Impact of unilateral vs. bilateral evaluation on cochlear implant candidacy.

BACKGROUND: The indication criteria for cochlear implantation differ considerably across regions. OBJECTIVES: To estimate the effects of different candidacy criteria on the number of cochlear implant (CI) candidates. METHODS: We analysed a very large clinical audiological database comprising pure-tone thresholds and speech-audiometric data in order to identify CI candidates on the basis of different audiometric candidacy criteria. In particular, we simulated the effects of three different CI candidacy criteria. RESULTS: The bilateral evaluation of CI candidacy has the strongest influence on the number of potential CI candidates. Additionally, the cut-off criteria for middle-ear implants have a large effect on numbers of candidates when air conduction has deteriorated.Conclusions and Significance: Expanding the indication criteria opens up the possibility of improving the accurate identification of individual cases suitable for cochlear-implant provision.

Evolving a Model for Cochlear Implant Outcome.

BACKGROUND: Cochlear implantation is an efficient treatment for postlingually deafened adults who do not benefit sufficiently from acoustic amplification. Implantation is indicated when it can be foreseen that speech recognition with a cochlear implant (CI) is superior to that with a hearing aid. Especially for subjects with residual speech recognition, it is desirable to predict CI outcome on the basis of preoperative audiological tests. PURPOSE: The purpose of the study was to extend and refine a previously developed model for CI outcome prediction for subjects with preoperative word recognition to include subjects with no residual hearing by incorporating additional results of routine examinations. RESULTS: By introducing the duration of unaided hearing loss (DuHL), the median absolute error (MAE) of the prediction was reduced. While for subjects with preoperative speech recognition, the model modification did not change the MAE, for subjects with no residual speech recognition before surgery, the MAE decreased from 23.7% with the previous model to 17.2% with the extended model. CONCLUSIONS: Prediction of word recognition with CI is possible within clinically relevant limits. Outcome prediction is particularly important for preoperative counseling and in CI aftercare to support systematic monitoring of CI fitting.

Validation of a predictive model for speech discrimination after cochlear impIant provision.

BACKGROUND: If sufficient speech discrimination is no longer achieved with conventional hearing systems, an audiological indication for a cochlear implant (CI) is given. However, there are no established target criteria for CI aftercare with regard to the level of speech comprehension to be achieved. The aim of this study is to validate an existing predictive model for speech comprehension after CI provision. This is applied to different patient groups. MATERIALS AND METHODS: The prospective study included 124 postlingually deaf adults. The model is based on preoperative maximum monosyllabic recognition score, aided monosyllabic recognition score at 65 dBSPL, and age the time of implantation. The model was investigated with regard to prediction accuracy for monosyllabic recognition with CI after 6 months. RESULTS: Mean speech discrimination improved from 10% with hearing aid to 65% with CI after 6 months, with a statistically significant improvement in 93% of cases. Deterioration of aided unilateral speech discrimination was not observed. The mean prediction error was 11.5 percentage points in the cases with preoperative scores better than zero and 23.2 percentage points in all other cases. CONCLUSION: Cochlear implantation should also be considered in patients with moderately severe to severe hearing loss and insufficient speech discrimination with hearing aids. The model based on preoperatively measured data for predicting speech discrimination with CI can be used in preoperative consultation and in the context of postoperative quality assurance.

[Validation of a predictive model for speech discrimination after cochlear implant provision]. / Validierung eines Modells zur Vorhersage des Sprachverstehens nach Cochleaimplantation.

