Delaying Cochlear Implantation Impacts Postoperative Speech Perception of Nontraditional Pediatric Candidates

2020 ◽  
pp. 1-6
Author(s):  
Lisa R. Park ◽  
Elizabeth L. Perkins ◽  
Jennifer S. Woodard ◽  
Kevin D. Brown
Keyword(s):  
Hearing Loss ◽  
Speech Perception ◽  
Word Recognition ◽  
Cochlear Implantation ◽  
Delay Time ◽  
Residual Hearing ◽  
Progressive Hearing Loss ◽  
Significant Difference ◽  
Significant Regression ◽  
The Impact

<b><i>Introduction:</i></b> As pediatric cochlear implant (CI) candidacy expands, children with greater degrees of residual hearing are receiving CIs. These nontraditional candidates have audiometric thresholds that meet adult manufacturer labeling but are better than current pediatric guidelines allow. The purpose of this study was to determine the impact of delayed cochlear implantation on speech perception in nontraditional pediatric CI recipients. <b><i>Methods:</i></b> Pediatric CI recipients with a history of progressive hearing loss and a preoperative 4-frequency pure-tone average of ≤75 dB HL at the time of implantation were considered for this retrospective study. Preoperative serial audiograms and word recognition scores were reviewed, and a method was created to establish a date when each individual ear 1st met nontraditional candidacy. The length of time between the date of candidacy and implantation was calculated and defined as the “delay time.” A multiple linear regression investigated delay time, age at surgery, surgery type (1st vs. 2nd side), and array type as predictive factors of maximum postoperative Consonant-Nucleus-Consonant (CNC) word scores. A one-way ANCOVA was performed comparing the postoperative CNC scores between subjects grouped by delay time. <b><i>Results:</i></b> A significant regression was found (<i>F</i>(4, 38) = 5.167, <i>p</i> = 0.002, <i>R</i><sup>2</sup> = 0.353). Both age at implantation (<i>p</i> = 0.023) and delay time (<i>p</i> = 0.002) predicted CNC word scores. Longer delay time was associated with poorer word recognition scores, while older age at implantation correlated with higher CNC word scores in this progressive hearing loss group. A significant difference was noted between subjects implanted with &#x3c;1 year of delay and those with 3 or more years of delay (<i>p</i> = 0.003). All ears implanted within a year of candidacy achieved word recognition abilities that are generally accepted as above average (<i>M</i> = 84.91). <b><i>Conclusion:</i></b> CI candidacy for adults has evolved to allow for greater degrees of residual hearing, while audiometric guidelines for children have not changed since 2000. Our findings suggest that delay of cochlear implantation, even for children with significant levels of residual hearing, leads to poorer outcomes. Modified candidacy guidelines for children should be established to expedite referral to multidisciplinary CI teams and minimize delays in this population.

Impact of Cochlear Implantation on Neurocognitive Subdomains in Adult Cochlear Implant Recipients

2021 ◽  
pp. 1-10
Author(s):  
Christiane Völter ◽  
Lisa Götze ◽  
Imme Haubitz ◽  
Janine Müther ◽  
Stefan Dazert ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Verbal Fluency ◽  
Homogeneous Population ◽  
Delayed Recall ◽  
Hearing Status ◽  
Age Related ◽  
Significant Difference ◽  
The Impact

