A Novel Performance‐Based Paradigm of Care for Cochlear Implant Follow‐Up

Grisel, Jedidiah J.; Miller, Sharon; Schafer, Erin C.

doi:10.1002/lary.29614

Cited by 8 publications

(11 citation statements)

References 30 publications

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“…Screening by title and abstract excluded 1263 articles. Full‐text review of the remaining articles excluded 259 publications, resulting in 22 articles being included in the final analysis 29–50 . The search process is summarized in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Longitudinal Speech Recognition Changes After Cochlear Implant: Systematic Review and Meta‐analysis

Fried

Nguyen

et al. 2022

The Laryngoscope

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Objectives To examine patterns of change and plateau in speech recognition scores in postlingually hearing impaired adult cochlear implant recipients. The study also examines variations in change patterns for different speech materials and testing conditions. Study Design Used systematic review with meta‐analysis. Methods Articles in English reporting speech recognition scores of adults with postlingual hearing loss at pre‐implantation and at least two post‐implantation time points were included. Statistically significant changes were determined by meta‐analysis and the 95% confidence interval. Results A total of 22 articles representing 1954 patients were included. Meta‐analysis of mean difference demonstrated significant improvements in speech recognition score for words in quiet (37.4%; 95% confidence interval [34.7%, 40.7%]), sentences in quiet (49.4%; 95% confidence interval [44.9%, 53.9%]), and sentences in noise (30.8%; 95% confidence interval [25.2%, 36.4%]) from pre‐op to 3 months. Scores continued to increase from 3 to 12 months but did not reach significance. Similarly, significant improvements from pre‐op to 3 months were observed for consonant nucleus consonant (CNC) words in quiet (37.1%; 95% confidence interval [33.8%, 40.4%]), hearing in noise test (HINT) sentences in quiet (46.5%; 95% confidence interval [37.0%, 56.0%]), AzBio sentences in quiet (45.9%; 95% confidence interval [44.2%, 47.5%]), and AzBio sentences in noise (26.4%; 95% confidence interval [18.6%, 34.2%]). HINT sentences in noise demonstrated improvement from pre‐op to 3 months (35.1%; 95% confidence interval [30.0%, 40.3%]) and from 3 to 12 months (15.5%; 95% confidence interval [7.2%, 23.8%]). Conclusions Mean speech recognition scores demonstrate significant improvement within the first 3 months, with no further statistically significant improvement after 3 months. However, large individual variation should be expected and future research is needed to explain the sources of these individual differences. Laryngoscope, 133:1014–1024, 2023

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Section: Resultsmentioning

confidence: 99%

Longitudinal Speech Recognition Changes After Cochlear Implant: Systematic Review and Meta‐analysis

Fried

Nguyen

et al. 2022

The Laryngoscope

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“…Previously, literature has reported that postlingually deaf adult CI users show significant improvements in speech perception up to 12-36 months post-implantation (Cusumano et al 2017;Grisel, Miller, and Schafer, 2022). However, there is also evidence of adult CI users reaching a performance plateau much earlier, with most significant speech perception improvements observed between 3-6 months post-implantation (Kelsall, Lupo, and Biever, 2021;Rasmussen et al 2022).…”

Section: Discussionmentioning

confidence: 99%

Variability in clinicians’ prediction accuracy for outcomes of adult cochlear implant users

Philpott

2023

Preprint

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Objective:The variability in outcomes among adult cochlear implant (CI) users poses challenges for clinicians in accurately predicting the benefits of the implant for individual candidates. This study aimed to investigate the accuracy and confidence of clinicians in predicting speech perception outcomes for adult CI users one-year post-implantation. Design: Participants were presented with comprehensive information on pre-implantation, one-month post-implantation, and six-month post-implantation data for 10 case studies. The cases encompassed a range of one-year post-implantation phoneme scores, from low performers (27%) to high performers (92%). Participants were tasked with predicting the speech perception outcomes for these cases one year after implantation. Study Sample: Forty-one clinicians completed the full outcome prediction survey. Results: Our findings revealed a significant over-prediction of low performance by clinicians. Interestingly, clinicians tended to predict average performance (73-76% phoneme score) even when provided with information suggesting lower-than-average performance. Most clinicians expressed confidence in their predictions, irrespective of their accuracy. Conclusions: Identifying signs of low performance, particularly in the early post-implantation period, can enable clinicians to implement early interventions. Further research into accurate outcome prediction is essential for managing expectations, providing counselling, increasing CI adoption, and optimising clinical care for both high and low performers.

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“…For healthcare centers, programming sessions are often poorly reimbursed, and the availability of programming audiologists is often outpaced by growing practices [ 5 , 6 , 7 ]. Additionally, frequent programming after the initial post-activation period may provide little benefit for patients, as many CI users approach their performance plateau early in the post-activation period [ 8 ]. Similarly, for many patients, changes to programming after 3 months are often minor [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Preliminary Evidence to Support a De-Escalated Cochlear Implant Programming Paradigm for New Adult Recipients: A Systematic Review

Dornhoffer,

Khandalavala,

Zwolan

et al. 2023

JCM

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Background: No standard schedule for cochlear implant (CI) programming has been developed, and common practices may have CI recipients seen in excess of what is necessary. The objective of this study was to review evidence for a de-escalated, evidence-based schedule for adult CI programming. Methods: Systematic review was undertaken in March 2023 of PubMed, Scopus, and CINAHL databases using the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if (1) they evaluated an evidence-based programming/follow-up schedule in new adult CI patients or (2) they evaluated programming or outcomes in a longitudinal fashion such that they could inform CI follow-up strategies. Level of evidence was evaluated using the LEGEND evidence assessment tool. Results: Our review identified 940 studies. After screening with a priori inclusion criteria, 18 studies were ultimately included in this review. Of these, 2 demonstrated feasibility of de-escalated approaches to new adult CI programming. The remainder presented longitudinal speech and programming parameter data that demonstrated relative stability of both categories by 3 to 6 months post-activation. Conclusions: Overall, there is a paucity of literature evaluating any form of evidence-based CI programming or follow-up. Most applicable data derive from longitudinal outcomes featured in studies of other CI features, with only a handful of studies directly evaluating CI programming strategies over time. However, stability in outcomes and programming detailed in the available data supports consideration of a de-escalated programming paradigm that could primarily limit programming to the very early post-activation period (before 3 to 6 months) to enhance patient care and reduce operational strains on cochlear implant programs.

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A Novel Performance‐Based Paradigm of Care for Cochlear Implant Follow‐Up

Cited by 8 publications

References 30 publications

Longitudinal Speech Recognition Changes After Cochlear Implant: Systematic Review and Meta‐analysis

Longitudinal Speech Recognition Changes After Cochlear Implant: Systematic Review and Meta‐analysis

Variability in clinicians’ prediction accuracy for outcomes of adult cochlear implant users

Preliminary Evidence to Support a De-Escalated Cochlear Implant Programming Paradigm for New Adult Recipients: A Systematic Review

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