Current Profile of Adults Presenting for Preoperative Cochlear Implant Evaluation.
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SUBMITTER: Holder JT
PROVIDER: S-EPMC6027468 | biostudies-other | 2018 Jan-Dec
REPOSITORIES: biostudies-other
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Current Profile of Adults Presenting for Preoperative Cochlear Implant Evaluation.
Holder Jourdan T JT Reynolds Susan M SM Sunderhaus Linsey W LW Gifford René H RH
Trends in hearing 20180101
Considerable advancements in cochlear implant technology (e.g., electric acoustic stimulation) and assessment materials have yielded expanded criteria. Despite this, it is unclear whether individuals with better audiometric thresholds and speech understanding are being referred for cochlear implant workup and pursuing cochlear implantation. The purpose of this study was to characterize the mean auditory and demographic profile of adults presenting for preoperative cochlear implant workup. Data w ...[more]
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Project description:ImportanceCurrently, no clear guidelines exist regarding clinical testing methods for identifying adult cochlear implant (CI) candidates. Indications provided by the US Food and Drug Administration, Medicare, and private insurers are ambiguous concerning test materials and the level and mode of test presentation. This could lead to wide variability in clinical assessment and, potentially, unequal access to CIs for individuals with clinically significant hearing loss.ObjectiveTo examine the preoperative testing methods used by audiologists in evaluating adult CI candidates across the United States.Design, setting, and participantsA survey assessing audiology practice patterns was created using a Research Electronic Data Capture system hosted at the University of Miami. A link to a survey (65 questions in multiple-choice or rank-order format was distributed electronically along with a request for completion to members of the American Cochlear Implant Alliance and to the Institute for Cochlear Implant Training forum. Responses were collected from January 17 to June 4, 2018. Participation was limited to audiologists who evaluate adult CI candidates, and respondents who do not provide adult CI care were excluded. Collected demographic information included work setting, years of experience, and highest level of education attained.Main outcomes and measuresPercentages, medians, and interquartile ranges were from aggregated responses concerning hearing aid verification methods; testing methods, materials, and practices; nonauditory factors that might affect CI candidacy; audiology practice patterns; and expanded indications for CIs.ResultsAnonymized surveys were returned by 99 respondents; because surveys were available electronically, the number of audiologists who viewed the survey but did not respond was not available. Seven respondents identified themselves as pediatric specialists and were excluded, resulting in a total of 92 surveys available for analysis (denominators vary because respondents could complete the survey without answering all questions). Seventy percent of respondents (51 of 72) were doctors of audiology, and nearly 50% (33 of 74) were employed at universities and academic centers performing more than 50 CIs per year. When assessing adult candidacy for implant, most respondents reported using test materials from the Minimum Speech Test Battery: 96% (51 of 53), using AzBio sentences in quiet; 89% (47 of 53), AzBio sentences in noise; and 100% (53 of 53), the consonant-vowel nucleus-consonant, monosyllabic words test. However, these tests were applied inconsistently, with 39 of 53 respondents (74%) reporting use of a sound pressure level scale and the other 14 (26%) a hearing level scale at various decibel levels, and with some using a single signal-to-noise ratio and others using multiple ratios for sound-in-noise tests. Respondents' definitions of the best aided listening condition for assessing implant candidates also varied widely. Among the nonauditory factors ranked most important for assessing CI candidacy were patient's level of cognition and expectations of CI; yet, few respondents reported including cognitive or psychological tests in the assessment protocol.Conclusions and relevanceFindings of this study reveal considerable variability in preoperative testing methods and practices across health care professionals assessing adult candidates for CI. This lack of standardization in the delivery of care may increase the risk for health care inequities, specifically in access to care for adults with clinically significant hearing loss.
| S-EPMC6990940 | biostudies-literature
Project description:Background and objectiveApproximately 6% of adults eligible for cochlear implantation (CI) undergo surgery. This study aims to understand how general perceptions about CI contribute to barriers causing this low utilization rate.MethodsParticipants completed an online survey regarding their perceptions about cochlear implantation. They were asked to rank CIQOL-10 Global priorities and corresponding risk tolerance for minor complications (changes in taste, vertigo) and major complications (infections requiring hospitalization, meningitis, reimplantation, facial paralysis, and cerebrospinal fluid [CSF] leak).ResultsA total of 615 responses (female 55%, mean age 39 years [range 20-78]) were included. Respondents identified issues with insurance (46%) and fear of undergoing surgery (21%) as barriers preventing eligible adults from receiving CI. Regarding surgical risk, respondents significantly underestimated rates of minor complications (p < 0.0001) and almost all major complications (all p < 0.0001) while overestimating rates of serious infections and need for reimplantation (both p < 0.005). The ability to hear strangers in noisy environments was identified as the highest priority for CI (26%). Individuals who knew someone with a cochlear implantation were willing to tolerate higher rates of all minor and major complications (all p < 0.05). Healthcare workers were similarly willing to tolerate significantly higher rates of meningitis, facial paralysis, and CSF leak to achieve their highest priority (all p < 0.05).ConclusionsRespondents identify insurance coverage and fear of surgery as primary reasons for low utilization of adult CI in the United States. However, healthcare workers or those who knew someone with a cochlear implantation indicated significantly higher rates of risk tolerance to achieve their highest quality of life priorities, indicating the potential that the benefits of cochlear implantation are underappreciated in the general population.
