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Purpose: To study outcome after cochlear implantation using the Cochlear Implant (CI) outcome assessment protocol based on the International Classification of Functioning, Disability and Health (ICF) model (CI-ICF)., Methods: Raw data of a prospective, longitudinal, multicenter study was analyzed. Seventy-two CI candidates were assessed preoperatively and six months postoperatively using the CI-ICF protocol. Following tools were used: (1) Work Rehabilitation Questionnaire (WORQ), (2) Abbreviated Profile of Hearing Aid Benefit (APHAB), (3) Audio Processor Satisfaction Questionnaire (APSQ), (4) Speech, Spatial, and Qualities of Hearing Scale (SSQ12), (5) Hearing Implant Sound Quality Index (HISQUI19), (6) Nijmegen CI Questionnaire (NCIQ) (7) pure tone audiometry, (8) speech audiometry, (9) sound localization., Results: There was a significant improvement of speech discrimination in quiet (p = 0.015; p < 0.001) and in noise (p = 0.041; p < 0.001), sound detection (p < 0.001), tinnitus (p = 0.026), listening (p < 0.001), communicating with-receiving-spoken messages (p < 0.001), conversation (p < 0.001), family relationships (p < 0.001), community life (p = 0.019), NCIQ total score and all subdomain scores (p < 0.001). Subjective sound localization significantly improved (p < 0.001), while psychometric sound localization did not. There was no significant subjective deterioration of vestibular functioning and no substantial change in sound aversiveness. CI users reported a high level of implant satisfaction postoperatively., Conclusion: This study highlights the positive impact of cochlear implantation on auditory performance, communication, and subjective well-being. The CI-ICF protocol provides a holistic and comprehensive view of the evolution of CI outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To investigate retrospectively the frequency of usage of bimodal stimulation among cochlear implant (CI) users, as well its clinical benefit relative to unilateral use., Design: All subjects had been monitored with the clinical Minimal Outcome Measurements test battery., Study Samples: 103 adults with bilateral postlingual profound sensorineural hearing loss and unilateral CI use were extracted from the local database. These were divided into two groups: those who only used a CI and those who used bimodal stimulation., Results: The preoperative contralateral residual hearing in the bimodal group was significantly better than that of the CI-only group. In both groups, speech perception in quiet and in noise improved after CI, with no significant difference between postoperative unimodal conditions. For the bimodal group, an additional significant improvement was found for the bimodal condition compared to the unimodal., Conclusion: Given the observed auditory benefit of bimodal stimulation in comparison to unimodal stimulation and given the finding that degree of residual hearing is not correlated with bimodal benefits, it is recommended to encourage CI recipients to continue contralateral HA use after CI. As a result of expanding CI criteria worldwide, the population of bimodal users is expected to grow in the near future.

Purpose: Recent literature suggests that tinnitus can impact cognition, but results were varied due to a diversity in investigated aspects of cognition and utilized tests, as well as the possible influence of confounding factors. The purpose of this study was to assess the impact of tinnitus loudness on cognition by use of a within-subjects design in patients with a cochlear implant (CI). In this population, tinnitus loudness can be modulated by switching the CI on or off as CI is known to highly suppress tinnitus., Methods: A total of 18 CI users completed two versions of the Repeatable Battery for Assessment of Neuropsychological Status for Hearing Impaired individuals (RBANS-H), once in unaided condition and once in best aided condition. Tinnitus suppression was defined as a difference in score on a visual-analogue scale (VAS) of at least one point out of ten between these two conditions., Results: No significant differences in RBANS-H scores were found between the suppression and no suppression group, nor for the suppression group alone. No significant correlations between tinnitus loudness and RBANS-H were found, neither for the suppression group alone, nor for the group as a whole., Conclusion: The current study shows no significant effect of tinnitus loudness on cognition, which contradicts previous literature. This discrepancy could be explained by the use of a within-subjects design, which controls for confounding factors. Future research should include a larger and more diverse study sample to draw definitive conclusions on this topic., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study aimed to report quality of life (QoL) scores in unilateral cochlear implant (CI) users and to generate guidance for clinicians on using QoL measures to individualize CI counselling and rehabilitation and to increase access to CIs as a mode of rehabilitation. Participants (n = 101) were unilateral CI users with single-sided deafness (SSD; n = 17), asymmetrical hearing loss (AHL; n = 26), or bilateral hearing loss (Uni; n = 58). Generic QoL was assessed via the Health Utilities Index (HUI-3), and disease-specific QoL was assessed via the Speech, Spatial, and Qualities of Hearing scale (SSQ12) and Nijmegen CI Questionnaire (NCIQ) at preimplantation and at 6 and 12 months of CI use. All groups had significantly increased HUI-3 scores at both intervals. The SSD group showed significant benefit on the SSQ12 at visit 3, the AHL group showed significant benefit on the SSQ12 and most NCIQ subdomains at both intervals, and the Uni group showed significant benefit with both tests at both intervals. Unilateral CI recipients demonstrate improved QoL within the first 12 months of device use. Regular assessment with generic and disease-specific questionnaires has the potential to play an important role in personalizing treatment and possibly in increasing access to CI provision.

Purpose: The main objective of this study is to evaluate the short-term and long-term audiological outcomes in patients who underwent cochlear implantation with a robot-assisted system to enable access to the cochlea, and to compare outcomes with a matched control group of patients who underwent cochlear implantation with conventional access to the cochlea., Methods: In total, 23 patients were implanted by robot-assisted cochlear implant surgery (RACIS). To evaluate the effectiveness of robotic surgery in terms of audiological outcomes, a statistically balanced control group of conventionally implanted patients was created. Minimal outcome measures (MOM), consisting of pure-tone audiometry, speech understanding in quiet and speech understanding in noise were performed pre-operatively and at 3 months, 6 months, 12 months and 2 years post-activation of the audioprocessor., Results: There was no statistically significant difference in pure-tone audiometry, speech perception in quiet and speech perception in noise between robotically implanted and conventionally implanted patients pre-operatively, 3 months, 6 months, 12 months and 2 years post-activation. A significant improvement in pure-tone hearing thresholds, speech understanding in quiet and speech understanding in noise with the cochlear implant has been quantified as of the first measurements at 3 months and this significant improvement remained stable over a time period of 2 years for HEARO implanted patients., Conclusion: Clinical outcomes in robot-assisted cochlear implant surgery are comparable to conventional cochlear implantation. CLINICALTRAILS., Gov Trail Registration Numbers: NCT03746613 (date of registration: 19/11/2018), NCT04102215 (date of registration: 25/09/2019)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Importance: Given the rapidly rising dementia incidence, management of modifiable risk factors, such as hearing loss, is vital. Multiple studies have demonstrated an improvement of cognitive functioning in older adults with severe hearing loss after cochlear implantation; however, few of these studies, to the authors' knowledge, specifically analyzed participants achieving poor cognitive results preoperatively., Objective: To evaluate the cognitive functioning of older adults with severe hearing loss at risk for mild cognitive impairment (MCI) before and after cochlear implantation., Design, Setting, and Participants: This prospective, longitudinal cohort study performed at a single center reports data obtained over a 6-year period (April 2015 to September 2021) of an ongoing prospective, longitudinal cohort study on cochlear implant outcomes in older adults. A consecutive sample of older adults with severe hearing loss eligible for cochlear implantation was included. All participants obtained a Repeatable Battery for the Assessment of Neuropsychological Status for hearing-impaired patients (RBANS-H) total score indicative of MCI preoperatively. Participants were assessed before cochlear implant activation and 12 months after cochlear implant activation., Intervention: The intervention consisted of cochlear implantation., Main Outcome and Measure: The primary outcome measure was cognition, measured by the RBANS-H., Results: A total of 21 older adult cochlear implant candidates were included in the analysis (mean [SD] age, 72 [9] years; 13 [62%] men). Cochlear implantation was associated with an improvement of overall cognitive functioning 12 months after activation (median [IQR] percentile, 5 [2-8] vs 12 [7-19]; difference, 7 [95% CI, 2-12]). Eight participants (38%) surpassed the MCI cutoff (16th percentile) postoperatively, while the overall median cognitive score remained under this cutoff. In addition, participants' speech recognition in noise improved, with a lower score indicating improvement (mean [SD] score, +17.16 [5.45] vs +5.67 [6.3]; difference, -11.49 [95% CI, -14.26 to -8.72]), after cochlear implant activation. Improvement of speech recognition in noise was positively associated with improvement in cognitive functioning (rs, -0.48 [95% CI, -0.69 to -0.19]). Years of education, sex, RBANS-H version, and symptoms of depression and anxiety were not related to the evolution in RBANS-H scores., Conclusions and Relevance: In this prospective, longitudinal cohort study, cognitive functioning and speech perception in noise showed a clinically meaningful improvement 12 months after cochlear implant activation in older adults with severe hearing loss at risk for MCI, suggesting that cochlear implantation is not contraindicated in cochlear implant candidates with cognitive decline and should be considered after multidisciplinary evaluation.

