Older Individuals Meeting Medicare Cochlear Implant Candidacy Criteria in Noise but Not in Quiet: Are These Patients Improved by Surgery?

Mudery, Jordan A.; Francis, Ross H.; McCrary, Hilary C.; Jacob, Abraham

doi:10.1097/mao.0000000000001271

Cited by 32 publications

(29 citation statements)

References 33 publications

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“…In light of improving outcomes and concerns about ceiling effects, the MSTB committee revised the sentence material recommendations in 2011, suggesting use of monosyllabic words in addition to AzBio Sentences (4) in quiet and noise and Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN;(5)) test (6). Subsequent studies demonstrated the clinical value of these speech in noise measures for 1) approximating realistic listening environments, 2) assessing listeners’ complaints, 3) avoiding ceiling effects, 4) and evaluating pre- and postoperative performance in populations that may not struggle in quiet (7–10).…”

Section: Introductionmentioning

confidence: 99%

Speech Recognition in Noise for Adults With Normal Hearing: Age-Normative Performance for AzBio, BKB-SIN, and QuickSIN

Holder

Levin

Gifford

2018

Otology &Amp; Neurotology

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Objective: Characterize performance for adults aged 20 to 79 years with normal hearing on tasks of AzBio, BKB-SIN, QuickSIN, and acoustic Quick Spectral Modulation Detection (QSMD) in the sound field. Setting: Cochlear implant (CI) program. Patients: Eighty-one adults with normal hearing and cognitive function were recruited evenly across four age groups (20–49, 50–59, 60–69, and 70–79 years). Interventions: Subjects completed AzBio sentence recognition testing in quiet and in five signal-to-noise ratios (SNRs: +10, +5, 0, −5, −10 dB), as well as the BKB-SIN, QuickSIN, and QSMD tasks. Main Outcome Measures: AzBio, BKB-SIN, QuickSIN, and acoustic QSMD scores were analyzed to characterize typical sound field performance in an older adult population with normal hearing. Results: AzBio sentence recognition performance approached ceiling for sentences presented at ≥ 0 dB SNR with mean scores ranging from 3.5% at −10 dB SNR to 99% at +10 dB SNR. Mean QuickSIN SNR-50 was −0.02. Mean BKB-SIN SNR-50 was −1.31 dB. Mean acoustic QSMD score was 88%. Performance for all measures decreased with age. Conclusion: Adults with age-normative hearing achieve ceiling-level performance for AzBio sentence recognition at SNRs used for clinical CI and/or HA testing. Thus, these tasks are not inherently contraindicated for older listeners. Older adults with normal hearing, however, demonstrated greater deficits for speech in noise compared to younger listeners—an effect most pronounced at negative SNRs. Lastly, BKB-SIN data obtained in the sound field replicated previous normative data for only the youngest age group, suggesting that new norms should be considered for older populations.

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Section: Introductionmentioning

confidence: 99%

Speech Recognition in Noise for Adults With Normal Hearing: Age-Normative Performance for AzBio, BKB-SIN, and QuickSIN

Holder

Levin

Gifford

2018

Otology &Amp; Neurotology

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“…[4][5][6] In addition, many researchers have specifically demonstrated the effectiveness of this treatment in Medicareeligible recipients, who typically include US citizens older than 65 years. 7,8 Such treatment is particularly important for Medicare beneficiaries because hearing loss has been associated with depression, social isolation, and a subjective decrease in wellbeing in elderly individuals. [9][10][11][12][13] Medicare indications for a cochlear implant have been in existence since 2005 and state the following: "The evidence is adequate to conclude that cochlear implantation is reasonable and necessary for treatment of bilateral pre-or postlinguistic, sensorineural, moderate to profound hearing loss in individuals who demonstrate limited benefit from amplification.…”

mentioning

confidence: 99%

Assessment of Cochlear Implants for Adult Medicare Beneficiaries Aged 65 Years or Older Who Meet Expanded Indications of Open-Set Sentence Recognition

Zwolan

Kallogjeri

Firszt

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Current indications for Medicare beneficiaries to receive a cochlear implant are outdated. Multichannel cochlear implant systems may be effective when provided to Medicare beneficiaries using expanded indications.OBJECTIVE To examine the effectiveness of cochlear implants, as measured by improvement on the AzBio Sentence Test, for newly implanted Medicare beneficiaries who meet the expanded indications of an AzBio Sentence Test score of 41% to 60% in their best-aided condition. DESIGN, SETTING, AND PARTICIPANTSA multicenter nonrandomized trial examined preoperative and postoperative speech recognition, telephone communication, hearing device benefit, health utility, and quality of life for 34 participants enrolled at 8 different centers who received a cochlear implant between September 17, 2014, and July 10, 2018. All participants were 65 years or older, had bilateral moderate to profound hearing loss, and had a best-aided preoperative AzBio Sentence Test score in quiet of 41% to 60%. Analysis was performed on an intention-to-treat basis. Statistical analysis of final results took place from July 29 to October 1, 2019.INTERVENTION Multichannel cochlear implants. MAIN OUTCOMES AND MEASURESThe study examined the a priori hypothesis that the cochlear implant would improve the AzBio Sentence Test score in the best-aided condition by 25% or more and in the implanted ear-alone condition by 30% or more. The study additionally examined word and telephone recognition and examined device benefit, health utility, and quality of life.RESULTS A total of 34 participants received a cochlear implant; 31 (23 men [74%]; median age, 73.6 years [range, 65.7-85.1 years]) completed testing through the 6-month evaluation, and 29 completed testing through the 12-month evaluation. Median preoperative AzBio Sentence Test scores were 53% (range, 26%-60%) for the best-aided condition and 24% (range, 0%-53%) for the cochlear implant-alone condition; median scores 12 months after implantation improved to 89% (range, 36%-100%) for the best-aided condition and 77% (range, 13%-100%) for the cochlear implant-alone condition. This outcome represents a median change of 36% (range, -22% to 75%) for the best-aided condition (lower bound of 1-sided 95% CI, 31%) and a median change of 53% (range, -15% to 93%) for the cochlear implant-alone condition (lower bound of 1-sided 95% CI, 45%). CONCLUSIONS AND RELEVANCEIntervention with a cochlear implant was associated with improved sentence, word, and telephone recognition in adult Medicare beneficiaries whose preoperative AzBio Sentence Test scores were between 41% and 60%. These findings support expansion of the Center for Medicare & Medicaid current indications for cochlear implants.

