Cochlear Implant Results in Older Adults with Post-Lingual Deafness: The Role of “Top-Down” Neurocognitive Mechanisms

Zucca, Milena; Albera, Andrea; Albera, Roberto; Montuschi, Carla; Gatta, Beatrice Della; Canale, Andrea; Rainero, Innocenzo

doi:10.3390/ijerph19031343

Cited by 8 publications

(25 citation statements)

References 63 publications

(110 reference statements)

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“…This result agrees with past studies, although conducted only on NH listeners, as F 0 tended to decrease markedly in association with aging [Nishio and Niimi, 2008]. Such correlation could be explained not only by the simple application of the CI but also by the reduced speed of cognitive processing with advancing age: a slowdown of specific executive cognitive resources, such as working memory, is known to influence several top-down mechanisms, one of which could also be phonation [Zucca et al, 2022].…”

Section: Role Of Prelingual and Postlingual Deafnesssupporting

confidence: 92%

Ambulatory Phonation Monitoring in Prelingual and Postlingual Deaf Patients after Cochlear Implantation

Albera¹,

Puglisi²,

Astolfi³

et al. 2022

Audiol Neurotol

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Introduction: Hearing loss is known to play a fundamental role in voice production due to a lack of auditory feedback. In this study, we evaluated both fundamental frequency (F0) and loudness of voice on adult deaf patients subjected to cochlear implantation, and we analyzed these results according to the prelingual or postlingual onset of the deafness. Methods: The study population, balanced in terms of sex, consisted of 32 adults who had undergone cochlear implantation due to severe or profound bilateral hearing loss (16 with prelingual deafness and 16 with postlingual deafness) and their outcomes were compared with a control group of 32 normal hearing (NH) subjects. All subjects were asked to utter the sustained vowel /a/ for at least 5 s and then to read an Italian phonetically balanced text. Voice recordings were performed by means of an ambulatory phonation monitoring (APM 3200). Measurements were performed without cochlear implant (CI), then with CI switched on, both in quiet condition and with background noise. Results: Compared to NH subjects, deaf individuals were overall characterized by higher F0 and loudness values, especially in the vowel task than the reading. In the sustained vowel task, no patients demonstrated significant voice changes after switching on the CI; contrarily, in the reading task, the use of the CI reduced both loudness and F0 up to values comparable to NH subjects, although only in males. There was no significant difference in speech parameters between prelingual and postlingual deafness, although overall lower values were evident in case of postlingual deafness. The use of the CI showed a significant reduction of F0 in males with postlingual deafness and of loudness, both for patients with prelingual and postlingual deafness. Finally, there was a positive correlation between postoperative hearing thresholds and overall speech loudness, highlighting how subjects with better hearing outcomes after CI positioning generally speak with a lower loudness and therefore a reduced vocal effort and load. Discussion/Conclusion: We found similar speech performances between prelingual and postlingual deafness, both in the vowel /a/ phonation and in the reading, providing a further suggestion that prelingual adult patients may benefit from cochlear implantation in phonation as well, in addition to the known excellent hearing outcomes. Overall, these results highlight the ability of the CI to adjust in everyday speech certain phonatory aspects such as F0 and loudness by restoring the auditory feedback.

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Section: Role Of Prelingual and Postlingual Deafnesssupporting

confidence: 92%

Ambulatory Phonation Monitoring in Prelingual and Postlingual Deaf Patients after Cochlear Implantation

Albera¹,

Puglisi²,

Astolfi³

et al. 2022

Audiol Neurotol

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“…Additionally, the "NIH Toolbox Dimensional Change Card Sort Test" (DCCS) is used (see Table 9 for an overview). As discussed before, the TMT-B score showed inconsistent correlations with word or sentence perception in quiet (Hua et al, 2017;Völter et al, 2021;Zucca et al, 2022). The other task was only applied in one paper.…”

Section: Flexibilitymentioning

confidence: 92%

“…Lastly, stimuli can be presented in the auditory and visual modality at the same time (Hillyer et al, 2019;Mussoi and Brown, 2019;Zucca et al, 2022; Table 8). The audiovisual digit span test was applied in three included studies, with no significant results when related to words in quiet (e.g., when measured preoperatively forward: r 2 = 0.003, p = 0.826, backward: r 2 = 0.036, p = 0.410), but a significant positive correlation with sentences in quiet (r = 0.539 p = 0.016) and noise (r = 0.573, p = 0.018) (Hillyer et al, 2019;Mussoi and Brown, 2019;Zucca et al, 2022) and visual letters and recall one of them or both. In the cued conditions they were instructed beforehand what they needed to recall after the stimuli were presented, but no instruction was given in the uncued condition.…”

Section: Audio-visual Working Memorymentioning

confidence: 99%

“…These skills are involved in many of the tasks discussed above. Only two papers used tasks that explicitly measure these skills (see Table 10b for an overview) (Hillyer et al, 2019;Zucca et al, 2022). Tasks used to measure this skill are the "WJ-IV visualization parts A and B, " the "corsi block tapping test" and the "block rotation task."…”

Section: Perceptual-motor Functionmentioning

confidence: 99%

“…Tasks used to measure this skill are the "WJ-IV visualization parts A and B, " the "corsi block tapping test" and the "block rotation task." These tasks were only applied in one paper each and did not show any significant relation with speech perception performance (e.g., r = 0.081-0.103, p = 0.156-0.588) (Hillyer et al, 2019;Zucca et al, 2022).…”

Section: Perceptual-motor Functionmentioning

confidence: 99%

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Exploring neurocognitive factors and brain activation in adult cochlear implant recipients associated with speech perception outcomes—A scoping review

Beckers

Tromp²,

Philips³

et al. 2023

Front. Neurosci.

