Preliminary assessment of the feasibility of using AB words to assess candidacy in adults
Deborah VickersAlison RileyR RicaudCarl VerschuurStacey CooperTerry NunnKath WebbJoanne MuffFrances HarrisMark ChungJane HumphriesAlison LangshawEmma Poynter-SmithCatherine TottenLynne TapperJillian RidgwellDeborah MawmanUnai Martinez de EstibarizMartin O’DriscollNicola GeorgeFrancesca PintoAnne L. HallCarol LlewellynRazun MiahGhada Al-MalkyPádraig T. Kitterick
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Background: Adult cochlear implant (CI) candidacy is assessed in part by the use of speech perception measures. In the United Kingdom the current cut-off point to fall within the CI candidacy range is a score of less than 50% on the BKB sentences presented in quiet (presented at 70 dBSPL).Goal: The specific goal of this article was to review the benefit of adding the AB word test to the assessment test battery for candidacy.Results: The AB word test scores showed good sensitivity and specificity when calculated based on both word and phoneme scores. The word score equivalent for 50% correct on the BKB sentences was 18.5% and it was 34.5% when the phoneme score was calculated; these scores are in line with those used in centres in Wales (15% AB word score).Conclusion: The goal of the British Cochlear Implant Group (BCIG) service evaluation was to determine if the pre-implant assessment measures are appropriate and set at the correct level for determining candidacy, the future analyses will determine whether the speech perception cut-off point for candidacy should be adjusted and whether other more challenging measures should be used in the candidacy evaluation.Keywords:
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Objective: Examine the relationship between duration of unilateral deafness and speech perception outcomes after cochlear implantation in adults with single-sided deafness.Methods: A systematic review of PubMed articles containing individual speech perception and duration of deafness data from single-sided deaf adults. Studies were selected for detailed review and duration of deafness and speech perception outcomes were extracted, with speech scores reported as percent correct. A linear regression as a function of study and length of deafness was performed.Results: A statistically significant negative effect of duration of unilateral deafness on speech perception was found, but there was substantial uncertainty regarding the strength of the effect.Discussion: Existing data make it difficult to either support or reject a hard 5- or 10-year unilateral auditory deprivation limit on cochlear implant (CI) candidacy for patients with single-sided deafness. This is because the totality of available data are consistent with a very small effect, perhaps negligible in practical terms, and just as consistent with a very large effect. Regardless of effect size, the present results have important basic implications. They suggest that unilateral sound deprivation may have a deleterious effect on auditory processing even though more central parts of the auditory system have continued to receive input from a contralateral normal ear.Conclusions: Speech perception scores in SSD patients are negatively correlated with duration of deafness, but the limited amount of data from cochlear implant users with long-term single-sided deafness leads to substantial uncertainly, which in turn precludes any strong clinical recommendations. Further study of SSD CI users with long-term deafness will be necessary to generate evidence-based guidelines for implantation criteria in this population.
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To identify differences in outcomes and map characteristics in pediatric bilateral cochlear implants with modiolar conforming and lateral wall arrays in opposite ears.Retrospective case series.Tertiary care pediatric referral center.Fourteen children who received a perimodiolar array in one ear and a slim straight array in the opposite ear in sequential surgeries.None.Consonant-nucleus-consonant test (CNC) word recognition score, battery life, power levels, electrical compound action potential (ECAP) thresholds, and electrical threshold and comfort charge levels.Speech perception outcomes were poorer in the lateral wall ears than the perimodiolar ears, and scores in the bilateral condition were better than with the lateral wall device alone. Sequential placement was a factor with differences in preoperative candidacy time correlating with greater difference in speech perception. There was no difference in charge levels between ears, in spite of higher ECAP threshold values for the lateral wall devices.While bilateral speech perception was good, speech perception with the lateral wall device alone was poorer. This cannot be explained solely by the device, as differences in preoperative candidacy time were a significant factor. ECAP thresholds are significantly higher for lateral wall electrodes, but that did not translate in to higher psychophysical measurements.
