Speech Perception Scores In Quiet Research Articles

Cochlear Implant Outcomes in Patients With TMTC2-Associated Sensorineural Hearing Loss and Auditory Neuropathy/Auditory Dys-Synchrony.

To investigate the outcomes of cochlear implantation in patients with TMTC2-associated sensorineural hearing loss and auditory neuropathy/auditory dys-synchrony. Adult and pediatric cochlear implant (CI) patients followed in an academic center who tested positive for TMTC2 genetic variant rs35725509. Cochlear implantation. Speech perception scores in quiet. Ten CI patients were identified with TMTC2 variant rs35725509 out of 157 patients who underwent genetic testing (i.e., 6.3% of patients tested). All demonstrated progressive, bilateral hearing loss with severe-to-profound audiometric thresholds preoperatively. Pre-CI and 1-year post-CI speech recognition percent correct scores were compared. Post-CI speech perception (mean 61.0%, standard deviation 31.4%) was significantly higher than pre-CI speech perception (mean 21.0%, standard deviation 27.0%) (p = 0.002). Individually, 9 of the 10 subjects experienced significant improvements in speech perception pre- to post-CI (p < 0.05). Electrically evoked compound action potential measures were available for five patients, and all showed normal electrically evoked compound action potential thresholds. Patients with TMTC2-associated sensorineural hearing loss and auditory neuropathy/auditory dys-synchrony have significantly improved speech perception outcomes with cochlear implantation and should be considered candidates for this intervention if there are no other contraindications.

Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures.

(1) Background: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data and a predictive model for postoperative speech perception in noise (SPiN) after CI provision. (2) Methods: CI candidates with substantial residual hearing (either in hearing threshold or in word recognition scores) were included in a retrospective analysis (n = 87). Speech perception scores in quiet 12 months post-surgery were compared with the predicted scores. A generalized linear model was fitted to speech reception thresholds (SRTs) after CI fitting to identify predictive variables for SPiN. (3) Results: About two-thirds of the recipients achieved the expected outcome in quiet or were better than expected. The mean absolute error of the prediction was 13.5 percentage points. Age at implantation was the only predictive factor for SPiN showing a significant correlation (r = 0.354; p = 0.007). (4) Conclusions: Outcome prediction accuracy for speech in quiet was comparable to previous studies. For CI recipients in the included study population, the SPiN outcome could be predicted only based on the factor age.

Direct Elicitation of Cortical Auditory Evoked Potentials by Electrical Stimulation and Their Use to Verify the Most Comfortable Level of Stimulation in Cochlear Implant Users

Introduction: This study was designed to investigate the use of electrically evoked cortical auditory evoked potentials (eCAEPs) as a tool for cochlear implant (CI) verification, the relationships between the site and intensity of stimulation and the detection rates and morphologies of eCAEPs as well as investigate whether correlations exist between the morphologies of eCAEPs and speech perception in quiet and in noise, duration of hearing loss, age at implantation, whether the hearing loss bilateral or single-sided and the electrode current level required to elicit MCL stimulation. Methods: 32 adult unilateral CI users with postlingual hearing loss were enrolled. The stimuli were 1 kHz biphasic alternating pulses and were presented at either the behaviorally measured MCL or 50% of this value (MCL_0.5) via the CI fitting software. Pulses were directed to apical, medial, or basal electrodes. CAEPs were recorded from a scalp electrode placed at the vertex, low forehead, and contralateral mastoid and were evaluated by two electrophysiologists. Results: Overall, eCAEPs could be detected in 31/32 users when stimulating at MCL, and in 29/32 users when stimulating at MCL_0.5. The detection rates were 31, 31, and 28/32 for apical, medial, and basal stimulation at MCL, and 29, 29, and 26/32 at MCL_0.5. Significant differences in eCAEP amplitudes and latencies were observed across electrodes and stimulation levels. No significant correlations were found between eCAEP latencies and amplitudes and user age, duration of deafness prior to CI surgery, or with bilateral versus single-sided hearing loss, nor with the charge level required to elicit MCL, or with speech perception scores in quiet. Peak latencies correlated with speech perception scores in some configurations of speech-in-noise. Conclusion: eCAEPs can readily be elicited in the majority of adult CI users and show normal waveform characteristics at stimulation levels corresponding to MCL, as well as at basal, medial, and apical electrode stimulation sites. Neither the latencies nor amplitudes of eCAEPs are confounded by variables of age, duration of deafness prior to CI surgery, or the laterality of hearing loss. eCAEPs are a useful, objective method evaluate sound perception in CI users.

