Clinical Management of Audiological Disorders: Outcome Measure in Demanding Listening Situation after CI Provision

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: 20 July 2024 | Viewed by 7825

Special Issue Editors


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Guest Editor
Audiology, ENT Clinic, Universitätsklinikum Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
Interests: electric stimulation; ear; deafness; acoustics; hearing loss; electrophysiology; audiometry; audiology; hearing disorders

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Guest Editor
Hals-, Nasen-, Ohrenklinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen Waldstraße 1, 91054 Erlangen, Germany
Interests: electric stimulation; ear; deafness; acoustics; hearing Loss; audiometry; audiology; hearing disorders

Special Issue Information

Dear Colleagues,

Profound sensorineural hearing loss can be successfully treated with cochlear implants. In recent decades, great success has been achieved for this device when used in quiet environments. However, cochlear implant (CI) users still face challenges in everyday communication. These include, for example, soft or distant speech, reverberation, interference of speech by sounds with different temporal characteristics, and varying numbers and locations of interfering signals. There are a variety of approaches to address this challenge, including digital signal processing algorithms, bilateral and bimodal provision, electro-acoustic stimulation, etc. Furthermore, research methods utilized to study this topic include, e.g., psycho-acoustics, speech audiometry, virtual acoustics, data-logging, and questionnaires.

This Special Issue aims to share the current state of the art in the management of everyday listening challenges and highlight possible solutions.

Dr. Matthias Hey
Prof. Dr. Ulrich Hoppe
Guest Editors

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Keywords

  • cochlear implant
  • hearing aid
  • speech intelligibility
  • signal processing
  • speech audiometry
  • noise reduction
  • ecological validity

Published Papers (9 papers)

