Word Recognition Scores Research Articles

Speech Perception Ability and Subjective Satisfaction After Upgrade of Speech Processor in Cochlear Implantation.

Objective: Cochlear implant (CI) users face the decision of whether to upgrade to a new sound processor (SP) with technological advances. We wanted to assess the changes of speech perception ability and aided hearing thresholds as well as subjective satisfaction after upgrade to a new SP. Methods: Fifty-five patients who have used CI for 10 years or more and upgraded to a new SP were enrolled. Word recognition scores were assessed before the upgrade and compared to those assessed 1 year after the upgrade to the Nucleus 7 SP. Changes of aided hearing thresholds and C- and T-levels were analyzed. Results: Previous SPs were 3G in 5, Freedom in 40, N5 in 24, and N6 in 6. Speech perception remained relatively unaffected by SP upgrade. The C- and T-levels increased after SP upgrading and the aided thresholds with previous generation SPs were higher than those 1 year after SP upgrading at all frequencies. In questionnaires, subjects felt that there was a definite subjective benefit to upgrading while most (60%) felt no difference regarding the communication in noise. Conclusions: Speech perception remained similar, but there were improved hearing sensitivity and better satisfaction after SP upgrade.

Minimum cochlear dose impacts hearing after radiosurgery for sporadic vestibular schwannoma.

It is uncertain which cochlear dose parameters significantly impact hearing after stereotactic radiosurgery (SRS) for sporadic vestibular schwannoma (VS). The objective of this study was to determine the impact of cochlear dose parameters on hearing outcomes for patients with serviceable hearing (SH). This was a historical cohort study performed at a single tertiary center that included patients with sporadic VS and SH who underwent single-session Gamma Knife radiosurgery treatment from 2007 to 2022. Associations of cochlear dose parameters with time to non-SH and rates of change in pure-tone average (PTA) and word recognition score (WRS) following SRS were assessed. A total of 205 patients with SH underwent SRS for a sporadic VS. At SRS, 54 (26%) tumors were confined to the internal auditory canal and 151 (74%) extended into the cerebellopontine angle. At 2, 5, and 10 years following SRS, 62%, 37%, and 15% of patients maintained SH, respectively. The median time to non-SH was 1.8 years. The median rates of change in PTA and WRS were 6.0 dB of hearing loss per year and -6.5% per year, respectively. In a multivariable analysis, each 1-Gy increase in minimum cochlear dose was significantly associated with time to non-SH (HR 1.5, 95% CI 1.2-1.9), rate of change in PTA decibel hearing loss per year (parameter estimate [PE] 3.4, 95% CI 0.6-6.2), and rate of change in WRS percentage per year (PE -6.4, 95% CI -11.2 to -1.5). The associations of each 1-Gy increase in mean cochlear dose with hearing outcomes were only significant among patients with class B hearing (time to non-SH HR 1.3, 95% CI 1.1-1.6; rate of change in PTA PE 3.6, 95% CI 1.2-5.9; and rate of change in WRS PE -5.7, 95% CI -9.7 to -1.7). The minimum cochlear dose impacts hearing outcomes after SRS for VS and should be considered in radiosurgical treatment planning. In this cohort, the mean cochlear dose was only associated with hearing outcomes in the subgroup of patients with class B hearing at SRS.

Clinical Outcomes for Adult Single-Sided Deafness Cochlear Implantees Exceeding the 5% Candidacy Criterion

