Adult Cochlear Implant Users Versus Typical Hearing Persons: An Automatic Analysis of Acoustic-Prosodic Parameters.

PURPOSE: The aim of this study was to investigate the speech prosody of postlingually deaf cochlear implant (CI) users compared with control speakers without hearing or speech impairment. METHOD: Speech recordings of 74 CI users (37 males and 37 females) and 72 age-balanced control speakers (36 males and 36 females) are considered. All participants are German native speakers and read Der Nordwind und die Sonne (The North Wind and the Sun), a standard text in pathological speech analysis and phonetic transcriptions. Automatic acoustic analysis is performed considering pitch, loudness, and duration features, including speech rate and rhythm. RESULTS: In general, duration and rhythm features differ between CI users and control speakers. CI users read slower and have a lower voiced segment ratio compared with control speakers. A lower voiced ratio goes along with a prolongation of the voiced segments' duration in male and with a prolongation of pauses in female CI users. Rhythm features in CI users have higher variability in the duration of vowels and consonants than in control speakers. The use of bilateral CIs showed no advantages concerning speech prosody features in comparison to unilateral use of CI. CONCLUSIONS: Even after cochlear implantation and rehabilitation, the speech of postlingually deaf adults deviates from the speech of control speakers, which might be due to changed auditory feedback. We suggest considering changes in temporal aspects of speech in future rehabilitation strategies. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21579171.

Comparison of ABR and ASSR using narrow-band-chirp-stimuli in children with cochlear malformation and/or cochlear nerve hypoplasia suffering from severe/profound hearing loss.

OBJECTIVES: In pediatric audiology, objective techniques for hearing threshold estimation in infants and children with profound or severe hearing loss play a key role. Auditory brainstem responses (ABR) and auditory steady-state responses (ASSR) are available for frequency-dependent hearing threshold estimations and both techniques show strong correlations but sometimes with considerable differences. The aim of the study was to compare hearing threshold estimations in children with and without cochlear and cochlear nerve malformations. METHODS: Two groups with profound or severe hearing loss were retrospectively compared. In 20 ears (15 children) with malformation of the inner ear and/or cochlear nerve hypoplasia and a control group of 20 ears (11 children) without malformation, ABR were measured with the Interacoustics Eclipse EP25 ABR system® (Denmark) with narrow-band CE-chirps® at 500, 1000, 2000 and 4000 Hz and compared to ASSR at the same center frequencies under similar conditions. RESULTS: ABR and ASSR correlated significantly in both groups (r = 0.413 in malformation group, r = 0.82 in control group). The malformation group showed a significantly lower percentage of "equal" hearing threshold estimations than the control group. In detail, patients with isolated cochlear malformation did not differ significantly from the control group, whereas patients with cochlear nerve hypoplasia showed significantly greater differences. CONCLUSION: ABR and ASSR should be used jointly in the diagnostic approach in children with suspected profound or severe hearing loss. A great difference in hearing threshold estimation between these techniques could hint at the involvement of cochlear nerve or cochlear nerve hypoplasia itself.

Diagnosis of Menière's disease according to the criteria of 2015: Characteristics and challenges in 96 patients.

BACKGROUND: The diagnosis of Menière's disease (MD) is made according to diagnostic criteria, the last revision of which was in 2015. For diagnosis, symptoms are weighted with audiometric findings and this can be challenging in individual patients. OBJECTIVE: To analyze patient's characteristics and symptoms in a real-life cohort of 96 patients with diagnosed MD regarding sociodemographic parameters, clinical specifics, and audiometry. METHODS: Prospective clinical patient registry containing demographic and socioeconomic parameters, symptoms, as well as pure-tone audiometry data. RESULTS: 31 patients with definite MD, and 36 with probable MD were identified. 29 patients showed typical clinical signs of MD, but did not meet the full diagnostic criteria, and were considered separately. Mean duration of symptoms prior to presentation was 3.9±4.6 years. Significant differences between categories were found regarding aural fullness, tinnitus, and fluctuating hearing. If multiple audiograms were available, 28.6 % (6/21) documented fluctuating hearing. CONCLUSIONS: Current diagnostic criteria probably do not represent patients with monosymptomatic presentation or an early stage very well. Long-term follow-up with repeated audiometry is advisable.