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12 pages, 1162 KiB  
Article
Enhancing Cochlear Implant Outcomes across Age Groups: The Interplay of Forward Focus and Advanced Combination Encoder Coding Strategies in Noisy Conditions
by Telse M. Wagner, Luise Wagner, Stefan K. Plontke and Torsten Rahne
J. Clin. Med. 2024, 13(5), 1399; https://doi.org/10.3390/jcm13051399 - 28 Feb 2024
Viewed by 462
Abstract
Background: Hearing in noise is challenging for cochlear implant users and requires significant listening effort. This study investigated the influence of ForwardFocus and number of maxima of the Advanced Combination Encoder (ACE) strategy, as well as age, on speech recognition threshold and listening [...] Read more.
Background: Hearing in noise is challenging for cochlear implant users and requires significant listening effort. This study investigated the influence of ForwardFocus and number of maxima of the Advanced Combination Encoder (ACE) strategy, as well as age, on speech recognition threshold and listening effort in noise. Methods: A total of 33 cochlear implant recipients were included (age ≤ 40 years: n = 15, >40 years: n = 18). The Oldenburg Sentence Test was used to measure 50% speech recognition thresholds (SRT50) in fluctuating and stationary noise. Speech was presented frontally, while three frontal or rear noise sources were used, and the number of ACE maxima varied between 8 and 12. Results: ForwardFocus significantly improved the SRT50 when noise was presented from the back, independent of subject age. The use of 12 maxima further improved the SRT50 when ForwardFocus was activated and when noise and speech were presented frontally. Listening effort was significantly worse in the older age group compared to the younger age group and was reduced by ForwardFocus but not by increasing the number of ACE maxima. Conclusion: Forward Focus can improve speech recognition in noisy environments and reduce listening effort, especially in older cochlear implant users. Full article
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10 pages, 1450 KiB  
Article
Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures
by Tobias Weissgerber, Marcel Löschner, Timo Stöver and Uwe Baumann
J. Clin. Med. 2024, 13(4), 994; https://doi.org/10.3390/jcm13040994 - 08 Feb 2024
Viewed by 507
Abstract
(1) Background: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data [...] Read more.
(1) Background: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data and a predictive model for postoperative speech perception in noise (SPiN) after CI provision. (2) Methods: CI candidates with substantial residual hearing (either in hearing threshold or in word recognition scores) were included in a retrospective analysis (n = 87). Speech perception scores in quiet 12 months post-surgery were compared with the predicted scores. A generalized linear model was fitted to speech reception thresholds (SRTs) after CI fitting to identify predictive variables for SPiN. (3) Results: About two-thirds of the recipients achieved the expected outcome in quiet or were better than expected. The mean absolute error of the prediction was 13.5 percentage points. Age at implantation was the only predictive factor for SPiN showing a significant correlation (r = 0.354; p = 0.007). (4) Conclusions: Outcome prediction accuracy for speech in quiet was comparable to previous studies. For CI recipients in the included study population, the SPiN outcome could be predicted only based on the factor age. Full article
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12 pages, 4108 KiB  
Article
Investigation of Maximum Monosyllabic Word Recognition as a Predictor of Speech Understanding with Cochlear Implant
by Ronja Czurda, Thomas Wesarg, Antje Aschendorff, Rainer Linus Beck, Thomas Hocke, Manuel Christoph Ketterer and Susan Arndt
J. Clin. Med. 2024, 13(3), 646; https://doi.org/10.3390/jcm13030646 - 23 Jan 2024
Cited by 1 | Viewed by 591
Abstract
Background: The cochlear implant (CI) is an established treatment option for patients with inadequate speech understanding and insufficient aided scores. Nevertheless, reliable predictive models and specific therapy goals regarding achievable speech understanding are still lacking. Method: In this retrospective study, 601 cases of [...] Read more.
Background: The cochlear implant (CI) is an established treatment option for patients with inadequate speech understanding and insufficient aided scores. Nevertheless, reliable predictive models and specific therapy goals regarding achievable speech understanding are still lacking. Method: In this retrospective study, 601 cases of CI fittings between 2005 and 2021 at the University Medical Center Freiburg were analyzed. We investigated the preoperative unaided maximum word recognition score (mWRS) as a minimum predictor for post-interventional scores at 65 dB SPL, WRS65(CI). The WRS65(CI) was compared with the preoperative-aided WRS, and a previously published prediction model for the WRS65(CI) was reviewed. Furthermore, the effect of duration of hearing loss, duration of HA fitting, and etiology on WRS65(CI) were investigated. Results: In 95.5% of the cases, a significant improvement in word recognition was observed after CI. WRS65(CI) achieved or exceeded mWRS in 97% of cases. Etiology had a significant impact on WRS65(CI). The predicted score was missed by more than 20 percentage points in 12.8% of cases. Discussion: Our results confirmed the minimum prediction via mWRS. A more precise prediction of the expected WRS65(CI) is possible. The etiology of hearing loss should be considered in the indication and postoperative care to achieve optimal results. Full article
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12 pages, 1400 KiB  
Article
Tone Decay Reconsidered: Preliminary Results of a Prospective Study in Hearing-Aid Users with Moderate to Severe Hearing Loss
by Florian Herrmann Schmidt, Thomas Hocke, Lichun Zhang, Wilma Großmann and Robert Mlynski
J. Clin. Med. 2024, 13(2), 500; https://doi.org/10.3390/jcm13020500 - 16 Jan 2024
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Abstract