Objectives: While single-sided deafness cochlear implants (SSD-CIs) have now received regulatory approval in the United States, candidate-ear candidacy criteria (no better than 5% word-recognition score) are stricter than for traditional CI candidates (50 to 60% speech recognition, best-aided condition). SSD implantation in our center began before regulatory approval, using a criterion derived from traditional candidacy: 50% consonant-nucleus-consonant (CNC) word-identification score in the candidate ear. A retrospective analysis investigated whether SSD patients exceeding the 5% CNC criterion nevertheless benefitted from a CI as assessed by spatial-hearing tests (speech understanding in noise [SIN] and localization) and by a patient-reported outcome measure quality-of-life instrument validated for patients with CIs. Design: A retrospective chart review assessed the clinical experience of a single CI center. Subjects consisted of 27 adult CI recipients with SSD (N = 21) or asymmetric hearing loss (AHL; N = 6) implanted since September 2019 with at least 3 months of postoperative follow-up. Patients with revision surgery or simultaneous labyrinthectomy and CI surgery were excluded from the sample. Subjects were divided into 2 groups based on preoperative CNC scores measured under best-aided conditions with a behind-the-ear hearing aid in the sound field at 0.9 m from a front loudspeaker, and the better ear masked using an insert earphone with 45 dB HL speech-weighted noise. The “MEETS” group had preoperative CNC word scores <5%; the “EXCEEDS” group had scores >5%. The clinical protocol also included intelligibility tests using AzBio sentences in the same test conditions as CNC; binaural spatial testing (broadband-noise sound localization, and matrix-sentence speech-reception thresholds in spatially separated noise) using a custom-built 7-speaker array; and the CI Quality of Life (CIQOL) instrument. To evaluate CI benefit, preoperative unaided performance was compared with postoperative binaural (acoustic ear + CI ear) performance at a clinic visit closest to 6 months postsurgery. Results: Of 27 SSD-CI recipients, 11 subjects exceeded the 5% preoperative CNC candidacy criterion. Both the MEETS and EXCEEDS groups improved significantly on all 5 primary study outcome measures (CI-alone CNC and AzBio, binaural SIN and sound localization, and CIQOL). The only statistically significant differences observed between the MEETS and EXCEEDS groups were that preoperative CNC and AzBio scores were significantly higher for the EXCEEDS group, as expected given that the groups were defined based on preoperative speech-perception scores in quiet. There were no statistically significant differences between the MEETS and EXCEEDS groups in postoperative scores in any test or in the magnitude of the improvement from preoperative to postoperative assessment. Conclusions: SSD- and AHL-CI recipients exceeding the 5% CNC preoperative candidacy criterion significantly improved in CI-alone speech perception, spatial hearing, and subjectively reported CIQOL outcomes and the observed benefits were indistinguishable from SSD- and AHL-CI recipients who met the 5% criterion. A less-restrictive SSD-CI and AHL-CI candidacy criterion should be considered, and larger-scale clinical trials to evaluate CI efficacy using a less-stringent candidate-ear criterion are warranted.

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.

Adult Simultaneous Cochlear Implantation: Local Anesthesia.

Purpose: Cochlear implant (CI) surgery is conventionally done under general anesthesia (GA). However, many patients are unable to undergo GA due to various reasons, raising the need for an alternative safe option. CI under local anesthesia is feasible and safely done in patients who can't tolerate GA. This approach allows for device fitting immediately after surgery. This study aims to evaluate simultaneous bilateral cochlear implant (BiCI) surgery performed under local anesthesia with sedation in adults. To our knowledge, this is the largest cohort of patients who underwent this approach. Methods: This is a retrospective chart review in a tertiary center. We included all adult patients who underwent simultaneous BiCI under local anesthesia with sedation from 2018 to 2024. The feasibility of BiCI under local anesthesia with sedation was assessed through clinical, surgical, audiological, and patient questionnaire data. Results: Six patients underwent simultaneous BiCI with local anesthetic and sedation. Mean age was 41.7 ± 16.0, comprising 66.7% male and 33.3% female. No intraoperative problems were encountered. All woke up from sedation without any agitation or difficulties. Their recovery was uneventful. No dizziness, nausea, or vomiting were reported. The device was activated immediately postoperatively. Pure tone audiometry, speech reception threshold, and word recognition score were significantly improved. Positive experiences were reported in all patients. Conclusion: Bilateral simultaneous cochlear implantation under local anesthesia in adults is achievable, through a multidisciplinary approach. This approach is a potential alternative option for some patients and could optimize their hearing rehabilitation.

Developing and Validating Monosyllabic Speech Materials with Psychometric Homogeneity for Young Adult Turkish-Azeri Speakers in Iran and Compiling the Equivalent Word Lists

Background and Aim: For the Word Recognition Score (WRS) test, homogenous lists of words with similar difficulty levels are needed. This study aimed to develop and validate Turkish-Azeri monosyllabic words with phonetic balance and psychometric homogeneity for the WRS test in young adult Turkish-Azeri speakers in Iran and to compile four 25-item word lists. Methods: In this cross-sectional/comparative study, four lists of 25 monosyllabic words with phonetic balance were created by extracting common words from Turkish-Azeri dialects and assessing them in terms of ease of use, familiarity, and relevance. Then, the lists were tested on 40 young adult Azari speakers aged 18–25 years to determine the validity and reliability. Results: All four lists showed adequate face and content validity. Cronbach’s alpha and split-half values for all four lists were above 0.9, indicating acceptable internal consistency and reliability. Construct validity was confirmed the factor analysis with one-dimensional variance of 77.9%, 80.0%, 79.9%, and 88% for the word lists 1 to 4, respectively, and reported the single-factor solution of the index in all four lists. Also, test-retest reliability with a two-week interval with Pearson correlation coefficients of the lists were 0.94, 0.97, 0.97, and 0.96, respectively. Conclusion: The four developed Turkish-Azeri word lists have phonetic balance and psychometric homogeneity with a high level of validity and reliability, which makes them suitable for evaluating the recognition of monosyllabic words by young adults in hearing centers of Azeri cities in Iran. Keywords: Speech audiometry; speech discrimination test; Azeri; monosyllabic; validity and reliability; psychometric function

