Perceptions of Sound Quality and Enjoyment After Cochlear Implantation.
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ABSTRACT: Objectives
To characterize the quality and enjoyment of sound by cochlear implant (CI) recipients and identify predictors of these outcomes after cochlear implantation.Study design
Cross-sectional study.Setting
A tertiary care hospital.Methods
Surveys based on the Hearing Implant Sound Quality Index were sent to all patients who received a CI at a tertiary care hospital from 2000 to 2019. Survey questions prompted CI recipients to characterize enjoyment and quality of voices, music, and various sounds.Results
Of the 339 surveys, 60 (17.7%) were returned with complete data. CI recipients had a mean ± SD age of 62.5 ± 17.4 years with a mean 8.0 ± 6.1 years since CI surgery. Older current age and age at implantation significantly predicted lower current sound quality (P < .05) and sound enjoyment (P < .05), as well as worsening of sound quality (P < .05) and sound enjoyment (P < .05) over time. Greater length of implantation was associated with higher reported quality and enjoyment (r = 0.4, P < .001; r = 0.4, P < .05), as well as improvement of sound quality (r = 0.3, P < .05) but not sound enjoyment over time.Conclusion
Recipients who had CIs for a longer period had improved quality of sound perception, suggesting a degree of adaptation. However, CI recipients with implantation at an older age reported poorer sound quality and enjoyment as well as worsening sound quality and enjoyment over time, indicating that age-related changes influence outcomes of cochlear implantation.
SUBMITTER: Bessen SY
PROVIDER: S-EPMC8477700 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:OBJECTIVE:To determine whether patient-derived programming of one's cochlear implant (CI) stimulation levels may affect performance outcomes. BACKGROUND:Increases in patient population, device complexity, outcome expectations, and clinician responsibility have demonstrated the necessity for improved clinical efficiency. METHODS:Eighteen postlingually deafened adult CI recipients (mean?=?53 years; range, 24-83 years) participated in a repeated-measures, within-participant study designed to compare their baseline listening program to an experimental program they created. RESULTS:No significant group differences in aided sound-field thresholds, monosyllabic word recognition, speech understanding in quiet, speech understanding in noise, nor spectral modulation detection (SMD) were observed (p?>?0.05). Four ears (17%) improved with the experimental program for speech presented at 45?dB SPL and two ears (9%) performed worse. Six ears (27.3%) improved significantly with the self-fit program at +10?dB signal-to-noise ratio (SNR) and four ears (26.6%) improved in speech understanding at +5?dB SNR. No individual scored significantly worse when speech was presented in quiet at 60?dB SPL or in any of the noise conditions tested. All but one participant opted to keep at least one of the self-fitting programs at the completion of this study. Participants viewed the process of creating their program more favorably (t?=?2.11, p?=?0.012) and thought creating the program was easier than the traditional fitting methodology (t?=?2.12, p?=?0.003). Average time to create the self-fit program was 10?minutes, 10?seconds (mean?=?9:22; range, 4:46-24:40). CONCLUSIONS:Allowing experienced adult CI recipients to set their own stimulation levels without clinical guidance is not detrimental to success.
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Project description:Purpose The aims of this study were (a) to longitudinally assess environmental sound recognition (ESR) before and after cochlear implantation in a sample of postlingually deafened adults and (b) to assess the extent to which spectro-temporal processing abilities influence ESR with cochlear implants (CIs). Method In a longitudinal cohort study, 20 postlingually deafened adults were tested with hearing aids on the Familiar Environmental Sound Test-Identification and AzBio sentences in quiet pre-CI and 6 months post-CI. A subset of 11 participants were also tested 12 months post-CI. Pre-CI spectro-temporal processing was assessed using the Spectral-temporally Modulated Ripple Test. Results Average ESR accuracy pre-CI (M = 63.60%) was not significantly different from ESR accuracy at 6 months (M = 65.40%) or 12 months (M = 69.09%) post-CI. In 11 participants (55%), however, ESR improved following implantation by 10.91 percentage points, on average. Pre-CI ESR correlated moderately and significantly with pre-CI and 12-month post-CI AzBio scores, with a trend toward significance for AzBio performance at 6 months. Pre-CI spectro-temporal processing was moderately associated with ESR at 6 and 12 months post-CI but not with speech recognition post-CI. Conclusions The present findings failed to demonstrate an overall significant improvement in ESR following implantation. Nevertheless, more than half of our sample showed some degree of improvement in ESR. Several environmental sounds were poorly identified both before and after implantation. Spectro-temporal processing ability prior to implantation appears to predict postimplantation performance for ESR. These findings indicate the need for greater attention to ESR following cochlear implantation and for developing individualized targets for ESR rehabilitation. Supplemental Material https://doi.org/10.23641/asha.13876745.
