A comparison of postcochlear implantation speech scores in an adult population.

OBJECTIVES: The vast majority of cochlear implant recipients realize significant improvement in speech perception. However, there continue to be a small group that does not realize such a benefit. In an effort to identify possible predictors for this, we have compared pre- and postimplant audiologic data using Hearing In Noise Test (HINT), City University of New York (CUNY), or Central Institute for the Deaf (CID) scores for 445 consecutive English-speaking adult patients followed for a minimum of 1 year postimplantation in two distinct groups, poor versus excellent performers. STUDY DESIGN: Retrospective. METHODS: Poor performers were those who realized a worsening, no improvement, or an improvement of less than 10%. This group numbered 58 (13%). High performers consisted of a cadre of 194 (44%) patients who scored between 91 and 100% postimplantation. Demographic data relating to onset of deafness, education exposure, etiology, etc., were evaluated. RESULTS: Of the poor performers, 33 (57%) were pre-/perilingually deafened. Of these, 79% had not received any auditory/oral training in childhood. On the other hand, a total of 109 implant recipients were individuals who were pre-/perilingually deafened. Of these, 24 were in the excellent performer category. All were identified early and were recipients of a strong auditory/oral education. Of the high performers, 170 (88%) were deafened late. Other findings such as preoperative electronystagmography with caloric testing, hearing aid use, device type, and high-resolution computed tomography scan of the temporal bone will be discussed for both groups. CONCLUSIONS: A high preimplant speech score, auditory verbal therapy, and postlingual deafness statistically correlate with higher postimplant speech scores 1 year after cochlear implantation. Device type, caloric response and hearing aid use preimplantation, age at surgery, and sex do not statistically correlate with either poor or excellent speech discrimination scores postcochlear implantation.

Benefits of cochlear implantation in early-deafened adults: the Toronto experience.

OBJECTIVE: To present the results of a survey administered to a group of early-deafened cochlear implants adults and to report the level of perceived benefit. DESIGN: Prospective. SETTING: Large tertiary referral centre. METHOD: A 47-item questionnaire designed to evaluate cochlear implant use and benefit was sent to 42 early-deafened adult cochlear implant users. The questionnaire can be divided into seven subcategories: time of use, associated symptoms, communication, employment status and function, socialization, perceived benefit, and the impact on quality of life. Responses from 30 patients were received. RESULTS: The majority of our patients use their cochlear implant all of their waking hours. The majority of patients continue to depend on lip-reading and hearing as their main mode of communication, although they reported improved lip-reading skills with their cochlear implant. Twenty-three patients (76.7%) were employed. Eleven patients had a change in employment subsequent to cochlear implantation, nine (81.8%) of whom attributed this to their cochlear implant. Our patients als reported greater independence, a greater sense of safety in their environment, and an improved social life. Twenty-nine patients (96.7%) said that they were satisfied with their implant, 28 (93.3%) said that they would go through the same process again, and 27 (90%) said that they would recommend it to a friend in a similar situation. Twenty-nine patients (96.7%) stated that the cochlear implant has had a positive effect on their quality of life. Family and peer support, prior auditory-verbal therapy, and a positive attitude were the most commonly cited factors in successful cochlear implant use. CONCLUSIONS: Early-deafened adult cochlear implant users perceive significant benefit from cochlear implantation. Importantly, family and peer support, prior auditory-verbal therapy, and a positive attitude are considered important factors in maximizing this benefit.

Early-deafened adult cochlear implant users: assessment of outcomes.

OBJECTIVE: To determine whether adults deafened in the prelingual and perilingual stages of speech development realize objective and subjective benefits from cochlear implantation. METHOD: Retrospective analysis of the open-set speech recognition and subjective data such as use and quality of life. RESULTS: Between 1989 and 1999, 198 deafened adults underwent cochlear implantation at Sunnybrook and Women's College Health Sciences Centre. Of these, 44 patients were deafened pre- or perilingually. These subjects were implanted with a Nucleus 22, Nucleus 24 (Cochlear Corporation, Denver, Colorado, USA), or Clarion (Advanced Bionics Corporation, Sylmar, California, USA) device. The average age at implantation was 34 years (range 14-62 years). Significant differences in speech perception, as measured by a composite score of open-set word, phoneme, and sentence recognition, were found among groups who differed by type of education and communication training received in childhood. CONCLUSION: By and large, open-set speech recognition in prelingually and perilingually deafened adults is inferior to that achieved in postlingually deafened adults and varies according to the type of communication training they received. However, cochlear implants have significantly improved the overall communication skills and quality of life in all subgroups of patients.