Speech Audiometrical Results Before and After Reimplantation of Cochlear Implants.

OBJECTIVES: This study aimed to compare the audiological outcomes of cochlear reimplantation with those of the first cochlear implant (CI). DESIGN: A retrospective analysis was performed on the data of all CI recipients who received the first CI at the age of 8 years or above and who were subsequently reimplanted on the same side. All participants who received their first implant after January 1, 2000, and who were reimplanted before January 1, 2021, were included. CI recipients who were unable to perform an open-set of Flemish monosyllable speech audiometry were excluded. The participants' clinical files were reviewed in terms of the cause of hearing loss, age at the first and second implantation, device types, the time between the first and second surgery, speech reception scores before and after reimplantation, and the reason for reimplantation. RESULTS: Reimplantation was due to device failure in 19 out of 22 patients, performance decrement in two patients, and medical reasons in one patient. The interval between the first and second CI ranged from 8 to 218 mo. Within-subject analysis showed the speech reception performance with the second CI to be significantly better than that with the first CI at all follow-up time points, with average within-patient gains of 17%, 16%, 12%, and 15% at 3 mo, 9 mo, 3 years, and the highest scores achieved, respectively. After reimplantation, the performance was better than the last results before reimplantation, and this was significant from 9 mo after reimplantation onwards. Three patients (14%) had a performance degradation with the second CI, which was probably owing to (1) difficulties in reimplantation surgery leading to a reduced number of active channels, (2) insufficient experience with the second CI as the reimplantation has been performed recently, and (3) advanced fenestral and retrofenestral otosclerosis. CONCLUSIONS: The present study shows that speech reception performance after reimplantation yields faster and better results than the first implant. It takes a couple of months to get better results than those before the reimplantation. Only in a minority of participants, a small deterioration may be observed. It seems that soft failures in the absence of measurable technical abnormalities call for caution with regard to reimplantation.

Cross-cultural adaptation of the Nijmegen cochlear implant questionnaire into Turkish language: validity, reliability and effects of demographic variables.

PURPOSE: The purpose of this study was to evaluate the validity and reliability of the Turkish version of the Nijmegen Cochlear Implant Questionnaire (Tr-NCIQ) and reveal the demographic factors contributing to the outcomes. METHODS: A group of 118 cochlear implant users aged between 18 and 70 years filled the Tr-NCIQ and the Turkish Hearing Handicapped Inventory for Adults (the Tr-HHI-Adult) via electronic survey. Cross-cultural adaptation of the Tr-NCIQ was performed. The reliability and validity of the questionnaire were evaluated utilizing internal consistency coefficient, split-half method, and predictive validity. RESULTS: The overall Cronbach's alpha coefficient of the scale was 0.91, and the Spearman-Brown coefficient was 0.91. A moderately significant and negative correlation was present between the basic sound perception, speech production, self-esteem, activity, and social interactions subdomain scores and the HHI-Adult scores. Patients with post-lingual onset of hearing loss had significantly better results than those with pre-lingual onset, in the advanced sound perception subdomain. In addition, bilateral cochlear implant users had better results than the unilateral and bimodal users in the speech production subdomain and then the bimodal users in the self-esteem subdomain. There was no effect of age, duration of implant use, age at implantation, and the daily usage of cochlear implant (CI) on the quality-of-life outcomes. CONCLUSION: The Tr-NCIQ is a reliable and valid tool to evaluate the subjective quality of life in CI users. In addition, as a standardized instrument, it can be easily self-administered both in clinical practice and for research purposes.

Assessment of Binaural Benefits in Hearing and Hearing-Impaired Listeners.