Hearing What You Can't See: Influence of Face Masks on Speech Perception and Eye Movement by Adults With Hearing Loss.

The aim of the study was to analyze how face masks influence speech perception and time spent looking at the speaker's mouth and eyes by adults with and without hearing loss. Twenty participants with hearing loss and 20 without were asked to repeat Spanish words presented in various conditions, including different types of face masks (no mask, transparent window mask, and opaque mask FFP2) and presentation modes (audiovisual, video only, and audio only). Recognition accuracy and the percentage of time looking at the speaker's eyes and mouth (dwell time) were measured. In the audiovisual condition, participants with hearing loss had significantly better word recognition scores when the speaker wore no mask compared to when they wore an opaque face mask. However, there were no differences between the transparent mask and no mask conditions. For those with typical hearing, the type of face mask did not affect speech recognition. Audiovisual presentation consistently improved speech recognition for participants with hearing loss across all face mask conditions, but for those with typical hearing, it only improved compared to video-only mode. These participants demonstrated a ceiling effect in audiovisual and audio-only modes. Regarding eye movement patterns, participants spent less time looking at the speaker's mouth and more time at the eyes when the speaker wore an opaque mask compared to no mask or a transparent mask. The use of transparent face masks (ClearMask-type model) is recommended in contexts where face masks are still used (hospitals) to prevent the hindering effect of opaque masks (FFP2-type model) in speech perception among people with hearing loss, provided that any fogging of the window of the transparent mask is controlled by wiping it off as needed and the light is in front of the speaker to minimize shadows.

Long-term safety and subjective satisfaction of Bonebridge and Vibrant Soundbridge in congenital unilateral conductive hearing loss.

The objective of this study was to assess and compare the long-term safety and subjective satisfaction levels of Bonebridge (BB) and Vibrant Soundbridge (VSB) in patients with congenital unilateral conductive hearing loss (UCHL). The hearing effectiveness was measured using sound field hearing threshold (SFHT) and word recognition score (WRS). Long-term safety and subjective satisfaction levels were measured by questionnaires, including Speech, Spatial, and Qualities of Hearing Scale-12 (SSQ-12) and Abbreviated Profile of Hearing Aid Benefit (APHAB). Both BB and VSB were effective in improving the hearing of patients with congenital UCHL. Four of the 20 patients discontinued wearing the device postoperatively, and no complications were reported by long-term users. Patients experienced an overall improvement in their hearing experience across most subscales of SSQ-12 and a lower hearing problem rate across most subscales of the APHAB after implantation. However, the 'quality of hearing' subscale in the SSQ-12 did not show any improvement, and the aversiveness subscale in the APHAB exhibited a relatively higher percentage of reported problems after BB or VSB implantation. No significant differences were observed in SFHT, WRS, SSQ-12, and APHAB between the two groups. Both BB and VSB are effective in improving the hearing of UCHL patients, with high subjective satisfaction and low complication rates in the long-term postoperative period, with no significant difference between the two devices. Follow-up device fitting is essential, especially to address increased device sound or noise after surgery, reduce non-usage rates and achieve higher subjective satisfaction levels.

Vestibular schwannoma-related increased labyrinthine post-gadolinium 3D-FLAIR signal intensity and association with hearing impairment.

