American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness.

The indications for cochlear implantation have expanded to include individuals with profound sensorineural hearing loss in the impaired ear and normal hearing (NH) in the contralateral ear, known as single-sided deafness (SSD). There are additional considerations for the clinical assessment and management of adult cochlear implant candidates and recipients with SSD as compared to conventional cochlear implant candidates with bilateral moderate to profound sensorineural hearing loss. The present report reviews the current evidence relevant to the assessment and management of adults with SSD. A systematic review was also conducted on published studies that investigated outcomes of cochlear implant use on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population. Expert consensus and systematic review of the current literature were combined to provide guidance for the clinical assessment and management of adults with SSD.

American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Cochlear Implantation in Children With Single-Sided Deafness.

More children with single-sided deafness (SSD) are receiving cochlear implants (CIs) due to the expansion of CI indications. This unique group of pediatric patients has different needs than the typical recipient with bilateral deafness and requires special consideration and care. The goal of cochlear implantation in these children is to provide bilateral input to encourage the development of binaural hearing. Considerations for candidacy and follow-up care should reflect and measure these goals. The purpose of this document is to review the current evidence and provide guidance for CI candidacy, evaluation, and management in children with SSD.

The feasibility, validity and reliability of a child friendly vestibular assessment in infants and children candidates to cochlear implant.

OBJECTIVES: The pediatric vestibular assessment has developed significantly in the past two decades, especially in terms of assessment of cochlear implant (CI) candidates. Different methods and test protocols have been applied, however without a general consensus. We present here the feasibility, validity and reliability of a child friendly vestibular testing in use at our department for the assessment of pediatric CI candidates. METHODS: The test battery consisted of head impulse test (HIT), video head impulse test (vHIT), cervical evoked myogenic potentials (cVEMP) and mini ice water caloric test (mIWC), all adapted from previous methods, mentioned in literature. We defined specific criteria for test feasibility, for test validity and test positivity (i.e. indicating vestibular insufficiency). The reliability of the whole protocol was assessed with test agreement analysis. RESULTS: Complete data from 35 children, all CI candidates, age ranging 4-79 months (67% under 2 years) and recruited over two years, were obtained. All but one child could complete at least one test with valid responses bilaterally, with the best compliance for HIT (97,1%) and least for cVEMP (68,6%). Feasibility did not appear to be affected by age or hearing loss etiology. Among the valid responses there was a substantial test agreement between HIT and vHIT, moderate agreement between vHIT/HIT and mIWC and no apparent agreement between the canal tests and cVEMP. Simple clinical guidelines were introduced to solve the tests' disagreement and to improve the protocol reliability: a) a pathological response had to be confirmed in at least two different canal tests and in at least three cVEMP trials; b) a canal/otolith disagreement was interpreted as a partial vestibular loss to be opposed to a complete vestibular insufficiency. CONCLUSIONS: The search for vestibular insufficiency in infants and young children can be attained with an opportunely adapted vestibular assessment, such the test battery proposed here. That assessment resulted easy to conduct and to interpret in a representative sample of CI candidates in preschool age, the most of whom were younger than 2 years. This method appears to particularly suit the demands of a vestibular assessment in young children CI candidates.

Speech-Language Pathologists' Perceptions of School-Based Services for Children With Hearing Loss.

Purpose School-aged children with hearing loss are best served by a multidisciplinary team of professionals. The purpose of this research was to assess school-based speech-language pathologists' (SLPs) perceptions of their access to, involvement of, and working relationships with educational audiologists in their current work setting. Method An online survey was developed and distributed to school-based SLPs in North Carolina. Results A significant difference in access to and involvement of educational audiologists across the state was found. Conclusions This research contributes to professional knowledge by providing information about current perceptions in the field about interprofessional practice in a school-based setting. Overall, SLPs reported positive feelings about their working relationship with educational audiologists and feel the workload is distributed fairly.

Perceptions of deaf subjects about communication in Primary Health Care.

OBJECTIVE: to analyze the perceptions of deaf individuals about the communication process with health professionals of the state of Rio de Janeiro. METHODS: cross-sectional observational study. Data were collected through the application of a questionnaire with quantitative and qualitative questions to 121 deaf adults. Objective responses were studied descriptively through frequency tables and analyzed by inferential statistics and logistic regression. The data from the open questions were analyzed through content analysis. RESULTS: the lack of interpreters and the lack of use of the Brazilian Sign Language by professionals were perceived as the main communication barriers. In turn, the presence of companions who are listeners (73%) and the use of mime/gestures (68%) were among the strategies most used by the deaf. The majority of deaf people reported insecurity in consultations, and those who best understood their diagnosis and treatment were the bilingual deaf (p = 0.0347) and the deaf who used oral communication (p = 0.0056). CONCLUSION: communication with the professionals was facilitated when the deaf people had a companion or when they used mimics and gestures. Sign language was neglected, despite the fact that the provision of care to the deaf by professionals trained to use this language is guaranteed in the legislation.