Cochlear implantation (CI) for deafblindness may have more impact than for non-syndromic hearing loss. Deafblind patients have a double handicap in a society that is more and more empowered by fast communication. CI is a remedy for deafness, but requires revision surgery every 20 to 25 years, and thus placement should be minimally invasive. Furthermore, failed reimplantation surgery will have more impact on a deafblind person. In this context, we assessed the safety of minimally invasive robotically assisted cochlear implant surgery (RACIS) for the first time in a deafblind patient. Standard pure tone audiometry and speech audiometry were performed in a patient with deafblindness as part of this robotic-assisted CI study before and after surgery. This patient, with an optic atrophy 1 ( OPA1 ) (OMIM#165500) mutation consented to RACIS for the second (contralateral) CI. The applicability and safety of RACIS were evaluated as well as her subjective opinion on her disability. RACIS was uneventful with successful surgical and auditory outcomes in this case of deafblindness due to the OPA1 mutation. RACIS appears to be a safe and beneficial intervention to increase communication skills in the cases of deafblindness due to an OPA1 mutation. The use of RACIS use should be widespread in deafblindness as it minimizes surgical trauma and possible failures.

Purpose: The goal of this study was to evaluate if bilaterally (partially) absent vestibular function during static sound localization testing, would have a negative impact on sound localization skills. Therefore, this study compared horizontal static sound localization skills of normal-hearing patients with bilateral vestibulopathy (BV) and healthy controls., Methods: Thirteen normal-hearing patients with BV and thirteen age-matched healthy controls were included. Sound localization skills were tested using seven loudspeakers in a frontal semicircle, ranging from - 90° to + 90°. Sound location accuracy was analyzed using the root-mean-square error (RMSE) and the mean absolute error (MAE). To evaluate the severity of the BV symptoms, the following questionnaires were used: Dizziness Handicap Inventory (DHI), Oscillopsia severity questionnaire (OSQ), 12-item Spatial, Speech, and Qualities Questionnaire (SSQ12), and Health Utilities Index Mark 3 (HUI3)., Results: The RMSE and MAE were significantly larger (worse) in the BV group than in the healthy control group, with respective median RMSE of 4.6° and 0°, and a median MAE of 0.7° and 0°. The subjective reporting of speech perception, spatial hearing, and quality of life only demonstrated a moderate correlation between DHI (positive correlation) and HUI total score (negative correlation), and localization scores., Conclusion: Static sound localization skills of patients with BV were only mildly worse compared to healthy controls. However, this difference was very small and therefore most likely due to impaired cognitive function. The vestibular system does not seem to have a modulating role in sound localization during static conditions, and its impact is negligible in contrast to the impact of hearing impairment. Furthermore, the subjective reporting of speech perception, spatial hearing, and quality of life was not strongly correlated with localization scores., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To study the evolution of type D personality traits in older adults after cochlear implantation compared with a control group of severely hearing impaired older adults who did not receive a cochlear implant (CI). The influence of COVID-19 on this evolution was also explored. Type D personality combines a high degree of negative affectivity (NA) and social inhibition (SI)., Methods: In this prospective, longitudinal, controlled multicenter exploratory study, 76 older CI users and 21 severely hearing impaired controls without CI were included. The CI group and the control group did not differ significantly regarding age, formal education, residual hearing, Type D Scale-14 (DS14) total score, NA, and SI at baseline. Type D personality traits were assessed with the DS14 at baseline (T0) and 14 months later (T14)., Results: Type D personality traits differed significantly over time between the CI group and the control group (p < 0.001). In the CI group, the DS14 total score (mean delta T = -6.63; p < 0.001), NA (mean delta T = -3.26; p < 0.001), and SI (mean delta T = -3.37; p < 0.001) improved significantly over time (delta T = T14-T0), whereas no significant difference was found in the control group. Significantly fewer subjects were categorized as type D personalities in the CI group (delta T = -12; p = 0.023) at T14, whereas no significant change was found in the control group (delta T = 3; p = 0.250). COVID-19 did not influence the evolution of type D personality traits significantly in the CI group., Conclusion: Cochlear implantation has a positive effect on type D personality traits in older adults with a severe-to-profound hearing impairment., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objectives: The 59-item Work Rehabilitation Questionnaire (WORQ) was developed based on the International Classification of Functioning, Disability and Health (ICF) core set for vocational rehabilitation to assess work related functioning. It was revised to include 17 questions, assigned to 14 ICF categories relevant to cochlear implant (CI) users. This cross-sectional multicenter study aimed to evaluate CI users' responses on the WORQ questions to describe and generate ICF qualifiers for the revised WORQ in CI users, forming part of a broader framework of CI outcome measures linked to the ICF., Methods: One hundred seventy-seven adults over the age of 18 years with a minimum of one year's device experience were included in the analysis. The WORQ was completed by the participants at a routine visit to the clinic, via email, or via post., Results: Most of the CI users perceived no problem on the WORQ questions (53.7%-91%), finished secondary school (54.2%) or obtained a college or university degree (32.8%) and are either employed (41.2%) or retired (34.5%). CI users that are currently working mostly have a full-time position (34.5%). Subjects reported no problem (91%) with sensation of falling, while handling communication devices and techniques (10.9%) and tinnitus (9.6%) showed the highest number of subjects reporting a complete problem., Conclusions: Overall, most of the CI users experienced no impairment, restriction or limitation on the WORQ questions and their assigned ICF categories. Their education level resembles the education level of the general population and they seem to integrate or reintegrate well in professional life postoperatively., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objective: To investigate the effect of frequency-to-place mismatch, i.e. the mismatch between the tonotopic frequency map in the cochlea and the frequency band that is assigned to an electrode contact of a cochlear implant (CI) at the same cochlear location on speech perception outcomes, using postoperative CT images., Study Design: Retrospective observational single-centre study., Methods: Retrospective pre- and postoperative clinical CT data of 39 CI recipients with normal cochlear anatomy were analysed in an otological surgical planning software. The tonotopic frequency at each electrode position was estimated using the Greenwood function. For each patient, frequency-to-place mismatch between the tonotopic frequency and the fitted centre frequency for each electrode contact was calculated. The influence of frequency-to-place mismatch on speech perception in noise at 6 and 12 months after CI activation was studied., Results: A significant linear correlation was found between the frequency-to-place mismatch and speech perception in noise 6 months after cochlear implantation (p < 0.05). The smaller the frequency-to-place mismatch, the better the initial speech perception in noise results of the CI recipients. The significant effect disappeared after 12 months CI experience., Conclusion: The study findings support the idea of minimizing the frequency-to-place mismatch in CI recipients in order to pursue better initial speech perception in noise. Further research is needed to investigate the prospect of tonotopic fitting strategies based upon postoperative CT images of the exact locations of the electrode contacts., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The primary objectives of this study were to evaluate the effect of hearing implant (HI) use on quality of life (QoL) and to determine which QoL measure(s) quantify QoL with greater sensitivity in users of different types of HIs. Participants were adult cochlear implant (CI), active middle ear implant (VIBRANT SOUNDBRIDGE (VSB)), or active transcutaneous bone conduction implant (the BONEBRIDGE (BB)) recipients. Generic QoL and disease-specific QoL were assessed at three intervals: pre-activation, 6 months of device use, and 12 months of device use. 169 participants completed the study (110 CI, 18VSB, and 41BB). CI users' QoL significantly increased from 0-6 m device use on both the generic- and the disease-specific measures. On some device-specific measures, their QoL also significantly increased between 6 and 12 m device use. VSB users' QoL significantly increased between all tested intervals with the disease-specific measure but not the generic measure. BB users' QoL significantly increased from 0-6 m device use on both the generic- and the disease-specific measures. In sum, HI users experienced significant postoperative increases in QoL within their first 12 m of device use, especially when disease-specific measures were used. Disease-specific QoL measures appeared to be more sensitive than their generic counterparts.