PURPOSE: The purpose of this study was to (a) investigate which speech material is most appropriate as stimulus in head shadow effect (HSE) and binaural squelch (SQ) tests, (b) obtain normative values of both tests using the material decided to be optimal, and (c) explore the results in bilateral cochlear implant (CI) users. METHOD: Study participants consisted of 30 normal-hearing (NH) persons and 34 bilateral CI users. This study consisted of three phases. In the first phase, three different speech materials (1) monosyllabic words, (2) spondee words, and (3) sentences were compared in terms of (a) effect size, (b) test-retest reliability, and (c) interindividual variability. In the second phase, the speech material selected in the first phase was used to test a further 24 NHs to obtain normative values for both tests. In the third phase, tests were administered to a further 23 bilateral CI users, together with localization test and the Speech, Spatial, and Qualities of Hearing scale. RESULTS: The results of the first phase indicated that spondees and sentences were more robust materials compared with monosyllables. Although the effect size and interindividual variability were comparable for spondees and sentences, sentences had higher test-retest reliability in this sample of CI users. With sentences, the mean (± standard deviation) HSE and SQ in the NH group were 58 ± 14% and 22 ± 11%, respectively. In the CI group, the mean HSE and SQ were 49 ± 13% and 13 ± 14%, respectively. There were no statistically significant correlations between the test results and the interval between the implantations, the length of binaural listening experience, or the asymmetry between the ears. CONCLUSIONS: Sentences are preferred as stimulus material in the binaural HSE and SQ tests. Normative data are given for HSE and SQ with the LiCoS (linguistically controlled sentences) test. HSE is present for all bilateral CI users, whereas SQ is present in approximately seven out of 10 cases.

Three Years of Vestibular Infant Screening in Infants With Sensorineural Hearing Loss.

OBJECTIVES: Although vestibular deficits are more prevalent in hearing-impaired children and can affect their development on many levels, a pediatric vestibular assessment is still uncommon in clinical practice. Since early detection may allow for timely intervention, this pioneer project has implemented a basic vestibular screening test for each six-month-old hearing-impaired infant in Flanders, Belgium. This study aims to report the vestibular screening results over a period of three years and to define the most important risk factors for abnormal vestibular screening results. METHODS: Cervical Vestibular Evoked Myogenic Potentials with bone-conduction were used as a vestibular screening tool in all reference centers affiliated to the Universal Newborn Hearing Screening Program in Flanders. From June 2018 until June 2021, 254 infants (mean age: 7.4 months, standard deviation: 2.4 months) with sensorineural hearing loss were included. RESULTS: Overall, abnormal vestibular screening results were found in 13.8% (35 of 254) of the infants. The most important group at risk for abnormal vestibular screening results were infants with unilateral or bilateral severe to profound sensorineural hearing loss (20.8%, 32 of 154) (P < .001, odds ratio = 9.16). Moreover, abnormal vestibular screening results were more prevalent in infants with hearing loss caused by meningitis (66.7%, 2 of 3), syndromes (28.6%, 8 of 28), congenital cytomegalovirus infection (20.0%, 8 of 40), and cochleovestibular anomalies (19.2%, 5 of 26). CONCLUSIONS: The vestibular screening results in infants with sensorineural hearing loss indicate the highest risk for vestibular deficits in severe to profound hearing loss, and certain underlying etiologies of hearing loss, such as meningitis, syndromes, congenital cytomegalovirus, and cochleovestibular anomalies.

Vestibular Infant Screening (VIS)-Flanders: results after 1.5 years of vestibular screening in hearing-impaired children.

Due to the close anatomical relationship between the auditory and vestibular end organs, hearing-impaired children have a higher risk for vestibular dysfunction, which can affect their (motor) development. Unfortunately, vestibular dysfunction often goes unnoticed, as vestibular assessment in these children is not standard of care nowadays. To timely detect vestibular dysfunction, the Vestibular Infant Screening-Flanders (VIS-Flanders) project has implemented a basic vestibular screening test for hearing-impaired infants in Flanders (Belgium) with a participation rate of 86.7% during the first year and a half. The cervical Vestibular Evoked Myogenic Potentials (cVEMP) test was applied as vestibular screening tool to map the occurrence of vestibular (mainly saccular) dysfunction in this population. At the age of 6 months, 184 infants were screened. No refers on vestibular screening were observed in infants with permanent conductive hearing loss. In infants with permanent sensorineural hearing loss, a cVEMP refer rate of 9.5% was observed. Failure was significantly more common in infants with severe-profound compared to those with mild-moderate sensorineural hearing loss (risk ratio = 9.8). Since this is the first regional study with a large sample size and successful participation rate, the VIS-Flanders project aims to set an example for other regions worldwide.