Parent challenges, perspectives and experiences caring for children who are deaf or hard-of-hearing with other disabilities: a comprehensive review.

OBJECTIVE: The purpose of this literature review was to explore parent challenges in caring for children who are deaf or hard of hearing with other disabilities and discuss implications for audiologists related to supporting families. DESIGN: A comprehensive literature review was conducted, and through qualitative analysis, emergent themes were identified, and a narrative summary generated. STUDY SAMPLE: Nine research studies were included in this review. Combined, these studies reflect a sample of 111 children, 23 families and 41 parents. RESULTS: Three broad themes were identified, and include parent-reported challenges related to family, professional and child variables. Sub-themes were identified within each broad theme to further describe parent experiences, such as challenges related to decision-making and planning, interprofessional collaboration, and child communication and behaviours. CONCLUSIONS: Parents of children with hearing loss and additional disabilities face unique challenges related to family, professional and child variables that could impact how they manage their child's hearing care.

A sustainable model for cochlear implantation in the developing world: perspectives from the Indian subcontinent.

PURPOSE OF REVIEW: The overall prevalence of deafness in India is 0.2%, but the prevalence in the southern state of Tamil Nadu is much higher (around 0.6%) because of consanguinity. Especially in India, establishing cochlear implantation as a treatment modality for hearing loss has been a daunting task, but in the last decade, the cochlear implantation program has emerged as an unqualified success in many states, with over 20 000 cochlear implantations done till date. Several states are sponsoring free implants to children under the age of 6 years and below poverty line. RECENT FINDINGS: Nearly 3000 cochlear implantations have been performed in Tamil Nadu under the Chief Minister's Comprehensive Health Insurance Scheme, with the goal to have a 'deafness free Tamil Nadu' by 2025. This scheme covers nearly 40 million people in rural areas. Valuable lessons have been learnt from this social experiment. One of the cornerstones of this scheme is the method to deliver habilitation via satellite centers in rural areas at the doorstep of the patient. The outcomes in peripheral centers were found to be statistically similar to those in the main center and correlated well with duration of habilitation. SUMMARY: Opening up satellite centers for habilitation across the state of Tamil Nadu has greatly helped to improve the attendance and outcomes. The Indian model has been hugely successful and has helped start similar cochlear implantation programs in neighboring countries such as Nepal, Sri Lanka and Bangladesh.

Overcoming developing-world challenges in cochlear implantation: a South American perspective.

PURPOSE OF REVIEW: Effective hearing rehabilitation with cochlear implantation is challenging in developing countries, and this review focuses on strategies for childhood profound sensorineural hearing loss care in South America. RECENT FINDINGS: Most global hearing loss exists in developing countries; optimal cost-effective management strategies are essential in these environments. This review aims to assess and discuss the challenges of cochlear implantation effectiveness in South America. The authors searched electronic databases, bibliographies, and references for published and unpublished studies. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and failure rate. Costs were obtained from experts in South America using known costs and estimations whenever necessary. Recent studies reported several challenges in unilateral or bilateral cochlear implants: cochlear implant costs, deaf education costs, increasing need for cochlear implant capacity, and training and increasing longevity. SUMMARY: Cochlear implantation was very cost-effective in all South American countries. Despite inconsistencies in the quality of available evidence, the robustness of systematic review methods substantiates the positive findings of the included studies, demonstrating that unilateral cochlear implantation is clinically effective and likely to be cost-effective in developing countries.

Addressing Mental Health Needs for Deaf Patients Through an Integrated Health Care Model.

Deaf individuals struggle with accessing mental health services because of language and cultural discordance. Our project's purpose was to design and pilot an accessible, integrated mental health program for the Deaf population, scalable for other health centers interested in serving these individuals. Our team addressed several identified barriers to care. The addition of a language-concordant mental health clinician and telemental health appointments helped us better manage Deaf patients' mental health needs. Individual and clinic level data were collected and analyzed. Results demonstrated a significant improvement in the patients' depression and anxiety scores from their baseline to their last documented visit. Patient satisfaction overall was high. Telemental health appears to be a feasible tool to address some of the mental health gaps in the Deaf community. Further studies are needed to demonstrate how this program can be effective within a larger geographical area.

Objective assessment of electrode discrimination with the auditory change complex in adult cochlear implant users.