Purpose: To determine the usefulness of the Health Utilities Index (HUI) in older cochlear implant (CI) recipients, the primary aims were: (1) to assess health-related quality of life (HRQoL), measured with HUI, in older CI candidates while comparing with age- and gender-matched normal-hearing controls; (2) to compare HRQoL after CI with the pre-operative situation, using HUI and the Nijmegen cochlear implant questionnaire (NCIQ). The difference between pre- and postoperative speech intelligibility in noise (SPIN) and in quiet (SPIQ) and the influence of pre-operative vestibular function on HRQoL in CI users were also studied., Methods: Twenty CI users aged 55 years and older with bilateral severe-to-profound postlingual sensorineural hearing loss and an age- and gender-matched normal-hearing control group were included. HRQoL was assessed with HUI Mark 2 (HUI2), HUI Mark 3 (HUI3) and NCIQ. The CI recipients were evaluated pre-operatively and 12 months postoperatively., Results: HUI3 Hearing (p = 0.02), SPIQ (p < 0.001), SPIN (p < 0.001) and NCIQ (p = 0.001) scores improved significantly comparing pre- and postoperative measurements in the CI group. No significant improvement was found comparing pre- and postoperative HUI3 Multi-Attribute scores (p = 0.07). The HUI3 Multi-Attribute score after CI remained significantly worse (p < 0.001) than those of the control group. Vestibular loss was significantly related to a decrease in HUI3 Multi-Attribute (p = 0.037) and HUI3 Emotion (p = 0.021) scores., Conclusion: The HUI is suitable to detect differences between normal-hearing controls and CI users, but might underestimate HRQoL changes after CI in CI users over 55., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Magnetic resonance imaging (MRI) is often used to visualize and diagnose soft tissues. Hearing implant (HI) recipients are likely to require at least one MRI scan during their lifetime. However, the MRI scanner can interact with the implant magnet, resulting in complications for the HI recipient. This survey, which was conducted in two phases, aimed to evaluate the safety and performance of MRI scans for individuals with a HI manufactured by MED-EL (MED-EL GmbH, Innsbruck, Austria)., Methods: A survey was developed and distributed in two phases to HEARRING clinics to obtain information about the use of MRI for recipients of MED-EL devices. Phase 1 focused on how often MRI is used in diagnostic imaging of the head region of the cochlear implant (CI) recipients. Phase 2 collected safety information about MRI scans performed on HI recipients., Results: 106 of the 126 MRI scans reported in this survey were performed at a field strength of 1.5 T, on HI recipients who wore the SYNCHRONY CI or SYNCHRONY ABI. The head and spine were the most frequently imaged regions. 123 of the 126 scans were performed without any complications; two HI recipients experienced discomfort/pain. One recipient required reimplantation after an MRI was performed using a scanner that had not been approved for that implant. There was only one case that required surgical removal of the implant to reduce the imaging artefact., Conclusion: Individuals with either a SYNCHRONY CI or SYNCHRONY ABI from MED-EL can safely undergo a 1.5 T MRI when it is performed according to the manufacturer's safety policies and procedures., (© 2021. The Author(s).)

Objective: To compare the cognitive evolution of older adults with severe or profound hearing impairment after cochlear implantation with that of a matched group of older adults with severe hearing impairment who do not receive a cochlear implant (CI)., Design: In this prospective, longitudinal, controlled, and multicenter study, 24 older CI users were included in the intervention group and 24 adults without a CI in the control group. The control group matched the intervention group in terms of gender, age, formal education, cognitive functioning, and residual hearing. Assessments were made at baseline and 14 months later. Primary outcome measurements included the change in the total score on the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired individuals score and on its subdomain score to assess cognitive evolution in both groups. Secondary outcome measurements included self-reported changes in sound quality (Hearing Implant Sound Quality Index), self-perceived hearing disability (Speech, Spatial, and Qualities of Hearing Scale), states of anxiety and depression (Hospital Anxiety and Depression Scale), and level of negative affectivity and social inhibition (Type D questionnaire)., Results: Improvements of the overall cognitive functioning (p = 0.05) and the subdomain "Attention" (p = 0.02) were observed after cochlear implantation in the intervention group; their scores were compared to the corresponding scores in the control group. Significant positive effects of cochlear implantation on sound quality and self-perceived hearing outcomes were found in the intervention group. Notably, 20% fewer traits of Type D personalities were measured in the intervention group after cochlear implantation. In the control group, traits of Type D personalities increased by 13%., Conclusion: Intervention with a CI improved cognitive functioning (domain Attention in particular) in older adults with severe hearing impairment compared to that of the matched controls with hearing impairment without a CI. However, older CI users did not, in terms of cognition, bridge the performance gap with adults with normal hearing after 1 year of CI use. The fact that experienced, older CI users still present subnormal cognitive functioning may highlight the need for additional cognitive rehabilitation in the long term after implantation., (Copyright © 2020 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Objective: Cochlear implantation results in restoration of hearing, potential cortical reorganisation and the reallocation of attentional resources to the auditory system. Hence, the distorted cortical activity of patients with profound sensorineural hearing loss may be partially reversed. The measurement of auditory event-related potentials (ERPs) forms a promising electrophysiological evaluation of the central auditory nervous system. In particular, the P3 component is hypothesised to be a differential indicator of subjective auditory discrimination. This overview discusses the association between the cortical P3 component and the performance on auditory tests in post-lingually deaf adults using a CI. Moreover, the current article proposes important guidelines on eliciting, recording and analysing ERPs in CI users. Design: The literature search was conducted in PubMed. Study sample: Articles were included if they focussed on the relationship between P3 and auditory performance of an adult CI population. Results: The higher-order processing of speech in quiet and in noise of adult CI users is correlated with the ERP components, including the P3, shedding light on neurophysiological foundations for auditory performance differences. Conclusions: There is a need for replicating studies with larger sample sizes to fully comprehend the relationship between P3 and the auditory performance of CI users.

Purpose: The traditional fitting method for cochlear implants (CI), the single-channel fitting (SCF), is effective but time-consuming. A fitting method that is significantly faster to perform, but provides at least equivalent speech understanding and subjective benefit would be of clinical usefulness. The study explored the ability of flat strategy-based fitting (FSBF) maps to fill this need., Methods: Participants were 16 experienced CI users. They were fit with: SCF maps; the maps that the participants used in their everyday lives, called fine-tuned clinical (FTC) maps; and FSBF maps. The fittings were assessed objectively via speech understanding in noise, time needed to create the map, deviation from FTC map, and correlation between auditory response telemetry thresholds and normalized charge levels; and subjectively via spectral balance and hearing quality., Results: FSBF maps were significantly faster to generate. FTC maps provided the best subjective hearing quality. In all other assessments, no significant differences were found., Discussion: FSBF maps can save time and provide CI users with the same level of speech understanding in noise. Participants may have preferred the FTC maps that they were already acclimated to them. These results suggest that the FSBF method could be used in first-fittings or in challenging fitting situations, but subsequent fine-tuning is required in follow-up appointments to improve sound quality., Conclusion: The FSBF method can be a useful and time-saving alternative fitting method in first-fittings or in challenging fitting situations.