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Project description:Cochlear implant (CI) users commonly report degraded musical sound quality. To improve CI-mediated music perception and enjoyment, we must understand factors that affect sound quality. In the present study, we utilize frequency response manipulation (FRM), a process that adjusts the energies of frequency bands within an audio signal, to determine its impact on CI-user sound quality assessments of musical stimuli. Thirty-three adult CI users completed an online study and listened to FRM-altered clips derived from the top songs in Billboard magazine. Participants assessed sound quality using the MUltiple Stimulus with Hidden Reference and Anchor for CI users (CI-MUSHRA) rating scale. FRM affected sound quality ratings (SQR). Specifically, increasing the gain for low and mid-range frequencies led to higher quality ratings than reducing them. In contrast, manipulating the gain for high frequencies (those above 2 kHz) had no impact. Participants with musical training were more sensitive to FRM than non-musically trained participants and demonstrated preference for gain increases over reductions. These findings suggest that, even among CI users, past musical training provides listeners with subtleties in musical appraisal, even though their hearing is now mediated electrically and bears little resemblance to their musical experience prior to implantation. Increased gain below 2 kHz may lead to higher sound quality than for equivalent reductions, perhaps because it offers greater access to lyrics in songs or because it provides more salient beat sensations.
| S-EPMC9393940 | biostudies-literature
Project description:ImportancePrevious research suggests that clinicians view realistic patient expectations as the most important nonaudiological factor in the decision to proceed with a cochlear implant (CI). However, clinicians have few data to determine whether patients' outcome expectations are realistic.ObjectiveTo address this unmet clinical need through the development and psychometric analysis of a new patient-reported outcome measure, the CI Quality of Life (CIQOL) Expectations.Design, setting, and participantsThis cross-sectional study was conducted at a tertiary CI center from February 26, 2020, to August 31, 2021. First, a team comprising 2 CI audiologists, a CI surgeon, a hearing scientist, and 2 psychometricians with experience in instrument development converted all items from the CIQOL-35 Profile instrument into statements reflecting expected outcomes. Then, cognitive interviews with 20 potential CI users assessed the clarity and comprehensiveness of the new instrument. Next, responses to the CIQOL-Expectations instrument for 131 potential adult CI candidates were psychometrically analyzed using confirmatory factor analysis and item response theory. Finally, degree to which patient expectations changed from before to after and their CI evaluation appointments was measured.InterventionThe CIQOL-Expectations instrument.ResultsOf 178 participants, 85 (47.8%) were female, and there was 1 (0.6%) Asian, 26 (14.6%) Black or African American, 1 (0.6%) Latinx, and 150 (84.3%) White individuals. No major content or grammar changes were identified during the cognitive interviews. Overall, all CIQOL domains demonstrated adequate to strong psychometric properties. Several domains did not meet all a priori established indicators of model fit or ability to separate CI users based on response patterns, but all met most indicators. Potential CI users demonstrated the highest mean (SD) expectation scores for the environment (70.2 [20.8]) and social (68.4 [18.0]) domains. In addition, the entertainment (20 [15.3%]) and environment (31 [24.4%]) domains had the highest percentage of patients with expectation scores of 100. Yet, normative CIQOL-35 Profile data from experienced CI users suggested few patients obtain this high degree of functional benefit after implant.Conclusions and relevanceThe results of this cross-sectional study suggest that the CIQOL-Expectations instrument may provide an opportunity to assess potential CI users' expected outcomes using modification of an established CIQOL instrument and a patient-centered framework. The included items and domains reflect real-world functional abilities valued by CI users and may provide opportunities for an evidence-based shared decision-making approach to the CI evaluation process. With this instrument, clinicians can compare individual patients' pre-CI outcome expectations with established normative data and provide appropriate counseling.