The spatial auditory change complex (ACC) is a cortical response elicited by a change in place of stimulation. There is growing evidence that it provides a useful objective measure of electrode discrimination in cochlear implant (CI) users. To date, the spatial ACC has only been measured in relatively experienced CI users with one type of device. Early assessment of electrode discrimination could allow auditory stimulation to be optimized during a potentially sensitive period of auditory rehabilitation. In this study we used a direct stimulation paradigm to measure the spatial ACC in both pre- and post-lingually deafened adults. We show that it is feasible to measure the spatial ACC in different CI devices and as early as 1 week after CI switch-on. The spatial ACC has a strong relationship with performance on a behavioural discrimination task and in some cases provides information over and above behavioural testing. We suggest that it may be useful to measure the spatial ACC to guide auditory rehabilitation and improve hearing performance in CI users.

[The application of artificial neural network on the assessment of lexical tone production of pediatric cochlear implant users].

Objective: The present study was carried out to explore the tone production ability of the Mandarin-speaking children with cochlear implants (CI) by using an artificial neural network model and to examine the potential contributing factors underlining their tone production performance. The results of this study might provide useful guidelines for post-operative rehabilitation processes of pediatric CI users. Methods: Two hundred and seventy-eight prelingually deafened children who received unilateral CI participated in this study. As controls, 170 similarly-aged children with normal hearing (NH) were recruited. A total of 36 Chinese monosyllabic words were selected as the tone production targets. Vocal production samples were recorded and the fundamental frequency (F0) contour of each syllable was extracted using an auto-correlation algorithm followed by manual correction. An artificial neural network was created in MATLAB to classify the tone production. The relationships between tone production and several demographic factors were evaluated. Results: Pediatric CI users produced Mandarin tones much less accurately than did the NH children (58.8% vs. 91.5% correct). Tremendous variability in tone production performance existed among the CI children. Tones 2 and 3 were produced less accurately than tones 1 and 4 for both groups. For the CI group, all tones when in error tended to be judged as tone 1. The tone production accuracy was negatively correlated with age at implantation and positively correlated with CI use duration with correlation coefficients (r) of -0.215 (P=0.003) and 0.203 (P=0.005), respectively. Age was one of the determinants of tonal ability for NH children. Conclusions: For children with severe to profound hearing loss, early implantation and persistent use of CI are beneficial to their tone production development. Artificial neural network is a convenient and reliable assessment tool for the development of tonal ability of hearing-impaired children who are in the rehabilitation processes that focus on speech and language expression.

Referral rates of postlingually deafened adult hearing aid users for a cochlear implant candidacy assessment.

OBJECTIVE: The aims of this study were: to investigate the referral rates of postlingually deafened adult cochlear implant (CI) candidates from a hearing aid (HA) clinic for a CI candidacy assessment and to gain insight about factors influencing the referral pathways to CI assessments. DESIGN: Two methodologies were used: a retrospective cohort study reviewing clinical files and a questionnaire to clinicians. STUDY SAMPLE: The files of 1249 adult clients from the HA clinic who had average puretone hearing thresholds greater or equal to 65 dB HL in the better hearing ear and unaided phoneme recognition scores of less than 50% in both ears were reviewed. All of the clinicians completed the online questionnaire. RESULTS: Eighteen adults met the CI candidacy criteria, of whom 16 (89%) had a CI discussion with their audiologist, with 11 (61%) being referred for a CI evaluation. Of these 11, four proceeded to implantation. Questionnaire responses revealed the need for better information on candidacy and referral guidelines for HA audiologists, in addition to enhanced communication between HA and CI clinics. CONCLUSIONS: Overall the results indicate that the referral pathway to obtain a CI assessment is a barrier contributing to the low CI penetration rate in adults.

Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America.

HYPOTHESIS: Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. BACKGROUND: CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. METHODS: Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)<3. RESULTS: Deaf education was very cost effective in all countries (CER/GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). CONCLUSION: Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.

Assessment of Spectral and Temporal Resolution in Cochlear Implant Users Using Psychoacoustic Discrimination and Speech Cue Categorization.