Objective: To evaluate the hearing outcomes of cochlear implantation in different age groups by using data collected in the HEARRING registry., Methods: A multicenter study. Data of 146 patients were collected in a HEARRING registry. Patients were divided into three different age groups; ≤ 55 years old (age group 1, n = 66), 56 to 69 years old (age group 2, n = 45), and ≥ 70 years old (age group 3, n = 35). Speech in quiet (SPIQ), speech in noise (SPIN), and hearing implant sound quality index (HISQUI19) scores were evaluated for the different age groups at different test moments (preoperatively, 3, 6, 12, and 24 mo after first fitting)., Results: A statistically significant difference (p < 0.01) was found between preoperative scores and the scores on all the follow-up moments across all age groups. For SPIQ and SPIN, none of the time points showed a statistically significant age effect (p = 0.88 and p = 0.89). For HISQUI19 scores, a statistically significant age effect was found at 12 months after first fitting. The oldest age group scored significantly lower on the HISQUI19 compared with the youngest age group., Conclusion: Hearing outcomes of adult cochlear implant users of different age groups were evaluated. The SPIQ and SPIN tests showed no significant differences between the different age groups. Nevertheless, the youngest group scored significantly better on self -perceived benefit (HISQUI19) with a cochlear implant compared with the oldest age group.Further research is needed to receive more insight into cochlear implantation in the elderly and its implications on rehabilitating and supporting this expanding older population.

Objectives: To investigate the long-term outcomes of cochlear implantation in individuals with single-sided deafness (SSD) in terms of speech perception, subjective hearing performance, and sound localization., Methods: Thirty-four subjects with SSD were recruited across two large cochlear implant (CI) centers (Antwerp, Belgium and Perth, Australia). The long-term hearing outcomes (between 4 and 10 years of CI use) were evaluated using speech in noise tests, a subjective hearing performance questionnaire (Speech, Spatial and Qualities Questionnaire [SSQ12]), and sound localization tests., Results: Statistically significant improvements were observed in speech perception in noise and sound localization results postoperatively with the use of a CI in comparison to preoperative measurements. Subjective hearing abilities also significantly improved after long-term CI use., Conclusion: Access to binaural hearing is important for subjects with SSD. CI users with SSD experience long-term benefits in speech understanding, sound localization, and quality of life.

The auditory system can theoretically encode frequencies by either the rate or place of stimulation within the cochlea. Previous work with cochlear implants has demonstrated that both changes in timing and place can be described as pitch changes but are perceptually orthogonal. Using multidimensional scaling, the present experiment extends the previous findings that timing and place changes are perceptually orthogonal into the cochlear apex using long 31-mm electrode arrays. However, temporal cues seem to be more reliable across subjects at the apex while place cues seem to be more reliable at the middle of the cochlea.

Objective: To evaluate cognitive change in severely hearing-impaired older adults after cochlear implantation., Study Design: Prospective, longitudinal cohort study with assessments before, and at 6 and 12 months after implantation., Patients: Twenty older adults (median age: 71.5 yr)., Main Outcome Measures: Change in the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing-impaired individuals (RBANS-H) total score and subdomain scores were used to assess cognitive evolution. In addition, change in best-aided speech audiometry in quiet (monosyllabic words) and in noise (Leuven Intelligibility Sentences Test [LIST]) was examined, as well as patient-reported measures of health-related quality of life (Nijmegen Cochlear Implant Questionnaire [NCIQ]), self-perceived hearing disability (Speech, Spatial, and Qualities of hearing Scale-12 [SSQ12]), sound quality (Hearing Implant Sound Quality Index-19 [HISQUI19]), and states of anxiety and depression (Hospital Anxiety and Depression Scale [HADS])., Results: The RBANS-H total scores improved significantly after 12 months cochlear implant (CI) usage (p < 0.001). At subdomain level, significant improvements were observed in the immediate and delayed memory domain (p = 0.005 and p = 0.002, respectively), and to a lesser extent also in the attention domain (p = 0.047). Furthermore, speech perception in quiet and in noise improved significantly after 6 months and remained stable after 12 months. Similarly, a significant improvement was observed on all patient-reported measures after 6 months of CI usage. These results remained stable after 12 months, except for the HADS., Conclusions: A significant improvement in overall cognition after 12 months of CI usage was established. However, future research is imperative to further disentangle possible practice effects from the effects of the cochlear implantation. The significant, positive effect of cochlear implantation on speech perception and patient-reported measures was confirmed.

Objectives: To critically assess the current status of the literature on cognitive outcomes after cochlear implantation in older adults., Methods: Studies were identified by searching MEDLINE (PubMed) and Cochrane Library, and checking reference lists of relevant articles. No restrictions were imposed regarding language, publication date, or publication status. Eligibility criteria were as follows: (1) the study sample included older adults aged 50 or over with severe to profound bilateral hearing loss, (2) the participants received a multi-electrode cochlear implant, and (3) a cognitive test was performed before and after implantation. Risk of bias was assessed with respect to: (A) the suitability of the cognitive tests to examine cognition in hearing-impaired (HI) subjects, (B) the control of practice effects, (C) statistical methods, and (D) other sources of bias., Results: Out of 2716 retrieved records, 6 were found eligible, examining a total of 166 patients. Five of these studies reported improvements in cognition postimplantation and one study did not observe significant changes. Control of practice effects and the statistical methods were the most common origin of observed bias., Discussion: The currently reviewed studies performed pioneering work and are indispensable for the field. However, they do not provide conclusive evidence of improved cognitive outcomes after cochlear implantation in older adults., Conclusion: Well-designed studies with long follow-up periods are imperative to verify whether cochlear implantation influences cognition in older adults. New research is stimulated to use appropriate cognitive assessment tools for HI individuals, to control for practice effects, and to perform appropriate statistical tests.

Objectives: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation., Methods: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time. The consensus statement addresses following three key questions: (1) Should these children be treated? (2) How to identify these children? (3) How to manage these children?, Summary: The HEARRING group concludes that irrespective of the degree of residual hearing present, the concepts of hearing and structure preservation should be applied in every child undergoing cochlear implantation and that HPCI is a safe and reliable treatment option. Early detection and multidisciplinary assessment are key to the identification of children with symptomatic PD, these children should undergo HPCI as early as possible.

One way to provide pitch information to cochlear implant users is through amplitude-modulation rate. It is currently unknown whether amplitude-modulation rate can provide cochlear implant users with pitch information adequate for perceiving melodic information. In the present study, the notes of a song were encoded via amplitude-modulation rate of pulse trains on single electrodes at the apex or middle of long electrode arrays. The melody of the song was either physically correct or modified by compression or expansion. Nine cochlear implant users rated the extent to which the song was out of tune in the different conditions. Cochlear implant users on average did not show sensitivity to melody compression or expansion regardless of place of stimulation. These results were found despite the fact that three of the cochlear implant users showed the expected sensitivity to melody compression and expansion with the same task using acoustic pure tones in a contralateral acoustic ear. Normal-hearing listeners showed an inconsistent and weak effect of melody compression and expansion when the notes of the song were encoded with acoustic pulse rate. The results suggest that amplitude-modulation rate provides insufficient access to melodic information for cochlear-implant and normal-hearing listeners.