Vestibular schwannomas (VSs) are benign neurogenic tumors commonly associated with progressive unilateral hearing loss, tinnitus, and vestibular symptoms. Growing evidence links signal changes in the VS-adjacent labyrinth with sensorineural hearing loss. This study seeks to quantify the association of labyrinthine signal on post-gadolinium 3D-FLAIR imaging correlates with hearing loss and to evaluate potential longitudinal changes over time. Selected patients were identified from a prospectively maintained VS registry. Mean signal intensity ratios of the bilateral labyrinth and pons were measured on 3D-FLAIR post-gadolinium MRI. Correlations with paired audiometric data including pure tone average (PTA), word recognition score (WRS), and AAO-HNS hearing class within one year were evaluated. 125 studies obtained from 2015 to 2022 among 66 patients undergoing observational management for sporadic VS were analyzed. Increased signal intensity was noted of the VS-affected labyrinth/contralateral labyrinth (mean ratio 1.56, SD 0.58). Increased signal intensity was associated with increased PTA on both labyrinthine (correlation coefficient [CC] 0.20, p=0.03) and pontine comparisons (CC 0.24, p=0.006), and with decreased WRS on pontine comparisons (CC -0.18, p=0.04). Increased signal intensity was significantly associated with non-serviceable AAO-HNS C/D hearing when intensities were compared to the pons (p=0.01) but not the contralateral labyrinth (p=0.1). Among 44 patients with available follow-up, no statistically significant associations were identified between audiometric data and signal changes over the same interval. Increased 3D-FLAIR post-gadolinium labyrinthine signal is associated with sensorineural hearing loss; however, its relationship with hearing trajectory remains unclear. Overall findings suggest that while post-gadolinium 3D-FLAIR techniques are sensitive to inner ear involvement associated with VS, the driving mechanism and their temporal relationships with labyrinthine signal intensity and hearing impairment remain unknown. AAO-HNS =American Academy of Otolaryngology -Head and Neck Surgery. BLB =blood-labyrinth barrier. CPA = cerebellopontine angle. IAC = internal auditory canal. PTA = pure tone average; SIR = signal intensity ratio. VS = vestibular schwannoma. WRS = word recognition score.

Outcomes After Exoscopic Versus Microscopic Ossicular Chain Reconstruction.

To analyze the outcomes of exoscopic versus microscopic ossicular chain reconstruction (OCR). Retrospective chart review. Tertiary care otology-neurotology practice. Adult subjects with a diagnosis of ossicular discontinuity from 2018 to 2022. Exoscopic or microscopic primary OCR (without mastoidectomy) with a partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP). Audiometric outcomes at 3 months and 1 year postoperatively including bone and air pure tone averages (PTA), air-bone gap (ABG), change in ABG, speech reception threshold (SRT), and word recognition score (WRS). Secondary outcomes included operative time and complication rates of primary and delayed graft failure, tympanic membrane lateralization, prosthesis extrusion, cerebrospinal fluid leak, facial nerve injury, profound hearing loss, persistent tinnitus, and persistent vertigo. Sixty ears underwent primary OCR and were subdivided based on prosthesis type (PORP and TORP) and surgical approach (exoscope vs microscope). Exoscopic OCR was performed on 30 ears (21 PORP, 9 TORP), and microscopic OCR was performed on 30 ears (19 PORP, 11 TORP). In the overall group (PORP + TORP) and in the PORP and TORP subgroups, there were no significant differences in 1) demographics, 2) intraoperative findings, and 3) audiometric outcomes of bone and air PTA, ABG, change in ABG, SRT, and WRS at 1 year postoperatively. Operative time was 64.7 and 59.6 minutes for the exoscopic and microscopic group, respectively (p = 0.4, 95% CI [-16.4, 6.1], Cohen's D = 0.2). Audiometric and surgical outcomes after exoscopic and microscopic OCR are comparable.

Long-term follow-up of Bonebridge BCI 601 implantation for microtia patients with aural atresia: acoustic and subjective benefits.

