The Effect of Soft Tissue Infections on Device Performance in Adult Cochlear Implant Recipients.

OBJECTIVE: The aim of this study was to examine the effect of cochlear implant (CI) site infection and its subsequent management on CI mapping and CI performance. Risk factors for CI infections and pathogens causing infections were reviewed. Treatment options for CI infections were examined. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Adult patients with a significant CI soft tissue infection from the Northern Cochlear Implant Programme, New Zealand over a 10-year period (August 2004 until August 2014). INTERVENTION: Patients were treated with intravenous antibiotics, washout and debridement or ex-plantation and reimplantation of CI. MAIN OUTCOME MEASURE: CI mapping results and implant performance before and after management of CI infections were compared. RESULTS: There were nine CI infections. Most patients (7/9) were treated with washout and debridement. One patient required removal of the CI and one patient was deemed medically unfit for a general anaesthetic and was managed conservatively with antibiotics alone. Seven patients received long-term antibiotics. Four patients were able to maintain CI performance after salvage treatment of the CI infection. Three patients had poorer CI performance after salvage treatment. One patient had reimplantation and became a nonuser due to only partial reinsertion. CONCLUSION: The pathophysiology of CI infections is complex. Infections can occur many years after CI surgery. The most common bacteria identified were Staphylococcus aureus, Pseudomonas aeruginosa, and skin commensals. Biofilms are present around implants that are removed from patients and biofilms may play a role in CI infections, but the mechanism of infection is not clear.

Impact of cognition and noise reduction on speech perception in adults with unilateral cochlear implants.

OBJECTIVES: The purpose of this study was to investigate the impact of cognition and noise reduction (NR) technology in cochlear implants (CIs) on speech perception and listening effort. METHODS: Thirteen adults fitted with unilateral CIs (Nucleus® 6, CP900) participated in this study. Participants performed: (I) cognitive tests of working memory and processing speed, (II) speech perception in noise tests, and (III) an auditory-visual dual-task paradigm to quantify listening effort, as a part of the three-phase experimental study. Both the participant and the tester, performing the outcome measures, were blinded to the NR settings (ON/OFF) of the CI for phases II and III. RESULTS: Speech intelligibility significantly improved with the NR activated, but was independent of individual differences in cognitive abilities. Listening effort did not significantly change with NR setting; however, there was a trend for participants with good working memory to have better speech perception scores with NR activated during the effortful listening task (dual-task paradigm). CONCLUSION: Future studies are warranted to explore the interaction between cognition and CI NR algorithms during an effortful listening task.

The Effect of Short-Term Auditory Training on Speech in Noise Perception and Cortical Auditory Evoked Potentials in Adults with Cochlear Implants.

This study investigated whether a short intensive psychophysical auditory training program is associated with speech perception benefits and changes in cortical auditory evoked potentials (CAEPs) in adult cochlear implant (CI) users. Ten adult implant recipients trained approximately 7 hours on psychophysical tasks (Gap-in-Noise Detection, Frequency Discrimination, Spectral Rippled Noise [SRN], Iterated Rippled Noise, Temporal Modulation). Speech performance was assessed before and after training using Lexical Neighborhood Test (LNT) words in quiet and in eight-speaker babble. CAEPs evoked by a natural speech stimulus /baba/ with varying syllable stress were assessed pre- and post-training, in quiet and in noise. SRN psychophysical thresholds showed a significant improvement (78% on average) over the training period, but performance on other psychophysical tasks did not change. LNT scores in noise improved significantly post-training by 11% on average compared with three pretraining baseline measures. N1P2 amplitude changed post-training for /baba/ in quiet (p = 0.005, visit 3 pretraining versus visit 4 post-training). CAEP changes did not correlate with behavioral measures. CI recipients' clinical records indicated a plateau in speech perception performance prior to participation in the study. A short period of intensive psychophysical training produced small but significant gains in speech perception in noise and spectral discrimination ability. There remain questions about the most appropriate type of training and the duration or dosage of training that provides the most robust outcomes for adults with CIs.

Erratum: The Effect of Short-Term Auditory Training on Speech in Noise Perception and Cortical Auditory Evoked Potentials in Adults with Cochlear Implants.