Variation of the cochlear anatomy and cochlea duct length: analysis with a new tablet-based software.

PURPOSE: In cochlear implantation, thorough preoperative planning together with measurement of the cochlear duct length (CDL) assists in choosing the correct electrode length. For measuring the CDL, different techniques have been introduced in the past century along with the then available technology. A tablet-based software offers an easy and intuitive way to visualize and analyze the anatomy of the temporal bone, its proportions and measure the CDL. Therefore, we investigated the calculation technique of the CDL via a tablet-based software on our own cohort retrospectively. METHODS: One hundred and eight preoperative computed tomography scans of the temporal bone (slice thickness < 0.7 mm) of already implanted FLEX28™ and FLEXSOFT™ patients were found eligible for analysis with the OTOPLAN software. Measurements were performed by two trained investigators independently. CDL, angular insertion depth (AID), and cochlear coverage were calculated and compared between groups of electrode types, sex, sides, and age. RESULTS: Mean CDL was 36.2 ± 1.8 mm with significant differences between sex (female: 35.8 ± 0.3 mm; male: 36.5 ± 0.2 mm; p = 0.037), but none concerning side or age. Differences in mean AID (FLEX28: 525.4 ± 46.4°; FLEXSOFT: 615.4 ± 47.6°), and cochlear coverage (FLEX28: 63.9 ± 5.6%; FLEXSOFT: 75.8 ± 4.3%) were significant (p < 0.001). CONCLUSION: A broad range of CDL was observed with significant larger values in male, but no significant differences concerning side or age. Almost every cochlea was measured longer than 31.0 mm. Preoperative assessment aids in prevention of complications (incomplete insertion, kinking, tipfoldover), attempt of atraumatic insertion, and addressing individual necessities (hearing preservation, cochlear malformation). The preferred AID of 720° (two turns of the cochlea) was never reached, opening the discussion for the requirement of longer CI-electrodes versus a debatable audiological benefit for the patient in his/her everyday life.

Stapes and Stapes Revision Surgery: Preoperative Air-Bone Gap Is a Prognostic Marker.

OBJECTIVE: Stapes surgery is considered an effective treatment in otosclerosis, but controversy remains regarding predictors of surgical outcome. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: One hundred sixty three cases of stapes surgery between 2012 and 2019 were reviewed. MAIN OUTCOME MEASURES: Primary outcome measures were relative hearing improvement (relHI), defined as preoperative minus postoperative air conduction divided by preoperative air-bone gap (ABG), as well as relative ABG closure (relABGc), defined as preoperative ABG minus postoperative ABG divided by preoperative ABG. Univariate and multivariate linear regression analyses were performed to determine independent predictors for these outcomes. RESULTS: Higher preoperative bone conduction (BC) and primary surgery (compared with revision) were independently associated with increased relHI (p = 0.001 and p = 0.004, respectively). Lower preoperative BC, higher preoperative ABG, primary surgery, and age were independently associated with increased relABGc (p = 0.0030, p < 0.001, p = 0.0214, and p = 0.0099, respectively). Sex did not predict surgical outcome. In patients with less than 20 dB preoperative ABG, likelihood of negative relABGc was increased (compared with 20-30 dB or >30 dB preoperative ABG, p = 0.0292, Fisher's exact test). This tendency was not significant for relHI (p = 0.074). CONCLUSIONS: Our findings demonstrate that calculating HI and ABGc in relation to preoperative ABG can reliably predict outcomes of stapes surgery. Both primary and revision stapes surgery are effective treatment options, but relative improvement is higher in primary cases. Preoperative BC, preoperative ABG, and age predict surgical outcomes as well. Otosclerosis patients with low preoperative ABG, especially less than 20 dB, should be counseled and selected cautiously regarding stapes surgery.

Comparison of ABR and ASSR using NB-chirp-stimuli in children with severe and profound hearing loss.