This study evaluated the long-term acoustic and subjective outcomes of Bonebridge bone conduction implant (BCI) 601 implantation in Taiwanese microtia patients with aural atresia (AA). A total of 41 microtia patients (26 with bilateral AA and 15 with unilateral AA) who received Bonebridge BCI 601 implantation between December 2014 and March 2021 at Chang Gung Memorial Hospital, Linkou, Taiwan, were included in this retrospective study. Acoustic outcomes, including the functional hearing gain (FHG), speech reception threshold (SRT), and word recognition score (WRS), were assessed. Subjective outcomes were assessed using the Chinese versions of four questionnaires: the Abbreviated Profile of Hearing Aid Benefit (APHAB); the Speech, Spatial and Qualities of Hearing Scale; the International Outcome Inventory for Hearing Aids; and the Satisfaction with Amplification in Daily Living. The mean follow-up duration was 6.3 years (range, 2.8-9.1). The mean unaided air conduction pure tone average (PTA4) was 65.3 ± 8.8 decibels (dB) hearing level (HL) and the mean aided sound field PTA4 was 31.1 ± 9.1 dB HL, resulting in a FHG of 34.2 ± 11.7 dB HL (p < 0.05). After Bonebridge implantation, the mean SRT in quiet, SRT in noise, WRS in quiet, and WRS in noise improved from 58.3 ± 7.4 dB HL to 29.4 ± 7.0 dB HL, from -1.4 ± 7.3 dB signal-to-noise ratio (SNR) to -9.6 ± 5.4 dB SNR, from 46.4 ± 26.9% to 93.8 ± 3.1%, and from 46.7 ± 21.8% to 72.7 ± 19.3%, respectively (p < 0.05). Additionally, the bilateral AA group exhibited greater SRT and WRS improvements compared to the unilateral AA group (p < 0.05). All mean subscale scores in the four questionnaires showed improvement after Bonebridge implantation, except for the mean aversiveness to sounds subscale score in the APHAB questionnaire. Bonebridge BCI 601 implantation provided long-term acoustic and subjective benefits to microtia patients with AA, particularly those with bilateral AA.

The Predictive Value of Preoperative Measurements of Cochlear Nerve Diameters From MRT and Postoperative Speech Perception in Adult Patients With Cochlear Implant.

The current study aims to investigate whether objective measurements of the cochlear nerve (CN), derived from preoperative MRI images, correlate with postoperative speech perception in CI patients. Retrospective cohort study. University Medical Center, tertiary academic referral center. Patients undergoing a cochlear implant surgery including MED-EL (Synchrony 2, FLEX electrode series; MED-EL, Innsbruck, Austria) Cochlear (slim straight electrodes; Cochlear Ltd., Sydney, Australia), Advanced Bionics (HiRes Ultra 3D CI, HiFocus SlimJ electrodes; Sonova, Zürich, Switzerland), and Oticon (Neuro Zti EVO; Oticon A/S, Smørum, Denmark) between 2020 and 2023. Preoperative MRI images were utilized to measure the volume of the modiolus (VM), the cross-sectional areas of the CN (ACN), and for normalization, the area of the facial nerve (AFN) and the area of the internal ear canal (AIEC). Postoperative speech perceptions were assessed through word recognition scores (WRS) at several stages following the first fitting (FF) of the CI processor: immediately after FF, 1 month, 3 months, and 6 months after FF. Sixty-eight patients were enrolled in this study. A statistically significant positive correlation between the ratio between ACN and AFN (ACN/AFN) and WRSFF was identified (R = 0.36, p < 0.003). However, this correlation disappeared in subsequent follow-up tests. Moreover, upon grouping patients based on their degree of asymmetrical hearing loss, it was observed that the correlation was primarily driven by patients with moderate to severe asymmetrical hearing loss (AHLm) on the contralateral side (R = 0.62, p = 0.0003). The present results suggest that assessing the size of the CN through MRI has limited predictive utility for postoperative speech perceptions during CI consultations. This limitation seems to be particularly relevant for AHLm patients and is confined to the initial activation period.

Long-Term Follow-Up After Translabyrinthine IAC Tumor Removal With Simultaneous Cochlear Implantation.

To evaluate the long-term hearing outcome after translabyrinthine resection of tumors within the internal auditory canal (IAC) with simultaneous cochlear implantation (CI). Prospective study. Tertiary referral center. Thirty-seven patients with tumors of the IAC undergoing translabyrinthine tumor surgery as a first-line therapy. Intraoperatively, electrically evoked auditory brainstem response audiometry (eABR) was performed in all patients to assess cochlear nerve (CN) integrity. In case of preserved CN function after tumor removal, CI was subsequently performed. Postoperatively, patients were regularly followed up to evaluate pure-tone hearing as well as speech recognition with a monosyllabic word comprehension test. Postoperative hearing thresholds and word recognition scores. Of 37 included patients, 22 (59.46%) had positive eABR responses after tumor removal. Twenty-one of these underwent simultaneous CI directly after tumor surgery and were followed-up for 24.24 ± 19.83 months after surgery. Hearing of these patients significantly improved from 73.87 ± 21.40 dB preoperatively to a mean pure-tone average of 41.56 ± 18.87 dB 1 year (p = 0.0008) and 34.58 ± 2.92 dB 3 years after surgery (p = 0.0157). Speech recognition significantly recovered from 13.33 ± 25.41% to 58.93 ± 27.61% 1 year (p = 0.0012) and 51.67 ± 28.58% 3 years postoperatively (p = 0.0164). Regardless of tumor histopathology, CI is an effective option to restore patients' hearing after translabyrinthine tumor surgery. After CI, patients hearing can be restored over a long-term period of a minimum of 3 years post-surgery. Furthermore, eABR proves to be a practical tool to evaluate CN function and screen for patients eligible for CI.