[This corrects the article DOI: 10.1055/s-0035-1570335.].

Health effects of cochlear implants.

AIM: To investigate whether people on a waiting list for cochlear implantation are more likely than those who have cochlear implants to suffer from illnesses which are potentially mediated by stress. METHOD: A questionnaire, designed to assess the presence, persistence, and medication use associated with stress-related illnesses, was administered to two groups: those on a waiting list for cochlear implantation and adult users of cochlear implants. RESULTS: Those on the cochlear implant waiting list had significantly poorer health as indicated by: a greater number of conditions experienced in the past year, longer illness length when affected by a condition, medication use for a greater number of conditions, and poorer mental health. CONCLUSION: There are lengthy waiting lists for adult cochlear implantation. The need to wait and the lack of a known date for surgery, in combination with having a profound hearing loss is likely to result in chronic stress. Chronic stress may increase the risk of physical and mental illness via physiological systems which mediate response to environmental threats. Cochlear implantation may alleviate chronic stress in people on the waiting list, and these findings support the hypothesis that this influences physical health.

Unsuccessful cochlear implantation in two patients with superficial siderosis of the central nervous system.

OBJECTIVE: To highlight the potential adverse outcomes with cochlear implantation (CI) in patients with superficial siderosis. PATIENTS: Two patients with superficial siderosis of the central nervous system with secondary sensorineural hearing loss. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURE: Postimplantation speech discrimination scores. RESULTS: In both cases, initial results after implantation were promising. However, in 1 case, their ability to use the CI rapidly declined after 1 week because of major difficulties adapting to electrical stimulation. For the other case, hearing rapidly declined over a 6-month period. CONCLUSION: The 2 patients reported did not benefit from CI in superficial siderosis that is in contrast to several previously published cases. Adequate counseling of patients with superficial siderosis is important when considering cochlear implantation as results are variable.

Evaluating the health-related quality of life effects of cochlear implants: a prospective study of an adult cochlear implant program.

This paper prospectively documents the health-related quality of life (HRQoL) and social participation benefits of adult patients receiving cochlear implants in Australia and New Zealand. Thirty-four consecutively implanted patients completed the Assessment of Quality of Life (AQoL) and Hearing Participation Scale (HPS) instruments before implantation, and at 3- and 6-month follow-ups. Implantation resulted in significant improvements in AQoL and HPS scores, The effect size was 1.09 for both measures. Those in the top socio-economic tertile obtained the greatest gains. The HRQoL and social participation benefits were slightly larger than those reported elsewhere. This may be because participants used more recent technology (Nucleus 24 rather than Nucleus 22) and received auditory and self-efficacy training as part of their rehabilitation. The results suggest that cochlear implants have a large beneficial effect. They show that social and HRQoL outcomes can be parsimoniously measured using the HPS and AQoL instruments.

It's a whole new ball game! Employment experiences of people with a cochlear implant.

Many implantees anecdotally report employment benefits being associated with implantation. This benefit has not been routinely reported in prospective studies of implant outcomes. It is important therefore to establish the nature of benefit reported by implantees so that further studies may document such outcomes in a representative fashion. To this end, a qualitative study of the experiences of 12 people with cochlear implants in the workplace is presented. A focus group methodology was used to collect the data. Patients use a before and after narrative style to relate the impact of the device on their working lives. Prior to implantation, deafened adults report being on the margins of the workplace, mostly concerned with holding on to a job that was quite difficult to obtain in the first place. Under-employment (working below their ability levels) was a key issue. Following implantation, working life was markedly better. Implantees report being able to pursue the jobs they were trained for with greater confidence. They also reported a greatly enhanced sense of job security. They had moved from the margins to the centre of working life, participating in non-vital, spontaneous conversations, and generally felt part of the workplace. Most notably, implantees felt able to take career risks such as seeking out better employment opportunities. Respondents note that a variety of accommodations still need to be made so that they can more readily take part in workplace communication. Overall, the post-implant transition back to work could be made simpler for implantees if appropriate vocational services were offered as part of their rehabilitation programme.