| S-EPMC10368452 | biostudies-literature
Project description:Introduction The Nijmegen cochlear implant questionnaire (NCIQ) is a quantifiable self-assessment health-related quality of life (HRQoL) tool used internationally to determine quality of life (QoL) in cochlear implant (CI) users and to evaluate the implant's subjective benefits. Objective This study aimed to validate the Danish version of the questionnaire (DA-NCIQ) with a test-retest including 60 participants (30 CI users and 30 CI candidates). Methods The intraclass correlation coefficients (ICC) were calculated to evaluate the temporal stability of the participants' answers and the internal consistency of the questionnaire domains was determined using the Cronbach alpha in order to compare these results with the NCIQ's other language versions. Results The DA-NCIQ was found to have Cronbach alpha coefficients between 0.7 and 0.91, as well as test-retest reliability with ICC values between 0.7 and 0.92. These findings were similar to the original and other language versions of this questionnaire. The Cronbach alpha coefficients varied between 0.73 and 0.89, while the ICC test-retest reliability varied between 0.64 and 0.85. Furthermore, the present study found that participants with CIs had an improved HRQoL in all subdomains, except for the advanced sound perception one, when compared to the CI candidates. Conclusion The results supported the DA-NCIQ as a reliable instrument to measure the subjective benefits of CIs in postlingually deafened/hearing-impaired adults.
| S-EPMC11753863 | biostudies-literature
Project description:ObjectivesThe primary objective of this study is to identify the biographic, audiologic, and electrode position factors that influence speech perception performance in adult cochlear implant (CI) recipients implanted with a device from a single manufacturer. The secondary objective is to investigate the independent association of the type of electrode (precurved or straight) with speech perception.DesignIn a cross-sectional study design, speech perception measures and ultrahigh-resolution computed tomography scans were performed in 129 experienced CI recipients with a postlingual onset of hearing loss. Data were collected between December 2016 and January 2018 in the Radboud University Medical Center, Nijmegen, the Netherlands. The participants received either a precurved electrode (N = 85) or a straight electrode (N = 44), all from the same manufacturer. The biographic variables evaluated were age at implantation, level of education, and years of hearing loss. The audiometric factors explored were preoperative and postoperative pure-tone average residual hearing and preoperative speech perception score. The electrode position factors analyzed, as measured from images obtained with the ultrahigh-resolution computed tomography scan, were the scalar location, angular insertion depth of the basal and apical electrode contacts, and the wrapping factor (i.e., electrode-to-modiolus distance), as well as the type of electrode used. These 11 variables were tested for their effect on three speech perception outcomes: consonant-vowel-consonant words in quiet tests at 50 dB SPL (CVC50) and 65 dB SPL (CVC65), and the digits-in-noise test.ResultsA lower age at implantation was correlated with a higher CVC50 phoneme score in the straight electrode group. Other biographic variables did not correlate with speech perception. Furthermore, participants implanted with a precurved electrode and who had poor preoperative hearing thresholds performed better in all speech perception outcomes than the participants implanted with a straight electrode and relatively better preoperative hearing thresholds. After correcting for biographic factors, audiometric variables, and scalar location, we showed that the precurved electrode led to an 11.8 percentage points (95% confidence interval: 1.4-20.4%; p = 0.03) higher perception score for the CVC50 phonemes compared with the straight electrode. Furthermore, contrary to our initial expectations, the preservation of residual hearing with the straight electrode was poor, as the median preoperative and the postoperative residual hearing thresholds for the straight electrode were 88 and 122 dB, respectively.ConclusionsCochlear implantation with a precurved electrode results in a significantly higher speech perception outcome, independent of biographic factors, audiometric factors, and scalar location.