Cochlear implantation outcomes in the older adult: a scoping review

Objectives The current study aimed to identify and map the available evidence surrounding cochlear implantation (CI) in older adults. Five outcomes were evaluated: speech perception scores, perioperative complications, neurocognitive outcomes, quality of life outcomes and vestibular dysfunction and fall rates after surgery. Methods A scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews and included patients over the age of 60. Results Ninety-seven studies met inclusion criteria, encompassing 7,182 patients. Mean (SD) speech perception scores in quiet and in noise pre-and postoperatively were 7.9% (6.7) and 52.8% (14.3) and 8.0% (68.1) and 68.1% (15.9) respectively. Postoperative cardiac arrhythmias, urinary retention, and delirium occurred slightly more frequently in older adults. In terms of cognition, most studies noted stability or improvement one year after implantation. A majority of studies indicated better quality of life post-CI. Rates of fall after surgery were rarely reported, and there was a general paucity of data surrounding vestibular function changes after CI. Discussion This scoping review identifies many positive outcomes linked to CI in older adults. No findings suggest a single patient characteristic that would warrant refusal to consider evaluation for cochlear implantation.

Poor Performer: A Distinct Entity in Cochlear Implant Users?

Introduction: Several factors are known to influence speech perception in cochlear implant (CI) users. To date, the underlying mechanisms have not yet been fully clarified. Although many CI users achieve a high level of speech perception, a small percentage of patients does not or only slightly benefit from the CI (poor performer, PP). In a previous study, PP showed significantly poorer results on nonauditory-based cognitive and linguistic tests than CI users with a very high level of speech understanding (star performer, SP). We now investigate if PP also differs from the CI user with an average performance (average performer, AP) in cognitive and linguistic performance. Methods: Seventeen adult postlingually deafened CI users with speech perception scores in quiet of 55 (9.32) % (AP) on the German Freiburg monosyllabic speech test at 65 dB underwent neurocognitive (attention, working memory, short- and long-term memory, verbal fluency, inhibition) and linguistic testing (word retrieval, lexical decision, phonological input lexicon). The results were compared to the performance of 15 PP (speech perception score of 15 [11.80] %) and 19 SP (speech perception score of 80 [4.85] %). For statistical analysis, U-Test and discrimination analysis have been done. Results: Significant differences between PP and AP were observed on linguistic tests, in Rapid Automatized Naming (RAN: p = 0.0026), lexical decision (LexDec: p = 0.026), phonological input lexicon (LEMO: p = 0.0085), and understanding of incomplete words (TRT: p = 0.0024). AP also had significantly better neurocognitive results than PP in the domains of attention (M3: p = 0.009) and working memory (OSPAN: p = 0.041; RST: p = 0.015) but not in delayed recall (delayed recall: p = 0.22), verbal fluency (verbal fluency: p = 0.084), and inhibition (Flanker: p = 0.35). In contrast, no differences were found hereby between AP and SP. Based on the TRT and the RAN, AP and PP could be separated in 100%. Discussion: The results indicate that PP constitute a distinct entity of CI users that differs even in nonauditory abilities from CI users with an average speech perception, especially with regard to rapid word retrieval either due to reduced phonological abilities or limited storage. Further studies should investigate if improved word retrieval by increased phonological and semantic training results in better speech perception in these CI users.

Cochlear Implantation in Adults With Single-Sided Deafness: A Systematic Review and Meta-analysis.

