Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation

Abstract

Objective: Establish up-to-date evidence-based guidelines for recommending cochlear implantation for young children. Design: Speech perception results for early-implanted children were compared to children using traditional amplification. Equivalent pure-tone average (PTA) hearing loss for cochlear implant (CI) users was established. Language of early-implanted children was assessed over six years and compared to hearing peers. Study sample: Seventy-eight children using CIs and 62 children using traditional amplification with hearing losses ranging 25–120?dB HL PTA (speech perception study). Thirty-two children who received a CI before 2.5 years of age (language study). Results: Speech perception outcomes suggested that children with a PTA greater than 60?dB HL have a 75% chance of benefit over traditional amplification. More conservative criteria applied to the data suggested that children with PTA greater than 82?dB HL have a 95% chance of benefit. Children implanted under 2.5 years with no significant cognitive deficits made normal language progress but retained a delay approximately equal to their age at implantation. Conclusions: Hearing-impaired children under three years of age may benefit from cochlear implantation if their PTA exceeds 60?dB HL bilaterally. Implantation as young as possible should minimize any language delay resulting from an initial period of auditory deprivation.     

The case for earlier cochlear implantation in postlingually deaf adults

Abstract

Objective: This paper aimed to estimate the difference in speech perception outcomes that may occur due to timing of cochlear implantation in relation to the progression of hearing loss. Design: Data from a large population-based sample of adults with acquired hearing loss using cochlear implants (CIs) was used to estimate the effects of duration of hearing loss, age, and pre-implant auditory skills on outcomes for a hypothetical standard patient. Study sample: A total of 310 adults with acquired severe/profound bilateral hearing loss who received a CI in Melbourne, Australia between 1994 and 2006 provided the speech perception data and demographic information to derive regression equations for estimating CI outcomes. Results: For a hypothetical CI candidate with progressive sensorineural hearing loss, the estimates of speech perception scores following cochlear implantation are significantly better if implantation occurs relatively soon after onset of severe hearing loss and before the loss of all functional auditory skills. Conclusions: Improved CI outcomes and quality of life benefit may be achieved for adults with progressive severe hearing loss if they are implanted earlier in the progression of the pathology.     

Prevalence of cochlear implants in postlingually deafened adults in a Swedish region

Cochlear implantation (CI) rates vary between countries, depending on identification routines and economic restrictions. The present study aimed at determining the prevalence of CIs in postlingually deafened, aged 20–69 years old, in Göteborg, Sweden. Three patient databases with information on PTA, a questionnaire, medical records and consultations identified 88 subjects with sensorineural hearing loss ≥80 dB HL (PTA of 500, 1000, 3000 Hz), PB word score of ≤30% (better ear), regular use of hearing-aid, and oral language. The prevalence of CIs was 11.8 per 100?000 population, and of subjects fulfilling the audiometric candidacy criteria 18.6 per 100?000. The mean PTA (op. ear) of subjects awaiting operation was 97 dB HL (SD 12.3), and of already implanted subjects 106 dB HL (SD 10.2). Mean PB word score was 9% (SD 8.9) and 3% (SD 4.9) respectively. Subjects awaiting operation had significantly better residual hearing, emphasizing recent changes in candidacy criteria. Comparing with prevalence from other countries demonstrated that more patients could be candidates for cochlear implantation.

