ARTFit-A Quick and Reliable Tool for Performing Initial Fittings in Users of MED-EL Cochlear Implants.

This study assessed the safety and performance of ARTFit, a new tool embedded in MAESTRO, the cochlear implant (CI) system software by MED-EL GmbH (Innsbruck, Austria). ARTFit automatically measures thresholds of the electrically evoked compound action potential (ECAP) to produce initial 'maps' (ECAPMAPs), i.e., configuration settings of the audio processor that the audiologist switches to live mode and adjusts for comfortable loudness (LiveECAPMAPs). Twenty-three adult and ten pediatric users of MED-EL CIs participated. The LiveECAPMAPs were compared to behavioral maps (LiveBurstMAPs) and to the participants' everyday clinical maps (ClinMAPs). Four evaluation measures were considered: average deviations of the maximum comfortable loudness (MCL) levels of the LiveECAPMAPs and the LiveBurstMAPs from the MCLs of the ClinMAPs; correlations between the MCLs of the LiveECAPMAPs (MCLecap) and the LiveBurstMAPs (MCLburst) with the MCLs of the ClinMAPs (MCLclin); fitting durations; and speech reception thresholds (SRTs). All evaluation measures were analyzed separately in the adult and pediatric subgroups. For all evaluation measures, the deviations of the LiveECAPMAPs from the ClinMAPs were not larger than those of the LiveBurstMAPs from the ClinMAPs. The Pearson correlation between the MCLecap and the MCLclin across all channels was r2 = 0.732 (p < 0.001) in the adult and r2 = 0.616 (p < 0.001) in the pediatric subgroups. The mean fitting duration in minutes for the LiveECAPMAPs was significantly shorter than for that of the LiveBurstMAPs in both subgroups: adults took 5.70 (range 1.90-11.98) vs. 9.27 (6.83-14.72) min; children took 3.03 (1.97-4.22) vs. 7.35 (3.95-12.77). SRTs measured with the LiveECAPMAPs were non-inferior to those measured with the ClinMAPs and not statistically different to the SRTs measured with the LiveBurstMAPs. ARTFit is a safe, quick, and reliable tool for audiologists to produce ECAP-based initial fitting maps in adults and young children who are not able to provide subjective feedback.

CI decision making and expectations by older adults.

OBJECTIVE: To document and analyze the cochlear implant (CI) decision-making process of hearing-impaired older adults. The aim of this study is to assess what support could be helpful during this process in order to improve care delivery. METHODS: 32 older adult CI recipients (≥ 60 years) with severe to profound sensorineural hearing loss were interviewed about their CI decision-making process 3-12 months after obtaining their first CI. RESULTS: Minimal information was provided to CI candidates by hearing aid acousticians or patient associations. High to very high expectations were reported by patients concerning issues beyond hearing improvement per se. Even though not all expectations were fulfilled by the CI, nearly all recipients who used an implant for at least six months would recommend a CI to others. DISCUSSION: We identified an opportunity for those professionals to play a greater role in supporting older CI candidates during the decision-making process. It is desirable to establish a comprehensive network of hearing care professionals to collaborate with CI clinics. CONCLUSION: In order to support older patients adequately in deciding about CI, intensive training should be offered to hearing care professionals in order to provide realistic expectations and reduce fear and uncertainty about the implantation process. These topics need to be communicated in a professional manner and adapted to the candidate's age and personality.

Development and validation of the audio processor satisfaction questionnaire (APSQ) for hearing implant users.

Objective: The satisfaction experienced with using an audio processor is very important to hearing implant system users. Currently there are no measures that can be used to assess user satisfaction with an audio processor. This study aims to develop and validate a specific and standardised questionnaire that focuses on user satisfaction with their audio processor.Design: A preliminary version of the questionnaire was initially developed by experts in the field. Following validation of these results, the final version of the Audio Processor Satisfaction Questionnaire (APSQ) was developed consisting of 15 items. Item analyses and questionnaire validation measurements were assessed.Study sample: Sixty-nine subjects were recruited and asked to complete the APSQ twice within 2-4 weeks.Results: Subjects reported a high user satisfaction with the questionnaire and with their audio processor. The questionnaire had good reliability and results for test-retest reliability were high and significant across all items and across subscale analyses.Conclusion: Item analyses and reliability analyses show that the questionnaire is a valid and reliable tool to assess user satisfaction across different audio processors and hearing implant systems. The APSQ is a quick and easy tool to measure user satisfaction with their audio processor.

Introducing real-life listening features into the clinical test environment: Part II: Measuring the hearing performance and evaluating the listening effort of individuals with a hearing implant.

Objectives: The controlled clinical test environment is very different from real-life listening situations, where the presence of additional speakers and variations in background noise signals can affect listening performances. The primary objective of this study is to reduce the gap between clinical results and real-life performances that are reported for many hearing implant users. Methods: Similar to Part I of this study, hearing performance and sound perception are evaluated using the following tests: (i) the Roving Level Test, (ii) the Just Understanding Speech Test, (iii) the Performance Perceptual Test, (iv) the Visual Analogue Scale to evaluate the perceived listening effort required for a range of background noise levels, and (v) the Hearing Implant Sound Quality questionnaire. All subjects recruited for this study used MED-EL hearing implant systems. Results: Results show that, similar to normal hearing listeners, hearing implant users tend to accurately estimate their hearing abilities, and both listening effort and speech recognition thresholds tend to increase with increasing noise. Discussion: The proposed test battery for evaluating speech understanding and listening effort were suitable for use in this study as all of the implant users were able to complete the tests. This test battery can be used to provide audiologists with further information relating to real-life listening performances. Conclusion: Evaluating the self-estimated and verified performance measurements of hearing implant users in real-life listening situations are essential for providing information regarding the discrepancies observed between the objective and subjective reports of hearing difficulties.

Introducing real-life listening features into the clinical test environment: Part I: Measuring the hearing performance and evaluating the listening effort of individuals with normal hearing.

OBJECTIVE: Controlled clinical test environments are very different from real-life listening situations in which speaker and background noise level variations can hinder a person's ability to hear and follow conversations. This study was performed to evaluate the ability of people with normal hearing to follow a single speaker in the presence of background noise, and to explore relations between those measures and the listeners' subjective assessments, listening effort, and sound quality judgements. METHODS: A group of adults with normal hearing were evaluated using the following battery of tests: (i) Roving Level Test, (ii) the Just Understanding Speech Test, (iii) Performance Perceptual Test, (iv) the Visual Analogue Scale to evaluate listening effort, and (iv) with a sound quality questionnaire. RESULTS: The results show that people with normal hearing tend to accurately estimate their hearing abilities, and both the listening effort required and speech recognition thresholds tend to increase with increasing background noise. DISCUSSION: Implementing a battery of tests that evaluate speech-in-noise listening abilities, listening effort, and subjective hearing perception might provide greater insight into hearing performance than traditional measures. Additionally, the data generated in this study can be used for comparison with measures obtained from hearing impaired and hearing device listeners, and as such, has the potential to guide counselling and rehabilitation to a range of clinical populations. CONCLUSION: The examination of both the self-estimated and verified performance measurements in simulated real-life listening situations can provide audiologists with a comprehensive and realistic profile of a person's hearing performance.