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BackgroundCochlear implants (CIs) are considered an effective treatment for severe-to-profound sensorineural hearing loss. However, speech perception outcomes are highly variable among adult CI recipients. Top-down neurocognitive factors have been hypothesized to contribute to this variation that is currently only partly explained by biological and audiological factors. Studies investigating this, use varying methods and observe varying outcomes, and their relevance has yet to be evaluated in a review. Gathering and structuring this evidence in this scoping review provides a clear overview of where this research line currently stands, with the aim of guiding future research.ObjectiveTo understand to which extent different neurocognitive factors influence speech perception in adult CI users with a postlingual onset of hearing loss, by systematically reviewing the literature.MethodsA systematic scoping review was performed according to the PRISMA guidelines. Studies investigating the influence of one or more neurocognitive factors on speech perception post-implantation were included. Word and sentence perception in quiet and noise were included as speech perception outcome metrics and six key neurocognitive domains, as defined by the DSM-5, were covered during the literature search (Protocol in open science registries: 10.17605/OSF.IO/Z3G7W of searches in June 2020, April 2022).ResultsFrom 5,668 retrieved articles, 54 articles were included and grouped into three categories using different measures to relate to speech perception outcomes: (1) Nineteen studies investigating brain activation, (2) Thirty-one investigating performance on cognitive tests, and (3) Eighteen investigating linguistic skills.ConclusionThe use of cognitive functions, recruiting the frontal cortex, the use of visual cues, recruiting the occipital cortex, and the temporal cortex still available for language processing, are beneficial for adult CI users. Cognitive assessments indicate that performance on non-verbal intelligence tasks positively correlated with speech perception outcomes. Performance on auditory or visual working memory, learning, memory and vocabulary tasks were unrelated to speech perception outcomes and performance on the Stroop task not to word perception in quiet. However, there are still many uncertainties regarding the explanation of inconsistent results between papers and more comprehensive studies are needed e.g., including different assessment times, or combining neuroimaging and behavioral measures.Systematic review registrationhttps://doi.org/10.17605/OSF.IO/Z3G7W.

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Association of Aging and Cognition With Complex Speech Understanding in Cochlear-Implanted Adults

Schvartz-Leyzac

Giordani

Pfingst

2023

JAMA Otolaryngol Head Neck Surg

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ImportanceThe association between cognitive function and outcomes in cochlear implant (CI) users is not completely understood, partly because some cognitive tests are confounded by auditory status. It is important to determine appropriate cognitive tests to use in a cohort of CI recipients.ObjectiveTo provide proof-of-concept for using an adapted version of the National Institutes of Health (NIH) Toolbox Cognition Battery in a cohort of patients with CIs and to explore how hearing in noise with a CI is affected by cognitive status using the adapted test.Design, Setting, and ParticipantsIn this prognostic study, participants listened to sentences presented in a speech-shaped background noise. Cognitive tests consisted of 7 subtests of the NIH Toolbox Cognition Battery that were adapted for hearing impaired individuals by including written instructions and visual stimuli. Participants were prospectively recruited from and evaluated at a tertiary medical center. All participants had at least 6 months’ experience with their CI.Main Outcomes and MeasuresThe main outcomes were performance on the adapted cognitive test and a speech recognition in noise task.ResultsParticipants were 20 adult perilingually or postlingually deafened CI users (50% male participants; median [range] age, 66 [26-80] years old). Performance on a sentence recognition in noise task was negatively associated with the chronological age of the listener (R2 = 0.29; β = 0.16; standard error, SE = 0.06; t = 2.63; 95% confidence interval, 0.03-0.27). Testing using the adapted version of the NIH Toolbox Cognition Battery revealed that a test of processing speed was also associated with performance, using a standardized score that accounted for contributions of other demographic factors (R2 = 0.28; 95% confidence interval, −0.42 to −0.05).Conclusions and RelevanceIn this prognostic study, older CI users showed poorer performance on a sentence-in-noise test compared with younger users. This poorer performance was correlated with a cognitive deficit in processing speed when cognitive function was assessed using a test battery adapted for participants with hearing loss. These results provide initial proof-of-concept results for using a standardized and adapted cognitive test battery in CI recipients.

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Cochlear Implant Results in Older Adults with Post-Lingual Deafness: The Role of “Top-Down” Neurocognitive Mechanisms

Cited by 8 publications

References 63 publications

Ambulatory Phonation Monitoring in Prelingual and Postlingual Deaf Patients after Cochlear Implantation

Ambulatory Phonation Monitoring in Prelingual and Postlingual Deaf Patients after Cochlear Implantation

Exploring neurocognitive factors and brain activation in adult cochlear implant recipients associated with speech perception outcomes—A scoping review

Association of Aging and Cognition With Complex Speech Understanding in Cochlear-Implanted Adults

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