Cochlear implantation under local anaesthesia - Our experience and a validated patient satisfaction questionnaire.

OBJECTIVES: Cochlear implantation (CI) under local anaesthetic (LA) has previously been shown to be a successful and safe option for a specific group of patients (e.g. elderly and significant co-morbidity). We aim to discuss our practice and obtain qualitative information about patient experience from our cohort of patients at the Yorkshire Auditory Implant Service (YAIS). METHODS: Retrospective chart review to include demographics, co-morbidities and physiological parameters were recorded and used to calculate P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity) scores. The Iowa Satisfaction with Anaesthesia Scale (ISAS) questionnaire was distributed to all patients who received CI under LA and subsequently analysed. RESULTS: Seven patients received CI under LA at YAIS. This included five males and two females. The mean age was 79 years (range 26 -93). The mean P-POSSUM mortality and morbidity for this cohort was 2.4 and 34.9%, respectively. The average ISAS score was +1.72 (where range of -3 is completely dissatisfied and +3 is completely satisfied). DISCUSSION: We discuss our cohort and show that patients receiving CI have a favourable experience when LA is used. CI under LA is a viable and safe option for more elderly patients and those who are deemed at high risk of morbidity or mortality associated with a general anaesthetic. CONCLUSIONS: The data regarding validated patient experience obtained from this study can be used to help counsel patients that may be offered CI under LA.

Participatory design of a music aural rehabilitation programme.

OBJECTIVES: Many cochlear implant (CI) users wish to enjoy music but are dissatisfied by its quality as perceived through their implant. Although there is evidence to suggest that training can improve CI users' perception and appraisal of music, availability of interactive music-based aural rehabilitation for adults is limited. In response to this need, an 'Interactive Music Awareness Programme' (IMAP) was developed with and for adult CI users. METHODS: An iterative design and evaluation approach was used. The process began with identification of user needs through consultations, followed by use of mock-up applications in workshops. Feedback from these were used to develop the prototype IMAP; a programme of 24 interactive sessions, enabling users to create and manipulate music. The prototype IMAP was subsequently evaluated in a home trial with 16 adult CI users over a period of 12 weeks. RESULTS: Overall ratings for the prototype IMAP were positive and indicated that it met users' needs. Quantitative and qualitative feedback on the sessions and software in the prototype IMAP were used to identify aspects of the programme that worked well and aspects that required improvement. The IMAP was further developed in response to users' feedback and is freely available online. CONCLUSIONS: The participatory design approach used in developing the IMAP was fundamental in ensuring its relevance, and regular feedback from end users in each phase of development proved valuable for early identification of issues. Observations and feedback from end users supported a holistic approach to music aural rehabilitation.

Jumpstarting auditory learning in children with cochlear implants through music experiences.

Musical experiences are a valuable part of the lives of children with cochlear implants (CIs). In addition to the pleasure, relationships and emotional outlet provided by music, it serves to enhance or 'jumpstart' other auditory and cognitive skills that are critical for development and learning throughout the lifespan. Musicians have been shown to be 'better listeners' than non-musicians with regard to how they perceive and process sound. A heuristic model of music therapy is reviewed, including six modulating factors that may account for the auditory advantages demonstrated by those who participate in music therapy. The integral approach to music therapy is described along with the hybrid approach to pediatric language intervention. These approaches share the characteristics of placing high value on ecologically valid therapy experiences, i.e., engaging in 'real' music and 'real' communication. Music and language intervention techniques used by the authors are presented. It has been documented that children with CIs consistently have lower music perception scores than do their peers with normal hearing (NH). On the one hand, this finding matters a great deal because it provides parameters for setting reasonable expectations and highlights the work still required to improve signal processing with the devices so that they more accurately transmit music to CI listeners. On the other hand, the finding might not matter much if we assume that music, even in its less-than-optimal state, functions for CI children, as for NH children, as a developmental jumpstarter, a language-learning tool, a cognitive enricher, a motivator, and an attention enhancer.