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As cochlear implant (CI) acceptance increases and candidacy criteria are expanded, these devices are increasingly recommended for individuals with less than profound hearing loss. As a result, many individuals who receive a CI also retain acoustic hearing, often in the low frequencies, in the nonimplanted ear (i.e., bimodal hearing) and in some cases in the implanted ear (i.e., hybrid hearing) which can enhance the performance achieved by the CI alone. However, guidelines for clinical decisions pertaining to cochlear implantation are largely based on expectations for postsurgical speech-reception performance with the CI alone in auditory-only conditions. A more comprehensive prediction of postimplant performance would include the expected effects of residual acoustic hearing and visual cues on speech understanding. An evaluation of auditory-visual performance might be particularly important because of the complementary interaction between the speech information relayed by visual cues and that contained in the low-frequency auditory signal. The goal of this study was to characterize the benefit provided by residual acoustic hearing to consonant identification under auditory-alone and auditory-visual conditions for CI users. Additional information regarding the expected role of residual hearing in overall communication performance by a CI listener could potentially lead to more informed decisions regarding cochlear implantation, particularly with respect to recommendations for or against bilateral implantation for an individual who is functioning bimodally.Eleven adults 23 to 75 years old with a unilateral CI and air-conduction thresholds in the nonimplanted ear equal to or better than 80 dB HL for at least one octave frequency between 250 and 1000 Hz participated in this study. Consonant identification was measured for conditions involving combinations of electric hearing (via the CI), acoustic hearing (via the nonimplanted ear), and speechreading (visual cues).The results suggest that the benefit to CI consonant-identification performance provided by the residual acoustic hearing is even greater when visual cues are also present. An analysis of consonant confusions suggests that this is because the voicing cues provided by the residual acoustic hearing are highly complementary with the mainly place-of-articulation cues provided by the visual stimulus.These findings highlight the need for a comprehensive prediction of trimodal (acoustic, electric, and visual) postimplant speech-reception performance to inform implantation decisions. The increased influence of residual acoustic hearing under auditory-visual conditions should be taken into account when considering surgical procedures or devices that are intended to preserve acoustic hearing in the implanted ear. This is particularly relevant when evaluating the candidacy of a current bimodal CI user for a second CI (i.e., bilateral implantation). Although recent developments in CI technology and surgical techniques have increased the likelihood of preserving residual acoustic hearing, preservation cannot be guaranteed in each individual case. Therefore, the potential gain to be derived from bilateral implantation needs to be weighed against the possible loss of the benefit provided by residual acoustic hearing.
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Objective: To compare the current metrics used in adult cochlear implant candidacy evaluations for consistency and applicability, and to make a recommendation for an updated assessment battery. Study Design: Prospective, multicenter, within-subject clinical trial. Setting: North American cochlear implant programs including private practices, universities, and hospital centers. Patients: One hundred adult hearing aid users scoring 40% or less on monosyllabic words in quiet in the aided test ear who presented for cochlear implantation evaluation. Intervention: Subjects underwent unilateral cochlear implantation. Main Outcome Measures: Speech perception measured via Consonant-Nucleus-Consonant words in quiet and AzBio sentences in noise. Patient-reported hearing disability measured via the Speech, Spatial, and Qualities of Hearing Scale administered preoperatively and at 6 months postoperatively. Results: Significant group mean improvement on all speech perception measures and SSQ subscales postoperatively with possible floor effects observed in objective background noise testing preoperatively and a broad range of variability seen postoperatively. Conclusions: Consonant-Nucleus-Consonant words are an effective tool to clinically evaluate hearing ability over time. Adjustment of cochlear implant screening protocols to prioritize monosyllabic words over sentences in noise as the chief determining factor appears justified, and this test can be supplemented by the SSQ for a holistic and applicable assessment of cochlear implant candidacy.