BACKGROUND: If sufficient speech discrimination is no longer achieved with conventional hearing systems, an audiological indication for a cochlear implant (CI) is given. However, there are no established target criteria for CI aftercare with regard to the level of speech comprehension to be achieved. The aim of this study is to validate an existing predictive model for speech comprehension after CI provision. This is applied to different patient groups. MATERIALS AND METHODS: The prospective study included 124 postlingually deaf adults. The model is based on preoperative maximum monosyllabic recognition score, aided monosyllabic recognition score at 65 dBSPL, and age the time of implantation. The model was investigated with regard to prediction accuracy for monosyllabic recognition with CI after 6 months. RESULTS: Mean speech discrimination improved from 10% with hearing aid to 65% with CI after 6 months, with a statistically significant improvement in 93% of cases. Deterioration of aided unilateral speech discrimination was not observed. The mean prediction error was 11.5 percentage points in the cases with preoperative scores better than zero and 23.2 percentage points in all other cases. CONCLUSION: Cochlear implantation should also be considered in patients with moderately severe to severe hearing loss and insufficient speech discrimination with hearing aids. The model based on preoperatively measured data for predicting speech discrimination with CI can be used in preoperative consultation and in the context of postoperative quality assurance.

Fluctuation in electrical hearing in a Morbus Meniere's patient.

The glycerol test is an easy-to-use instrument to elucidate fluctuations of electrical hearing in patients with Meniere's disease and it might be also used as a therapeutic option.

Cochlear Implantation in Candidates With Moderate-to-Severe Hearing Loss and Poor Speech Perception.

OBJECTIVES/HYPOTHESIS: To determine the improvement in word recognition score (WRS65 ) after cochlear implant (CI) surgery in hearing aid (HA) users with preoperative hearing threshold ≤80 dB HL and inadequate speech recognition scores with HA. Secondarily, to identify predictive factors for WRS65 with a CI (WRS65 [CI]) 6 months after surgery, derived from the standard German CI preoperative assessment. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective review of all adult patients who received a Nucleus cochlear implant in the ear, nose, and throat department of the University Hospital of Erlangen between January 2010 and April 2019. The inclusion criteria were a preoperative hearing threshold ≤80 dB HL in the ear to receive the implantation, German as the native language, and at least 6 months postimplantation care at our center. RESULTS: The inclusion criteria were met by 128 patients. All but two patients (98.4%) showed a significant improvement, WRS65 (CI) versus WRS65 with an (HA) (WRS65 [HA]), of at least 15 percentage points (pp). The median improvement was 55 pp with a median WRS65 (CI) of 70%. Three preoperative audiometric measures, the maximum word recognition score, age at implantation, and WRS65 (HA) were identified as predictive factors for WRS65 (CI). For three-quarters of the CI recipients, the score was not poorer than 12 pp below the predicted WRS65 (CI). CONCLUSIONS: For patients with a hearing loss ≤80 dB HL, cochlear implantation should be considered when speech perception with an HA is insufficient. The prediction model can support counseling in this patient group. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E940-E945, 2021.

Speech Perception in Bilateral Hearing Aid Users With Different Grades of Asymmetric Hearing Loss.

Hearing loss is associated with decreased speech perception as well as with changes in the auditory pathway. The effects of those changes on binaural speech perception with hearing aids are not yet fully understood. To provide further evidence on the functional changes of the auditory pathway, several speech perception tests (unilateral and bilateral, aided and unaided, in quiet, and in noise) were conducted in a population of 370 bilateral hearing aid users covering the entire range of the World Health Organization's most recent classification of hearing loss. To characterize the effects of asymmetric hearing thresholds, a generalized linear model was used for regression analysis. The model revealed a detrimental effect of the poorer ears' thresholds on both the unaided and the aided unilateral word recognition scores that were attained by the better ear. Moreover, aided binaural word recognition (in quiet and in noise) was affected to a degree that cannot be explained on the sole basis of bilateral summation. Thus, this study provides evidence that there is reorganization and altered functioning of the afferent and efferent auditory pathways due to asymmetric hearing loss. Consequently, more attention should be paid to provision with a hearing aid as early as possible, and separately for each ear.

Maximum preimplantation monosyllabic score as predictor of cochlear implant outcome.