[Dance projects as an integral part of CI rehabilitation and their impact on mental health: a pilot study]. / Tanzprojekte als integraler Bestandteil der CI-Rehabilitation und ihr Stellenwert für die psychische Gesundheit: Eine Pilotstudie.

BACKGROUND: Alongside improvements in hearing and communication skills, the rehabilitation of children, adolescents and adults with a cochlear implant (CI) in recent years has increasingly taken into account mental health and quality of life issues. In the context of the programs offered, this study assesses the significance of dance for the mental health of adult clients with a CI. METHODS: Eleven adult CI users participated in a dance project, which took place as a cooperation between the ENT University Hospital Heidelberg and the Baden State Theatre Karlsruhe. Participants were questioned at two different time points for assessment with the mental health scales (SPG). These scales measure seven different aspects of psychosocial well-being (including autonomy, willpower, affirmation of life and meaningfulness). RESULTS: Significant positive changes in the domains of affirmation of life, self-reflection and social integration were revealed by before and after comparisons; tendencies toward positive change were observed (p ≤ 0.10) in the domains of willpower, naturalness and meaningfulness. No changes were observed in the autonomy domain. CONCLUSION: The results indicate that the mental health of adult clients with a CI can be strengthened by dance as a complementary rehabilitation module. Concepts of CI rehabilitation should increasingly find anchor in the consideration of such arrangements for its range of offers.

Music mixing preferences of cochlear implant recipients: a pilot study.

OBJECTIVE: Music perception and appraisal are generally poor in cochlear implant recipients. Simple musical structures, lyrics that are easy to follow, and clear rhythm/beat have been reported among the top factors to enhance music enjoyment. The present study investigated the preference for modified relative instrument levels in music with normal-hearing and cochlear implant subjects. DESIGN: In experiment 1, test subjects were given a mixing console and multi-track recordings to determine their most enjoyable audio mix. In experiment 2, a preference rating experiment based on the preferred relative level settings in experiment 1 was performed. STUDY SAMPLE: Experiment 1 was performed with four postlingually deafened cochlear implant subjects, experiment 2 with ten normal-hearing and ten cochlear implant subjects. RESULTS: A significant difference in preference rating was found between normal-hearing and cochlear implant subjects. The latter preferred an audio mix with larger vocals-to-instruments ratio. In addition, given an audio mix with clear vocals and attenuated instruments, cochlear implant subjects preferred the bass/drum track to be louder than the other instrument tracks. CONCLUSIONS: The original audio mix in real-world music might not be suitable for cochlear implant recipients. Modifying the relative instrument level settings potentially improves music enjoyment.

Assessment of the subjective benefit of electric acoustic stimulation with the abbreviated profile of hearing aid benefit.

CONCLUSION: This study demonstrates that electric-acoustic stimulation (EAS) significantly decreases the subjective impairment in speech perception. OBJECTIVES: To assess the subjective benefit of EAS over the first 12 months after EAS fitting using the Abbreviated Profile of Hearing Aid Benefit (APHAB). METHOD: Twenty-three EAS users, implanted with either the PULSAR(CI)(100) FLEX(EAS) provided with the DUET EAS processor or the COMBI40+ Medium provided with the TEMPO+ speech processor, were included. Electric stimulation was activated about 1 month postoperatively; ipsilateral acoustic stimulation was added 2 months thereafter. EAS benefit was measured preoperatively with only a hearing aid and postoperatively at EAS fitting and then 3, 6 and 12 months after EAS fitting using the APHAB. RESULTS: Subjects reported significant improvements in the global score with a mean decrease in impairment from 74% preoperatively to 45% after 3 months of EAS use. Furthermore, clinical relevance was demonstrated in multiple subscales between preoperative and first fitting reflecting a true benefit of EAS with a probability of 95%.