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Cochlear implant (CI) candidacy guidelines continue to evolve as a result of advances in both cochlear implant and hearing aid technology. Empirical studies comparing the speech perception abilities of children using cochlear implants or hearing aids will be reviewed in the context of current device technology and CI candidacy evaluations.
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As cochlear implant (CI) candidacy expands to consider children with more residual hearing, the use of a CI and a hearing aid (HA) at the non-implanted ear (bimodal devices) is increasing. This case study examines the contributions of acoustic and electric input to speech perception performance for a pediatric bimodal device user (S1) who is a borderline bilateral cochlear implant candidate. S1 completed a battery of perceptual tests in CI-only, HA-only and bimodal conditions. Since CIs and HAs differ in their ability to transmit cues related to segmental and suprasegmental perception, both types of perception were tested. Performance in all three device conditions were generally similar across tests, showing no clear device-condition benefit. Further, S1's spoken language performance was compared to those of a large group of children with prelingual severe-profound hearing loss who used two devices from a young age, at least one of which was a CI. S1's speech perception and language scores were average or above-average compared to these other pediatric CI recipients. Both segmental and suprasegmental speech perception, and spoken language skills should be examined to determine the broad-scale performance level of bimodal recipients, especially when deciding whether to move from bimodal devices to bilateral CIs.
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Objectives: Determining cochlear implant candidacy status requires a specific sentence‐level testing paradigm in best‐aided conditions. Correlation of the findings on routine audiometry with those of formal cochlear implant (CI) evaluation has not been performed. Our objective was to determine if findings on routine office‐based audiometry could predict the results of a formal CI candidacy evaluation. Methods: The charts of all adult patients who were evaluated for CI candidacy at a tertiary care center from June 2008 through June 2013 were included. Routine, unaided audiologic measures (pure‐tone hearing thresholds and recorded monosyllabic word recognition test [MWRT] results) were then correlated with best‐aided sentence‐level word discrimination test (SWDT) results using either the Hearing in Noise Test (HINT) or AzBio sentences. Results: The degree of hearing loss at 250 to 4000 Hz significantly correlated with SWDT results. Additionally, 87% of patients who scored <30% in MWRT qualified for implantation using HINT sentences. Similarly, in patients whose MWRT scores were <35%, 81%, and 93% met CI candidacy criteria when using AZBio sentence testing in quiet and noise, respectively. Conclusions: Routine office‐based audiometry can be used to identify patients who would highly likely meet CI candidacy upon formal testing. For example, a pure tone threshold of ≥55 dB at 250 Hz and a MWRT score of ≤35% when evaluating using AzBio sentences collectively identifies a patient who is likely to meet candidacy criteria. Using these predictive patterns during routine audiometry may assist hearing health professionals in deciding when to refer patients for a formal CI evaluation.
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Cochlear implants (CI) candidacy criteria have expanded to include children with more residual hearing. This study explored the clinical profiles and outcomes of children with CIs who had preoperative residual hearing in at least one ear.A retrospective chart review was conducted to collect clinical characteristics and speech perception data. Pre- and post-CI auditory and speech perception data were analysed using a modified version of the Pediatric Ranked Order Speech Perception (PROSPER) score.This study included all children with residual hearing who received CIs in one Canadian paediatric centre from 1992 to 2018.A total of 100 of 389 (25.7%) children with CIs had residual hearing (median 77.6 dB HL, better ear). The proportion of children with residual hearing increased from 1992 to 2018. Children who had auditory behaviour and speech perception tests (n = 83) showed higher modified PROSPER scores post-CI compared to pre-CI. Phonologically Balanced Kindergarten (PBK) test scores were available for 71 children post-CI; 81.7% (58/71) of children achieved > 80% on the PBK.One in four children who received CIs had residual hearing, and most of them had severe hearing loss at pre-CI. These children showed a high level of speech perception with CIs.
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