EFFECTIVENESS OF THE ADHEAR BONE CONDUCTION DEVICE FITTED BILATERALLY IN A CHILD WITH CONDUCTIVE HEARING LOSS: CASE STUDY

IntroductionFrequently, bone conduction hearing aids on a softband are not tolerated by children due to pressure on the head or visual esthetics. By way of contrast, a non-surgical hearing system – Adhear (Med-El, Innsbruck, Austria) – allows the sound processor to be attached using a noninvasive adhesive adapter. The objective of this study was to evaluate the effectiveness of the Adhear system and assess its subjective benefits in a child who had bilateral conductive hearing loss.Case reportThe Adhear system was tested in a 13-year-old child with bilateral conductive hearing loss. Pure tone audiometry and speech audiometry in quiet were performed without and then with a pair of devices placed bilaterally. Word recognition scores (WRS) at 50 and 65 dB SPL in quiet were measured using the Pruszewicz monosyllabic Polish word test. After 4 weeks, subjective hearing benefit and experience with the Adhear system was done using the APHAB (&lt;i&gt;Abbreviated Profile of Hearing Aid Benefit&lt;/i&gt;) questionnaire.ResultsWith Adhear, WRS at 50 dB SPL increased significantly from an unaided score of 10% to 80%. The result of free-field audiometry with Adhear on both sides indicated a hearing level within the normal range.ConclusionsAdhear is an effective rehabilitation option for children with bilateral conductive hearing loss.

Sudden sensorineural hearing loss: audiological profile during the COVID-19 pandemic.

Sudden sensorineural hearing loss (SSNHL) is an otological emergency that requires prompt recognition and intervention to prevent devastating impacts on people's lives. During the COVID-19 pandemic, sensory deprivations have been reported in patients positive for SARS-CoV-2 virus, including deleterious effects on the auditory pathway. This study aims to describe the audiological profile of individuals with SSNHL during the COVID-19 pandemic and to correlate hearing recovery in subgroups of individuals with or without COVID-19. Prospective cohort including patients diagnosed with SSNHL evaluated in a tertiary care center between March 2020 and September 2022. Hearing loss was confirmed with pure-tone and speech audiometry, with Speech Recognition Threshold (SRT) and word recognition score (WRS). Audiometric testing was performed at the moment of diagnosis, then 7, 30 and 120 days after diagnosis. The average degree of hearing loss was assessed by calculating the 4-frequency pure tone average (4fPTA). The investigation of COVID-19 included RT-PCR technique for the SARS-CoV-2 virus and collection of information regarding disease severity. A statistical analysis was performed using an analysis of covariance (ANCOVA) model to compare the 4fPTA between the four groups (with and without a history of COVID-19, unilateral and bilateral cases) at the end of the follow-up period. Fifty-two patients with SSNHL were assessed, 40 (76.9%) with unilateral and 12 (23.1%) with bilateral hearing loss, totaling 64 ears included. Of those, 15 (28.8%) patients tested positive for SARS-CoV-2 and were symptomatic for COVID-19. Of all unilateral cases, 22.5% were seropositive and showed symptoms of COVID-19, a number that increased to 50% for bilateral cases. Comparing the COVID-19 positive groups, individuals with unilateral SSNHL went from 40 dB as their average 4fPTA at onset to 20 dB as their average 4fPTA after 120 days, whereas those with bilateral SSNHL went from an initial average of 60 dB to a final average of 66 dB. Although the 4fPTA value of individuals with unilateral SSNHL improved in 7 days, the mean values showed no significant difference between positive and negative groups. There was a higher incidence of bilateral simultaneous SSNHL in patients who had not been vaccinated against COVID-19 and who presented with symptoms of severe COVID-19. Infection with SARS-CoV-2 resulted in more severe SSNHL, in bilateral SSNHL, and in poorer recovery from SSNHL in bilateral cases. Bilateral SSNHL was seen more frequently in patients who had not received vaccination against COVID-19.

Validating an Evoked Potential Platform for Electrocochleography During Cochlear Implantation.

