Cochlear Implants in Adults

Beyea, Jason A.; McMullen, Kyle P.; Harris, Michael S.; Houston, Derek M.; Martin, Jennifer; Bolster, Virginia; Adunka, Oliver F.; Moberly, Aaron C.

doi:10.1097/mao.0000000000001162

Cited by 59 publications

(54 citation statements)

References 42 publications

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“…While previous studies have shown mixed results on whether aging and age-related temporal processing deficits affect speech understanding with a CI, there is mounting evidence that older CI listeners perform worse than their younger peers, particularly when duration of deafness is accounted for in the study (Beyea et al 2016; Sladen and Zappler 2015). Many studies in this area use sentence recognition as a metric for CI performance.…”

Section: Discussionmentioning

confidence: 90%

Age-Related Differences in the Processing of Temporal Envelope and Spectral Cues in a Speech Segment

et al. 2017

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OBJECTIVE As people age, they experience reduced temporal processing abilities. This results in poorer ability to understand speech, particularly for degraded input signals. Cochlear implants (CIs) convey speech information via the temporal envelopes of a spectrally degraded input signal. Because there is an increasing number of older CI users, there is a need to understand how temporal processing changes with age. Therefore, the goal of this study was to quantify age-related reduction in temporal processing abilities when attempting to discriminate words based on temporal envelope information from spectrally degraded signals. DESIGN Younger normal-hearing (YNH) and older normal-hearing (ONH) participants were presented a continuum of speech tokens that varied in silence duration between phonemes (0 to 60 ms in 10-ms steps), and were asked to identify whether the stimulus was perceived more as the word “Dish” or “Ditch.” Stimuli were vocoded using tonal carriers. The number of channels (1, 2, 4, 8, 16, and unprocessed) and temporal envelope low-pass filter cutoff frequency (50 and 400 Hz) were systematically varied. RESULTS For the unprocessed conditions, the YNH participants perceived the word Ditch for smaller silence durations than the ONH participants, indicating that aging affects temporal processing abilities. There was no difference in performance between the unprocessed and 16-channel, 400-Hz vocoded stimuli. Decreasing the number of spectral channels caused decreased ability to distinguish Dish and Ditch. Decreasing the envelope cutoff frequency also caused decreased ability to distinguish Dish and Ditch. Nevertheless, the overall pattern of results revealed that reductions in spectral and temporal information had a relatively larger effect on the ONH participants compared to the YNH participants. CONCLUSION Aging reduces the ability to utilize brief temporal cues in speech segments. Reducing spectral information – as occurs in a channel vocoder and in CI speech processing strategies – forces participants to use temporal envelope information; however, older participants are less capable of utilizing this information. These results suggest that providing as much spectral and temporal speech information as possible would benefit older CI users relatively more than younger CI users. In addition, the present findings help set expectations of clinical outcomes for speech understanding performance by adult CI users as a function of age.

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Section: Discussionmentioning

confidence: 90%

Age-Related Differences in the Processing of Temporal Envelope and Spectral Cues in a Speech Segment

et al. 2017

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“…Younger subjects performed better with monosyllabic words at baseline and maintained this advantage at the 3-and 6-month testing intervals over the older age group as expected. Other authors have noted a relationship between a younger age and better postoperative performance [4,18,[40][41][42]. Holden et al [18] even found that once scalar location had been removed as a variable, age was the only factor that still correlated significantly with outcomes.…”

Section: Discussionmentioning

confidence: 97%

Outcomes for a clinically representative cohort of hearing-impaired adults using the Nucleus® CI532 cochlear implant

Hey¹,

Neben²,

Stöver

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Hearing performance data was collected from a large heterogeneous group of subjects implanted with the Coch-lear™ Nucleus® CI532 with Slim Modiolar Electrode, for the purposes of postmarket clinical follow-up. Data was analysed for factors which may predict postoperative speech recognition scores. Methods Data was collected retrospectively from five German clinics for 159 subjects from March 2017 to August 2018. Hearing thresholds and recognition scores for monosyllabic words in quiet and sentences in noise were measured preoperatively and at 3 and 6 months postoperatively. Results There was a mean gain of 44% points (95% CI 39-49%) at 6 months in monosyllable scores in quiet for implanted ears. Preoperative hearing thresholds in implant ears increased systematically with decreasing age; however, younger subjects had better baseline monosyllable scores with hearing aids compared with older subjects. Baseline performance alone explained 14% of the variation in postoperative scores. Residual hearing was preserved on average to within 22 dB at 250 Hz and 30 dB at 500 Hz of preoperative levels. Conclusions In a large and varied cohort of routinely treated hearing-impaired adults, speech recognition with the CI532 for German monosyllabic words in quiet at 6 months was equivalent to performance reported at one year or more in other published studies. Although younger subjects had poorer preoperative pure-tone thresholds, they had better preoperative word recognition scores compared with older subjects, and also had higher post implant scores. Further research is required to identify if this phenomenon is just applicable to German health system assessment and referral practices.

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“…Low uptake of CI seemingly conflicts with extensive evidence showing that CI improves quality of life (Crowson et al 2017) and improve outcomes in multiple domains when compared to hearing aids, including psychosocial health, functional health and social inclusion (Francis et al 2002;Cohen et al 2004;Bosdriesz et al 2017), while being cost effective (Bond et al 2009). Delaying implantation has been shown to be disadvantageous; evidence suggests a correlation between increasing duration of hearing loss prior to implantation (Blamey et al 2013), as well as links between increasing age at time of implantation and poorer speech recognition scores (Blamey et al 2013;Beyea et al 2016;Hiel et al 2016).…”

Section: Introductionmentioning

confidence: 99%

What makes someone choose cochlear implantation? An exploration of factors that inform patient decision making

Dillon¹,

Pryce

2019

International Journal of Audiology

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Objective: Our objective was to understand the factors that determine whether an adult who is eligible for cochlear implantation (CI) choose to take up or not take up the implant. Design: We conducted a qualitative in-depth interview study, informed by grounded theory methods of constant comparison to build a theory to describe why and how people decide to opt for CI or not. Study sample: Our samples were patients from an audiology service in England. Results: Our results describe the key factors in weighing up risks and benefits. These are influenced by living context and support, information and social identity. We identify the key features that impact decision making for adults eligible for cochlear implants. The importance of the patient lifeworld view is discussed. Conclusions: This qualitative study provides the first in depth examination of how and why patients do and do not take up the offer of cochlear implants. It highlights the complex and iterative nature of this decision making and the individualised risks that trade off benefits of implantation.

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Cochlear Implants in Adults

Abstract: Older age at testing was associated with poorer recognition of words in difficult sentences, suggesting that cognitive aging may negatively impact CI outcomes. Further studies are needed to examine how a long duration of auditory deprivation affects CI outcomes.

Cited by 59 publications

References 42 publications

Age-Related Differences in the Processing of Temporal Envelope and Spectral Cues in a Speech Segment

Age-Related Differences in the Processing of Temporal Envelope and Spectral Cues in a Speech Segment

Outcomes for a clinically representative cohort of hearing-impaired adults using the Nucleus® CI532 cochlear implant

What makes someone choose cochlear implantation? An exploration of factors that inform patient decision making

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