A MultiCenter Analysis of Factors Associated with Hearing Outcome for 2,735 Adults with Cochlear Implants.
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ABSTRACT:
SUBMITTER: Goudey B
PROVIDER: S-EPMC8450683 | biostudies-literature | 2021 Jan-Dec
REPOSITORIES: biostudies-literature
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A MultiCenter Analysis of Factors Associated with Hearing Outcome for 2,735 Adults with Cochlear Implants.
Goudey Benjamin B Plant Kerrie K Kiral Isabell I Jimeno-Yepes Antonio A Swan Annalisa A Gambhir Manoj M Büchner Andreas A Kludt Eugen E Eikelboom Robert H RH Sucher Cathy C Gifford Rene H RH Rottier Riaan R Anjomshoa Hamideh H
Trends in hearing 20210101
While the majority of cochlear implant recipients benefit from the device, it remains difficult to estimate the degree of benefit for a specific patient prior to implantation. Using data from 2,735 cochlear-implant recipients from across three clinics, the largest retrospective study of cochlear-implant outcomes to date, we investigate the association between 21 preoperative factors and speech recognition approximately one year after implantation and explore the consistency of their effects acro ...[more]
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Project description:A great deal of variability exists in the speech-recognition abilities of postlingually deaf adult cochlear implant (CI) recipients. A number of previous studies have shown that duration of deafness is a primary factor affecting CI outcomes; however, there is little agreement regarding other factors that may affect performance. The objective of the present study was to determine the source of variability in CI outcomes by examining three main factors, biographic/audiologic information, electrode position within the cochlea, and cognitive abilities in a group of newly implanted CI recipients.Participants were 114 postlingually deaf adults with either the Cochlear or Advanced Bionics CI systems. Biographic/audiologic information, aided sentence-recognition scores, a high resolution temporal bone CT scan and cognitive measures were obtained before implantation. Monosyllabic word recognition scores were obtained during numerous test intervals from 2 weeks to 2 years after initial activation of the CI. Electrode position within the cochlea was determined by three-dimensional reconstruction of pre- and postimplant CT scans. Participants' word scores over 2 years were fit with a logistic curve to predict word score as a function of time and to highlight 4-word recognition metrics (CNC initial score, CNC final score, rise time to 90% of CNC final score, and CNC difference score).Participants were divided into six outcome groups based on the percentile ranking of their CNC final score, that is, participants in the bottom 10% were in group 1; those in the top 10% were in group 6. Across outcome groups, significant relationships from low to high performance were identified. Biographic/audiologic factors of age at implantation, duration of hearing loss, duration of hearing aid use, and duration of severe-to-profound hearing loss were significantly and inversely related to performance as were frequency modulated tone, sound-field threshold levels obtained with the CI. That is, the higher-performing outcome groups were younger in age at the time of implantation, had shorter duration of severe-to-profound hearing loss, and had lower CI sound-field threshold levels. Significant inverse relationships across outcome groups were also observed for electrode position, specifically the percentage of electrodes in scala vestibuli as opposed to scala tympani and depth of insertion of the electrode array. In addition, positioning of electrode arrays closer to the modiolar wall was positively correlated with outcome. Cognitive ability was significantly and positively related to outcome; however, age at implantation and cognition were highly correlated. After controlling for age, cognition was no longer a factor affecting outcomes.There are a number of factors that limit CI outcomes. They can act singularly or collectively to restrict an individual's performance and to varying degrees. The highest performing CI recipients are those with the least number of limiting factors. Knowledge of when and how these factors affect performance can favorably influence counseling, device fitting, and rehabilitation for individual patients and can contribute to improved device design and application.
