Late Cochlear Implantation in Early-Deafened Adults: A Detailed Analysis of Auditory and Self-Perceived Benefits

Abstract

Objectives: It is known that early-deafened cochlear implant (CI) users are a very heterogeneously performing group. To gain more insight into this population, this study investigated (1) postoperative changes in auditory performance over time based on various outcome measures, focusing on poor performers, (2) self-perceived outcomes, (3) relations between auditory and self-perceived outcomes, and (4) preimplantation factors predicting postoperative outcomes. Methods: Outcomes were assessed prospectively in a group of 27 early-deafened, late-implanted CI users, up to 3 years after implantation. Outcome measures included open-set word and sentence recognition, closed-set word recognition, speech tracking and a questionnaire on self-perceived outcomes. Additionally, the relative influence of 8 preimplantation factors on CI outcome was assessed with linear regression analyses. Results: Significant improvements were found for auditory performance measures and most of the questionnaire domains. Significant changes of the closed-set word test, speech tracking and questionnaire were also found for a subgroup of poor performers. Correlations between auditory and self-perceived outcomes were weak and nonsignificant. Preoperative word recognition and preoperative hearing thresholds, both for the implanted ear, were significant predictors of postoperative outcome in the multivariable regression model, explaining 63.5% of the variation. Conclusions: Outcome measurement in this population should be adjusted to the patients’ individual performance level and include self-perceived benefit. There is still a need for more knowledge regarding predictors of CI outcomes in this group, but the current study suggests the importance of the preoperative performance of the ear to be implanted.

Cochlear implant in prelingually hearing-impaired adults: prognostic factors and results

“…Studies in the international literature in this field are limited, and mostly related to heterogeneous samples composed of patients with an exclusive oral communication modality, patients communicating with sign language and patients using total communication 7,10,12,17 . This is a remarkable bias.…”

“…It is well known that outcomes after CI in prelingually deafened adults are variable as stressed in the recent investigation by Debruyne et al 12 . In 27 patients, indeed, the results in terms of open-set word recognition ranged from 0% to 88%.…”

“…Consequently, the educational programmes that stress oral communication as the preferred educational modality could potentially reduce the cortical colonisation of the central speech and language processing areas, and therefore the use of oral communica-tion should be an important candidacy criterion in cochlear implantation of adult patients with prelingual deafness 1,2,4-6 . In addition to the factors previously mentioned, it is well known that other pre-operative individual and audiological features play a role in post-operative hearing performance, such as age at onset of hearing loss and at first hearing aid fitting, speech perception performance with hearing aids, residual hearing, communication mode, educational environment, motivation and psychological aspects 2,4,6,9,12,13 . Moreover, in 2011 Dijkhuizen et al reported that speech intelligibility is predictive of post-implantation hearing results in prelingually deafened adults 13,14 .…”

Cochlear implantation in adults with early-onset deafness

“…BPF1 in Figure 2), and high-frequency sounds to electrodes at the base (outer end) of the cochlea (e.g. BPF4), following the natural tonotopy 3 of this auditory structure.…”

“…For computation of the scores on the questions, the answer categories were transformed, with never/not at all = 0, occasionally/somewhat = 25, regularly/more or less = 50, usually/for the most part = 75 and always/completely = 100. For 20 questions which were phrased in opposite form (questions number 3,4,5,8,9,14,15,16,18,25,27,29,31,36,37,40,43,44,45,47), the transformation was reversed. The results of the 20 subjects that completed the questionnaire 1 year postoperatively were used to perform a reliability analysis.…”