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

Zhao, Elise E.; Dornhoffer, James R.; Loftus, Catherine; Nguyen, Shaun A.; Meyer, Ted A.; Dubno, Judy R.; McRackan, Theodore R.

doi:10.1001/jamaoto.2020.0662

Cited by 70 publications

(107 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Bernhard

Gauger

Ventura

et al. 2021

Laryngoscope Investig Oto

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Objective Hearing loss is a highly disabling condition. Cochlear implantation is an established remedy if conventional hearing aids have failed to alleviate the level of disability. Unfortunately, cochlear implant (CI) performance varies dramatically. This study aims to examine the effects of duration of deafness (DoD) prior to cochlear implantation and the postoperative duration of implant experience with resulting hearing performance in postlingually deaf patients. Methods A systematic literature review and two meta‐analyses were conducted using the search terms cochlear implant AND duration deafness. Included studies evaluate the correlation between the DoD and auditory performance after cochlear implantation using monosyllabic and sentence tests. Correlation coefficients were determined using Pearson's correlation and Spearman rho. Results A total of 36 studies were identified and included data on cochlear implantations following postlingual deafness and postoperative speech testing of hearing outcomes for 1802 patients. The mean age ranged from 44 to 68 years with a DoD of 0.1 to 77 years. Cochlear implant use varied from 3 months to 14 years of age. Speech perception, which was assessed by sentence and monosyllabic word perception, was negatively correlated with DoD. Subgroup analyses revealed worse outcomes for longer DoD and shorter postoperative follow‐up. Conclusion DoD is one of the most important factors to predict speech perception after cochlear implantation in postlingually deaf patients. The meta‐analyses revealed a negative correlation between length of auditory deprivation and postoperative sentence and monosyllabic speech perception. Longer DoD seems to lead to worse CI performance, whereas more experience with CI mitigates the effect.

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Section: Discussionmentioning

confidence: 99%

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

Bernhard

Gauger

Ventura

et al. 2021

Laryngoscope Investig Oto

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“…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.…”

Section: During My Fellowship With Dr D Bradley Welling and Dr Edwardmentioning

confidence: 99%

“…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 …”

Section: Guidance Pointmentioning

confidence: 99%

“…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.…”

Section: Guidance Pointmentioning

confidence: 99%

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

Moberly

2020

Laryngoscope Investig Oto

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Objective(s): Enormous variability in speech recognition outcomes persists in adults who receive cochlear implants (CIs), which leads to a barrier to progress in predicting outcomes before surgery, explaining "poor" outcomes, and determining how to provide tailored rehabilitation therapy for individual CI users. The primary goal of my research program over the past 9 years has been to extend our understanding of the contributions of "top-down" cognitive-linguistic skills to CI outcomes in adults, acknowledging that "bottom-up" sensory processes also contribute substantially. The main objective of this invited narrative review is to provide an overview of this work. A secondary objective is to provide career "guidance points" to budding surgeon-scientists in Otolaryngology. Methods: A narrative, chronological review covers work done by our group to explore top-down and bottom-up processing in adult CI outcomes. A set of ten guidance points is also provided to assist junior Otolaryngology surgeon-scientists. Results: Work in our lab has identified substantial contributions of cognitive skills (working memory, inhibition-concentration, speed of lexical access, nonverbal reasoning, verbal learning and memory) as well as linguistic abilities (acoustic cue-weighting, phonological sensitivity) to speech recognition outcomes in adults with CIs. These top-down skills interact with the quality of the bottom-up input. Conclusion: Although progress has been made in understanding speech recognition variability in adult CI users, future work is needed to predict CI outcomes before surgery, to identify particular patients' strengths and weaknesses, and to tailor rehabilitation approaches for individual CI users.

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“…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.…”

Section: Practical Applicationsmentioning

confidence: 99%

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

Carlyon¹,

Guérit²,

Deeks³

et al. 2020

Preprint

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We measured the sustained neural response to electrical stimulation by a cochlear implant(CI). To do so we interleaved two stimuli with frequencies F1 and F2 Hz and recorded a neuraldistortion response (NDR) at F2-F1 Hz. We show that, because any one time-point containsonly the F1 or F2 stimulus, the instantaneous nonlinearities typical of electrical artefactshould not produce distortion at this frequency. However if the stimulus is smoothed, such asby charge integration at the nerve membrane, subsequent (neural) nonlinearities can producea component at F2-F1 Hz. We stimulated a single CI electrode with interleaved sinusoids orinterleaved amplitude-modulated pulse trains such that F2=1.5F1, and found no evidence foran NDR when F2-F1 was between 90-120 Hz. However, interleaved amplitude-modulated pulsetrains with F2-F1 40 Hz revealed a substantial NDR with a group delay of about 45 ms,consistent with a thalamic and/or cortical response. The NDR could be measured even fromrecording electrodes adjacent to the implant and at the highest pulse rates (>4000 pps) usedclinically. We then measured the selectivity of this sustained response by presenting F1 andF2 to different electrodes and at different between-electrode distances. This revealed abroad tuning that, we argue, reflects the overlap between the excitation elicited by the twoelectrodes. Our results also provide a glimpse of the neural nonlinearity in the auditorysystem, unobscured by the biomechanical cochlear nonlinearities that accompany acousticstimulation. Several potential clinical applications of our findings are discussed.

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

Cited by 70 publications

References 50 publications

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

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

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

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

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