| S-EPMC3636188 | biostudies-literature
Project description:ObjectivesBinaural pitch fusion is the perceptual integration of stimuli that evoke different pitches between the ears into a single auditory image. Adults who use hearing aids (HAs) or cochlear implants (CIs) often experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3 to 4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The main goal of this study was to measure binaural pitch fusion in children with different hearing device combinations and compare results across groups and with adults. A second goal was to examine the relationship of binaural pitch fusion to interaural pitch differences or pitch match range, a measure of sequential pitch discriminability.DesignBinaural pitch fusion was measured in children between the ages of 6.1 and 11.1 years with bilateral HAs (n = 9), bimodal CI (n = 10), bilateral CIs (n = 17), as well as normal-hearing (NH) children (n = 21). Depending on device combination, stimuli were pure tones or electric pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Interaural pitch match functions were measured using sequential presentation of reference and comparison stimuli, and varying the comparison stimulus to find the pitch match center and range.ResultsChildren with bilateral HAs had significantly broader binaural pitch fusion than children with NH, bimodal CI, or bilateral CIs. Children with NH and bilateral HAs, but not children with bimodal or bilateral CIs, had significantly broader fusion than adults with the same hearing status and device configuration. In children with bilateral CIs, fusion range was correlated with several variables that were also correlated with each other: pure-tone average in the second implanted ear before CI, and duration of prior bilateral HA, bimodal CI, or bilateral CI experience. No relationship was observed between fusion range and pitch match differences or range.ConclusionsThe findings suggest that binaural pitch fusion is still developing in this age range and depends on hearing device combination but not on interaural pitch differences or discriminability.
| S-EPMC9014818 | biostudies-literature
Project description:Neurodevelopmental changes occur with asymmetric hearing loss, limiting binaural/spatial hearing and putting children at risk for social and educational challenges. These deficits may be mitigated by providing bilateral hearing in children through auditory prostheses. Effects on speech perception and spatial hearing were measured in a large cohort of >450 children who were deaf and used bilateral cochlear implants or bimodal devices (one cochlear implant and a contralateral hearing aid). Results revealed an advantage of bilateral over unilateral device use but this advantage decreased as hearing in the two ears became increasingly asymmetric. Delayed implantation of an ear with severe to profound deafness allowed asymmetric hearing, creating aural preference for the better hearing ear. These findings indicate that bilateral input with the most appropriate device for each ear should be provided early and without delay during development.
| S-EPMC6123397 | biostudies-literature
Project description:BACKGROUND:Previous research has demonstrated an association of scores on a visual test of nonverbal reasoning, Raven's Progressive Matrices (RPM), with scores on open-set sentence recognition in quiet for adult cochlear implant (CI) users as well as for adults with normal hearing (NH) listening to noise-vocoded sentence materials. Moreover, in that study, CI users demonstrated poorer nonverbal reasoning when compared with NH peers. However, it remains unclear what underlying neurocognitive processes contributed to the association of nonverbal reasoning scores with sentence recognition, and to the poorer scores demonstrated by CI users. OBJECTIVES:Three hypotheses were tested: (1) nonverbal reasoning abilities of adult CI users and normal-hearing (NH) age-matched peers would be predicted by performance on more basic neurocognitive measures of working memory capacity, information-processing speed, inhibitory control, and concentration; (2) nonverbal reasoning would mediate the effects of more basic neurocognitive functions on sentence recognition in both groups; and (3) group differences in more basic neurocognitive functions would explain the group differences previously demonstrated in nonverbal reasoning. METHOD:Eighty-three participants (40 CI and 43 NH) underwent testing of sentence recognition using two sets of sentence materials: sentences produced by a single male talker (Harvard sentences) and high-variability sentences produced by multiple talkers (Perceptually Robust English Sentence Test Open-set, PRESTO). Participants also completed testing of nonverbal reasoning using a visual computerized RPM test, and additional neurocognitive assessments were collected using a visual Digit Span test and a Stroop Color-Word task. Multivariate regression analyses were performed to test our hypotheses while treating age as a covariate. RESULTS:In the CI group, information processing speed on the Stroop task predicted RPM performance, and RPM scores mediated the effects of information processing speed on sentence recognition abilities for both Harvard and PRESTO sentences. In contrast, for the NH group, Stroop inhibitory control predicted RPM performance, and a trend was seen towards RPM scores mediating the effects of inhibitory control on sentence recognition, but only for PRESTO sentences. Poorer RPM performance in CI users than NH controls could be partially attributed to slower information processing speed. CONCLUSIONS:Neurocognitive functions contributed differentially to nonverbal reasoning performance in CI users as compared with NH peers, and nonverbal reasoning appeared to partially mediate the effects of these different neurocognitive functions on sentence recognition in both groups, at least for PRESTO sentences. Slower information processing speed accounted for poorer nonverbal reasoning scores in CI users. Thus, it may be that prolonged auditory deprivation contributes to cognitive decline through slower information processing.