<b><i>Introduction:</i></b> Age-related hearing loss affects about one-third of the population worldwide. Studies suggest that hearing loss may be linked to cognitive decline and auditory rehabilitation may improve cognitive functions. So far, the data are limited, and the underlying mechanisms are not fully understood. The study aimed to analyze the impact of cochlear implantation on cognition in a large homogeneous population of hearing-impaired adults using a comprehensive non-auditory cognitive assessment with regard to normal-hearing (NH) subjects. <b><i>Material and Methods:</i></b> Seventy-one cochlear implant (CI) candidates with a postlingual, bilateral severe or profound hearing loss aged 66.3 years (standard deviation [SD] 9.2) and 105 NH subjects aged 65.96 years (SD 9.4) were enrolled. The computer-based neurocognitive tool applied included 11 subtests covering attention (M3), short- and long-term memory (recall and delayed recall), working memory (0- and 2-back, Operation Span [OSPAN] task), processing speed (Trail Making Test [TMT] A), mental flexibility (TMT B), inhibition (cFlanker and iFlanker), and verbal fluency. CI patients underwent a neurocognitive testing preoperatively as well as 12 months postoperatively. Impact of hearing status, age, gender, and education on cognitive subdomains was studied. Additionally, after controlling for education and age, cognitive performance of CI subjects (<i>n</i> = 41) was compared to that of NH (<i>n</i> = 34). <b><i>Results:</i></b> CI users achieved significantly better neurocognitive scores 12 months after cochlear implantation than before in most subtests (M3, [delayed] recall, 2-back, OSPAN, iFlanker, and verbal fluency; all <i>p</i> &#x3c; 0.05) except for the TMT A and B. A significant correlation could be found between the postoperative improvement in speech perception and in the attentional task M3 (<i>p</i> = 0.01). Hearing status (<i>p</i> = 0.0006) had the strongest effect on attention, whereas education had a high impact on recall (<i>p</i> = 0.002), OSPAN (<i>p</i> = 0.0004), and TMT A (<i>p</i> = 0.005) and B (<i>p</i> = 0.003). Inhibition was mainly age-dependent with better results in younger subjects (<i>p</i> = 0.016). Verbal fluency was predicted by gender as females outperformed men (<i>p</i> = 0.009). Even after controlling for age and education NH subjects showed a significantly better performance than CI candidates in the recall (<i>p</i> = 0.03) and delayed recall (<i>p</i> = 0.01) tasks. Postoperatively, there was no significant difference between the 2 groups anymore. <b><i>Conclusion:</i></b> Impact of cochlear implantation on neurocognitive functions differs according to the cognitive subdomains. Postoperatively, CI recipients performed as good as age- and education-matched NH subjects.

scholarly journals Neuroprotective Effect of Near-Infrared Light in an Animal Model of CI Surgery

2020 ◽  
pp. 1-7
Author(s):  
Ira Strübing ◽  
Moritz Gröschel ◽  
Susanne Schwitzer ◽  
Arne Ernst ◽  
Felix Fröhlich ◽  
...  
Keyword(s):  
Animal Model ◽  
Hearing Loss ◽  
Hair Cells ◽  
Cochlear Implantation ◽  
Near Infrared ◽  
Outer Hair Cells ◽  
Auditory Brainstem Responses ◽  
Infrared Light ◽  
Residual Hearing ◽  
Significant Difference

<b><i>Introduction:</i></b> The preservation of residual hearing has become an important consideration in cochlear implant (CI) recipients in recent years. It was the aim of the present animal experimental study to investigate the influence of a pretreatment with near-infrared (NIR) light on preservation of sensory hair cells and residual hearing after cochlear implantation. <b><i>Methods:</i></b> NIR was applied unilaterally (15 min, 808 nm, 120 mW) to 8 guinea pigs, immediately before a bilateral scala tympani CI electrode insertion was performed. The nonirradiated (contralateral) side served as control. Twenty-eight days postoperatively, auditory brainstem responses (ABRs) were registered from both ears to screen for hearing loss. Thereafter, the animals were sacrificed and inner hair cells (IHCs) and outer hair cells (OHCs) were counted and compared between NIR-pretreated and control (contralateral) cochleae. <b><i>Results:</i></b> There was no IHC loss upon cochlear implantation. OHC loss was most prominent on both sides at the apical part of the cochlea. NIR pretreatment led to a statistically significant reduction in OHC loss (by 39.8%). ABR recordings (across the frequencies 4–32 kHz) showed a statistically significant difference between the 2 groups and corresponds well with the apical structural damage. Hearing loss was reduced by about 20 dB on average for the NIR-pretreated group (<i>p</i> ≤ 0.05). <b><i>Discussion/Conclusion:</i></b> A single NIR pretreatment in this animal model of CI surgery appears to be neuroprotective for residual hearing. This is in line with other studies where several NIR posttreatments have protected cochlear and other neural tissues. NIR pretreatment is an inexpensive, effective, and noninvasive approach that can complement other ways of preserving residual hearing and, hence, should deserve further clinical evaluation in CI patients.