To validate electrocochleography (ECochG) between an auditory evoked potential (AEP) machine and an established cochlear implant (CI) manufacturer ECochG system. Intraoperative validation study at a tertiary referral center. Patients included adults and children undergoing cochlear implantation. Intraoperative ECochG was measured with both the Intelligent Hearing Systems (IHS) Duet AEP machine and Cochlear Corporation (CC) ECochG platform. Recording electrodes captured extracochlear measurements through a standard facial recess. Tone-bursts were presented from 250 Hz to 2 kHz (~110 dB SPL). A fast Fourier transform (FFT) of ECochG waveforms at key frequencies was summed into a total response (ECochG-TR). Pearson's correlation was utilized to evaluate the relationship between IHS-ECochG-TR and CC-ECochG-TR after confirming normality. Thirty patients were enrolled with an average age of 67 years (SD 18.8). In the ear that was implanted, mean preoperative pure-tone average (PTA; 0.5, 1, 2, and 4 kHz) was 87.4 dB HL (SD 19.3) and mean preoperative word-recognition scores (WRS) was 17.0% correct (SD 19.1). There was strong correlation (r = 0.905, 95% confidence interval: 0.809 to 0.954) between IHS-ECochG-TR (median 2.30 μV, range 0.1-148.26) and CC-ECochG-TR (median 3.00 μV, range 0.1-239.63). Four patients underwent transtympanic ECochG with the IHS system for feasibility evaluation and achieved similar responses. Extracochlear ECochG has been predictive of CI speech perception performance. The IHS duet system is a valid measure of extracochlear ECochG for the CI population. Future work will utilize this system for measuring transtympanic ECochG to improve preoperative estimation of CI performance. 3 Laryngoscope, 2024.

Impedance and Functional Outcomes in Robotic-Assisted or Manual Cochlear Implantation: A Comparative Study

Introduction: Preservation of residual hearing, mainly the low frequencies, is the current main objective of cochlear implantation. New electrode arrays and the development of minimally invasive surgery have allowed electroacoustic stimulation. Over the past several years, robotic-assisted cochlear implant surgery aimed to improve the insertion process while respecting inner ear structures. However, the introduction of a foreign body inside the cochlea can lead to the development of fibrous tissue around the electrode array, or even induce osteogenesis. These histological changes disrupt the parameters of the cochlear implant, resulting in elevated impedance. In addition, long-term auditory performance can be affected, with a deterioration in word comprehension. We evaluated the potential impact of RobOtol® on impedance changes over time, leading to potentially positive functional outcomes. Methods: Cochlear implant surgery with a round window approach was performed under general anesthesia. Fifteen Med-El Flex24 electrode arrays were inserted manually and 24 using RobOtol®. All subjects underwent pure-tone audiometry tests before the surgery and at regular intervals up to 1 year after the surgery. Based on the pure-tone average at the low frequencies from 250 to 1,000 Hz, we divided the patients according to the degree of auditory preservation (full preservation ≤15 dB, partial preservation 15 dB–30 dB, significant loss >30 dB). These different groups were compared in terms of impedance changes and auditory performance, specifically word recognition score. Results: We found proportionally fewer patients who experienced significant low-frequency hearing loss after robotic insertion (53.33% in the manual group compared to 41.67% in the robot-assisted insertion group). Impedance changes at the apex of the electrode array, especially at the first electrode (p = 0.04), after robotic surgery, with less overall variability, a continuous decreasing trend without secondary elevation, and lower values in cases of complete residual hearing preservation (for the three first electrodes: p = 0.017, p = 0.04, p = 0.045). The speech intelligibility amelioration over time showed favorable evolution in patients with complete residual hearing preservation regardless of the insertion method. However, in the absence of auditory preservation, the positive evolution continued more than 6 months after robotic surgery but stagnated after manual insertion (difference at 1 year, p = 0.038; median auditory capacity index 83% vs. 57%). Conclusion: Atraumatic electrode array insertion with consistent, slow speed and the assistance of RobOtol® minimizes disturbances in the delicate neurosensory structures of the inner ear and leads to better auditory performance.