| S-EPMC8221708 | biostudies-literature
Project description:The use and utility of cochlear implantation has rapidly increased in recent years as technological advances in the field have expanded both the efficacy and eligible patient population for implantation. This review aims to serve as a general overview of the most common hearing disorders that have favorable auditory outcomes with cochlear implants (CI). Hearing loss in children caused by congenital cytomegalovirus infection, syndromic conditions including Pendred Syndrome, and non-syndromic genetic conditions such as hearing impairment associated with GJB2 mutations have shown to be successfully managed by CI. Furthermore, cochlear implantation provides the auditory rehabilitation for the most common etiology of hearing loss in adults and age-related hearing loss (ARHL) or presbycusis. However, in some cases, cochlear implantation have been associated with some challenges. Regarding implantation in children, studies have shown that sometimes parents seem to have unrealistic expectations regarding the ability of CI to provide auditory rehabilitation and speech improvement. Given the evidence revealing the beneficial effects of early intervention via CI in individuals with hearing disorders especially hearing loss due to genetic etiology, early auditory and genetic screening efforts may yield better clinical outcomes. There is a need to better understand genotype-phenotype correlations and CI outcome, so that effective genetic counseling and successful treatment strategies can be developed at the appropriate time for hearing impaired individuals.
| S-EPMC7381205 | biostudies-literature
Project description:The cochlear implant (CI) has been labeled the most successful neural prosthesis. Despite this success, a significant number of CI recipients experience poor speech understanding, and, even among the best performers, restoration to normal auditory fidelity is rare. While significant research efforts have been devoted to improving stimulation strategies, few developments have led to significant hearing improvement over the past two decades. We have recently introduced image processing techniques that open a new direction for advancement in this field by making it possible, for the first time, to determine the position of implanted CI electrodes relative to the nerves they stimulate using computed tomography images. In this article, we present results of an image-guided, patient-customized approach to stimulation that utilizes the electrode position information our image processing techniques provide. This approach allows us to identify electrodes that cause overlapping stimulation patterns and to deactivate them from a patient's map. This individualized mapping strategy yields significant improvement in speech understanding in both quiet and noise as well as improved spectral resolution in the 68 adult CI recipients studied to date. Our results indicate that image guidance can improve hearing outcomes for many existing CI recipients without requiring additional surgery or the use of 'experimental' stimulation strategies, hardware or software.
| S-EPMC4305276 | biostudies-literature
Project description:Cochlear implantation in subjects with single-sided deafness (SSD) offers a unique opportunity to directly compare the percepts evoked by a cochlear implant (CI) with those evoked acoustically. Here, nine SSD-CI users performed a forced-choice task evaluating the similarity of speech processed by their CI with speech processed by several vocoders presented to their healthy ear. In each trial, subjects heard two intervals: their CI followed by a certain vocoder in Interval 1 and their CI followed by a different vocoder in Interval 2. The vocoders differed either (i) in carrier type-(sinusoidal [SINE], bandfiltered noise [NOISE], and pulse-spreading harmonic complex) or (ii) in frequency mismatch between the analysis and synthesis frequency ranges-(no mismatch, and two frequency-mismatched conditions of 2 and 4 equivalent rectangular bandwidths [ERBs]). Subjects had to state in which of the two intervals the CI and vocoder sounds were more similar. Despite a large intersubject variability, the PSHC vocoder was judged significantly more similar to the CI than SINE or NOISE vocoders. Furthermore, the No-mismatch and 2-ERB mismatch vocoders were judged significantly more similar to the CI than the 4-ERB mismatch vocoder. The mismatch data were also interpreted by comparing spiral ganglion characteristic frequencies with electrode contact positions determined from postoperative computed tomography scans. Only one subject demonstrated a pattern of preference consistent with adaptation to the CI sound processor frequency-to-electrode allocation table and two subjects showed possible partial adaptation. Those subjects with adaptation patterns presented overall small and consistent frequency mismatches across their electrode arrays.
| S-EPMC6753516 | biostudies-literature
Project description:INTRODUCTION: The cochlear implant is a device that is intended to substitute for the function of cochlear hair cells, electrically stimulate auditory nerve fibers, and contribute to the perception of speech sounds. However, the surgical procedure alone is not enough for the user to achieve favorable results in habilitation/rehabilitation. OBJECTIVE: To characterize the patients from Manaus who have received cochlear implants based on the criteria for surgery. METHODS: We conducted a retrospective cross-sectional study of 15 cases and recorded etiological aspects of deafness, age, gender, duration of implant use, use of hearing aids, and participation in individual therapy. Data were recorded in a protocol designed specifically for this purpose. All patients were natives of Manaus. RESULTS: The leading etiological aspect was ototoxicity associated with prematurity in newborns undergoing treatment in the neonatal intensive care unit. The age at surgery is carefully observed in the evaluation of implant centers, as well as if the candidate is pre-or post-lingual. In this study, 73% of patients were pre-lingual and did not benefit from hearing aids. As to the degree and type of hearing loss, 93% had audiological reports indicating profound bilateral sensorineural hearing loss and 7% had severe bilateral sensorineural hearing loss. This latter finding confirmed one of the basic principles of implant placement. CONCLUSION: This study allowed us to verify that there are reduced number of cochlear implant recipients in Manaus, but they have met the criteria required by implant centers located in other states of Brazil.