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“…20 Speech-in-noise measures more appropriately reflect real-world listening performance and appear to have a higher sensitivity for selecting appropriate CI candidates than SIQ. 6,10,16 When SIN testing was used, it was conditionally based on scores obtained in quiet; yet no clear performance marker for when to include SIN was identified. These results differ from those reported by Carlson et al, 21 wherein 68% of respondents reported that SIN testing is performed routinely.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, criteria for Medicare candidates 15 tend to be more stringent than the FDA criteria despite increasing criticism of their appropriateness for selecting adult candidates for CI. 6,9,16 The primary objective of this study was to investigate preoperative assessment methods used by audiologists to evaluate adult candidates for CI in the United States. Secondarily, we investigated clinical practice variables that might contribute to decision-making regarding assessment methods.…”

mentioning

confidence: 99%

Audiology Practices in the Preoperative Evaluation and Management of Adult Cochlear Implant Candidates

Prentiss

Snapp

Zwolan

2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Currently, no clear guidelines exist regarding clinical testing methods for identifying adult cochlear implant (CI) candidates. Indications provided by the US Food and Drug Administration, Medicare, and private insurers are ambiguous concerning test materials and the level and mode of test presentation. This could lead to wide variability in clinical assessment and, potentially, unequal access to CIs for individuals with clinically significant hearing loss. OBJECTIVE To examine the preoperative testing methods used by audiologists in evaluating adult CI candidates across the United States. DESIGN, SETTING, AND PARTICIPANTS A survey assessing audiology practice patterns was created using a Research Electronic Data Capture system hosted at the University of Miami. A link to a survey (65 questions in multiple-choice or rank-order format was distributed electronically along with a request for completion to members of the American Cochlear Implant Alliance and to the Institute for Cochlear Implant Training forum. Responses were collected from January 17 to June 4, 2018. Participation was limited to audiologists who evaluate adult CI candidates, and respondents who do not provide adult CI care were excluded. Collected demographic information included work setting, years of experience, and highest level of education attained. MAIN OUTCOMES AND MEASURES Percentages, medians, and interquartile ranges were from aggregated responses concerning hearing aid verification methods; testing methods, materials, and practices; nonauditory factors that might affect CI candidacy; audiology practice patterns; and expanded indications for CIs. RESULTS Anonymized surveys were returned by 99 respondents; because surveys were available electronically, the number of audiologists who viewed the survey but did not respond was not available. Seven respondents identified themselves as pediatric specialists and were excluded, resulting in a total of 92 surveys available for analysis (denominators vary because respondents could complete the survey without answering all questions). Seventy percent of respondents (51 of 72) were doctors of audiology, and nearly 50% (33 of 74) were employed at universities and academic centers performing more than 50 CIs per year. When assessing adult candidacy for implant, most respondents reported using test materials from the Minimum Speech Test Battery: 96% (51 of 53), using AzBio sentences in quiet; 89% (47 of 53), AzBio sentences in noise; and 100% (53 of 53), the consonant-vowel nucleus-consonant, monosyllabic words test. However, these tests were applied inconsistently, with 39 of 53 respondents (74%) reporting use of a sound pressure level scale and the other 14 (26%) a hearing level scale at various decibel levels, and with some using a single signal-to-noise ratio and others using multiple ratios for sound-in-noise tests. Respondents' definitions of the best aided listening condition for assessing implant candidates also varied widely. Among the nonauditory factors ranked most important for as...

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Older Individuals Meeting Medicare Cochlear Implant Candidacy Criteria in Noise but Not in Quiet: Are These Patients Improved by Surgery?

Abstract: All patients undergoing CI candidacy testing should be tested in both quiet and noise conditions. For those who qualify only in noise, our results demonstrate that cochlear implantation typically improves hearing both in quiet and noise.

Cited by 32 publications

References 33 publications

Speech Recognition in Noise for Adults With Normal Hearing: Age-Normative Performance for AzBio, BKB-SIN, and QuickSIN

Speech Recognition in Noise for Adults With Normal Hearing: Age-Normative Performance for AzBio, BKB-SIN, and QuickSIN

Assessment of Cochlear Implants for Adult Medicare Beneficiaries Aged 65 Years or Older Who Meet Expanded Indications of Open-Set Sentence Recognition

Audiology Practices in the Preoperative Evaluation and Management of Adult Cochlear Implant Candidates

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