To determine the clinical outcomes of adult patients with single-sided deafness (SSD) undergoing ipsilateral cochlear implantation. An electronic search of Medline and Embase articles. A systematic review was performed with a search strategy developed by a licensed librarian to identify studies of adult patients with SSD who underwent ipsilateral cochlear implantation. Articles were managed in Covidence and evaluated by 2 independent reviewers. Risk of bias was assessed and data were extracted, including patient demographics, etiology of deafness, duration of deafness, and postoperative change in speech recognition, tinnitus, sound localization, and quality of life (QoL). A meta-analysis was performed, and pooled mean differences were calculated for each outcome of interest via random effects models by each outcome, as well as subgroup analyses by the individual clinical score used. Of 2309 studies identified, 185 full texts were evaluated, and 50 were ultimately included involving 674 patients. Speech perception scores in quiet and noise, tinnitus control, sound localization, and QoL all significantly improved after implantation. Pooled outcomes demonstrated score improvements in speech perception (standardized mean difference [SMD], 2.8 [95% CI, 2.16-3.43]), QoL (SMD, 0.68 [95% CI, 0.45-0.91]), sound localization (SMD, -1.13 [95% CI, -1.68 to -0.57]), and tinnitus score reduction (SMD, -1.32 [95% CI, -1.85 to -0.80]). Cochlear implantation in adults with SSD results in significant improvements in speech perception, tinnitus control, sound localization, and QoL.

Electrocochleography and cognition are important predictors of speech perception outcomes in noise for cochlear implant recipients

Although significant progress has been made in understanding outcomes following cochlear implantation, predicting performance remains a challenge. Duration of hearing loss, age at implantation, and electrode positioning within the cochlea together explain ~ 25% of the variability in speech-perception scores in quiet using the cochlear implant (CI). Electrocochleography (ECochG) responses, prior to implantation, account for 47% of the variance in the same speech-perception measures. No study to date has explored CI performance in noise, a more realistic measure of natural listening. This study aimed to (1) validate ECochG total response (ECochG-TR) as a predictor of performance in quiet and (2) evaluate whether ECochG-TR explained variability in noise performance. Thirty-five adult CI recipients were enrolled with outcomes assessed at 3-months post-implantation. The results confirm previous studies showing a strong correlation of ECochG-TR with speech-perception in quiet (r = 0.77). ECochG-TR independently explained 34% of the variability in noise performance. Multivariate modeling using ECochG-TR and Montreal Cognitive Assessment (MoCA) scores explained 60% of the variability in speech-perception in noise. Thus, ECochG-TR, a measure of the cochlear substrate prior to implantation, is necessary but not sufficient for explaining performance in noise. Rather, a cognitive measure is also needed to improve prediction of noise performance.

Long-term auditory processing outcomes in early implanted young adults with cochlear implants: The mismatch negativity vs. P300 response

ObjectiveLong-term outcomes of early implanted, young adult cochlear implant (CI) users remain variable. We measured auditory discrimination by means of event-related potentials in this population to examine whether variability at the level of cortical auditory processing helps to explain speech abilities. MethodsUsing an auditory oddball paradigm, the P300 and Mismatch Negativity (MMN) were measured in 8 young adult CI users and 14 normal-hearing peers. We related P300 amplitude and latency to clinical speech perception scores in quiet and to duration of deafness. ResultsAll individuals showed P300 responses. The MMN response was less robust in both groups. There was no evidence for differences in P300 responses between CI users and controls. P300 amplitude was associated with speech perception scores (r = 0.70, p = .05) and duration of deafness (r = −0.83, p = .009). ConclusionsEarly CI implantation yields good auditory processing outcomes at young adult age and, in contrast to MMN, the P300 provides a robust measure for auditory processing on an individual level. SignificanceAt the cortical level, early implanted, long-term CI users have good auditory discrimination, leaving variability in implantation outcomes unexplained. This group provides unique insight into the long-term neurophysiological underpinnings of early implantation.

Insurance Payer Status Predicts Postoperative Speech Outcomes in Adult Cochlear Implant Recipients.