| S-EPMC7055483 | biostudies-literature
Project description:PurposeThe breadth of binaural pitch fusion, the integration of sounds differing in frequency across the two ears, can limit the ability to segregate and understand speech in background noise. Binaural pitch fusion is one type of central auditory processing that may still be developing in the pre-adolescent age range. In addition, children with hearing loss potentially have different trajectories of development of central auditory processing compared to their normal-hearing (NH) peers, due to disruption of auditory input and/or abnormal stimulation from hearing devices. The goal of this study was to measure and compare binaural pitch fusion changes during development in children with NH versus hearing loss and different hearing device combinations. Interaural pitch discrimination abilities were also measured to control for pitch discrimination as a potential limiting factor for fusion that may also change during development.MethodsBaseline measurements of binaural pitch fusion and interaural pitch discrimination were conducted in a total of 62 (22 female) children with NH (n = 25), bilateral hearing aids (HA; n = 10, bimodal cochlear implants (CI; n = 9), and bilateral CIs (n = 18), with longitudinal follow-up for a subset of participants (18 NH, 9 HA, 8 bimodal CI, and 15 bilateral CI). Age at the start of testing ranged from 6 to 10 years old, with a goal of repeated measurements over 3-6 years. Binaural pitch fusion ranges were measured as the range of acoustic frequencies (electrodes) presented to one ear that was perceptually fused with a single reference frequency (electrode) presented simultaneously to the other ear. Similarly, interaural pitch discrimination was measured as the range of frequencies (electrodes) that could not be consistently ranked in pitch compared to a single reference frequency (electrode) under sequential presentation to opposite ears.ResultsChildren with NH and HAs initially had broad binaural pitch fusion ranges compared to adults. With increasing age, the binaural fusion range narrowed by 1-3 octaves for children with NH, bilateral HAs, and bimodal CIs, but not for children with bilateral CIs. Interaural pitch discrimination showed no changes with age, though differences in discrimination ability were seen across groups.ConclusionBinaural fusion sharpens significantly on the scale of octaves in the age range from 6 to 14 years. The lack of change in interaural pitch discrimination with increasing age rules out discrimination changes as an explanation for the binaural fusion range changes. The differences in the trajectory of binaural fusion changes across groups indicate the importance of hearing device combination for the development of binaural processing abilities in children with hearing loss, with implications for addressing challenges with speech perception in noise. Together, the results suggest that pruning of binaural connections is still occurring and likely guided by hearing experience during childhood development.
