Association of Patient-Related Factors With Adult Cochlear Implant Speech Recognition Outcomes

Abstract

IMPORTANCE Multiple studies have evaluated associations between post-cochlear implant (CI) speech recognition outcomes and patient-related factors. Current literature often appears equivocal or contradictory, so little is known about the factors that contribute to successful speech recognition outcomes with CIs.OBJECTIVE To use a meta-analysis to pool data from the extant literature and provide an objective summary of existing evidence on associations of patient-related factors and CI speech recognition outcomes.DATA SOURCES A literature search was performed using PubMed, Scopus, and CINAHL databases in January 2019 using the following search terms: cochlear implant or cochlear implants or cochlear implantation and speech recognition or word recognition or sentence recognition. Studies of postlingually deafened adult CI recipients that reported word or sentence recognition scores were included.STUDY SELECTION Inclusion criteria were postlingual adult CI recipients 18 years or older with word or sentence recognition scores at minimum 6-month postimplantation. Studies that included patients undergoing revision or reimplantation surgery were excluded. DATA EXTRACTION AND SYNTHESIS Following the Preferred Reporting Items for SystemicReviews and Meta-analyses (PRISMA) guidelines, 1809 unique articles underwent review by abstract, and 121 articles underwent full-text review, resulting in 13 articles of 1095 patients for a meta-analysis of correlations. Random-effects model was used when the heterogeneity test yielded a low P value (P < .05). MAIN OUTCOMES AND MEASURESThe planned primary outcome was the pooled correlation values between postimplant speech recognition scores and patient-related factors. RESULTSOf the 1095 patients included from the 13 studies, the mean age at implantation ranged from 51.2 to 63.7 years and the mean duration of hearing loss ranged from 9.5 to 31.8 years; for the 825 patients for whom sex was reported, 421 (51.0%) were women. A weak negative correlation was observed between age at implantation and postimplant sentence recognition in quiet (r = −0.31 [95% CI, −0.41 to −0.20]). Other correlations between patient-related factors and postimplant word or sentence recognition were statistically significant, but all correlations were absent to negligible (r = 0.02-0.27). CONCLUSIONS AND RELEVANCEGiven that most associations were weak, negligible, or absent, patient-related factors often thought to affect CI speech recognition ability offer limited assistance in clinical decision-making in cochlear implantation. Additional research is needed to identify patient-related and other factors that predict CI outcomes, including speech recognition and other important variables related to success with CIs.

Duration of deafness impacts auditory performance after cochlear implantation: A meta‐analysis

“…Remarkably, a multicenter review associated different speech coding strategies to CI performance rather than to other individual characteristics 82 . An interesting recent meta‐analysis examined the effect of patient related factors on speech recognition outcomes (13 studies including 1095 patients) 83 . In their analysis, a weak negative association was present for age at implantation and sentence recognition.…”

A surgeon‐scientist's perspective and review of cognitive‐linguistic contributions to adult cochlear implant outcomes

“…In trying to answer this question by reading the clinical literature, the traditional demographic and audiologic factors we consider -age, duration of deafness, severity of hearing loss, prior use of hearing aids -were altogether relatively weak predictors of outcomes. [1][2][3] Moreover, these traditional measures do not tell us anything about the underlying mechanisms that may serve as targets for intervention. 4 As a related concern, we had a few older patients who were years out from their CIs, and they were still struggling to understand speech; i.e.…”

“…And they would say, “But will it help ME?” Our response would be, “Well, you'll almost certainly do better than you do right now!” which was a relatively uninformative answer, because we did not (and still do not) have a good way to predict an individual's ultimate CI outcome. In trying to answer this question by reading the clinical literature, the traditional demographic and audiologic factors we consider ‐ age, duration of deafness, severity of hearing loss, prior use of hearing aids ‐ were altogether relatively weak predictors of outcomes 1‐3 . Moreover, these traditional measures do not tell us anything about the underlying mechanisms that may serve as targets for intervention 4 …”

“…I also selected nonclinical measures with which patients would not be familiar. These included the CID‐W22 isolated words, 25 and three types of sentences 1 : the IEEE or Harvard Standard sentences, 26 which are relatively complex and semantically meaningful, spoken by a single male talker 2 ; the Harvard Anomalous sentences, 27 which were developed from the Harvard Standard sentences but lack semantic context, so they should rely more heavily on bottom‐up processing; and 3 the PRESTO sentences, 28 which are complex sentences spoken by lots of different talkers, which results in increased cognitive load.…”

Using interleaved stimulation to measure the size and selectivity of the sustained phaselocked neural response to cochlear-implant stimulation

“…The most likely practical application of the ALFIES method for CIs is that it can measure the selectivity of the sustained auditory response at the level of the auditory cortex and/or thalamus. CI patients differ substantially in their ability to perceive speech, probably due to a combination of sensory and cognitive factors (Zhao et al, 2020), and this ability can also be affected by the patient's experience with speech prior to and following implantation. The clinician, faced with a patient having very poor speech understanding, has to disentangle these various factors in order to identify appropriate diagnoses and treatment.…”