Cochlear implant qualifying criteria for adult patients with public insurance policies are stricter than the labeled manufacturer criteria. It remains unclear whether insurance payer status affects expedient access to implants for adult patients who could derive benefit from the devices. This study examined whether insurance payer status affected access to cochlear implant services and longitudinal speech-perception outcomes in adult cochlear implant recipients. Retrospective cross-sectional study. Sixty-eight data points were queried from the Health Insurance Portability and Accountability Act-Secure, Encrypted, Research Management and Evaluation Solution database which consists of 12,388 de-identified data points from adult and pediatric cochlear implant recipients. Linear mixed-effects models were used to determine whether insurance payer status affected expedient access to cochlear implants and whether payer status predicted longitudinal postoperative speech-perception scores in quiet and noise. Results from linear mixed-effects regression models indicated that insurance payer status was a significant predictor of behavioral speech-perception scores in quiet and in background noise, with patients with public insurance experiencing poorer outcomes. In addition, extended wait time to receive a cochlear implant was predicted to significantly decrease speech-perception outcomes for patients with public insurance. This study documented patients covered by public health insurance wait longer to receive cochlear implants and experience poorer postoperative speech-perception outcomes. These results have important clinical implications regarding the cochlear implant candidacy criteria and intervention protocols.

Benefits of a Hearing Registry: Cochlear Implant Candidacy in Quiet Versus Noise in 1,611 Patients.

Purpose This retrospective study used a cochlear implant registry to determine how performing speech recognition candidacy testing in quiet versus noise influenced patient selection, speech recognition, and self-report outcomes. Method Database queries identified 1,611 cochlear implant recipients who were divided into three implant candidacy qualifying groups based on preoperative speech perception scores (≤ 40% correct) on the AzBio sentence test: quiet qualifying group, +10 dB SNR qualifying group, and +5 dB SNR qualifying group. These groups were evaluated for demographic and preoperative hearing characteristics. Repeated-measures analysis of variance was used to compare pre- and postoperative performance on the AzBio in quiet and noise with qualifying group as a between-subjects factor. For a subset of recipients, pre- to postoperative changes on the Speech, Spatial and Qualities of Hearing Scale were also evaluated. Results Of the 1,611 patients identified as cochlear implant candidates, 63% of recipients qualified in quiet, 10% qualified in a +10 dB SNR, and 27% qualified in a +5 dB SNR. Postoperative speech perception scores in quiet and noise significantly improved for all qualifying groups. Across qualifying groups, the greatest speech perception improvements were observed when tested in the same qualifying listening condition. For a subset of patients, the total Speech, Spatial and Qualities of Hearing Scale ratings improved significantly as well. Conclusion Patients who qualified for cochlear implantation in quiet or background noise test conditions showed significant improvement in speech perception and quality of life scores, especially when the qualifying noise condition was used to track performance.

A Role for Acoustic Stimulation in Advanced Otosclerosis: Direct Acoustic Cochlear Implant versus Cochlear Implant

Recent findings support the efficacy of the direct acoustic cochlear implant (DACI) in patients with advanced otosclerosis whose rehabilitation is very challenging. Standard treatment consists of stapes surgery combined with hearing aids or a cochlear implant (CI). CI surgery, however, is often challenging depending on the grade of otosclerosis. This study aims to compare speech perception scores in quiet and noise of 6 DACI and 12 CI patients with advanced otosclerosis at 3 and 12 months after fitting. Preoperative computed tomographic scans of all patients were scored by experts using an existing otosclerosis grading system (stages 1–3). Speech perception in quiet was significantly better for DACI compared to CI users at 3 months after fitting. At 12 months, no difference was found between DACI and CI patients. Speech perception scores in noise were significantly better in the DACI group. In summary, a DACI system seems to provide an effective treatment option as the acoustic component can be preserved in patients with advanced otosclerosis.