Background: Quantitative electroencephalography (qEEG) is effective when used to analyze ongoing cortical oscillations in cochlear implant (CI) users. However, localization of cortical activity in such users via qEEG is confounded by the presence of artifacts produced by the device itself. Typically, independent component analysis (ICA) is used to remove CI artifacts in auditory evoked EEG signals collected upon brief stimulation and it is effective for auditory evoked potentials (AEPs). However, AEPs do not reflect the daily environments of patients, and thus, continuous EEG data that are closer to such environments are desirable. In this case, device-related artifacts in EEG data are difficult to remove selectively via ICA due to over-completion of EEG data removal in the absence of preprocessing., New Methods: EEGs were recorded for a long time under conditions of continuous auditory stimulation. To obviate the over-completion problem, we limited the frequency of CI artifacts to a significant characteristic peak and apply ICA artifact removal., Results: Topographic brain mapping results analyzed via band-limited (BL)-ICA exhibited a better energy distribution, matched to the CI location, than data obtained using conventional ICA. Also, source localization data verified that BL-ICA effectively removed CI artifacts., Comparison With Existing Method: The proposed method selectively removes CI artifacts from continuous EEG recordings, while ICA removal method shows residual peak and removes important brain activity signals., Conclusion: CI artifacts in EEG data obtained during continuous passive listening can be effectively removed with the aid of BL-ICA, opening up new EEG research possibilities in subjects with CIs., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Conclusion: The results show that the DUET2 offers users speech perception that is equivalent to or better than the DUET. Moreover, the DUET2 offers subjective benefits above those provided by the DUET., Background: The DUET is a combination of hearing aid and CI in one device for electric acoustic stimulation. Since its introduction: a second generation, the DUET2, has been developed. This study aimed to investigate the benefits of the DUET2 compared to the DUET., Methods: Speech reception was determined in quiet and in noise. The sound quality of speech and music was rated using a visual analogue scale. Test intervals were at upgrade and at 3 and 6 months after upgrade., Results: Speech reception in quiet and in noise was significantly better than with the DUET after 6 months. For sentence reception in quiet, the SRT with the DUET2 did not change significantly between test intervals. Sentence reception in noise with the DUET2 improved significantly between 3 and 6 months and upgrade and 6 months. After 6 months, speech reception in quiet and in noise with the DUET2 was significantly better than with the DUET. Subjects rated the sound quality of speech and of music with the DUET2 significantly better than with the DUET.

Introduction: Single-sided deaf (SSD) patients report multiple benefits after cochlear implantation (CI), such as tinnitus suppression, speech perception, and sound localization. The first single-unit speech processor, the RONDO, was launched recently. Both the RONDO and the well-known behind-the-ear (BTE) speech processor work on the same audio processor platform. However, in contrast to the BTE, the microphone placement on the RONDO is different. The aim of this study was to evaluate the hearing performances using the BTE speech processor versus using the single-unit speech processor. Subjective and objective outcomes in SSD CI patients with a BTE speech processor and a single-unit speech processor, with particular focus on spatial hearing, were compared., Methodology: Ten adults with unilateral incapacitating tinnitus resulting from ipsilateral sensorineural deafness were enrolled in the study. The mean age at enrollment in the study was 56 (standard deviation, 13) years. The subjects were cochlear implanted at a mean age of 48 (standard deviation, 14) years and had on average 8 years' experience with their CI (range, 4-11 yr). At the first test interval (T0), testing was conducted using the subject's BTE speech processor, with which they were already familiar. Aided free-field audiometry, speech reception in noise, and sound localization testing were performed. Self-administered questionnaires on subjective evaluation consisted of HISQUI-NL, SSQ5, SHQ, and a Visual Analogue Scale to assess tinnitus loudness and disturbance. All 10 subjects were upgraded to the single-unit processor and retested after 28 days (T28) with the same fitting map. At T28, an additional single-unit questionnaire was administered to determine qualitative experiences and the effect of the position of the microphone on the new speech processor., Results: Equal hearing outcomes were found between the single-unit speech processor: median PTA(single-unit) (0.5, 1, 2 kHz) = 40 (range, 33-48) dB HL; median Speech Reception Threshold in noise = -1.00 (range, -8.50 to +1.00) dB SNR; median Root Mean Square Error of sound localization = 45 (range, 19-139) degrees; HISQUI = 128 (range, 106-180); SHQ = 68 (range, 45-83); SSQ5 = 6 (range, 3-9) and the BTE speech processor: median PTA(BTE) (0.5, 1, 2 kHz) = 41 (range, 30-53) dB HL; median Speech Reception Threshold in noise = -0.25 (range, -7.00 to +4.00) dB SNR; median Root Mean Square Error of sound localization = 38 (range, 26-164) degrees; HISQUI = 144 (range, 120-183); SHQ = 56 (range, 47-85); SSQ5 = 6 (range, 3-9). The results in the condition with the single-unit speech processor were not significantly influenced by the position of the microphone., Conclusion: The study showed that long-term BTE speech processor SSD users are able to be upgraded to a single-unit speech processor without compromising their speech performance, aided hearing thresholds, sound localization, objective speech quality, hearing abilities, sound localization, and tinnitus reduction. Microphone position on the single-unit speech processor did not influence the outcomes measures. Moreover, after a short time of experience, 80% of the users preferred the single-unit processor.

Conclusion: On average, adult CI recipients report a moderate sound quality using the Dutch version of the HISQUI19 questionnaire. These results are correlated with their age, speech perception scores, CI aided hearing thresholds, and the SSQ5 and the APHAB questionnaire., Background: The general aim of the study was to assess sound quality in adult cochlear implant (CI) recipients and to link these findings to other patients reported outcome measures (PROM) and subject characteristics. Therefore, the Hearing Implant Sound Quality Index (HISQUI19), which was translated into Dutch, was used. This user-friendly instrument quantifies sound quality experienced by hearing implant users., Methods: The Dutch version of the original German HISQUI19 was obtained by the process of translation and back-translation. The HISQUI19 was assessed in 65 experienced adult CI users at the Ear, Nose, and Throat (ENT) department of the Antwerp University Hospital to assess a sound quality profile of experiences adult CI recipients. Therefore, descriptive statistics were used to summarize the mean, standard deviation, and ceiling or floor effects of the total HISQUI19 scores in a CI population. Spearman correlations between the HISQUI19 scores and objective audiological measures and other PROM were investigated (APHAB and SSQ5 questionnaire)., Results: The mean HISQUI19 score of the Dutch version in adult CI recipients was 64.9 (SD = 20.8), which corresponds to moderate sound quality. The psychometric characters of the Dutch questionnaire are similar to the characters of the original HISQUI19 questionnaire, emphasizing good internal consistency (α = 0.93) and construct validity. Moderate correlation was found with speech perception in quiet (r = 0.36, p < 0.01), speech perception in noise (r = 0.29, p < 0.05), CI aided Pure Tone Average (PTA0.5, 1, 2 and 4 kHz) of the subjects (r = 0.34, p < 0.01), and the age of the subject (r = 0.38, p < 0.01). Gender did not influence the experienced sound quality significantly. Furthermore, the relation to other questionnaires was found to be significantly strong (SSQ5: r = 0.68 and the APHAB: r = 0.64; p < 0.01).

Long (31.5 mm) electrode arrays are inserted deeper into the cochlea than the typical 1.25 turn insertion. With these electrode arrays, the apical electrodes are closer to (and possibly extend past) the end of the spiral ganglion. Using multi-dimensional scaling with patients implanted with a 31.5 mm electrode array, the perceptual space between electrodes was measured. The results suggest that deeper insertion increases the range of place pitches, but the perceptual differences between adjacent electrodes become smaller in the apex.