| S-EPMC4435439 | biostudies-other
Project description:BACKGROUND:Current measures used to determine sentence recognition abilities in cochlear implant recipients often include tests with one talker and one rate of speech. Performance with these measures may not accurately represent the speech recognition abilities of the listeners. Evaluation of cochlear implant performance should include measures that reflect realistic listening conditions. For example, the use of multiple talkers who vary in gender, rate of speech, and regional dialects represent varied communication interactions that people encounter daily. The TIMIT sentences, which use multiple talkers and incorporate these variations, provide additional test material for evaluating speech recognition. Dorman and colleagues created 34 lists of TIMIT sentences that were normalized for equal intelligibility using simulations of cochlear implant processing with normal-hearing listeners. Adults with sensorineural hearing loss who listen with cochlear implants represent a different population. Further study is needed to determine if these lists are equivalent for adult cochlear implant recipients and, if not, to identify a subset of lists that may be used with this population. PURPOSE:To evaluate the speech recognition equivalence of 34 TIMIT sentence lists with adult cochlear implant recipients. RESEARCH DESIGN:A prospective study comparing test-retest results within the same group of listeners. STUDY SAMPLE:Twenty-two adult cochlear implant recipients who met the inclusion criteria of at least 3 mo device use and a monosyllabic word score of 30% or greater participated in the study. DATA COLLECTION AND ANALYSIS:Participants were administered 34 TIMIT sentence lists (20 sentences per list) at each of two test sessions several months apart. List order was randomized and results scored as percent of words correct. Test-retest correlations and 95% confidence intervals for the means were used to identify equivalent lists with high test-retest reliability. RESULTS:Mean list scores across participants ranged from 66 to 81% with an overall mean of 73%. Twenty-nine lists had high test-retest reliability. Using the overall mean as a benchmark, the 95% confidence intervals indicated that 25 of the remaining 29 lists were equivalent (e.g., the benchmark of 73% fell within the 95% confidence interval for both test and retest). CONCLUSIONS:Twenty-five of the TIMIT lists evaluated are equivalent when used with adult cochlear implant recipients who have open-set word recognition abilities. These lists may prove valuable for monitoring progress, comparing listening conditions or treatments, and developing aural rehabilitation plans for cochlear implant recipients.
| S-EPMC3428733 | biostudies-literature
Project description:ObjectiveDetermine associations expected and actual cochlear implant (CI) outcomes, decisional regret, and satisfaction in experienced adult CI users.Study designCross-sectional cohort study.SettingTertiary medical center.PatientsThirty-nine adult CI users meeting traditional bilateral hearing loss indications with ≥12 months CI experience.Interventions/main outcome measuresPatients completed the validated Satisfaction with Amplification in Daily Living and Decisional Regret instruments. Pre- and post-CI outcomes (CI Quality of Life [CIQOL]-Expectations; CIQOL-35 Profile; CNC words, AzBio Sentences) were obtained from a prospectively maintained clinical database.ResultsUsing established cutoff scores, 29% of patients reported a substantial degree of post-CI decisional regret. For each CIQOL domain, patients without decisional regret obtained post-CI outcome scores closer to pre-CI expectations compared with patients with decisional regret ( d = 0.34 to 0.91); similar results were observed with higher CI user satisfaction ( d = 0.17-0.83). Notably, the degree of pre- to post-CI improvement in CNC or AzBio scores did not differ between patients with and without decisional regret or with lower and higher satisfaction. Finally, greater pre-/postimprovement in CIQOL-35 Profile domain scores demonstrated far stronger associations with lower decisional regret and higher satisfaction than changes in speech recognition scores.ConclusionsPatients with better alignment of their pre-CI expectations and post-CI outcomes and greater pre-/post-CIQOL improvement had lower decisional regret and higher satisfaction. This emphasizes the importance of evidence-based pre-CI counseling regarding real-world CI benefits and caution against assuming that improvements in speech recognition are related to patient satisfaction.
| S-EPMC10840889 | biostudies-literature