Cochlear implant in prelingually deafened oralist adults: speech perception outcomes, subjective benefits and quality of life improvement

Abstract

Lo scopo di questo studio è riportare i risultati ottenuti in un gruppo di pazienti adulti con ipoacusia prelinguale, che hanno seguito un programma di riabilitazione di tipo oralista, sottoposti ad impianto cocleare nella nostra clinica. Sono stati analizzati 30 pazienti adulti, 18 maschi e 12 femmine, con un’età media di 35 anni, selezionati da un gruppo di 36 adulti con sordità prelinguale sottoposti ad impianto cocleare unilaterale nella U.O. Otorinolaringoiatria, Foniatria ed Audiologia Universitaria di Pisa. Dopo la procedura di impianto cocleare i pazienti hanno raggiunto significativi benefici in termini di percezione del linguaggio, inclusa la capacità di avere una conversazione telefonica in qualche caso; benefici sono stati raggiunti anche riguardo la qualità della vita e la percezione della propria disabilità. In accordo con i dati riportati in letteratura i risultati da noi presentati sono variabili ma generalmente soddisfacenti. Per valutare i benefici dell’impianto cocleare nei pazienti riportati in questo studio devono essere considerate altre procedure oltre a quelle tradizionali di valutazione della percezione verbale, così da poter apprezzare complessivamente i benefici, non solo in termini di percezione verbale ma anche di miglioramento della qualità della vita quotidiana.

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

“…Moreover, a few participants attained speech recognition levels typically found in adults with postlingual deafness. In the same year, Forli et al 2 reported a significant improvement in terms of speech perception and subjective benefits in a group of 30 prelingually deafened implanted adult patients.…”

“…In 27 patients, indeed, the results in terms of open-set word recognition ranged from 0% to 88%. Similarly, Duchesne et al 3 reported a wide variability of speech perception outcomes with recognition scores after implantation ranging from 0 to 95% and Forli et al 2 reported a disyllabic word recognition score ranging from 0 to 100%. In the present cohort, post-implantation results in terms of disyllabic word recognition score were also variable, ranging from 0 to 100% in quiet and from 0 to 80% in noise.…”

“…Prelingually deafened adult patients who receive a cochlear implant (CI) in adulthood, after many years of severe-toprofound hearing impairment or auditory deprivation, constitute a very specific group of cochlear implant users [1][2][3][4][5][6][7][8][9] . Until the mid-1990s, prelingually deafened adult patients were considered poor CI candidates because of limited improvement in speech perception.…”

“…When considering potential prognostic factors in early hearing-impaired adults, it must be underlined that these patients have some peculiarities since they have never experienced normal hearing in their lifetime, or since the first moments of life. Their neural system, therefore, lacks the spatial and structural organisation for auditory processing with variability between subjects [2][3][4][5][6]8,9 . Furthermore, even if it is possible that auditory pathway fiber tracts develop in a limited degree independently of the experience 11 , the literature suggests that in the case of severe-to-profound prelingual hearing loss, the colonisation of the auditory cortex by other sensory modalities is the main limiting factor in post-implantation performance, and not the pathological degenerative changes of the auditory nerve, cochlear nucleus, or auditory midbrain 5,6 .…”

“…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 .…”