INTRODUCTION: Objective techniques for hearing threshold estimation in infants and children with profound or severe hearing loss play a key role in pediatric audiology to prevent speech acquisition disorders by choosing the adequate therapy. Auditory brainstem responses and auditory steady-state responses are available for frequency-dependent hearing threshold estimations and both techniques show strong correlations. However, various systems and stimuli are available, which is one reason why comparison is challenging, and, so far, no single "gold standard" could be established for hearing threshold estimation in children suffering from profound or severe hearing loss. The aim of the study was to compare hearing threshold estimations in children with profound or severe hearing loss derived with narrow-band CE-chirps evoked auditory brainstem responses and auditory steady-state response. SUBJECTS: and Methods: 71 children (121 ears) with an age from 3 month to 15 years were measured with the Interacoustics Eclipse EP25 ABR system® (Denmark) with narrow-band CE-chirps® at 500, 1000, 2000 and 4000 Hz under identical conditions. RESULTS: Auditory brainstem responses and auditory steady-state responses highly correlate (r = 0.694, p < 0.001). Correlation coefficients differ depending on the center frequency and patient age. Generally, auditory steady-state responses show a better hearing threshold than auditory brainstem responses or a remaining hearing threshold when auditory brainstem responses could not be obtained. In approximately 15% of cases this would have affected the therapeutic strategy when only taking one technique into account. CONCLUSION: Auditory brainstem responses and auditory steady-state responses should be jointly used in the diagnostic approach in children with suspected profound or severe hearing loss.

Threshold changes of ABR results in toddlers and children.

INTRODUCTION: Auditory brainstem response (ABR) is a clinically established method to identify the hearing threshold in young children and is regularly performed after hearing screening has failed. Some studies have shown that, after the first diagnosis of hearing impairment in ABR, further development takes place in a spectrum between progression of hearing loss and, surprisingly, hearing improvement. OBJECTIVE: The aim of this study is to evaluate changes over time of auditory thresholds measured by ABR among young children. MATERIAL AND METHODS: For this retrospective study, 459 auditory brainstem measurements were performed and analyzed between 2010 and 2014. Hearing loss was detected and assessed according to national guidelines. 104 right ears and 101 left ears of 116 children aged between 0 and 3 years with multiple ABR measurements were included. The auditory threshold was identified using click and/or NB-chirp-stimuli in natural sleep or in general anesthesia. The frequency of differences of at least more than 10dB between the measurements was identified. RESULTS: In 37 (35%) measurements of right ears and 38 (38%) of left ears there was an improvement of the auditory threshold of more than 10dB; in 27 of those measurements more than 20dB improvement was found. Deterioration was seen in 12% of the right ears and 10% of the left ears. Only half of the children had stable hearing thresholds in repeated measurements. The time between the measurements was on average 5 months (0 to 31 months). CONCLUSION: Hearing threshold changes are often seen in repeated ABR measurements. Therefore multiple measurements are necessary when ABR yields abnormal. Hearing threshold changes should be taken into account for hearing aid provision.

The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users.

OBJECTIVE: The present study evaluated whether the poorer baseline performance of cochlear implant (CI) users or the technical and/or physiological properties of CI stimulation are responsible for the absence of masking release. DESIGN: This study measured speech reception thresholds (SRTs) in continuous and modulated noise as a function of signal to noise ratio (SNR). STUDY SAMPLE: A total of 24 subjects participated: 12 normal-hearing (NH) listeners and 12 subjects provided with recent MED-EL CI systems. RESULTS: The mean SRT of CI users in continuous noise was -3.0 ± 1.5 dB SNR (mean ± SEM), while the normal-hearing group reached -5.9 ± 0.8 dB SNR. In modulated noise, the difference across groups increased considerably. For CI users, the mean SRT worsened to -1.4 ± 2.3 dB SNR, while it improved for normal-hearing listeners to -18.9 ± 3.8 dB SNR. CONCLUSIONS: The detrimental effect of fluctuating maskers on SRTs in CI users shown by prior studies was confirmed by the current study. Concluding, the absence of masking release is mainly caused by the technical and/or physiological properties of CI stimulation, not just the poorer baseline performance of many CI users compared to normal-hearing subjects. Speech understanding in modulated noise was more robust in CI users who had a relatively large electrical dynamic range.

Towards a Unified Testing Framework for Single-Sided Deafness Studies: A Consensus Paper.

BACKGROUND: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL. METHODS: This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada. RESULTS: A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable. CONCLUSION: A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.