Cortical volumetric changes after cochlear implantation in postlingually deaf adults: correlation with speech perception abilities

This study aims to analyse the volumetric changes in brain MRI after cochlear implantation (CI), focusing on the speech perception in postlingually deaf adults. We conducted a prospective cohort study with 16 patients who had bilateral hearing loss and received unilateral CI. Based on the surgical side, patients were categorized into left and right CI groups. Volumetric T1-weighted brain MRI were obtained before and one year after the surgery. To overcome the artifact caused by the internal device in post-CI scan, image reconstruction method was newly devised and applied using the contralateral hemisphere of the pre-CI MRI data, to run FreeSurfer. We conducted within-subject template estimation for unbiased longitudinal image analysis, based on the linear mixed effect models. When analyzing the contralateral cerebral hemisphere before and after CI, a substantial increase in superior frontal gyrus and superior temporal gyrus (STG) volumes was observed in the left CI group. A positive correlation was observed in the STG and post-CI word recognition score in both groups. As far as we know, this is the first study attempting longitudinal brain volumetry based on post-CI MRI scans. We demonstrate that better auditory performance after CI is associated with structural restoration in central auditory structures.

Bonebridge implants versus atresiaplasty in children with unilateral congenital aural atresia: A comparison study of audiological outcomes

ObjectivesTo evaluate and compare audiological outcomes of atresiaplasty and Bonebridge (BB) implantation in patients with unilateral congenital aural atresia (UCAA), to guide clinical decision-making. MethodsTwenty-seven subjects diagnosed with UCAA were included in the study. Thirteen were implanted with the BB, while 14 undergone atresiaplasty. All patients underwent pre-and post-surgery examinations, including pure-tone audiometry, sound field threshold (SFT), speech reception threshold (SRT), word recognition score (WRS), and horizontal sound source localization tests. Results(1) Postoperatively, the average SFT decreased by 11.79 ± 5.93 dB HL in the atresiaplasty group and by 24.46 ± 9.36 dB HL in the BB group, with a significantly greater decrease in the BB group compared to the atresiaplasty group (P < 0.05). (2) Both groups demonstrated a significant improvement in average disyllabic WRS postoperatively under normal ear-masking conditions, with the BB group showing a significantly higher improvement than the atresiaplasty group. (3) When the speech signal was presented from the CAA side with noise from the normal hearing side, both surgical groups exhibited a significant decrease in postoperative signal-to-noise ratio compared to preoperative levels, with improvements of 2.14 ± 2.95 dB SNR in the atresiaplasty group and 4.92 ± 5.83 dB SNR in the BB group (P < 0.05). (4) The average minimum audible angle preoperative in the atresiaplasty group was 29.71 ± 18.42°, which decreased to 18.1 ± 10.07° at 6 months postoperatively, showing a statistically significant improvement (P < 0.05). ConclusionWe concluded that both atresiaplasty and Bonebridge implantation can significantly improve speech perception under both quiet and noisy conditions in children with UCAA. BoneBridge implantation appears to provide better audiological outcomes than atresiaplasty. Atresiaplasty can significantly improve the accuracy of sound localization. No significant improvement in sound localization accuracy was observed in the short period after Bonebridge implantation. Further research should be conducted with a larger sample size and longer follow-up time.

Phase I/II Study of a Vascular Endothelial Growth Factor Receptor Vaccine in Patients With NF2-Related Schwannomatosis.

The humanized antivascular endothelial growth factor (VEGF) antibody bevacizumab (Bev) is efficacious for the treatment of NF2-related schwannomatosis (NF2), previously known as neurofibromatosis type 2. This study evaluated the safety and efficacy of a VEGF receptor (VEGFR) vaccine containing VEGFR1 and VEGFR2 peptides in patients with NF2 with progressive schwannomas (jRCTs031180184). VEGFR1 and VEGFR2 peptides were injected subcutaneously into infra-axillary and inguinal regions, once a week for 4 weeks and then once a month for 4 months. The primary end point was safety. Secondary end points included tolerability, hearing response, imaging response, and immunologic response. Sixteen patients with NF2 with progressive schwannomas completed treatment and were assessed. No severe vaccine-related adverse events occurred. Among the 13 patients with assessable hearing, word recognition score improved in five patients at 6 months and two at 12 months. Progression of average hearing level of pure tone was 0.168 dB/mo during the year of treatment period, whereas long-term progression was 0.364 dB/mo. Among all 16 patients, a partial response was observed in more than one schwannoma in four (including one in which Bev had not been effective), minor response in 5, and stable disease in 4. Both VEGFR1-specific and VEGFR2-specific cytotoxic T lymphocytes (CTLs) were induced in 11 patients. Two years after vaccination, a radiologic response was achieved in nine of 20 assessable schwannomas. This study demonstrated the safety and preliminary efficacy of VEGFR peptide vaccination in patients with NF2. Memory-induced CTLs after VEGFR vaccination may persistently suppress tumor progression.