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The aim is to present a case of cochlear implantation (CI) after vestibular schwannoma (VS) resection and intracochlear auditory nerve monitoring. The case of a 53-year-old man with left-sided iatrogenic dehiscence of the posterior semicircular canal after VS resection using the retrosigmoid approach is reported. Because of third mobile window symptoms, transmastoid plugging of the posterior and superior semicircular canal was carried out. In the following 3 years, ipsilateral hearing problems and tinnitus loudness increased, and therefore CI was considered. To investigate the electrophysiological status of the left cochlear nerve, intraoperative auditory nerve monitoring was performed using the Auditory Nerve Test System (ANTS). Audiological assessments included tinnitus evaluation, speech perception in noise, and sound localization. Because reliable electrical auditory brainstem response waveforms were found during intracochlear ANTS testing, supporting the integrity of cochlear nerve function, CI was performed during the same surgery using a flexible 34-mm electrode array. Audiological evaluation 3 months after CI activation showed a significant positive effect of CI usage on tinnitus loudness (8/10 in the CIOFF condition going to 0/10 in the CION condition). Moreover, speech perception in noise and localization testing showed restored binaural hearing in the CION condition. Cochlear implantation was found to be successful in a single-sided deaf case with iatrogenic dehiscence of the posterior semicircular canal after VS resection. Prior to implantation, intraoperative ANTS measurement proved integrity of the cochlear nerve function and therefore has the ability to guide the decision of placing a CI after VS resection in case of preservation of cochlear nerve function. [ABSTRACT FROM AUTHOR]

Hearing outcomes of two cases of growing sporadic vestibular schwannoma, resected via a translabyrinthine approach with simultaneous cochlear implantation are reported. After gross total resection and anatomical preservation of the facial and cochlear nerve, the integrity of the cochlear nerve--on an electrophysiological level--was evaluated using the intracochlear test electrode of the Auditory Nerve Test System. After confirming electrically-evoked auditory brainstem recordings, cochlear implantation and hearing rehabilitation were performed as per the single-sided deafness protocol. This report describes the audiological outcome with respect to speech understanding in quiet and noise, localization of sounds as well as phoneme discrimination up to one year after surgery. [ABSTRACT FROM AUTHOR]

Introduction: In challenging listening situations, speech perception with a cochlear implant (CI) remains demanding and requires high levels of listening effort, which can lead to increased levels of listening-related fatigue. The body of literature on these topics increases as the number of CI users rises. This scoping review aims to provide an overview of the existing literature on listening effort, fatigue, and listening-related fatigue among CI users and the measurement techniques to evaluate them. Methods: The Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) Statements were used to conduct the scoping review. The search was performed on PubMed, Scopus, and Web of Science to identify all relevant studies. Results: In total, 24 studies were included and suggests that CI users experience higher levels of listening effort when compared to normal hearing controls using scales, questionnaires and electroencephalogram measurements. However, executing dual-task paradigms did not reveal any difference in listening effort between both groups. Uncertainty exists regarding the difference in listening effort between unilateral, bilateral, and bimodal CI users with bilateral hearing loss due to ambiguous results. Only five studies were eligible for the research on fatigue and listening-related fatigue. Additionally, studies using objective measurement methods were lacking. Discussion: This scoping review highlights the necessity for additional research on these topics. Moreover, there is a need for guidelines on how listening effort, fatigue, and listening-related fatigue should be measured to allow for study results that are comparable and support optimal rehabilitation strategies. [ABSTRACT FROM AUTHOR]

Background: The purpose of this article is to propose how the International Classification of Functioning, Disability and Health (ICF), particularly the ICF core sets for hearing loss, can be used to plan and evaluate the holistic (re)habilitation of cochlear implant recipients. Methods and materials: The opinions of HearRing experts were gathered on what - based on their clinical experience - are the most relevant ICF categories and codes to describe audiological rehabilitation after cochlear implantation. For each ICF category, the most commonly used audiological assessment tools and methods were identified. Results: The most relevant codes for Body functions and structures, Activities and Participation as well as Environmental factors were identified. These were the following. Body structures: structure of the inner ear (s260), auditory nerve (s260), brainstem (s1105), midbrain (s1101), diencephalon (s1102), and cortical lobe (s110). Hearing functions: sound detection (b2300), sound discrimination (b2301), localization of sound source (b2302), lateralization of sound (b2303), and speech discrimination (b2304). Activities and participation: listening (d115); communicating with (receiving) spoken messages (d310); handling stress and other psychological demands (d240); using communication devices and techniques (d360); conversation (d350); family relationships (d760); school education (d820); paid employment (d850); and community life (d910). Environmental factors: sounds (e250), products and technology for communication (e125), immediate family (e310), attitudes of immediate family members (e410), societal attitudes (e460), health professionals (e355), and health services, systems, and policies (e580). Conclusions: Using the ICF can help target the holistic (re)habilitation of cochlear implant recipients. By providing a common language, it can enable clearer communication across disciplines, and closer comparison between different studies, which is essential for meta-analyses. [ABSTRACT FROM AUTHOR]

The study aimed to develop a consensus classification system for the reporting of sound localization testing results, especially in the field of cochlear implantation. Against the background of an overview of the wide variations present in localization testing procedures and reporting metrics, a novel classification system was proposed to report localization errors according to the widely accepted International Classification of Functioning, Disability and Health (ICF) framework. The obtained HEARRING_LOC_ICF scale includes the ICF graded scale: 0 (no impairment), 1 (mild impairment), 2 (moderate impairment), 3 (severe impairment), and 4 (complete impairment). Improvement of comparability of localization results across institutes, localization testing setups, and listeners was demonstrated by applying the classification system retrospectively to data obtained from cohorts of normal-hearing and cochlear implant listeners at our institutes. The application of our classification system will help to facilitate multi-center studies, as well as allowing better meta-analyses of data, resulting in improved evidence-based practice in the field. [ABSTRACT FROM AUTHOR]

Image-guided and robot-assisted surgeries have found their applications in skullbase surgery. Technological improvements in terms of accuracy also opened new opportunities for robotically-assisted cochlear implantation surgery (RACIS). The HEARO® robotic system is an otological next-generation surgical robot to assist the surgeon. It first provides software-defined spatial boundaries for orientation and reference information to anatomical structures during otological and neurosurgical procedures. Second, it executes a preplanned drill trajectory through the temporal bone. Here, we report how safe the HEARO procedure can provide an autonomous minimally invasive inner ear access and the efficiency of this access to subsequently insert the electrode array during cochlear implantation. In 22 out of 25 included patients, the surgeon was able to complete the HEARO® procedure. The dedicated planning software (OTOPLAN®) allowed the surgeon to reconstruct a three-dimensional representation of all the relevant anatomical structures, designate the target on the cochlea, i.e., the round window, and plan the safest trajectory to reach it. This trajectory accommodated the safety distance to the critical structures while minimizing the insertion angles. A minimal distance of 0.4 and 0.3 mm was planned to facial nerve and chorda tympani, respectively. Intraoperative cone-beam CT supported safe passage for the 22 HEARO® procedures. The intraoperative accuracy analysis reported the following mean errors: 0.182 mm to target, 0.117 mm to facial nerve, and 0.107 mm to chorda tympani. This study demonstrates that microsurgical robotic technology can be used in different anatomical variations, even including a case of inner ear anomalies, with the geometrically correct keyhole to access to the inner ear. Future perspectives in RACIS may focus on improving intraoperative imaging, automated segmentation and trajectory, robotic insertion with controlled speed, and haptic feedback. This study [Experimental Antwerp robotic research otological surgery (EAR2OS) and Antwerp Robotic cochlear implantation (25 refers to 25 cases) (ARCI25)] was registered at clinicalTrials.gov under identifier NCT03746613 and NCT04102215. Clinical Trial Registration: https://www.clinicaltrials.gov, Identifier: NCT04102215. [ABSTRACT FROM AUTHOR]

Background: A suggested solution to suppress tinnitus is to restore the normal sensory input. This is based on the auditory deprivation hypothesis. It is known that hearing aids can provide sufficient activation of the auditory nervous system and reduce tinnitus in subjects with mild to moderate hearing loss and that cochlear implantation can reduce tinnitus in subjects with severe to profound hearing loss. This applies to subjects with single-sided deafness (SSD) or bilateral hearing loss.Aim: To investigate if electric-acoustic stimulation (EAS) can reduce severe tinnitus in a subject with residual hearing in the ipsilateral ear and contralateral normal hearing (high-frequency SSD) by restoring the auditory input.Methods: Tinnitus reduction was investigated for 1 year after implantation in a subject with high-frequency SSD, who uses EAS, and was compared to 11 subjects with a cochlear implant (CI) with SSD. The Visual Analogue Scale (VAS) and the Tinnitus Questionnaire (TQ) were administered pre-operatively and at 1, 3, 6, and 12 months after implantation.Results: Significant tinnitus reduction was observed 1 month after implantation on the VAS in the subjects with SSD using a CI. Tinnitus reduction was also observed in the subject with high-frequency SSD using EAS. A further decrease was observed 3 months after implantation. The TQ and VAS scores remained stable up to 1 year after implantation.Conclusion: A CI can significantly reduce ipsilateral severe tinnitus in a subject with SSD. Ipsilateral severe tinnitus can also be reduced using EAS in subjects with high-frequency SSD. [ABSTRACT FROM AUTHOR]

