Bilateral, Sequential Sudden Hearing Loss in a Patient With Multiple COVID-19 Infections and Potential Implications on Subsequent Cochlear Implant Performance.

Viruses are often implicated as a cause of sensorineural hearing loss (SNHL), particularly sudden cases, including COVID-19. Determining the viral mechanism that leads to hearing loss is necessary for its future prevention and treatment. The 47-year-old woman who is the subject of this case study presented with sudden SNHL following multiple infections of COVID-19. Following a trial of a contralateral routing of sound device, she received a right cochlear implant (CI). Following a period of high performance, additional cases of COVID-19 infection and device failure issues resulted in the explant/reimplant of 1 ear and implantation of the contralateral ear. Despite extensive rehabilitation after these events, the patient continues to experience difficulties in speech understanding, not reaching her initial high levels of right ear performance. Further research is needed to determine the implications of COVID-19 as it relates to SNHL. This case study aimed to highlight the course of treatment and provide insight into the impact of COVID-19 on sudden hearing loss and its relationship to CI performance.

How Craniofacial Anomalies Can Obscure the Diagnosis of Unilateral Auditory Neuropathy Spectrum Disorder: A Case Study.

Comorbidities are common with craniofacial anomalies and can include auditory neuropathy spectrum disorder (ANSD). Identification of these comorbidities, such as a diagnosis of ANSD, has increased with expanded multi-disciplinary care teams and the use of auditory objective measures. Patients with craniofacial anomalies often have complex medical histories including extreme prematurity and jaundice, which may lead to the development of additional comorbidities. The 5-year-old boy that is the subject of this case study presented with noted developmental delays and residing in foster care with an unknown family/medical history. Initially presenting with middle ear dysfunction, exacerbated by craniofacial anomalies, the underlying cause of his speech delays was missed. Behavioral audiometry was attempted with inaccurate results. Surgery was performed to correct the craniofacial anomalies, middle ear dysfunction, and was followed with auditory brainstem response (ABR) testing. The boy healed well without complications. The ABR revealed ANSD, hearing aids were fitted for the diagnosis, regular speech therapy was initiated, and the boy continues to make steady progress toward developmental milestones. The purpose of this case study was to highlight the course of identification and treatment of a complex case that may provide insight into determining a differential diagnosis of ANSD when initially obscured by craniofacial anomalies.

Use of Direct-Connect for Remote Speech-Perception Testing in Cochlear Implants.

OBJECTIVES: Previous research has demonstrated the feasibility of programming cochlear implants (CIs) via telepractice. To effectively use telepractice in a comprehensive manner, all components of a clinical CI visit should be validated using remote technology. Speech-perception testing is important for monitoring outcomes with a CI, but it has yet to be validated for remote service delivery. The objective of this study, therefore, was to evaluate the feasibility of using direct audio input (DAI) as an alternative to traditional sound-booth speech-perception testing for serving people with CIs via telepractice. Specifically, our goal was to determine whether there was a significant difference in speech-perception scores between the remote DAI (telepractice) and the traditional (in-person) sound-booth conditions. DESIGN: This study used a prospective, split-half-design to test speech perception in the remote DAI and in-person sound-booth conditions. Thirty-two adults and older children with CIs participated; all had a minimum of 6 months of experience with their device. Speech-perception tests included the consonant-nucleus-consonant (CNC) words, Hearing-in-Noise test (HINT) sentences, and Arizona Biomedical Institute at Arizona State University (AzBio) sentences. All three tests were administered at levels of 50 and 60 dBA in quiet. Sentence stimuli were also presented in 4-talker babble at signal to noise ratios (SNRs) of +10 and +5 dB for both the 50- and 60-dBA presentation levels. A repeated-measures analysis of variance was used to assess the effects of location (remote, in person), stimulus level (50, 60 dBA), and SNR (if applicable; quiet, +10, +5 dB) on each outcome measure (CNC, HINT, AzBio). RESULTS: The results showed no significant effect of location for any of the tests administered (p > 0.1). There was no significant effect of presentation level for CNC words or phonemes (p > 0.2). There was, however, a significant effect of level (p < 0.001) for both HINT and AzBio sentences, but the direction of the effect was opposite of what was expected-scores were poorer for 60 dBA than for 50 dBA. For both sentence tests, there was a significant effect of SNR, with poorer performance for worsening SNRs, as expected. CONCLUSIONS: The present study demonstrated that speech-perception testing via telepractice is feasible using DAI. There was no significant difference in scores between the remote and in-person conditions, which suggests that DAI testing can be used as a valid alternative to standard sound-booth testing. The primary limitation is that the calibration tools are presently not commercially available.

Techniques for Remotely Programming Children With Cochlear Implants Using Pediatric Audiological Methods via Telepractice.

PURPOSE: The purpose of this report is to describe the equipment setup and techniques for successfully testing behavioral thresholds in young children with cochlear implants (CIs) using telepractice. We will also discuss challenges associated with pediatric CI programming that are unique to the use of distance technology, and we will describe ways to overcome those challenges. Last, we will review the results from 2 recent studies specifically targeted toward testing behavioral thresholds in young children with CIs. METHOD: Conditioned play audiometry or visual reinforcement audiometry was used to measure behavioral thresholds (T levels) for 35 young children with CIs (n = 19 for conditioned play audiometry and n = 16 for visual reinforcement audiometry). Participants were tested in the traditional in-person condition and in the remote condition using an AB-BA study design over 2 visits. RESULTS: There was no significant difference in T levels between the in-person and remote conditions, indicating that it is feasible to test young children using conventional pediatric testing procedures via remote technology. The primary challenges encountered were in regard to proper camera and video monitor placement at the remote site and the timing of communication between the audiologist and test assistant. CONCLUSIONS: The results from studies to date suggest that distance technology can be used successfully to program CI sound processors for young children using standard, age-appropriate testing techniques. The alternative of remote testing has substantial implications for reducing time and travel burdens for families, potentially leading to the construction of appropriate maps for young children with CIs in a timelier manner.

Measuring Sound-Processor Thresholds for Pediatric Cochlear Implant Recipients Using Visual Reinforcement Audiometry via Telepractice.

Purpose: The goal of this study was to test the feasibility of using telepractice for measuring behavioral thresholds (T levels) in young children with cochlear implants (CIs) using visual reinforcement audiometry (VRA). Specifically, we examined whether there were significant differences in T levels, test time, or measurement success rate between in-person and remote test conditions. Method: Data were collected for 17 children, aged 1.1-3.4 years. A within-subject AB-BA (A, in-person; B, remote) study design was used, with data collection typically occurring over 2 visits. T levels were measured during each test session using VRA for one basal, middle, and apical electrode. Two additional outcome measures included test time and response success rate, the latter of which was calculated as the ratio of the number of electrode thresholds successfully measured versus attempted. All 3 outcome measures were compared between the in-person and remote sessions. Last, a parent/caregiver questionnaire was administered at the end of the study to evaluate subjective aspects of remote versus traditional CI programming. Results: Results showed no significant difference in T levels between in-person and remote test conditions. There were also no significant differences in test time or measurement success rate between the two conditions. The questionnaires indicated that 82% of parents or caregivers would use telepractice for routine CI programming visits some or all of the time if the option was available. Conclusion: Results from this study suggest that telepractice can be used successfully to set T levels for young children with CIs using VRA.