Evidence-Based Recommendation for Bilateral Cochlear Implantation in Adults

2019 ◽  
Vol 28 (3S) ◽  
pp. 775-782 ◽  
Author(s):  
Agnes Au ◽  
Richard C. Dowell
Keyword(s):  
Hearing Loss ◽  
Speech Perception ◽  
Word Recognition ◽  
Cochlear Implant ◽  
Developed Countries ◽  
Evidence Based ◽  
Residual Hearing ◽  
Speech Perception In Noise ◽  
Bilateral Group ◽  
Acquired Hearing Loss

Purpose Most adult cochlear implant (CI) users in developed countries benefit from the use of a hearing aid in conjunction with their implant device (bimodal hearing). Benefits have also been documented for the use of bilateral CIs for speech perception in quiet, localization, and speech perception in noise. This study attempted to quantify speech perception results for bimodal and bilateral CIs in adults and provide a guide for those considering a 2nd CI. Method Speech perception outcomes were reviewed for 1,394 adults with acquired hearing loss who received a CI at the Melbourne Cochlear Implant Clinic between 2000 and 2015. Results Bimodal and bilateral users significantly outperformed unilateral CI users on consonant–vowel–consonant word recognition in quiet. For the bilateral group, word recognition scores with the 1st CI were predictive of 2nd CI word scores. The analysis suggested that bimodal users who were gaining less than 19% benefit from the nonimplanted ear were likely to perform better with a 2nd implant. Conclusions CI users who score less than 19% on consonant–vowel–consonant words in the nonimplanted ear have a good chance of benefiting from a 2nd implant. Consideration of many other factors including age, hearing goals, medical factors, and the risk to residual hearing also needs to play a part in recommending a 2nd CI.

The Effect of Monaurally Fitted Hearing Aid Use on the Evolution of Presbycusis

2021 ◽  
pp. 000348942199527
Author(s):  
Gabriel Dunya ◽  
Fadi Najem ◽  
Aurelie Mailhac ◽  
Samer Abou Rizk ◽  
Marc Bassim
Keyword(s):  
Word Recognition ◽  
Pure Tone ◽  
Hearing Aid ◽  
Residual Hearing ◽  
Inclusion Criteria ◽  
Pure Tone Average ◽  
Hearing Aid Use ◽  
Deprivation Effect ◽  
Significant Difference

Objective: The effect of hearing aid use on the evolution of presbycusis has not been well described in the literature, with only a handful of publications addressing this topic. This paper aims to evaluate the long-term use of amplification and its effect on pure-tone thresholds and word recognition scores. Method: Monaurally fitted patients were followed with serial audiograms. Data was collected from hearing aid centers. Seventy-seven patients with presbycusis met the inclusion criteria and participated in the present study. The progression of hearing loss in both pure tone thresholds and word recognition scores were compared between the hearing aid ears (HA), and the non-hearing aid ears (NHA). Pure tone thresholds were analyzed by comparing the pure tone average at the initial and last audiograms. Word Recognition Scores (WRS) were analyzed using the model of Thornton and Raffin (1978), and by comparing the change in the absolute values of WRS from the initial to the last audiogram between the HA ear and the NHA ear. Results: No significant difference in pure-tone thresholds between the HA ear and NHA ear was found at the last audiogram ( P = .696), even after dividing the patients into groups based on the duration of amplification. Both methods of analysis of patients’ WRS showed a statistically significant worsening in NHA ( P < .05). Conclusion: The present study supports the previously defined auditory deprivation effect on non-fitted ears, which showed worsening of word recognition over time and no effect on pure tone average. It provides an additional argument for the counseling of patients with presbycusis considering amplification, and highlights the importance of bilateral amplification in preserving the residual hearing of hearing impaired patients.