Speech intelligibility and subjective benefit in single-sided deaf adults after cochlear implantation

Treatment with cochlear implants (CIs) in single-sided deaf individuals started less than a decade ago. CIs can successfully reduce incapacitating tinnitus on the deaf ear and allow, so some extent, the restoration of binaural hearing. Until now, systematic evaluations of subjective CI benefit in post-lingually single-sided deaf individuals and analyses of speech intelligibility outcome for the CI in isolation have been lacking.For the prospective part of this study, the Bern Benefit in Single-Sided Deafness Questionnaire (BBSS) was administered to 48 single-sided deaf CI users to evaluate the subjectively perceived CI benefit across different listening situations. In the retrospective part, speech intelligibility outcome with the CI up to 12 month post-activation was compared between 100 single-sided deaf CI users and 125 bilaterally implanted CI users (2nd implant).The positive median ratings in the BBSS differed significantly from zero for all items suggesting that most individuals with single-sided deafness rate their CI as beneficial across listening situations. The speech perception scores in quiet and noise improved significantly over time in both groups of CI users. Speech intelligibility with the CI in isolation was significantly better in bilaterally implanted CI users (2nd implant) compared to the scores obtained from single-sided deaf CI users.Our results indicate that CI users with single-sided deafness can reach open set speech understanding with their CI in isolation, encouraging the extension of the CI indication to individuals with normal hearing on the contralateral ear. Compared to the performance reached with bilateral CI users’ second implant, speech reception threshold are lower, indicating an aural preference and dominance of the normal hearing ear. The results from the BBSS propose good satisfaction with the CI across several listening situations.

Satisfaction With Cochlear Implants in Postlingually Deaf Adults and Its Nonaudiological Predictors

A postlingually deaf patient who receives a cochlear implant (CI) acquires multiple benefits, not just audiological but also nonaudiological: improvement in quality of life, psychological well-being, and social interaction. The aim of the study was to ascertain the relationship between the CI satisfaction experienced by adult, postlingually deaf individuals and their level of psychological distress, stress coping strategies, and global self-esteem. We also considered sociodemographic variables (such as sex, age, education, marital/partner status, and employment/study status), variables related to their deafness, and their length of experience with a CI. The study had a cross-sectional design in which participants were asked to fill in a mailed personal inquiry form seeking sociodemographic data and one question related to CI satisfaction, and the following questionnaires: General Health Questionnaire-28, the Brief Coping Orientation to Problems Experienced, and the Rosenberg Self-Esteem Scale. This study included 98 patients with postlingual deafness between 19 and 85 years old who had unilateral CIs. For some analyses, the patients were also divided into two groups: younger (≤60 years) and older (>60 years). Two other subgroups were those with shorter CI experience (1 to 2 years) and those with longer CI experience (5 to 6 years). As an objective reference, speech perception scores in quiet and in noise were also used. The majority of postlingually deaf subjects rated their CI satisfaction as high or very high, and this was at similar levels in younger and older subjects, as well as in those who had used CIs for either a short or a long time. CI satisfaction was not related to speech perception scores, duration of deafness, length of CI use, or other sociodemographic factors. Positive self-esteem, having less severe symptoms of depression, and the use of humor or self-distraction were conducive to CI satisfaction. Using a coping strategy of denial had a negative association with CI satisfaction. Coping strategies and symptoms of mental distress varied between younger and older subjects. For younger subjects, higher CI satisfaction was associated with lower severity of depressive symptoms, whereas for the elderly, higher CI satisfaction was associated with less severe social dysfunction symptoms. Over the years of using a CI, the same strategy may have a different psychological function in providing satisfaction: for example, venting, which in the group with a short CI experience is negatively correlated to satisfaction, is positively correlated to satisfaction for those with longer CI experience. The results show that psychological factors—self-esteem, distress, and coping strategies—are important for CI satisfaction in postlingually deaf CI users. The results point to advantages in widening the availability of various tailored forms of psychological intervention for patients with postlingual deafness after receiving a CI.