Among hearing aid (HA) users, there is a considerable variability in word recognition scores (WRSs). This variability is most pronounced among individuals with moderately severe to severe hearing loss. The variability cannot be adequately explained by factors such as pure-tone audiogram, audiogram type [...] Read more.
Among hearing aid (HA) users, there is a considerable variability in word recognition scores (WRSs). This variability is most pronounced among individuals with moderately severe to severe hearing loss. The variability cannot be adequately explained by factors such as pure-tone audiogram, audiogram type or age. This prospective study was designed to investigate the relationship between tone decay (TD) and WRS in a group of HA users with corresponding pure-tone hearing loss. The study population included 22 patients with hearing loss between 50 and 80 dB HL. Aided WRS, unaided WRS and TD were assessed for both ears. TD was found to be frequency-dependent. TD and WRS were correlated, with up to R = −0.66. The TD test was revealed to be a feasible method for explaining variability in WRS among HA users with hearing loss below 80 dB. This may contribute to improved differential diagnostics. The TD test may thus offer a better understanding of the limitations of HA use in the context of cochlear implant candidacy assessment for HA users. Full article
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12 pages, 2110 KiB  
Article
Word Recognition with a Cochlear Implant in Relation to Prediction and Electrode Position
by Annett Franke-Trieger, Susen Lailach, Joshua Shetty, Katrin Murrmann, Thomas Zahnert and Marcus Neudert
J. Clin. Med. 2024, 13(1), 183; https://doi.org/10.3390/jcm13010183 - 28 Dec 2023
Viewed by 1061
Abstract
Background: the word recognition score (WRS) achieved with cochlear implants (CIs) varies widely. To account for this, a predictive model was developed based on patients’ age and their pre-operative WRS. This retrospective study aimed to find out whether the insertion depth of the [...] Read more.
Background: the word recognition score (WRS) achieved with cochlear implants (CIs) varies widely. To account for this, a predictive model was developed based on patients’ age and their pre-operative WRS. This retrospective study aimed to find out whether the insertion depth of the nucleus lateral-wall electrode arrays contributes to the deviation of the CI-achieved WRS from the predicted WRS. Materials and methods: patients with a pre-operative maximum WRS > 0 or a pure-tone audiogram ≥80 dB were included. The insertion depth was determined via digital volume tomography. Results: fifty-three patients met the inclusion criteria. The median WRS achieved with the CI was 70%. The comparison of pre- and post-operative scores achieved with a hearing aid and a CI respectively in the aided condition showed a median improvement of 65 percentage points (pp). A total of 90% of the patients improved by at least 20 pp. The majority of patients reached or exceeded the prediction, with a median absolute error of 11 pp. No significant correlation was found between the deviation from the predicted WRS and the insertion depth. Conclusions: our data support a previously published model for the prediction of the WRS after cochlear implantation. For the lateral-wall electrode arrays evaluated, the insertion depth did not influence the WRS with a CI. Full article
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10 pages, 272 KiB  
Article
The Effects of Stimulus Repetition Rate on Electrically Evoked Auditory Brainstem Potentials in Postlingually Deafened Adult Cochlear Implant Recipients
by Oliver C. Dziemba, Tina Brzoska, Thomas Hocke and Friedrich Ihler
J. Clin. Med. 2023, 12(22), 7188; https://doi.org/10.3390/jcm12227188 - 20 Nov 2023
Viewed by 661
Abstract
Background: By using outcome prediction scores, it is possible to distinguish between good and poor performers with cochlear implants (CI) after CI implantation. The reasons for poor performance, despite good basic conditions, can be manifold. On the one hand, the postoperative fitting may [...] Read more.
Background: By using outcome prediction scores, it is possible to distinguish between good and poor performers with cochlear implants (CI) after CI implantation. The reasons for poor performance, despite good basic conditions, can be manifold. On the one hand, the postoperative fitting may be inadequate; on the other, neurophysiological disease processes may impair speech understanding with a CI. These disease processes are not yet fully understood. In acoustics, it is known that the auditory brainstem responses (ABR) and their latencies and amplitudes allow differential diagnosis based on reference values for normal-hearing individuals. The aim of this study was to provide reference values for electrically evoked brainstem responses (EABRs) in terms of rate-dependent latencies and amplitudes. Methods: 20 ears of 18 experienced adult CI recipients with a predicted and measured good postoperative word recognition score were recruited from the clinic’s patient pool. In the same stimulation mode and intensity we measured latencies and interpeak-latencies of EABRs and electrically evoked compound action potentials (ECAPs). With a defined supra-threshold stimulation intensity above the individual ECAP threshold, we applied stimulation at several rates between 11 and 91 stimuli per second. Results: We found rate dependences for EABR latency t3 and t5 in the order of 0.19 ms and 0.37 ms, respectively, while ECAP was not affected by rate. Correspondingly, the interpeak intervals’ rate dependences for t5t1, t5t3 and t3t1 were of the order of 0.37 ms, 0.18 ms and 0.19 ms. Comparing the EABR amplitudes between the stimulation rates 11/s and 81/s, we found that at 81/s the amplitudes were significantly reduced down: to 73% for A3 and 81% for A5. These rate dependences of latency and amplitude in EABR have characteristics comparable to those of acoustic ABR. Conclusions: These data may serve to provide reference values for EABR and ECAP latencies, interpeak intervals and amplitudes with respect to stimulation rate. Altered response patterns of ECAPs and EABRs to normalised stimulation modes could be used in the future to describe and classify neuropathological processes in a better-differentiated way. Full article