The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss

2017 ◽  
Vol 28 (01) ◽  
pp. 058-067 ◽  
Author(s):  
Samuel R. Atcherson ◽  
Lisa Lucks Mendel ◽  
Wesley J. Baltimore ◽  
Chhayakanta Patro ◽  
Sungmin Lee ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Speech Perception ◽  
Hearing Impairment ◽  
Visual Input ◽  
Acoustic Properties ◽  
Speech Understanding ◽  
Profound Hearing Loss ◽  
Cross Sectional ◽  
Surgical Masks ◽  
Significant Difference

AbstractIt is generally well known that speech perception is often improved with integrated audiovisual input whether in quiet or in noise. In many health-care environments, however, conventional surgical masks block visual access to the mouth and obscure other potential facial cues. In addition, these environments can be noisy. Although these masks may not alter the acoustic properties, the presence of noise in addition to the lack of visual input can have a deleterious effect on speech understanding. A transparent (“see-through”) surgical mask may help to overcome this issue.To compare the effect of noise and various visual input conditions on speech understanding for listeners with normal hearing (NH) and hearing impairment using different surgical masks.Participants were assigned to one of three groups based on hearing sensitivity in this quasi-experimental, cross-sectional study.A total of 31 adults participated in this study: one talker, ten listeners with NH, ten listeners with moderate sensorineural hearing loss, and ten listeners with severe-to-profound hearing loss.Selected lists from the Connected Speech Test were digitally recorded with and without surgical masks and then presented to the listeners at 65 dB HL in five conditions against a background of four-talker babble (+10 dB SNR): without a mask (auditory only), without a mask (auditory and visual), with a transparent mask (auditory only), with a transparent mask (auditory and visual), and with a paper mask (auditory only).A significant difference was found in the spectral analyses of the speech stimuli with and without the masks; however, no more than ∼2 dB root mean square. Listeners with NH performed consistently well across all conditions. Both groups of listeners with hearing impairment benefitted from visual input from the transparent mask. The magnitude of improvement in speech perception in noise was greatest for the severe-to-profound group.Findings confirm improved speech perception performance in noise for listeners with hearing impairment when visual input is provided using a transparent surgical mask. Most importantly, the use of the transparent mask did not negatively affect speech perception performance in noise.

Cochlear Implantation in Children with Postlingual Progressive Steeply Sloping High-Frequency Hearing Loss

2017 ◽  
Vol 28 (10) ◽  
pp. 913-919 ◽  
Author(s):  
Margaret A. Meredith ◽  
Jay T. Rubinstein ◽  
Kathleen C. Y. Sie ◽  
Susan J. Norton
Keyword(s):  
Hearing Loss ◽  
Speech Perception ◽  
Hearing Aids ◽  
Cochlear Implantation ◽  
High Frequency ◽  
Case Series ◽  
Hearing Preservation ◽  
Rapid Improvement ◽  
Retrospective Case ◽  
Monosyllabic Word