Sumario

La tasa de implantes cocleares (CI) varía según los países, dependiendo de las rutinas de identificación y de las restricciones económicas. Este estudio pretende determinar la prevalencia de los CI en adultos ensordecidos de 20 a 69 años en Goteborg, Suecia. Mediante una base de datos con información sobre PTA, un cuestionario, antecedentes médicos y de consulta se identificaron 88 sujetos con hipoacusia sensorineural ≥80 dB HL (PTA de 0.5, 1.0, 3.0 kHz), calificación en palabras PB?≤?30% (mejor oído), uso regular de auxiliares auditivos y de lenguaje oral. La prevalencia de CI fue de 11.8 por 100,000 personas y de 18.6 por 100,000 la de los sujetos que reunían los criterios audiométricos para ser candidatos. El promedio de PTA del oído propuesto en los sujetos que esperaban la operación fue de 97dB HL (SD 12.3) y en los sujetos ya implantados de 106 dB HL (SD 10.2). La calificación promedio de la prueba con palabras PB fue de 9% (SD 8.9) y 3% (SD 4.9) respectivamente. Los sujetos que estaban esperando la cirugía tenían una audición residual significativamente mejor, con énfasis en los recientes cambios en los criterios de candidatura. Comparando la prevalencia de otros países, queda demostrado que más pacientes podrían ser candidatos para implante coclear.     

Referral rates of postlingually deafened adult hearing aid users for a cochlear implant candidacy assessment

Objective: The aims of this study were: to investigate the referral rates of postlingually deafened adult cochlear implant (CI) candidates from a hearing aid (HA) clinic for a CI candidacy assessment and to gain insight about factors influencing the referral pathways to CI assessments. Design: Two methodologies were used: a retrospective cohort study reviewing clinical files and a questionnaire to clinicians. Study sample: The files of 1249 adult clients from the HA clinic who had average puretone hearing thresholds greater or equal to 65?dB?HL in the better hearing ear and unaided phoneme recognition scores of less than 50% in both ears were reviewed. All of the clinicians completed the online questionnaire. Results: Eighteen adults met the CI candidacy criteria, of whom 16 (89%) had a CI discussion with their audiologist, with 11 (61%) being referred for a CI evaluation. Of these 11, four proceeded to implantation. Questionnaire responses revealed the need for better information on candidacy and referral guidelines for HA audiologists, in addition to enhanced communication between HA and CI clinics. Conclusions: Overall the results indicate that the referral pathway to obtain a CI assessment is a barrier contributing to the low CI penetration rate in adults.     

The effect of psychosocial factors on outcomes of cochlear implantation

Conclusion: Psychosocial factors should be considered during cochlear implantation (CI). There were differences in psychosocial characteristics according to the etiology of deafness. The outcomes may be affected by psychosocial variables such as the severity of mental distress and social problems as well as duration of deafness. Objective: To evaluate the psychosocial characteristics of deaf people undergoing CI and to determine which psychosocial factors affect performance after CI. Methods: A total of 289 subjects who underwent CI were enrolled. The participants were classified into prelingually deaf (pre-LD) and postlingually deaf groups (post-LD), including progressive and sudden deafness subgroups. The Minnesota Multiphasic Personality Inventory (MMPI) was administered before CI to measure psychosocial and emotional problems. To measure CI outcomes, speech perception ability was assessed by the open-set Korean version of the Central Institute of Deafness (K-CID) test and categories of auditory performance (CAP) scores before and after CI. Results: Approximately 45% of subjects experienced psychological problems before undergoing CI. Subjects in the Pre-LD group had more psychosocial distress and were more likely to be oversensitive in interpersonal situations, while those in the post-LD group were more depressed. Deafness duration and psychosocial factors significantly predicted hearing ability after CI. Deafness duration directly and indirectly affected the outcome of CI. That is, duration of deafness caused psychosocial problems, which may have resulted in negative effects on outcomes of CI.     

儿童人工耳蜗手术的并发症与处理

通过复习国内外文献、内部交流及根据我院临床病例经验，回顾、总结儿童人工耳蜗手术常见并发症的发病率、临床表现、诊断和处理方法，其中包括国内外有关手术并发症的最新进展。本文着重讨论的是临床经常遇到而且较难处理的并发症，包括皮瓣感染及坏死，植入体硅橡胶过敏，面神经损伤，面神经刺激和开机后无听性反应等。认真做好术前诊断，完善手术细节，提高手术经验，手术并发症是可以避免和减少的。     

Music appreciation and music listening in prelingual and postlingually deaf adult cochlear implant recipients

