Use of Auditory Training and Its Influence on Early Cochlear Implant Outcomes in Adults

Abstract

Objective: Assess associations between postcochlear implant (CI) auditory training and early outcomes related to speech recognition and CI quality of life (CIQOL). Study Design: Longitudinal, prospective cohort. Setting: Tertiary academic center. Patients: Seventy-two adults undergoing cochlear implantation for bilateral severe-to-profound hearing loss. Interventions: Self-reported use of three categories of auditory training post-CI activation: (1) face-to-face training (e.g., speech pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) computer-based training (e.g., interactive software). Main Outcome Measures: Change in Consonant-Nucleus-Consonant phoneme (CNCp), CNC word (CNCw), AzBio sentences in quiet, and CIQOL-35 Profile global and domain scores from pre-CI to 3-month post-CI. Results: Of 72 patients, 52 (72.2%) used an auditory training resource. Of all patients, 18.4% used face-to-face training, 58.3% passive home-based training, and 33.3% computerbased training. At 3 months post-CI, use of any training was associated with greater improvement in speech recognition (d-range ¼ 0.57 -0.85) and global and domain-specific CIQOL scores, except entertainment (d-range ¼ À0.33 to 0.77). Use of computer-based training demonstrated the greatest effect, with larger improvements in speech recognition (CNCp: d ¼ 0.69[0.03,1.35]; CNCw: d ¼ 0.80[0.14,1.46]; AzBio: d ¼ 1.11[0.44,1.77]) and global and all domainspecific CIQOL scores (d-range ¼ 0.05-1.35). Controlling for age, sex, household income, and use of multiple training resources, computer-based training remained the strongest positive predictor of speech recognition and CIQOL improvement, with significant associations with CNCp (ß ¼ 33.07[1,43,64.719]), AzBio (ß ¼ 33.03[5.71,60.35]), and 20.70]) score improvement. Conclusions: Our findings provide preliminary evidencebased recommendations for use of specific auditory training resources for new adult CI recipients. Auditory training, especially self-directed computer software, resulted in improved speech recognition and CIQOL outcomes after 3 months and are widely available for CI users.

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

“…Patients who demonstrate little improvement in speech recognition in the early post-operative period might require additional interventions such as speech-language pathologist-led auditory rehabilitation and computer-based auditory training activities, which have been demonstrated to improve speech recognition in the early post-implantation period. [56][57][58][59][60] Long-term evaluation of speech recognition is necessary for all patients as individual patient outcomes may demonstrate wide variation from group means. 61,62 Although speech recognition is considered to be the standard for measuring outcomes in CI users, word and sentence recognition measured in a controlled environment does not assess communication abilities in more complex environments and, therefore, does not reflect CI users' abilities in real-world listening situations.…”

“…For clinicians, these findings underscore the importance of regular use of the device and repeated evaluation in the early post‐operative period. Patients who demonstrate little improvement in speech recognition in the early post‐operative period might require additional interventions such as speech‐language pathologist‐led auditory rehabilitation and computer‐based auditory training activities, which have been demonstrated to improve speech recognition in the early post‐implantation period 56–60 . Long‐term evaluation of speech recognition is necessary for all patients as individual patient outcomes may demonstrate wide variation from group means 61,62 …”

Understanding Patient Expectations Before Implantation Using the Cochlear Implant Quality of Life–Expectations Instrument

“…If patients’ pre-CI outcome expectations are found to be associated with long-term outcomes, then the significance of the modifiability of patient expectation could be substantial. In addition, further research will be needed to identify the mechanism for effect, such as the association of patient expectations with postimplant behaviors (eg, increase hours of CI use or increase use of computer-based auditory training). However, more research is needed to provide the evidence to guide pre-CI outcome expectation discussion that can optimize CI outcomes.…”

Early Datalogging Predicts Cochlear Implant Performance: Building a Recommendation for Daily Device Usage

“…Surgical variables such as electrode position, electrode type, and surgical technique are implicated in outcomes but are imperfectly modifiable and only accessible in the immediate perioperative period (6)(7)(8)(9)(10)(11)(12)(13). Postoperative elements include utilization of residual low-frequency acoustic hearing, advanced device mapping/programming, and the utilization of aural rehabilitation (14,15). Despite a multitude of potential factors contributing to speech performance, our ability to affect or improve CI performance is limited by individual patient characteristics, the limited windows of intervention for certain variables, as well as the cost associated with therapies, imaging, and clinical encounters.…”