Background: Children with steeply sloping sensorineural hearing loss (SNHL) lack access to critical high-frequency cues despite the use of advanced hearing aid technology. In addition, their auditory-only aided speech perception abilities often meet Food and Drug Administration criteria for cochlear implantation. Purpose: The objective of this study was to describe hearing preservation and speech perception outcomes in a group of young children with steeply sloping SNHL who received a cochlear implant (CI). Research Design: Retrospective case series. Study Sample: Eight children with steeply sloping postlingual progressive SNHL who received a unilateral traditional CI at Seattle Children’s Hospital between 2009 and 2013 and had follow-up data available up to 24 mo postimplant were included. Data Collection and Analysis: A retrospective chart review was completed. Medical records were reviewed for demographic information, preoperative and postoperative behavioral hearing thresholds, and speech perception scores. Paired t tests were used to analyze speech perception data. Hearing preservation results are reported. Results: Rapid improvement of speech perception scores was observed within the first month postimplant for all participants. Mean monosyllabic word scores were 76% and mean phoneme scores were 86.7% at 1-mo postactivation compared to mean preimplant scores of 19.5% and 31.0%, respectively. Hearing preservation was observed in five participants out to 24-mo postactivation. Two participants lost hearing in both the implanted and unimplanted ear, and received a sequential bilateral CI in the other ear after progression of the hearing loss. One participant had a total loss of hearing in only the implanted ear. Results reported in this article are from the ear implanted first. Bilateral outcomes are not reported. Conclusions: CIs provided benefit for children with steeply sloping bilateral hearing loss for whom hearing aids did not provide adequate auditory access. In our cohort, significant improvements in speech understanding occurred rapidly postactivation. Preservation of residual hearing in children with a traditional CI electrode is possible.

scholarly journals Hearing Rehabilitation through Bone-Conducted Sound Stimulation: Preliminary Results

2018 ◽  
Vol 23 (01) ◽  
pp. 012-017 ◽  
Author(s):  
Fayez Bahmad Jr ◽  
Carolina Cardoso ◽  
Fernanda Caldas ◽  
Monique Barreto ◽  
Anacléia Hilgenberg ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Speech Perception ◽  
Hearing Aids ◽  
Subcutaneous Tissue ◽  
Bone Conduction ◽  
Free Field ◽  
Pure Tone Audiometry ◽  
Skin Impedance ◽  
Significant Difference ◽  
Before And After

Introduction The bone-anchored hearing aid (BAHA) is a bone conduction system that transmits the sound directly to the inner ear by surpassing the skin impedance and the subcutaneous tissue. It is indicated for patients with mixed, conductive and unilateral sensorineural hearing loss who did not benefit from conventional hearing aids (HAs). Although the benefits from BAHA are well demonstrated internationally, this field still lacks studies in Brazil. Objective To assess the auditory rehabilitation process in BAHA users through audiological, speech perception and tinnitus aspects. Methods Individuals with hearing loss were assessed before and after the implantation. The participants were subjected to pure tone audiometry in free field, functional gain audiometry, speech perception tests, tinnitus handicap inventory (THI) in open format, and to the visual analog scale (VAS). Results It was found that the participants benefited from the use of BAHA. The difference in the performance of the participants before and after the BAHA surgery was significant in terms of hearing acuity. There was no statistically significant difference in the speech perception tests. The tinnitus assessment showed that 80% of the participants scored slight tinnitus severity in THI after using a BAHA. Eighty percent of the participants classified their tinnitus as absent to mild in the VAS after the surgery. Conclusion Based on the results of the current study, we can conclude that the participants improved both the auditory perception and the tinnitus handicap.

Speech Understanding Using Surgical Masks: A Problem in Health Care?

2008 ◽  
Vol 19 (09) ◽  
pp. 686-695 ◽  
Author(s):  
Lisa Lucks Mendel ◽  
Julie A. Gardino ◽  
Samuel R. Atcherson
Keyword(s):  
Health Care ◽  
Hearing Loss ◽  
Speech Perception ◽  
Hearing Impairment ◽  
Deleterious Effect ◽  
Normal Hearing ◽  
Speech Understanding ◽  
Speech Stimuli ◽  
Dental Office ◽  
Significant Difference