OBJECTIVE: This study investigated the speech perception of cochlear implant (CI) recipients with measurable preoperative ipsilateral speech perception. These data should support improved individual counselling of CI candidates. MATERIALS AND METHODS: Pre- and postoperative speech audiometric parameters were analyzed, including maximum score for phonemically balanced words (PBmax) and monosyllabic score at a normal conversational level of 65 dBSPL, with hearing aids one hand and CI on the other. Data of 284 experienced adult CI wearers were grouped and evaluated in terms of preoperative PBmax. RESULTS: The preoperative PBmax was exceeded by the postoperative monosyllabic score in 96% of cases. The overall median postoperative score was 72.5%. The groups with preoperative PBmax > 0% showed significantly better speech perception scores with CI than the group with PBmax = 0%. Median improvement compared to the preoperative monosyllabic score with hearing aids was 65 percentage points, independent of preoperative PBmax. CONCLUSION: The preoperatively measured PBmax may be used as a predictor for the minimum speech perception obtained with CI. This is of high clinical relevance for CI candidates with a PBmax above zero.

[Longterm Results of a Screening Procedure for Adult Cochlear Implant Candidates]. / Langzeitergebnisse eines Screeningverfahrens für erwachsene Cochlea-Implantat-Kandidaten.

This study gives an estimation of the long term outcome of a screening procedure for cochlear implant candidacy in hearing aid users.In a recent retrospective study, hearing aid performance and audiometric measures in 185 subjects (318 ears) were analyzed. In the context of 2 years follow-up, the outcome of the ipsilateral screening procedure was analyzed. For patients who did receive a cochlear implant, their audiometric outcome measures were viewed into relation to their preoperative results.From the 96 ears identified as cochlear implant candidates, 34 were provided with a cochlear implant. 222 ears were identified as hearing aid users. Only 4 of these 222 ears were provided with a cochlear implant. Cochlear implant recipients with a preoperative speech recognition score with hearing aids above zero showed a mean improvement of 65% points in Freiburg monosyllabics.The audiometry-based screening procedure enables an effective management of the referral process of cochlear implant candidates.

Speech Perception and Information-Carrying Capacity for Hearing Aid Users of Different Ages.

Hearing impairment in the elderly is usually treated with conventional hearing aids; however, a large number of older people do not achieve sufficient speech recognition with hearing aids. The aim of the study was to describe speech perception with hearing aids in comparison to pure-tone hearing loss and maximum speech recognition scores for phonemically balanced words. Data from 392 hearing aid users with different degrees of hearing loss were evaluated retrospectively. In particular, pure-tone thresholds, the maximum monosyllabic word score, and the monosyllabic word score in quiet at conversational level with a hearing aid were analysed. The results showed that speech perception scores decline with increasing age. Even when corrected for pure-tone hearing loss, a significant decline in speech recognition scores after the age of 80 years was observed. Regarding the maximum monosyllabic word score, the effect is smaller but still observable; thus, speech recognition with hearing aids is significantly lower for older subjects. This can be attributed partially to the reduction of the information-carrying capacity in this group.

Speech Perception of Elderly Cochlear Implant Users Under Different Noise Conditions.

OBJECTIVE: The primary objective of this study was the comparison of younger and older (>75 yr) CI recipients' performance for speech perception in quiet and in competing continuous and fluctuating noise. STUDY DESIGN: Prospective, comparative clinical study. SETTING: University hospital. PATIENTS: Fifty patients, 25 older and 25 younger than 75 years, with a postlingually acquired profound hearing loss who received a cochlear implant at least 1 year before study start were enrolled. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURES: We measured speech perception using monosyllable (Freiburg monosyllables) and sentence materials (Göttingen sentences) in quiet. In addition, speech perception for sentences was measured under two different noise conditions: with a continuous, speech-simulating noise signal (CCITT noise) and the FASTL noise (fluctuating noise). RESULTS: We did not find a significant difference between the performance for younger and the older cohort on speech perception tasks in quiet for Freiburg monosyllables (63.4% ±â€Š20% and 61.7% ±â€Š18.1%, respectively) and for the Göttingen sentences in quiet (73.5% ±â€Š24.3% and 75% ±â€Š25%, respectively). No significant difference was observed for performance between the two age groups when listening in continuous CCITT noise (18.9% ±â€Š24.0% and 29.5% ±â€Š25.2% perception score respectively) or in FASTL noise (27.8% ±â€Š24.2% and 34.4% ±â€Š27.8% perception score, respectively). CONCLUSION: There is no supporting evidence from our evaluations of word and sentence perception in quiet and noise that elderly CI users older than 75 years of age perform more poorly than those younger than 75 years of age.