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Project description:BackgroundResearch has shown unilateral cochlear implants (CIs) significantly improve clinical outcomes and quality of life in adults. However, only 13% of eligible Swedish adults currently use a unilateral CI. The objective was to estimate the cost-effectiveness of unilateral CIs compared to a hearing aid for Swedish adults with severe to profound hearing loss.MethodsA Markov model with a lifetime horizon and six-month cycle length was developed to estimate the benefits and costs of unilateral CIs from the Swedish health system perspective. A treatment pathway was developed through consultation with clinical experts to estimate resource use and costs. Unit costs were derived from the Swedish National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions. Health outcomes were reported in terms of Quality Adjusted Life Years (QALYs).ResultsUnilateral CIs for Swedish adults with severe to profound hearing loss are likely to be deemed cost-effective when compared to a hearing aid (SEK 140,474 per QALY gained). The results were most sensitive to the age when patients are implanted with a CI and the proportion of patients eligible for CIs after triage.ConclusionsAn increase in the prevalence of Swedish adults with severe to profound hearing loss is expected as the population ages. Earlier implantation of unilateral CIs improves the cost-effectiveness among people eligible for CIs. Unilateral CIs are an efficacious and cost-effective option to improve hearing and quality of life in Swedish adults with severe to profound hearing loss.
| S-EPMC8034197 | biostudies-literature
Project description:BackgroundHearing loss impacts health-related quality of life and general well-being and was identified in a Lancet report as one of the largest potentially modifiable factors for the prevention of age-related dementia. There is a lack of robust data on how cochlear implant treatment in the elderly impacts quality of life. The primary objective was to measure the change in health utility following cochlear implantation in individuals aged ≥ 60 years.MethodsThis study uniquely prospectively recruited a large multinational sample of 100 older adults (mean age 71.7 (SD7.6) range 60-91 years) with severe to profound hearing loss. In a repeated-measures design, pre and post implant outcome measures were analysed using mixed-effect models. Health utility was assessed with the Health Utilities Index Mark III (HUI3). Subjects were divided into groups of 60-64, 65-74 and 75 + years.ResultsAt 18 months post implant, the mean HUI3 score improved by 0.13 (95%CI: 0.07-0.18 p < 0.001). There was no statistically significant difference in the HUI3 between age groups (F[2,9228] = 0.53, p = 0.59). The De Jong Loneliness scale reduced by an average of 0.61 (95%CI: 0.25-0.97 p < 0.014) and the Lawton Instrumental Activities of Daily Living Scale improved on average (1.25, 95%CI: 0.85-1.65 p < 0.001). Hearing Handicap Inventory for the Elderly Screening reduced by an average of 8.7 (95%CI: 6.7-10.8, p < 0.001) from a significant to mild-moderate hearing handicap. Age was not a statistically significant factor for any of the other measures (p > 0.20). At baseline 90% of participants had no or mild depression and there was no change in mean depression scores after implant. Categories of Auditory perception scale showed that all subjects achieved a level of speech sound discrimination without lip reading post implantation (level 4) and at least 50% could use the telephone with a known speaker.ConclusionsBetter hearing improved individuals' quality of life, ability to communicate verbally and their ability to function independently. They felt less lonely and less handicapped by their hearing loss. Benefits were independent of age group. Cochlear implants should be considered as a routine treatment option for those over 60 years with bilateral severe to profound hearing loss.Trial registrationClinicalTrials.gov ( http://www.Clinicaltrialsgov/ ), 7 March 2017, NCT03072862.
| S-EPMC10768457 | biostudies-literature
Project description:PurposeThe affective properties of infant-directed speech influence the attention of infants with normal hearing to speech sounds. This study explored the affective quality of maternal speech to infants with hearing impairment (HI) during the 1st year after cochlear implantation as compared to speech to infants with normal hearing.MethodMothers of infants with HI and mothers of infants with normal hearing matched by age (NH-AM) or hearing experience (NH-EM) were recorded playing with their infants during 3 sessions over a 12-month period. Speech samples of 25 s were low-pass filtered, leaving intonation but not speech information intact. Sixty adults rated the stimuli along 5 scales: positive/negative affect and intention to express affection, to encourage attention, to comfort/soothe, and to direct behavior.ResultsLow-pass filtered speech to HI and NH-EM groups was rated as more positive, affective, and comforting compared with the such speech to the NH-AM group. Speech to infants with HI and with NH-AM was rated as more directive than speech to the NH-EM group. Mothers decreased affective qualities in speech to all infants but increased directive qualities in speech to infants with NH-EM over time.ConclusionsMothers fine-tune communicative intent in speech to their infant's developmental stage. They adjust affective qualities to infants' hearing experience rather than to chronological age but adjust directive qualities of speech to the chronological age of their infants.