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Project description:BackgroundHearing-related quality of life (QoL) after cochlear implantation (CI) is as important as audiological performance. We evaluated the functional results and QoL after CI in a heterogeneous patient cohort with emphasis on patients with long-term deafness (>10 years).MethodsTwenty-eight patients (n = 32 implanted ears, within n = 12 long-term deaf ears) implanted with a mid-scala electrode array were included in this retrospective mono-centric cohort study. Speech intelligibility for monosyllables (SIM), speech reception thresholds (SRT50) and QoL with Nijmegen Cochlear Implant Questionnaire (NCIQ) were registered. Correlation of SIM and QoL was analyzed.ResultsSIM and SRT50 improved significantly 12 months postoperatively up to 54.8 ± 29.1% and 49.3 ± 9.6 dB SPL, respectively. SIM progressively improved up to 1 year, but some early-deafened, late implanted patients developed speech understanding several years after implantation. The global and all subdomain QoL scores increased significantly up to 12 months postoperatively and we found a correlation of SIM and global QoL score at 12 months postoperatively. Several patients of the "poor performer" (SIM < 40%) group reported high improvement of hearing-related QoL.ConclusionsCochlear implantation provides a benefit in hearing-related QoL, even in some patients with low postoperative speech intelligibility results. Consequently, hearing-related QoL scores should be routinely used as outcome measure beside standard speech understanding tests, as well. Further studies with a prospective multi-centric design are needed to identify factors influencing post-implantation functional results and QoL in the patient group of long-term deafness.
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Project description:We present motions of individual freestanding hair bundles in an isolated cochlea in response to tonal sound stimulation. Motions were measured from images taken by strobing a light source at the tone frequency. The tips and bases of hair bundles moved a comparable amount, but with a phase difference that increased by 180 degrees with frequency, indicating that distributed fluid properties drove hair bundle motion. Hair bundle rotation increased with frequency to a constant value, and underwent >90 degrees of phase change. The frequency at which the phase of rotation relative to deflection of the bundle base was 60 degrees was comparable to the expected best frequency of each hair cell, and varied inversely with the square of bundle height. The sharpness of tuning of individual hair bundles was comparable to that of hair cell receptor potentials at high sound levels. These results indicate that frequency selectivity at high sound levels in this cochlea is purely mechanical, determined by the interaction of hair bundles with the surrounding fluid. The sharper tuning of receptor potentials at lower sound levels is consistent with the presence of a negative damping, but not a negative stiffness, as an active amplifier in hair bundles.