Background: Successful communication is necessary in health-care environments. Yet the presence of noise in hospitals, operating rooms, and dental offices may have a deleterious effect on health-care personnel and patients understanding messages accurately. The presence of a surgical mask and hearing loss may further affect speech perception. Purpose: To evaluate whether a surgical mask had an effect on speech understanding for listeners with normal hearing and hearing impairment when speech stimuli were administered in the presence or absence of dental office noise. Research Design: Participants were assigned to one of two groups based on hearing sensitivity in this quasi-experimental, cross-sectional study. Study Sample: A total of 31 adults participated in this study (1 talker, 15 listeners with normal hearing, and 15 with hearing impairment). The normal hearing group had thresholds of 25 dB HL or better at the octave frequencies from 250 through 8000 Hz while the hearing loss group had varying degrees and configurations of hearing loss with thresholds equal to or poorer than 25 dB HL for the same octave frequencies. Data Collection And Analysis: Selected lists from the Connected Speech Test (CST) were digitally recorded with and without a surgical mask present and then presented to the listeners in four conditions: without a mask in quiet, without a mask in noise, with a mask in quiet, and with a mask in noise. Results: A significant difference was found in the spectral analyses of the speech stimuli with and without the mask. The presence of a surgical mask, however, did not have a detrimental effect on speech understanding in either the normal-hearing or hearing-impaired groups. The dental office noise did have a significant effect on speech understanding for both groups. Conclusions: These findings suggest that the presence of a surgical mask did not negatively affect speech understanding. However, the presence of noise did have a deleterious effect on speech perception and warrants further attention in health-care environments.

scholarly journals Cochlear Implants in Single-Sided Deafness. Comparison Between Children and Adult Populations With Post-lingually Acquired Severe to Profound Hearing Loss

2021 ◽  
Vol 12 ◽  
Author(s):  
Nadia Falcón Benítez ◽  
Juan Carlos Falcón González ◽  
Ángel Ramos Macías ◽  
Silvia Borkoski Barreiro ◽  
Ángel Ramos de Miguel
Keyword(s):  
Hearing Loss ◽  
Speech Perception ◽  
Cochlear Implantation ◽  
Speech Test ◽  
Deaf Adults ◽  
Common Etiology ◽  
Single Sided Deafness ◽  
Positive Results ◽  
Auditory Lateralization

Objective: To determine audiological and clinical results of cochlear implantation (CI) comparing two populations with single-sided deafness (SSD): post-lingually deaf children between 6 and 12 years of age, and post-lingually deaf adults, in order to evaluate the effect of CI in different age groups.Design: Retrospective case review.Setting: Tertiary clinic.Patients and Method: Twenty-three children and twenty-one adult patients that were candidates for CI with single-side deafness were included. In all cases we evaluate: Speech perception thresholds; disyllabic words test (65 dB SPL) were performed in the modalities S0–SCI–SNH and Auditory Lateralization Test. The Speech, Spatial, and Qualities of Hearing Scale (SSQ) questionnaire was also used. All results were obtained after 12 months of CI activation.Results: In children, the most common etiology was idiopathic sensory-neural hearing loss. They showed positive results in the Auditory Lateralization Test. In the Speech Test, word recognition in noise improved from 2% preoperatively to 61.1% at a mean follow-up of 1 year (S0 condition) in children [test with signal in CI side 60% and signal normal hearing side (plugged) 31%]. The processor was used for &gt;12 h in all cases. With respect to the SSQ questionnaire, parents were more satisfied within the postoperative period than within the preoperative period. For adults, the most common etiology was idiopathic sudden sensorineural hearing loss (SNHL). Positive results in the Auditory Lateralization Test were found. With respect to the Speech Test in quiet conditions: Word recognition in noise improved from 5.7% preoperatively to 71.8% at a mean follow-up of 1 year [test with signal in CI side 68% and signal normal hearing side (plugged) 41%]. The processor was used for &gt;12 h. In the SSQ questionnaire, the post-operative results showed a beneficial effect of the CI. No adverse events were reported during the study period. No differences were found between children and adults in all tests in this study.Conclusions: Cochlear implantation in post-lingually deaf adults and children with SSD can achieve a speech perception outcome comparable with CI in conventional candidates. Improvements in spatial hearing were also observed. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.

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