Primary Objective: To compare cognitive functioning among experienced, unilateral cochlear implant (CI) recipients and normal-hearing (NH) controls by means of the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing-impaired individuals (RBANS-H). Methods: Sixty-one post-lingually and bilaterally severely hearing-impaired CI recipients (median age: 71.0, range: 58.3 to 93.9 years) with at least 1 year of CI experience (median: 12.4, range: 1.1 to 18.6 years) and 81 NH control participants (median age: 69.9, range: 50.1 to 87.1 years) took part in this cross-sectional study. The RBANS-H was performed, as well as an audiometric assessment, including best-aided speech audiometry in quiet (monosyllabic words) and in noise (Leuven Intelligibility Sentences test). Results: The RBANS-H performances of the CI recipients (mean: 88.1 ± 14.9) were significantly poorer than the those of the NH participants (mean: 100.5 ± 13.2), with correction of age, sex, and education differences (general linear model: p = 0.001). The mean difference, corrected for the effects of these three demographic factors, was 8.8 (± 2.5) points. Additionally, in both groups, a significant correlation was established between overall cognition and speech perception, both in quiet and in noise, independently of age. Conclusion: Experienced, unilateral CI recipients present subnormal cognitive functioning, beyond the effect of age, sex and education. This has implications for auditory rehabilitation after CI and may highlight the need for additional cognitive rehabilitation in the long term after implantation. Long-term prospective and longitudinal investigations are imperative to improve our understanding of cognitive aging in severely hearing-impaired individuals receiving CIs and its association with CI outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Postoperative cognitive dysfunction (PCD) is a subtle, prolonged deterioration in cognition after surgery. This complication has been frequently investigated, mainly after major (cardiac) surgery. However, the incidence after cochlear implantation is unknown. Therefore, the aim of the study was to investigate the incidence and possible risk factors of PCD in severely hearing-impaired older adults after cochlear implantation.Methods: In a prospective cohort study, 26 older participants (age: M = 70, SD = 8 years), scheduled for cochlear implantation, were assessed prior to and 1 week after implantation by means of the Montreal Cognitive Assessment (MoCA). The incidence of PCD was calculated. In addition, the following possible risk factors were recorded: age, sex, education, duration of hearing impairment, preoperative signs of depression and anxiety, duration of anesthesia, anesthetic and surgical events and postoperative complications.Results: The incidence of PCD was 11.5%, defined by a Z score of change in MoCA scores ≥ 1.96 (i.e., a decrease of ≥ 4 points). The incidence of PCD was corrected for practice effects by incorporating data from a reference group. Besides an effect of age on the postoperative cognitive performance, no significant risk factors were identified.Conclusions: The incidence of PCD after cochlear implantation is lower than after major surgeries, but higher than after other minor surgeries. Routine cognitive screening before and after cochlear implantation is recommended to identify patients with PCD and to provide additional care for these patients. [ABSTRACT FROM AUTHOR]

Hypothesis: Auditory information through an active cochlear implant (Cl) influences gait parameters in adults with bilateral caloric areflexia and profound sensorineural hearing loss. Background: Patients with bilateral caloric areflexia suffer from imbalance, resulting in an increased risk of falling. In case of simultaneous deafness, the lack of auditory feedback results in less awareness of the auditory scene. This combination might produce significant challenges while walking and navigating. Auditory cues can be restored to some extent with a Cl. Electrical stimulation through a Cl can also produce a vestibulocollic reflex through current spread, which can be measured as cervical vestibular-evoked myogenic potentials. Methods: Adults (seven males, one female, mean age 61 ± 14 years), wearing a Cl to treat profound sensorineural hearing loss and presenting with bilateral caloric areflexia walked barefoot, over ground, at self-selected speed in three different conditions: with Cl turned on, while listening to music and with Cl turned off. Spatiotemporal and kinematic parameters of gait were calculated using the conventional gait model. Results: Removing auditory feedback by turning off the Cl decreased stride time (mean difference 0.03 ± 0.15 s) and slightly increased stride length (mean difference 0.5 ± 1.2 cm) compared to the control condition with the Cl on. Walking while playing music positively affected gait compared to walking with the Cl on but without auditory feedback. By increasing the motion of the pelvis (mean difference 1.3° ± 0.4°), the knee (mean difference 3.9° ± 0.8°) and the ankle (mean difference 2.2° ± 0.2°), stride length increased (7.8 ± 1.2 cm), while stride time decreased (0.059 ± 0.016 s). Conclusion: Although a practice effect cannot be completely ruled out, this pilot study suggests that playing music while wearing an active Cl may improve gait in patients with bilateral otovestibular loss. It remains unclear if the musical cues boost balance control or the Cl might produce current spread and electrical stimulation to the vestibular afferents, thereby boosting its detection threshold, through stochastic resonance, and improving gait. [ABSTRACT FROM AUTHOR]

The mechanism of tinnitus suppression after cochlear implantation (CI) in single-sided deafness (SSD) is not fully understood. In this regard, by comparing pre- and post-CI quantitative electroencephalography (qEEG), we explored cortical changes relevant to tinnitus improvement. In SSD patients who underwent CI, qEEG data were collected: (1) before CI, (2) 6 months post-operatively with CI-on, and (3) 30 min after CI-off and source-localized cortical activity/functional connectivity analyses were performed. Compared to the pre-operative baseline, the CI-on condition demonstrated significantly decreased activity in the right auditory- and orbitofrontal cortices (OFC) for the delta frequency band as well as decreased connectivity between the auditory cortex/posterior cingulate cortex for the delta/beta2 bands. Meanwhile, compared to the CI-off condition, the CI-on condition displayed decreased activity in the right auditory cortices/OFC for the delta band, and in bilateral auditory cortices, left inferior frontal cortex/OFC for the gamma band. However, qEEG analyses showed no significant differences between the CI-off and baseline conditions. CI induced overall decreased cortical activity and functional connectivity. However, judging from no differences between the CI-off and baseline conditions, CI-induced cortical activity and functional connectivity changes are not by cortical plastic changes, but by dynamic peripheral reafferentation. [ABSTRACT FROM AUTHOR]

Background: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL.Methods: This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada.Results: A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable.Conclusion: A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options. [ABSTRACT FROM AUTHOR]

Background: Currently, an independent relationship between hearing loss and cognitive decline in older adults is suggested by large prospective studies. In general, cochlear implants improve hearing and the quality of life in severely to profoundly hearing impaired older persons. However, little is known about the effects of cochlear implantation on the cognitive evolution in this population. Aim of the study: The primary goal of this prospective, longitudinal cohort study is to explore the cognitive profile of severely to profoundly postlingually hearing impaired subjects before and after cochlear implantation. In addition, the current study aims to investigate the relationship between the cognitive function, audiometric performances, quality of life, and self-reliance in these patients. Methods: Twenty-five patients aged 55 or older, scheduled for cochlear implantation, will be enrolled in the study. They will be examined prior to implantation, at 6 and 12 months after implantation and annually thereafter. The test battery consists of (1) a cognitive examination, using the Repeatable Battery for the Assessment of Neuropsychological Status adapted for Hearing impaired persons (RBANS-H), (2) an audiological examination, including unaided and aided pure tone audiometry, speech audiometry in quiet and speech audiometry in noise, (3) the administration of four questionnaires evaluating quality of life and subjective hearing benefit and (4) a semi-structured interview about the self-reliance of the participant. Discussion: Up until now only one study has been conducted on this topic, focusing on the short-term effects of cochlear implantation on cognition in older adults. The present study is the first study to apply a comprehensive neuropsychological assessment adapted for severely to profoundly hearing impaired subjects in order to investigate the cognitive capabilities before and after cochlear implantation. Trial registration: The present protocol is retrospectively registered at Clinical Trials (ClinicalTrials.gov) on June 9th, 2016. The first participant was enrolled on June 22nd, 2015. The protocol identifier is NCT02794350. [ABSTRACT FROM AUTHOR]