OBJECTIVES: This study was conducted to measure auditory perception by cochlear implant users in the spectral and temporal domains, using tests of either categorization (using speech-based cues) or discrimination (using conventional psychoacoustic tests). The authors hypothesized that traditional nonlinguistic tests assessing spectral and temporal auditory resolution would correspond to speech-based measures assessing specific aspects of phonetic categorization assumed to depend on spectral and temporal auditory resolution. The authors further hypothesized that speech-based categorization performance would ultimately be a superior predictor of speech recognition performance, because of the fundamental nature of speech recognition as categorization. DESIGN: Nineteen cochlear implant listeners and 10 listeners with normal hearing participated in a suite of tasks that included spectral ripple discrimination, temporal modulation detection, and syllable categorization, which was split into a spectral cue-based task (targeting the /ba/-/da/ contrast) and a timing cue-based task (targeting the /b/-/p/ and /d/-/t/ contrasts). Speech sounds were manipulated to contain specific spectral or temporal modulations (formant transitions or voice onset time, respectively) that could be categorized. Categorization responses were quantified using logistic regression to assess perceptual sensitivity to acoustic phonetic cues. Word recognition testing was also conducted for cochlear implant listeners. RESULTS: Cochlear implant users were generally less successful at utilizing both spectral and temporal cues for categorization compared with listeners with normal hearing. For the cochlear implant listener group, spectral ripple discrimination was significantly correlated with the categorization of formant transitions; both were correlated with better word recognition. Temporal modulation detection using 100- and 10-Hz-modulated noise was not correlated either with the cochlear implant subjects' categorization of voice onset time or with word recognition. Word recognition was correlated more closely with categorization of the controlled speech cues than with performance on the psychophysical discrimination tasks. CONCLUSIONS: When evaluating people with cochlear implants, controlled speech-based stimuli are feasible to use in tests of auditory cue categorization, to complement traditional measures of auditory discrimination. Stimuli based on specific speech cues correspond to counterpart nonlinguistic measures of discrimination, but potentially show better correspondence with speech perception more generally. The ubiquity of the spectral (formant transition) and temporal (voice onset time) stimulus dimensions across languages highlights the potential to use this testing approach even in cases where English is not the native language.

Brief Assessment of Parental Perception (BAPP): Development and validation of a new measure for assessing paediatric outcomes after bilateral cochlear implantation.

OBJECTIVE: In contrast to previous clinical practice, current guidelines recommend bilateral cochlear implantation in children, resulting in a cohort of children who initially received one implant, but have subsequently had a second, contralateral implant. This study aimed to explore satisfaction and quality of life in children implanted simultaneously or sequentially. DESIGN: A novel measure of satisfaction and quality of life following paediatric bilateral cochlear implantation (the Brief Assessment of Parental Perception; BAPP) was developed and preliminary validation undertaken as part of a large, national project of bilateral implantation. Children's parents completed the measure yearly for up to three years following implantation. STUDY SAMPLE: Children from 14 UK implant centres were recruited into the study; data were available for 410 children one year post-implantation. RESULTS: The BAPP was found to have good face and convergent validity, and internal consistency. Results indicated very high levels of satisfaction with the devices, and improvements in quality of life. However there was evidence that children implanted sequentially were less willing to wear their second implant in the first two years than those children receiving simultaneous implants. CONCLUSION: Simultaneous and sequential cochlear implants have a positive impact on the quality of life of deaf children.

Personalised long-term follow-up of cochlear implant patients using remote care, compared with those on the standard care pathway: study protocol for a feasibility randomised controlled trial.

INTRODUCTION: Many resources are required to provide postoperative care to patients who receive a cochlear implant. The implant service commits to lifetime follow-up. The patient commits to regular adjustment and rehabilitation appointments in the first year and annual follow-up appointments thereafter. Offering remote follow-up may result in more stable hearing, reduced patient travel expense, time and disruption, more empowered patients, greater equality in service delivery and more freedom to optimise the allocation of clinic resources. METHODS AND ANALYSIS: This will be a two-arm feasibility randomised controlled trial (RCT) involving 60 adults using cochlear implants with at least 6 months device experience in a 6-month clinical trial of remote care. This project will design, implement and evaluate a person-centred long-term follow-up pathway for people using cochlear implants offering a triple approach of remote and self-monitoring, self-adjustment of device and a personalised online support tool for home speech recognition testing, information, self-rehabilitation, advice, equipment training and troubleshooting. The main outcome measure is patient activation. Secondary outcomes are stability and quality of hearing, stability of quality of life, clinic resources, patient and clinician experience, and any adverse events associated with remote care. We will examine the acceptability of remote care to service users and clinicians, the willingness of participants to be randomised, and attrition rates. We will estimate numbers required to plan a fully powered RCT. ETHICS AND DISSEMINATION: Ethical approval was received from North West-Greater Manchester South Research Ethics Committee (15/NW/0860) and the University of Southampton Research Governance Office (ERGO 15329). RESULTS: Results will be disseminated in the clinical and scientific communities and also to the patient population via peer-reviewed research publications both online and in print, conference and meeting presentations, posters, newsletter articles, website reports and social media. TRIAL REGISTRATION NUMBER: ISRCTN14644286; Pre-results.