in 37 participants with SNHL. Ten disyllabic words represented each combination. Disyllabic wordlists showed significantly higher word recognition scores than monosyllabic lists across all degrees of hearing loss. Individuals with mild-to-moderately severe SNHL achieved higher PBmax scores, with performance declining at severe- and profound-loss levels. The higher recognition of disyllabic words was attributed to contextual cues and low-frequency vowel-based information, particularly benefiting those with residual low-frequency hearing. Error analysis highlighted the influence of specific vowel combinations on word recognition performance. Disyllabic words are easier to recognize than monosyllabic words for individuals with SNHL due to their rich contextual and low-frequency energy cues. Disyllabic wordlists sustain higher recognition scores up to moderately severe hearing loss but show a marked decline with more severe losses. The phonemic balance of wordlists and vowel combinations significantly influences word recognition, emphasizing the importance of these factors in developing wordlists for clinical use.

Auditory agnosia progressing to cortical deafness. Long-term follow up of a one-year-old child to age 37

Background There are two types of central auditory disorders due to pathology of the bilateral auditory cortices in adult patients: auditory agnosia with residual hearing; cortical deafness with total hearing loss. However, long-term changes of hearing acuity over physical development time are unknown. Objective The aim of this case report was to illustrate the pathophysiology of auditory changes in a 1 year-3 months old child who was diagnosed with auditory agnosia as a sequel of herpes encephalitis and later developed cortical deafness during a 36-year follow-up. Materials and Methods Brain MRI, hearing tests, ABR, DPOAE and developmental tests of speech/language were periodically performed. Results Brain imaging revealed extensive damage in the bilateral auditory cortices. His auditory speech perception was lost and his language development was seriously delayed. His hearing threshold progressively decreased over time from normal at first to profound hearing loss as a teenager. However, at 29 years of age his ABR was normal. He was able to communicate and converse by sign language or writing. Conclusions and Significance Later developing cortical deafness with profound hearing loss could be caused by retrograde degeneration of the auditory radiation overtime to the bilateral medial geniculate bodies.

Developing a Virtual Model of the Rhesus Macaque Inner Ear.

A virtual model of the rhesus macaque inner ear was created in the present study. Rhesus macaques have been valuable in cochlear research; however, their high cost prompts a need for alternative methods. Finite Element (FE) analysis offers a promising solution by enabling detailed simulations of the inner ear. This study employs FE analysis to create a virtual model of the rhesus macaque's inner ear, reconstructed from MRI scans, to explore how cochlear implants (CIs) impact residual hearing loss. Harmonic-acoustic simulations of sound wave transmission indicate that CIs have minor effects on the displacement of the basilar membrane and thus minimally impact residual hearing loss post-implantation, but stiffening of the round window membrane worsens this effect. While the rhesus macaque FE model presented in this study shows some promise, its potential applications will require further validation through additional simulations and experimental studies.

Silicone-based AC102-loaded cochlear implant coatings protect residual hearing in an animal model of cochlear implantation

Cochlear implant users with residual hearing benefit synergistically from combined electrical stimulation via the cochlear implant and preserved residual hearing after surgery. However, direct mechanical trauma and subsequent inflammation may deteriorate hearing function. AC102, a novel otoprotective pyridoindole with anti-apoptotic and anti-oxidative properties significantly improved hearing recovery following cochlear implantation when administered intratympanically prior to surgery. Additionally, AC102 exerts neurotrophic effects, possibly aiding in the preservation of auditory nerve fibers and spiral ganglion neurons. Rapid clearance of the drug, however, might be a limiting factor to further attenuate the inflammatory response and maintain neuronal health. The aim of the current study was to design an AC102-loaded electrode array for sustained drug delivery and investigate its effects in hearing preservation cochlear implantation.First, the release-kinetics of AC102 were investigated in vitro and modelled by the Higuchi equation of drug release. An electrode array coated with 10 % AC102 was manufactured, its release kinetics evaluated, and subsequently tested in vivo. 20 normal hearing Mongolian gerbils were unilaterally implanted with an AC102-loaded or an unloaded control electrode. Compound action potentials were measured prior to cochlear implantation and serially over 28 days. Hair cells, inner hair cell synapses, and auditory nerve fibers were quantified in cochlear whole-mounts by immunofluorescence staining.AC102 release from silicone coating could be predictably modelled by the Higuchi equation of drug release. The electrode array with an AC102-silicone depot enabled non-linear sustained drug release with initially higher release concentrations. In vivo, the AC102-loaded electrode array significantly recovered auditory threshold shifts near the maximum insertion depth over 28 days. In the apical region, a significant recovery was noticed only until day 14, after which threshold shifts aligned between groups. Histologically, AC102-loaded electrodes significantly preserved outer hair cells apical of the maximum insertion depth and inner hair cells and neuronal structures at the tip of the inserted electrode.In conclusion, the drug-loaded electrode arrays could predictably release AC102 over a period of 28 days. AC102 enabled the restoration of auditory thresholds near the area of maximum insertion, which is the desired region to be preserved in cochlear implant recipients with residual hearing.