Abstract

Objective: To explore the music appreciation of prelingually deaf adults using cochlear implants (CIs). Design: Cohort study. Adult CI recipients were recruited based on hearing history and asked to complete the University of Canterbury Music Listening Questionnaire (UCMLQ) to assess each individual’s music listening and appreciation. Results were compared to previous responses to the UCMLQ from a large cohort of postlingually deaf CI recipients. Study sample: Fifteen prelingually deaf and 15 postlingually deaf adult cochlear implant recipients. Results: No significant differences were found between the prelingual and postlingual participants for amount of music listening or music listening enjoyment with their CI. Sound quality of common instruments was favourable for both groups, with no significant difference in the pleasantness/naturalness of instrument sounds between the groups. Prelingually deaf CI recipients rated themselves as significantly less able to follow a melody line and identify instrument styles compared to their postlingual peers. Conclusions: The results suggest that the pre- and postlingually deaf CI recipients demonstrate equivalent levels of music appreciation. This finding is of clinical importance, as CI clinicians should be actively encouraging all of their recipients to explore music listening as a part of their rehabilitation.     

耳蜗性耳硬化症人工耳蜗植入的应用研究

分析耳蜗性耳硬化症患者的临床特点、人工耳蜗植入术中情况及人工耳蜗植入术后听觉言语康复效果,为该疾病的诊治提供参考。方法分析4例耳蜗性耳硬化症患者病史资料、听力学检查结果及影像学结果,观察人工耳蜗植入手术的术中所见,并定期对4例患者进行听力学及影像学随访。结果①所有患者人工耳蜗电极均经圆窗膜径路完全植入鼓阶。其中1例于术中发现镫骨完全固定,导致术中鼓阶开孔时外淋巴波动不明显;1例发现圆窗膜骨化,术中鼓阶开孔定位困难;其余2例患者镫骨活动好,圆窗结构清晰。所有患者术中电极阻抗检测均正常,且引出标准的神经反应遥测波形;②术后随访1~5年无术后并发症出现,声场测听示平均听阈为40.8 dBHL,平均言语识别率为77.3%,言语及交流能力较术前提高;颞骨高分辨率CT提示双侧内耳病变范围无明显进展。结论耳蜗性耳硬化症进展缓慢,严重时可导致重度/极重度感音神经性聋,当使用助听器无效时,人工耳蜗植入能帮助患者获得较满意的听觉康复效果。     

Cognitive outcomes after cochlear implantation in older adults: A systematic review

Objectives: To critically assess the current status of the literature on cognitive outcomes after cochlear implantation in older adults.

Methods: Studies were identified by searching MEDLINE (PubMed) and Cochrane Library, and checking reference lists of relevant articles. No restrictions were imposed regarding language, publication date, or publication status. Eligibility criteria were as follows: (1) the study sample included older adults aged 50 or over with severe to profound bilateral hearing loss, (2) the participants received a multi-electrode cochlear implant, and (3) a cognitive test was performed before and after implantation. Risk of bias was assessed with respect to: (A) the suitability of the cognitive tests to examine cognition in hearing-impaired (HI) subjects, (B) the control of practice effects, (C) statistical methods, and (D) other sources of bias.

Results: Out of 2716 retrieved records, 6 were found eligible, examining a total of 166 patients. Five of these studies reported improvements in cognition postimplantation and one study did not observe significant changes. Control of practice effects and the statistical methods were the most common origin of observed bias.

Discussion: The currently reviewed studies performed pioneering work and are indispensable for the field. However, they do not provide conclusive evidence of improved cognitive outcomes after cochlear implantation in older adults.

Conclusion: Well-designed studies with long follow-up periods are imperative to verify whether cochlear implantation influences cognition in older adults. New research is stimulated to use appropriate cognitive assessment tools for HI individuals, to control for practice effects, and to perform appropriate statistical tests.     