Audiometry-Based Screening Procedure for Cochlear Implant Candidacy.

OBJECTIVE: This study defines a screening procedure for cochlear implant (CI) candidacy in hearing aid users by using simple audiometric measures. METHODS: Within this retrospective study, hearing aid performance and audiometric measures in 185 subjects (318 ears) were analyzed. By means of a linear Naive Bayes classifier, the pure-tone average and the maximum monosyllabic score (PB(max)) were used to predict the aided monosyllabic word score and CI candidacy. RESULTS: The two parameters PB(max) and four-frequency hearing threshold average can be used to predict speech perception with hearing aids with reasonable accuracy for screening purposes. The classification has a sensitivity of 87% and a specificity of 91%. The classification can be represented by a simple linear formula. CONCLUSION: CI candidacy can be predicted based on commonly used audiometric measures.Cochlear implant candidacy may be considered if the difference between the average pure-tone threshold (in decibels) and PBmax (in percent) exceeds 8.

Speech performance and training effects in the cochlear implant elderly.

OBJECTIVES: Cochlear implantation requires acclimatization to the electrical input. Usually, cochlear implant (CI) listeners undergo an auditory rehabilitation program that includes auditory training sessions. Recently, it was shown that a phoneme-based training may improve speech perception abilities even in experienced CI listeners. The current study focuses on whether the effect of an auditory training program depends on the age of CI listeners. DESIGN: Fifteen CI listeners took part in an auditory phoneme-based computer training program. Before and after training, speech recognition tests in moderate and difficult noise (+5 dB SNR and 0 dB SNR, respectively) were administered. Additionally, speech recognition was tested 6 months after the training (follow-up). A control group consisting of 12 subjects underwent audiometric testing without any auditory training. RESULTS: Speech perception in moderate noise improved significantly during the training as revealed by comparing pre- and posttraining scores evaluated in the moderate noise condition. No significant change was observed for the difficult noise situation at 0 dB SNR. The speech perception measures of the control group remained unchanged. No significant effect of age on the training effect was observed. CONCLUSION: Speech recognition can be improved even in experienced CI listeners. When motivated to participate, senior CI users with long-term CI experience may benefit in a similar way from an auditory, phoneme-based computer training program as younger CI users.

Utilizing complexity science to drive practice change through patient- and family-centered care.

Complexity science applied through a 6-step patient- and family-centered care methodology provides a practical framework for achieving meaningful change in organizations. This approach was used to improve the preoperative preparation experience of patients undergoing total joint arthroplasty in an orthopedic specialty hospital.

Melody identification for cochlear implant users and normal hearers using expanded pitch contours.

Music perception is considered unsatisfactory for most cochlear implant (CI) users. Usually, rhythm identification is adequate while pitch and melody recognition are rather limited. The aim of this study was to investigate whether insufficient contour information in the low-frequency range is one cause that contributes to the poor melody recognition results in CI users. For this purpose, the recognition of familiar melodies was tested with three differently expanded pitch contours. Ten cochlear implant subjects and five normal-hearing (NH) volunteers were investigated. Each subject chose ten out of a possible set of 23 well-known nursery songs without verbal cues. The songs were played in the original version and with three different pitch-contour expansions. All versions were tested with and without rhythm and in random order. CI subjects exhibited best results when melodies were presented with expanded pitch contours, although no clear preference for a specific contour modification was observed. Normal-hearing subjects exhibited poorer results for expanded pitch contours, especially when testing without rhythm. Both NH and CI-user groups exhibited large inter-individual differences, and melody recognition with rhythm was always better than melody recognition without rhythm. Insufficient contour information in the low-frequency range is confirmed as one contributing cause for the poor melody recognition results in CI users. Therefore, other efforts to improve low-frequency pitch discrimination, e.g., a more sophisticated design of the electrode array, a focus of the electrical stimulation pattern or an improved signal processing scheme could potentially improve melody recognition as well.