Unilateral cochlear implantation in elderly patients: assessment of the auditory and non-auditory functions of patients

Introduction. One of the few ways to rehabilitate profound hearing loss in elderly patients is cochlear implantation. A number of studies have been published assessing the effect of unilateral cochlear implantation on cognitive function in elderly patients, but the results have been mixed.Aim. Evaluation of the impact of unilateral cochlear implantation on auditory and non-auditory functions in elderly patients.Materials and methods. The study included 50 elderly and senile patients (mean age 67.16 ± 3.5 years). RBANS-H, HI-MoCA tests were used to assess cognitive function. Quality of life, depression and anxiety levels were assessed by HADS, SF-36. Auditory function was assessed by pure tone audiometry, speech audiometry, SSQ, HISQUI19.Results. The study showed improvement in cognitive function in patients with and without residual hearing. There was also an improvement in quality of life, a decrease in depression and anxiety in both study groups. When assessing the auditory function, statistically significant differences between the study groups remained during the study for the sound quality indicator (SSQ test), while other parameters did not have a statistically significant difference at the end of the study. In addition, the study did not reveal a statistically significant effect of vestibular dysfunction on cognitive function in patients.Conclusions. Unilateral CI as a method of rehabilitation of profound impairments of auditory function in elderly and senile patients has demonstrated its high effectiveness.

Intraoperative Acoustic Monitoring Using Threshold and Suprathreshold Pure Tone Audiometry during Cochlear Implantation Under Local Anesthesia: A Simple and Novel Method to Potentially Enhance Hearing Preservation Cochlear Implant Surgery.

To report the feasibility and potential utility of monitoring acoustic hearing on awake patients using intraoperative behavioral responses to threshold and suprathreshold stimuli while undergoing cochlear implantation (CI) under local anesthesia, without any form of sedation. Retrospective review of the first five cases performed by one surgeon. Tertiary care academic medical center. Adult patients with residual acoustic hearing undergoing CI. CI under local anesthesia, without any form of sedation. Procedural tolerance, reliability of intraoperative pure tone threshold and suprathreshold audiometry, and correlation of intraoperative findings with early postoperative residual hearing. Five ears in four patients underwent CI, including three males and one female, with a median age of 61 years. Intraoperatively, patients reported reliable behavioral responses to pure tone threshold and suprathreshold stimuli and provided real-time feedback on perceived stimulus change to the surgeon just prior to, during, and immediately following electrode insertion. All patients were able to complete the operation under local anesthesia. During electrode insertion, three cases reported no change and two cases reported diminished stimulus perception that reversed with limited electrode pull back near terminal insertion. Immediate postoperative audiograms demonstrated preservation of bone conduction thresholds within 10 dB of their preoperative baseline for all cases, suggesting hearing preservation. Three-month postoperative AzBio in quiet scores were available for two patients, measuring 45% and 94%, respectively. This report describes the feasibility of intraoperative behavioral audiometry during CI under local anesthesia, using patient feedback during electrode insertion to optimize hearing preservation surgery. Akin to other surgical subspecialties that use real-time patient feedback where objective intraoperative measures of neurofunction are imperfect, we demonstrate feasibility and potential utility of live acoustic monitoring during CI.

“Fresh vs dry grafting in interlay type-1 tympanoplasty”

BackgroundChronic otitis media is a common middle ear disease that leads to varying degrees of hearing loss and otorrhoea. Tympanoplasty is a common surgery used for the reconstruction of sound conductive pathways in mucosal-type COM.AimsThe study aims to compare the fresh and the dry grafting technique in interlay type-1 tympanoplasty amongst the patients of inactive mucosal type chronic otitis media.ObjectivesThe objectives of the study are to compare graft uptake rate, pre-op and post-op AB gap, residual hearing loss, and average graft epithelialization time between the fresh and the dry grafting technique in interlay type-1 tympanoplasty.MethodsA retrospective cohort study of 48 patients of COM inactive mucosal-type who underwent interlay type-1 tympanoplasty between July 2020 and March 2022.ResultsOut of 48 patients, in 23 patients, the fresh graft was used, while in the rest 25 patients, the dry graft was used. The overall (fresh + dry group) graft uptake rate at the end of three months was 97.9%. The graft uptake rate was 100% with the use of the fresh graft and 96% with the use of the dry graft. The pre-op average air-bone (AB) gap was 12.21 ± 4.23 dB in patients where the fresh graft was used and in patients where the dry graft was used. An overall pre-op average AB gap was 13.35 ± 3.81 dB. The average time for epithelialization was 24.43 ± 4.17 days with the use of the fresh graft and 49.75 ± 6.93 days with the use of the dry graft. It was also statistically significant with a P-value of 0.001.ConclusionsThe fresh graft in the interlay type-1 tympanoplasty shows higher graft uptake rates, reduced epithelialization time, and better hearing improvement compared to dry graft. However, different complication rates are similar with the use of both types of grafts.