Speech perception after multichannel cochlear implantation in Finnish-speaking postlingually deafened adults

This study was done to examine the short-term and long-term effects of multichannel cochlear implantation on speech perception in Finnish-speaking adults. The subjects comprise 20 adults. Pure-tone thresholds (0.125-8kHz), discrimination of phoneme quantity, sentence recognition, word recognition, phoneme recognition and listening performance were studied before and after implantation. After switch-on of the implant, the median pure-tone threshold values in the sound field were comparable to the level of mild hearing impairment. Most improvement in sentence recognition took place during the 6 months after the switch-on (mean score 74%). In word recognition, most improvement took place during the 12 months after the switch-on (mean score 66%), and clear improvement was noted even thereafter. In phoneme recognition, the performance of the subjects improved over the entire follow-up period, and 24 months after the switch-on the mean score was 52%. Individual variation was seen in the performance of the subjects. With 3 months of listening experience, all subjects were able to recognize some speech without speechreading, and they gained good functional benefit from the implant. The use of speech recognition tests with different degrees of difficulty is essential for the follow-up of adult cochlear implant subjects.     

语后聋人工耳蜗患者音乐节奏与音色感知能力的评价

目的 评价成人语后聋人工耳蜗使用者感知音乐中节奏和音色的能力.方法 选取年龄与音乐经验相匹配的听力正常受试者与人工耳蜗使用者各12名,均为男5名,女7名.应用人工耳蜗音乐评估软件( Musical Sounds in Cochlear Implants,MuSIC)中的节奏辨别、乐器识别与乐器数辨别测试评价两组受试者的音乐节奏和音色感知能力.结果 12名人工耳蜗受试者平均节奏辨别率为84.4％,与听力正常受试者(85.1％)比较,差异无统计学意义(t=0.116,P＞0.05);人工耳蜗受试者平均乐器识别率为72.3％、乐器数辨别正确率为39.2％,均低于听力正常受试者平均88.3％和73.5％的正确率,差异具有统计学意义(t值分别为2.498和4.673,P值均＜0.05).结论 成人语后聋人工耳蜗使用者的节奏辨别能力与听力正常人相似,但音色感知能力明显差于听力正常人群.     

Barriers to early cochlear implantation

Abstract

Objective: Identify variables associated with paediatric access to cochlear implants (CIs). Design: Part 1. Trends over time for age at CI surgery (N?=?802) and age at hearing aid (HA) fitting (n?=?487) were examined with regard to periods before, during, and after newborn hearing screening (NHS). Part 2. Demographic factors were explored for 417 children implanted under 3 years of age. Part 3. Pre-implant steps for the first 20 children to receive CIs under 12 months were examined. Results: Part 1. Age at HA fitting and CI surgery reduced over time, and were associated with NHS implementation. Part 2. For children implanted under 3 years, earlier age at HA fitting and higher family socio-economic status were associated with earlier CI. Progressive hearing loss was associated with later CIs. Children with a Connexin 26 diagnosis received CIs earlier than children with a premature / low birth weight history. Part 3. The longest pre-CI steps were Step 1: Birth to diagnosis/identification of hearing loss (mean 16.43 weeks), and Step 11: MRI scans to implant surgery (mean 15.05 weeks) for the first 20 infants with CIs under 12 months. Conclusion: NHS implementation was associated with reductions in age at device intervention in this cohort.     