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Project description:BackgroundSensorineural hearing loss occurs as a result of damage to the hair cells in the cochlea, or to the auditory nerve. It negatively affects learning and development in children, and employment and economic attainment in adults. Current policy in Ontario is to provide unilateral cochlear implantation for patients with bilateral severe to profound sensorineural hearing loss. However, hearing with both ears as a result of bilateral cochlear implantation may offer added benefits.MethodsWe completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, budget impact, and patient preferences related to bilateral cochlear implantation. We performed a systematic literature search for studies on bilateral cochlear implantation in adults and children from inception to March 2017. We conducted a cost-utility analysis with a lifetime horizon from a public payer perspective and analyzed the budget impact of publicly funding bilateral cochlear implantation in adults and children in Ontario for the next 5 years. Finally, we conducted interviews with adults who have sensorineural hearing loss and unilateral or bilateral cochlear implants, and with parents of children with bilateral cochlear implants.ResultsWe included 24 publications (10 in adults, 14 in children) in the clinical evidence review. Compared with unilateral cochlear implantation, bilateral cochlear implantation improved sound localization, speech perception in noise, and subjective benefits of hearing in adults and children with severe to profound sensorineural hearing loss (GRADE: moderate to high). Bilateral cochlear implantation also allowed for better language development and more vocalization in preverbal communication in children (GRADE: moderate). The safety profile was acceptable.Bilateral cochlear implantation was more expensive and more effective than unilateral cochlear implantation. The incremental cost-effectiveness ratio was $48,978/QALY in adults and between $27,427/QALY and $30,386/QALY in children. Cost-effectiveness was highly dependent on the quality-of-life values used. We estimated that the net budget impact of publicly funding bilateral cochlear implantation for adults in Ontario would be between $510,000 and $780,000 per year for the next 5 years.Patients described the social and emotional effects of hearing loss, and the benefits and challenges of using cochlear implants.ConclusionsBased on evidence of moderate to high quality, we found that bilateral cochlear implantation improved hearing in adults and children with severe to profound sensorineural hearing loss. Bilateral cochlear implantation was potentially cost-effective compared to unilateral cochlear implantation in adults and children. Patients with sensorineural hearing loss reported the positive effects of cochlear implants, and patients with unilateral cochlear implants generally expressed a desire for bilateral implants.
| S-EPMC6235073 | biostudies-literature
Project description:ObjectivesCorrect electrode placement is a challenge of cochlear implant surgery, which occurs because electrode position cannot be directly visualized. This work aims to 1) develop a protocol for a practical, consistent, single view plain radiograph able to be used to confirm cochlear implantation, 2) confirm its usefulness on patients, and 3) confirm its usefulness for identifying misplaced electrodes in cadaveric ears.Study designImaging procedure and quality improvement initiative.SettingTertiary academic hospital.PatientsCadaveric ears, and patients undergoing cochlear implantation.InterventionsAn intraoperative imaging protocol was developed specifying patient head position, machine position, and exposure setting. This was tested to confirm proper cochlear implantation in patients, including one revision case. This technique allowed the electrode placement to be reliably identified in patients of all ages. Its usefulness for identifying maligned electrodes (partial insertion, and insertion into the vestibule or hypotympanum) was confirmed using four cadaveric hemi-heads.Main outcome measuresAbility to accurately identify correct or incorrect electrode insertion based on radiographic images.ResultsAfter adjusting radiographic exposure to account for the embalming process of the cadaveric heads, this new protocol was confirmed to be able to identify incorrect placement. This was also successfully used to confirm proper placement of cochlear implants in patients.ConclusionsFollowing a standardized radiographic protocol for cochlear implantation is a quick and easy method for checking electrode position.Supplemental Digital Content, http://links.lww.com/MAO/B253.
| S-EPMC8192428 | biostudies-literature
Project description:Cochlear implantation has become the standard-of-care for adults and children with severe to profound hearing loss. There is growing evidence that qualitative as well as quantitative deficits in the auditory nerve may affect cochlear implant (CI) outcomes. Auditory neuropathy spectrum disorder (ANSD) is characterized by dysfunctional transmission of sound from the cochlea to the brain due to defective synaptic function or neural conduction. In this review, we examine the precise mechanisms of genetic lesions causing ANSD and the effect of these lesions on CI outcomes. Reviewed data show that individuals with lesions that primarily affect the cochlear sensory system and the synapse, which are bypassed by the CI, have optimal CI outcomes. Individuals with lesions that affect the auditory nerve show poor performance with CIs, likely because neural transmission of the electrical signal from the CI is affected. We put forth a nuanced molecular classification of ANSD that has implications for preoperative counseling for patients with this disorder prior to cochlear implantation. We propose that description of ANSD patients should be based on the molecular site of lesion typically derived from genetic evaluation (synaptopathy vs. neuropathy) as this has implications for expected CI outcomes. Improvements in our understanding of genetic site of lesions and their effects on CI function should lead to better CI outcomes, not just for individuals with auditory neuropathy, but all individuals with hearing loss.
| S-EPMC6703118 | biostudies-literature