Comparing the Outcomes of a Personalized Versus Nonpersonalized Home-Based Auditory Training Program for Cochlear Implant Users.

OBJECTIVES: Audiological rehabilitation includes sensory management, auditory training (AT), and counseling and can alleviate the negative consequences associated with (untreated) hearing impairment. AT aims at improving auditory skills through structured analytical (bottom-up) or synthetic (top-down) listening exercises. The evidence for AT to improve auditory outcomes of postlingually deafened adults with a cochlear implant (CI) remains a point of debate due to the relatively limited number of studies and methodological shortcomings. There is a general agreement that more rigorous scientific study designs are needed to determine the effectiveness, generalization, and consolidation of AT for CI users. The present study aimed to investigate the effectiveness of a personalized AT program compared to a nonpersonalized Active Control program with adult CI users in a stratified randomized controlled clinical trial. DESIGN: Off-task outcomes were sentence understanding in noise, executive functioning, and health-related quality of life. Participants were tested before and after 16 weeks of training and after a further 8 months without training. Participant expectations of the training program were assessed before the start of training. RESULTS: The personalized and nonpersonalized AT programs yielded similar results. Significant on-task improvements were observed. Moreover, AT generalized to improved speech understanding in noise for both programs. Half of the CI users reached a clinically relevant improvement in speech understanding in noise of at least 2 dB SNR post-training. These improvements were maintained 8 months after completion of the training. In addition, a significant improvement in quality of life was observed for participants in both treatment groups. Adherence to the training programs was high, and both programs were considered user-friendly. CONCLUSIONS: Training in both treatments yielded similar results. For half of the CI users, AT transferred to better performance with generalization of learning for speech understanding in noise and quality of life. Our study supports the previous findings that AT can be beneficial for some CI users.

A Role for Acoustic Stimulation in Advanced Otosclerosis: Direct Acoustic Cochlear Implant versus Cochlear Implant.

Recent findings support the efficacy of the direct acoustic cochlear implant (DACI) in patients with advanced otosclerosis whose rehabilitation is very challenging. Standard treatment consists of stapes surgery combined with hearing aids or a cochlear implant (CI). CI surgery, however, is often challenging depending on the grade of otosclerosis. This study aims to compare speech perception scores in quiet and noise of 6 DACI and 12 CI patients with advanced otosclerosis at 3 and 12 months after fitting. Preoperative computed tomographic scans of all patients were scored by experts using an existing otosclerosis grading system (stages 1-3). Speech perception in quiet was significantly better for DACI compared to CI users at 3 months after fitting. At 12 months, no difference was found between DACI and CI patients. Speech perception scores in noise were significantly better in the DACI group. In summary, a DACI system seems to provide an effective treatment option as the acoustic component can be preserved in patients with advanced otosclerosis.

Measures of Speech Understanding in Noise for Young Children with a Cochlear Implant in Mainstream and Special Education.

The use of two types of speech-in-noise (SPIN) assessment, namely digits-in-noise self-tests and open-set, monosyllabic word tests, to assess the SPIN understanding performance of children with cochlear implants (CI) in mainstream and special education, was investigated. The tests' feasibility and reliability and the influence of specific cognitive abilities on their results were studied. The results of 30 children with CIs in mainstream and special education were compared to those of 60 normal-hearing children in elementary school. Results indicate that the digit triplet test (DTT) was feasible for all children tested in this study, as seen by the familiarity of all the digits, the high stability of the test results (<3 dB SNR), and a small measurement error (≤2 dB SNR). Remembering full triplets did not form a problem and results did not show systematic attention loss. For children with CIs, the performance on the DTT was strongly related to the performance on the open-set monosyllabic word-in-noise task. However, small but significant differences were observed in the performance of children with CIs in mainstream and special education on the monosyllabic word test. Both tests showed little influence of cognitive abilities, making them both useful in situations where the bottom-up auditory aspect of SPIN performance needs to be investigated or in situations where sentence-in-noise tests are too challenging.