语后聋成人人工耳蜗植入后言语感知能力的测评

目的通过对植入人工耳蜗的语后聋成人听力言语感知能力的测评,探讨人工耳蜗对语后聋成人言语康复的作用.方法受试者为14名语后聋成人患者,男性9例,女性5例;耳蜗植入年龄22岁～67岁,平均46岁;耳聋时间6年-42年,平均16年.在人工耳蜗植入6个月、12个月及24个月时,进行开放性单词和短句言语感知测试.分别在三种模式下进行:只听模式(开放人工耳蜗)、听觉加视觉模式(开放人工耳蜗加唇读)及视觉模式(关闭人工耳蜗只用唇读).结果在听觉模式及听觉加视觉模式下,患者对单词和句子的正确感知随人工耳蜗使用时间而不断改善.术后6个月,听觉模式下的开放性单词和短句的正确感知率分别是38%和54%;听觉加视觉模式下的开放性单词和短句的正确感知率分别是70%和76%.术后24个月,听觉模式下的开放性单词和短句的正确感知率分别是65%和72%;听觉加视觉模式下的开放性单词和短句的正确感知率分别是84%和88%.结论人工耳蜗植入能显著改善语后聋成人的言语感知能力,并随着人工耳蜗使用时间的增加,言语感知能力逐渐得到提高.     

The hearing benefit of cochlear implantation for individuals with unilateral hearing loss,but no tinnitus

Conclusion: Cochlear implants improve the hearing abilities of individuals with unilateral hearing loss and no tinnitus. The benefit is no different from that seen in patients with unilateral hearing loss and incapacitating tinnitus.

Objective: To evaluate hearing outcomes after cochlear implantation in individuals with unilateral hearing loss and no tinnitus and compare them to those obtained in a similar group who had incapacitating tinnitus.

Methods: Six cases who did not experience tinnitus before operation and 15 subjects with pre-operative tinnitus were evaluated with a structured interview, a monosyllabic word test under difficult listening situations, a sound localization test, and an APHAB (abbreviated profile of hearing aid benefit) questionnaire.

Results: All subjects used their cochlear implant more than 8?hours a day, 7 days a week. In ‘no tinnitus’ patients, mean benefit of cochlear implantation was 19% for quiet speech, 15% for speech in noise (with the same signal-to-noise ratio in the implanted and non-implanted ear), and 16% for a more favourable signal-to-noise ratio at the implanted ear. Sound localization error improved by an average of 19°. The global score of APHAB improved by 16%. The benefits across all evaluations did not differ significantly between the ‘no tinnitus’ and ‘tinnitus’ groups.     

Impact of cochlear implantation on peripheral vestibular function in adults

ObjectiveCochlear implantation may have a detrimental effect on vestibular function and residual hearing. Our goal was to investigate the impact of cochlear implantation on peripheral vestibular function and the symptomatology that ensues.Material and methodsA prospective observational study included all adults undergoing cochlear implantation by the same operator between July 2014 and December 2015, with pre- and postoperative (4 months) neurovestibular balance examination comprising a questionnaire and clinical tests [head impulse test (HIT), head-shaking test (HST), skull vibration test (SVT)] and instrumental tests [caloric test of the lateral semicircular canal and cervical vestibular-evoked myogenic potentials (cVEMP)].ResultsTwenty-two patients were included, with a mean age of 62 years and sex-ratio of 1.2. Before implantation, 50% of subjects (n = 11) reported at least one episode of vertigo associated with balance disorder during their life. After implantation, there were 11 cases of vertigo but only one patient described persistent discomfort related to vertigo 4 months after surgery. Patients with impaired vestibular function after 4 months, taking all symptoms together, were all aged more than 75 years. HIT was abnormal in 18% of cases before implantation and in 59% after (P = NS). HST showed nystagmus in one patient both before and after surgery. Only 18% of patients showed nystagmus induced by SVT before surgery, increasing to one-third after surgery (P = NS). Caloric test of the lateral canal showed hypofunction in 50% of cases before surgery, including 10% of cases with areflexia. This rate increased after surgery to 58%, with 18% areflexia (P = NS). cVEMPs were not detected in 68% of cases before implantation and this rate increased to 86% after surgery (P = NS). There were no significant associations (P > 0.05) between test results and symptoms.ConclusionsIn the medium term, although older subjects more frequently presented vestibular disorder, cochlear implantation induced little vertigo or balance disorder, sometimes even improving vestibular function. However, vestibular disorders were frequent preoperatively and increased postoperatively. We tested vestibular function on different stimulation frequencies and yet found no correlation between postoperative test results and postoperative vertigo.