ABSTRACT
Modern health services need efficient tools for measuring outcomes from interventions, that is, tools of proven efficacy which make minimal demands on the time of clinicians in learning to administer tests and in interpreting results. This paper describes an apparatus designed to meet those requirements. The apparatus administers performance tests of spatial listening for children and adults with unilateral and bilateral cochlear implants. The apparatus was designed with guidance from clinicians. It possesses three key attributes: it is simple to use; the results of tests are scored automatically and are compared with reference data; the apparatus generates comprehensive personalized reports for individual participants that can be included in clinical notes. This paper describes the apparatus and reports results of a test measuring spatial release from masking of speech which illustrates the compatibility between the new apparatus and an older apparatus with which the reference data were gathered.
Subject(s)
Acoustic Stimulation/instrumentation , Cochlear Implantation/rehabilitation , Deafness/rehabilitation , Perceptual Masking/physiology , Sound Localization/physiology , Speech Perception/physiology , Acoustic Stimulation/methods , Adolescent , Adult , Child , Deafness/diagnosis , Eye Movements/physiology , Head Movements/physiology , Hearing Tests/instrumentation , Hearing Tests/methods , Humans , Noise , Photic Stimulation/instrumentation , Photic Stimulation/methods , Psychomotor Performance , Software , User-Computer Interface , Young AdultABSTRACT
OBJECTIVE: Cochlear implantation in one ear (unilateral implantation) has been the standard treatment for severe-profound childhood deafness. We assessed whether cochlear implantation in both ears (bilateral implantation) is associated with better listening skills, higher health-related quality of life (health utility) and higher general quality of life (QOL) than unilateral implantation. DESIGN: Cross-sectional observational study. SETTING: University of York. PARTICIPANTS: Fifty severely-profoundly deaf and 56 normally-hearing children recruited via a charity, the UK National Health Service and schools. INTERVENTIONS: Thirty of the deaf children had received bilateral cochlear implants; 20 had unilateral cochlear implants. MAIN OUTCOME MEASURES: Performance measures of children's listening skills; parental-proxy valuations of the deaf children's health utility obtained with the Health Utilities Index Mark 3 and of their QOL obtained with a visual analogue scale. RESULTS: On average, bilaterally-implanted children performed significantly better than unilaterally implanted children on tests of sound localisation and speech perception in noise. After conservative imputation of missing data and while controlling for confounds, bilateral implantation was associated with increases of 18.5% in accuracy of sound localisation (95% CI 5.9 to 31.1) and of 3.7 dB in speech perception in noise (95% CI 0.9 to 6.5). Bilaterally-implanted children did not perform as well as normally-hearing children, on average. Bilaterally- and unilaterally-implanted children did not differ significantly in parental ratings of health utility (difference in medians 0.05, p>0.05) or QOL (difference in medians 0.01, p>0.05). CONCLUSIONS: Compared with unilateral cochlear implantation, bilateral implantation is associated with better listening skills in severely-profoundly deaf children.