Introduction The authors previously demonstrated that tinnitus resulting from unilateral hearing loss (UHL) can be treated with electrical stimulation via a Cochlear Implant (CI). The study aimed to do a long-term (LT) evaluation of CI in subjects suffering from UHL and accompanied incapacitating tinnitus up to 10 years. The primary focus of the study is on LT tinnitus reduction. Subjects LT evaluation was derived from 23 subjects suffering from UHL and accompanied incapacitating tinnitus (Pre-operative Tinnitus Loudness Visual Analogue Scale (VAS) score >6/10). They were cochlear implanted at a median age of 55 years (22–71 yr) and had 8 years (3–10 yr) experience with their CI at the LT testing. The subjects were categorized into two groups: a Single-Sided Deaf Group (SSD) and an Asymmetric Hearing Loss Group (AHL). The SSD group comprises subjects with contralateral normal hearing (i.e. air conduction pure tone average (PTA 0.5, 1, 2 and 4 kHz ) ≤ 30 dB HL) and the AHL group subjects with contralateral mild to moderate hearing loss (i.e. air conduction PTA 0.5, 1, 2 and 4 kHz > 30 dB HL). Methods In order to obtain a LT structural overview of the CI use in UHL subjects, a structured interview was conducted including questions about daily amount of CI use, residual inhibition of the tinnitus after switch off, tinnitus type, etc. The VAS tinnitus loudness and the Tinnitus Questionnaire were obtained pre-operatively, one, three, six, 12, and 36-months post-operatively and at the long-term test interval (8 (3–10 years) post-operative). The Hyperacusis Questionnaire was administered in the CI ON and the CI OFF condition. Results The structural interview revealed that all patients (23/23) still wear their CI seven days a week, eight (3–10) years after cochlear implantation. It appeared that in all subjects but one CI switch-on is the first act when rising and CI switch-off is the last act before bedtime. In the SSD group, tinnitus suppression is still the primary benefit reported (83%), whereas in the AHL the majority of the subjects (55%) report that the primary benefit shifted to improved hearing. In the majority of the subjects the tinnitus reduction starts within 1 min (in 70% of the cases) and the residual inhibition after CI switch-off is less than a minute (in 65% of the cases). The VAS and TQ scores significantly improved up to three months after the first-fitting and remain stable up to the LT test interval. The median score on the Hyperacusis Questionnaire was 17 (7–36) in the CI OFF condition and improved to 23,5 (12–39) in the CI ON condition in the SSD group. Conclusion This is the first study to report on LT results in a large number of UHL CI users, up to 10 years. Structured interviews shows that 100% of the subjects wears their CI seven days a week. The tinnitus reduces significantly up to three months after the first-fitting and the tinnitus reduction remain stable up to the LT test interval. The SSD group report tinnitus reduction as the primary benefit, whereas the majority of the AHL group report improved hearing as the primary benefit, eight (3–10) years after implantation. In addition to the tinnitus reduction, the CI provides also a benefit regarding reported. [ABSTRACT FROM AUTHOR]

The value of cochlear implants (CI) in patients with profound unilateral hearing loss (UHL) and tinnitus has recently been investigated. The authors previously demonstrated the feasibility of CI in a 12- month outcome study in a prospective UHL cohort. The aim of this study was to investigate the binaural auditory outcomes in this cohort 36 months after CI surgery. The 36-month outcome was evaluated in 22 CI users with postlingual UHL and severe tinnitus. Twelve subjects had contralateral normal hearing (single-sided deafness - SSD group) and 10 subjects had a contralateral, mild to moderate hearing loss and used a hearing aid (asymmetric hearing loss - AHL group). Speech perception in noise was assessed in two listening conditions: the CIoff and the CIon condition. The binaural summation effect (S0N0), binaural squelch effect (S0NCI) and the combined head shadow effect (SCIN0) were investigated. Subjective benefit in daily life was assessed by means of the Speech, Spatial and Qualities of Hearing Scale (SSQ). At 36 months, a significant binaural summation effect was observed for the study cohort (2.00, SD 3.82 dB; p < 0.01) and for the AHL subgroup (3.34, SD 5.31 dB; p < 0.05). This binaural effect was not significant 12 months after CI surgery. A binaural squelch effect was significant for the AHL subgroup at 12 months (2.00, SD 4.38 dB; p < 0.05). A significant combined head shadow and squelch effect was also noted in the spatial configuration SCIN0 for the study cohort (4.00, SD 5.89 dB; p < 0.01) and for the AHL subgroup (5.67, SD 6.66 dB; p < 0.05). The SSQ data show that the perceived benefit in daily life after CI surgery remains stable up to 36 months at CIon. CI can significantly improve speech perception in noise in patients with UHL. The positive effects of CIon speech perception in noise increase over time up to 36 months after CI surgery. Improved subjective benefit in daily life was also shown to be sustained in these patients. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The HEARO® robotic system is an assistive otological next-generation surgical robot to assist the surgeon with cochlear implantation surgery. It provides software-defined spatial boundaries for orientation and reference information to anatomical structures in order to execute drilling directly toward the inner ear to facilitate keyhole access. Here, we report not only the feasibility but also the safety and efficiency of this procedure for Robot-assisted cochlear implant surgery in the first 25 patients. All patients indicated for cochlear implantation in a routine conventional work-up fulfilling the audiological criteria were radiologically screened. Patients with suitable anatomy were approached for participation with written informed consent. This clinical trial was approved by the medical ethics comity. Seven cases had not passed the radiological screening and only one patient opted to have conventional cochlear implantation surgery. The robot-assisted cochlear implant surgery was performed in 25 patients including 6 women (24%) and 19 men (76%). The age values of 25 patients ranged from 20 to 89 (Figure 5). Three procedures were converted to conventional surgery because of our safety protocols, mainly for the facial nerve during drilling of middle ear access. In total, 22 procedures were successfully drilled up to the level of the inner ear without any facial nerve injuries or any other adverse events. From these 22 cases, all patients had a full insertion of the cochlear implant. In 1 case, the post-op image showed that the last electrode was at the level of the round window. Although the patient had auditory sensations with this electrode, it was the only electrode that was switched off by the audiologist. Specific cases with aberrant anatomy, surgical challenges, and anatomical accuracy will be discussed in the presentation. We conclude that the HEARO® procedure is safe and effective assistive tool for a cochlear implant surgeon. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAims/ObjectivesMaterial and methodsResultsConclusions and significanceIn cases of congenital sensorineural hearing loss, testing for genetic etiologies and congenital cytomegalovirus (cCMV) infection have become common practice.The purpose of this study is to determine which specific testing methodologies should be used and when.We surveyed 20 practicing otolaryngologists across eighteen institutions in thirteen countries about their approach to cCMV, GJB2, and wider genetic testing.We found 90% of respondents employ all three tests, either in routine or special cases. cCMV testing is widely used, with 95% of respondents incorporating it into their clinical practice. GJB2 testing was employed by 90%. In cases with negative GJB2 test results, a majority of respondents proceeded to wider genetic screening. Test reimbursement was also examined for each test. For cCMV testing, 63.1% reported reimbursement, 68.4% reported reimbursement for GJB2 variant testing and 52.6% reported reimbursement for wider genetic screening.A common approach is to perform cCMV and GJB2 testing as the first tests, followed by wider genetic testing. This study offers insight into the prevalence, methodologies, and reimbursement status of these testing methodologies across multiple hearing centers and countries. Current consensus and future directions are described based on the current survey. [ABSTRACT FROM AUTHOR]