| S-EPMC4610283 | biostudies-literature
Project description:PurposeTo systematically review the existing literature that examines the relationship between cognition, hearing, and language in children using cochlear implants and hearing aids.MethodThe review has been registered in Prospero (Registration: CRD 42020203974). The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and examined the scientific literature in VHL, MEDLINE, CINAHL, Scopus, WOS, and Embase. It included original observational studies in children using hearing aids and/or cochlear implants who underwent cognitive and auditory and/or language tests. Data were extracted from the studies and their level of evidence was graded with the Oxford Center for Evidence-Based Medicine: Levels of Evidence. Meta-analysis could not be performed due to data heterogeneity. Outcomes are described in narrative and tables synthesis.ResultsThe systematic search and subsequent full-text evaluation identified 21 studies, conducted in 10 different countries. Altogether, their samples comprised 1,098 individuals, aged 0.16-12.6 years. The studies assessed the following cognitive domains: memory, nonverbal cognition, reasoning, attention, executive functions, language, perceptual-motor function, visuoconstructive ability, processing speed, and phonological processing/phonological memory. Children with hearing loss using cochlear implants and hearing aids scored significantly lower in many cognitive functions than normal hearing (NH) children. Neurocognitive functions were correlated with hearing and language outcomes.ConclusionMany cognitive tools were used to assess cognitive function in children with hearing devices. Results suggest that children with cochlear implants and hearing aids have cognitive deficits; these outcomes are mainly correlated with vocabulary. This study highlights the need to understand children's cognitive function and increase the knowledge of the relationship between cognition, language, and hearing in children using cochlear implants and hearing aids.
| S-EPMC10582571 | biostudies-literature
Project description:Early hearing intervention in children with congenital hearing loss is critical for improving auditory development, speech recognition and both expressive and receptive language, which translates into better educational outcomes and quality of life. In children receiving hearing aids or cochlear implants, both adaptive and potentially maladaptive neural reorganization can mitigate higher-level functions that impact reading. The focus of the present study was to dissect the neural underpinnings of the reading networks in children with cochlear implants and assess how these networks mediate the reading ability in children with cochlear implants. Cortical activity was obtained using naturalistic stimuli from 75 children (50 cochlear implant recipients, aged 7-17, and 25 age-matched children with typical hearing) using functional near-infrared spectroscopy. Assessment of basic reading skill was completed using the Reading Inventory and Scholastic Evaluation. We computed directed functional connectivity of the haemodynamic activity in reading-associated anterior and posterior brain regions using the time-frequency causality estimation method known as temporal partial directed coherence. The influence of the cochlear implant-related clinical measures on reading outcome and the extent to which neural connectivity mediated these effects were examined using structural equation modelling. Our findings reveal that the timing of intervention (e.g. age of first cochlear implants, age of first hearing aid) in children with cochlear implants significantly influenced their reading ability. Furthermore, reading-related processes (word recognition and decoding, vocabulary, morphology and sentence processing) were substantially mediated by the directed functional connectivity within reading-related neural circuits. Notably, the impact of these effects differed across various reading skills. Hearing age, defined as the age at which a participant received adequate access to sound, and age of initial implantation emerged as robust predictors of reading proficiency. The current study is one of the first to identify the influence of neural characteristics on reading outcomes for children with cochlear implants. The findings emphasize the importance of the duration of deafness and early intervention for enhancing outcomes and strengthening neural network connections. However, the neural evidence further suggested that such positive influences cannot fully offset the detrimental impact of early auditory deprivation. Consequently, additional, perhaps more specialized, interventions might be necessary to maximize the benefits of early prosthetic hearing intervention.
| S-EPMC11881800 | biostudies-literature