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11 pages, 1563 KiB  
Article
Evolving a Model for Cochlear Implant Outcome
by Ulrich Hoppe, Anne Hast, Joachim Hornung and Thomas Hocke
J. Clin. Med. 2023, 12(19), 6215; https://doi.org/10.3390/jcm12196215 - 26 Sep 2023
Cited by 2 | Viewed by 873
Abstract
Background: Cochlear implantation is an efficient treatment for postlingually deafened adults who do not benefit sufficiently from acoustic amplification. Implantation is indicated when it can be foreseen that speech recognition with a cochlear implant (CI) is superior to that with a hearing aid. [...] Read more.
Background: Cochlear implantation is an efficient treatment for postlingually deafened adults who do not benefit sufficiently from acoustic amplification. Implantation is indicated when it can be foreseen that speech recognition with a cochlear implant (CI) is superior to that with a hearing aid. Especially for subjects with residual speech recognition, it is desirable to predict CI outcome on the basis of preoperative audiological tests. Purpose: The purpose of the study was to extend and refine a previously developed model for CI outcome prediction for subjects with preoperative word recognition to include subjects with no residual hearing by incorporating additional results of routine examinations. Results: By introducing the duration of unaided hearing loss (DuHL), the median absolute error (MAE) of the prediction was reduced. While for subjects with preoperative speech recognition, the model modification did not change the MAE, for subjects with no residual speech recognition before surgery, the MAE decreased from 23.7% with the previous model to 17.2% with the extended model. Conclusions: Prediction of word recognition with CI is possible within clinically relevant limits. Outcome prediction is particularly important for preoperative counseling and in CI aftercare to support systematic monitoring of CI fitting. Full article
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12 pages, 2687 KiB  
Article
Influence of Age on Speech Recognition in Noise and Hearing Effort in Listeners with Age-Related Hearing Loss
by Torsten Rahne, Telse M. Wagner, Anna C. Kopsch, Stefan K. Plontke and Luise Wagner
J. Clin. Med. 2023, 12(19), 6133; https://doi.org/10.3390/jcm12196133 - 22 Sep 2023
Cited by 1 | Viewed by 1205
Abstract
The aim of this study was to measure how age affects the speech recognition threshold (SRT50) of the Oldenburg Sentence Test (OLSA) and the listening effort at the corresponding signal-to-noise ratio (SNRcut). The study also investigated the effect of [...] Read more.
The aim of this study was to measure how age affects the speech recognition threshold (SRT50) of the Oldenburg Sentence Test (OLSA) and the listening effort at the corresponding signal-to-noise ratio (SNRcut). The study also investigated the effect of the spatial configuration of sound sources and noise signals on SRT50 and SNRcut. To achieve this goal, the study used olnoise and icra5 noise presented from one or more spatial locations from the front and back. Ninety-nine participants with age-related hearing loss in the 18–80 years age range, specifically in the 18–30, 31–40, 41–50, 51–60, 61–70, and 71–80 age groups, participated in this study. Speech recognition and listening effort in noise were measured and compared between the different age groups, different spatial sound configurations and noise signals. Speech recognition in noise decreased with age and became significant from the age group of 50–51. The decrease in SRT50 with age was greater for icra5 noise than for olnoise. For all age groups, SRT50 and SNRcut were better for icra5 noise than for olnoise. The measured age-related reference data for SRT50 and SNRcut can be used in further studies in listeners with age-related hearing loss and hearing aid or implant users. Full article
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10 pages, 8788 KiB  
Brief Report
Triple Semi-Circular Canal Occlusion and Cochlear Implantation: A Treatment Option for Single-Sided Menière’s Disease with Functional Deafness—A Case Series
by Ronny Jacob, Gina Lauer, Arneborg Ernst, Rainer Seidl, Lenneke Kiefer and Philipp Mittmann
J. Clin. Med. 2023, 12(17), 5500; https://doi.org/10.3390/jcm12175500 - 24 Aug 2023
Viewed by 1128
Abstract
The surgical options for patients with single-sided Menière’s disease and functional deafness are challenging. Our case series reports the outcomes of surgical treatments of patients with single-sided Menière’s disease and functional deafness. These patients have undergone a one-staged occlusion of all semi-circular canals [...] Read more.
The surgical options for patients with single-sided Menière’s disease and functional deafness are challenging. Our case series reports the outcomes of surgical treatments of patients with single-sided Menière’s disease and functional deafness. These patients have undergone a one-staged occlusion of all semi-circular canals and cochlear implantation. Five patients (four female and one male; 62 ± 8.2 years with a range from 50 to 72 years) with single-sided Menière’s disease and functional deafness were included in this study. In all cases, the patients suffered from frequent rotational vertigo episodes for many years. Other treatment options (e.g., medication) had not yet been successful. Preoperatively, the Dizziness Handicap Inventory (DHI) of all patients indicated severe emotional, physical, and functional deficits. Patients showed a functional (near-total) deafness of the affected ear in all cases. All patients were supplied with cochlear implants in combination with a triple occlusion of all semi-circular canals in a one-stage procedure. After a short period of increased dizziness following surgery and after the activation of the cochlear implant and CI rehabilitation (auditory-verbal therapy), vertigo control and an adequate audiological outcome were achieved. The DHI showed a constant decrease after surgery. The combination of a triple semi-circular canal occlusion and cochlear implantation can be an efficient treatment for patients with single-sided Menière’s disease. Full article
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