Restoring speech perception with cochlear implants by spanning defective electrode contacts

Conclusion: Even with six defective contacts, spanning can largely restore speech perception with the HiRes120 speech processing strategy to the level supported by an intact electrode array. Moreover, the sound quality is not degraded. Objectives: Previous studies have demonstrated reduced speech perception scores (SPS) with defective contacts in HiRes120. This study investigated whether replacing defective contacts by spanning, i.e. current steering on non-adjacent contacts, is able to restore speech recognition to the level supported by an intact electrode array. Methods: Ten adult cochlear implant recipients (HiRes90K, HiFocus1J) with experience with HiRes120 participated in this study. Three different defective electrode arrays were simulated (six separate defective contacts, three pairs or two triplets). The participants received three take-home strategies and were asked to evaluate the sound quality in five predefined listening conditions. After 3 weeks, SPS were evaluated with monosyllabic words in quiet and in speech-shaped background noise. Results: The participants rated the sound quality equal for all take-home strategies. SPS with background noise were equal for all conditions tested. However, SPS in quiet (85% phonemes correct on average with the full array) decreased significantly with increasing spanning distance, with a 3% decrease for each spanned contact.

Central auditory function in early Alzheimer's disease and in mild cognitive impairment

to investigate auditory function in subjects with early Alzheimer's disease, mild cognitive impairment and with subjective memory complaints, in search of signs of central auditory processing dysfunction even in early stages of cognitive impairment. a consecutive group of men and women, referred to the Memory Clinic at the Karolinska University Hospital, was approached for inclusion in this prospective study. One hundred and thirty-six subjects, mean age 64 years (range 50-78 years), diagnosed with Alzheimer's disease (n = 43), mild cognitive impairment (n = 59) or with subjective memory complaints (n = 34), were included. auditory function was assessed with pure tone audiometry, speech perception in quiet and in background noise and dichotic digits tests with two or three digits. pure tone audiometry and speech perception scores in quiet and in background noise were normal for age and without between-group differences. Dichotic digits tests showed strongly significant differences between the three groups, where the Alzheimer's disease group performed significantly poorer than the other two groups, with the mild cognitive impairment group in an intermediate position. our results demonstrate that central auditory processing dysfunction is highly evident in subjects with Alzheimer's disease, and to a considerable extent even in subjects with mild cognitive impairment.

What Matched Comparisons Can and Cannot Tell Us: The Case of Cochlear Implants

To examine the conclusions and possible misinterpretations that may or may not be drawn from the "outcome-matching method," a study design recently used in the cochlear implant literature. In this method, subject groups are matched not only on potentially confounding variables but also on an outcome measure that is closely related to the outcome measure under analysis. For example, subjects may be matched according to their speech perception scores in quiet, and their speech perception in noise is compared. The present study includes two components, a simulation study and a questionnaire. In the simulation study, the outcome-matching method was applied to pseudo-randomly generated data. Simulated speech perception scores in quiet and in noise were generated for two comparison groups, in two imaginary worlds. In both worlds, comparison group A performed only slightly worse in noise than in quiet, whereas comparison group B performed significantly worse in noise than in quiet. In Imaginary World 1, comparison group A had better speech perception scores than comparison group B. In Imaginary World 2, comparison group B had better speech perception scores than comparison group A. The outcome-matching method was applied to these data twice in each imaginary world: 1) matching scores in quiet and comparing in noise, and 2) matching scores in noise and comparing in quiet. This procedure was repeated 10,000 times. The second part of the study was conducted to address the level of misinterpretation that could arise from the outcome-matching method. A questionnaire was administered to 54 students in a senior level course on speech and hearing to assess their opinions about speech perception with two different models of cochlear implant devices. The students were instructed to fill out the questionnaire before and after reading a paper that used the outcome-matching method to examine speech perception in noise and in quiet with those two cochlear implant devices. When pseudorandom scores were matched in quiet, comparison group A's scores in noise were significantly better than comparison group B's scores. Results were different when scores were matched in noise: in this case, comparison group B's scores in quiet were significantly better than comparison group A's scores. Thus, the choice of outcome measure used for matching determined the result of the comparison. Additionally, results of the comparisons were identical regardless of whether they were conducted using data from Imaginary World 1 (where comparison group A is better) or from Imaginary World 2 (where comparison group B is better). After reading the paper that used the outcome-matching method, students' opinions about the two cochlear implants underwent a significant change even though, according to the simulation study, this opinion change was not warranted by the data. The outcome-matching method can provide important information about differences within a comparison group, but it cannot be used to determine whether a given device or clinical intervention is better than another one. Care must be used when interpreting the results of a study using the outcome-matching method.