Quality-of-life outcomes for adult cochlear implant recipients in New Zealand.

AIM: There were two aims to this study: to investigate the effect of a cochlear implant (CI) on quality-of-life (QOL) for adult recipients in New Zealand; and to determine which aspects of life that these changes are most noticed. METHOD: There were two groups of participants: CI Group - 94 postlingually deafened adult CI recipients; and WL group - 70 postlingually deafened adults on the waiting list (WL) for a CI. Two questionnaires were developed for this study. RESULTS: The results showed that cochlear implantation had a significant positive impact on QOL for recipients. The CI group had significantly higher ratings in all areas of QOL and satisfaction compared to the WL group. CONCLUSION: Overall, high QOL and satisfaction ratings were obtained from CI recipients. The significantly lower ratings from those on the WL for an implant highlight the difficulties experienced by those with a significant hearing impairment. Assessment of CI outcomes should include QOL measures in order to provide a more holistic picture.

Pitch matching psychometrics in electric acoustic stimulation.

OBJECTIVE: Combined electric-acoustic stimulation (EAS) is a therapeutic option for patients with severe to profound mid- and high-frequency hearing loss while low-frequency hearing is mostly unaffected. The present study investigates bimodal pitch matching in EAS users as a function of the angular placement of electrodes. Results are compared with data obtained from previous pitch matching studies. Knowledge of electric and acoustic pitch mapping may be important for effective fitting to control the frequency range of acoustic and electric processing. DESIGN: Pitch adjustment experiments were conducted in eight subjects with residual hearing in the opposite ear as well as in the implanted ear. Four subjects received a standard 31.5-mm electrode array and four subjects received the shorter, more flexible 24-mm FLEX electrode array (PULSARCI100 or SONATATI100 stimulator, MED-EL, Innsbruck, Austria). The subjects' task was to listen to single-electrode stimuli presented at a fixed rate (800 pulses per second) via the cochlear implant and to adjust the frequency of the acoustic stimulus until the perceived pitch matched the perception of the electrically conveyed stimulus. Two to four of the most apical electrodes were tested depending on the range of the individual's residual hearing. Postoperative x rays (modified Stenver's view) were analyzed to compare individual pitch matching data in terms of the electrode arrays' insertion angle. RESULTS: The average mean frequency match for the most apical electrode 1 in EAS subjects implanted with the FLEX array was 583 Hz, while for the two subjects with a deep insertion of the 31.5-mm standard electrode array, the matches were 128 and 223 Hz. Because the residual hearing in the EAS subgroup was rather limited in the high-frequency range, a limited number of basal electrodes were assessed to determine the slope of the electric place/pitch function. A considerable variation in terms of the individual pitch function was observed. The slope of the pitch function varied to a large extent among subjects. The differences between contra- and ipsilateral adjustments were very small (mean average 14 Hz) and within the range of the variance (average SD 124 Hz). CONCLUSIONS: The application of a pitch matching procedure to assess the electric/acoustic crossover frequency is feasible. In the present study, ipsi- and contralateral pitch matches made by EAS patients were nearly equal; therefore, a severe alteration in the excitation pattern of the basilar membrane in the implanted ear can be ruled out.

Source localization of auditory evoked potentials after cochlear implantation.

Little is known about how the auditory cortex adapts to artificial input as provided by a cochlear implant (CI). We report the case of a 71-year-old profoundly deaf man, who has successfully used a unilateral CI for 4 years. Independent component analysis (ICA) of 61-channel EEG recordings could separate CI-related artifacts from auditory-evoked potentials (AEPs), even though it was the perfectly time-locked CI stimulation that caused the AEPs. AEP dipole source localization revealed contralaterally larger amplitudes in the P1-N1 range, similar to normal hearing individuals. In contrast to normal hearing individuals, the man with the CI showed a 20-ms shorter N1 latency ipsilaterally. We conclude that ICA allows the detailed study of AEPs in CI users.