Hearing and Quality-of-Life Outcomes After Cochlear Implantation in Adult Hearing Aid Users 65 Years or Older: A Secondary Analysis of a Nonrandomized Clinical Trial.

Importance: Hearing loss, especially moderate to severe forms, has the potential to negatively affect an individual's physical, social, emotional, and cognitive well-being. Moreover, having ineffective binaural hearing increases difficulty understanding speech in noise and leads to a greater degree of social isolation and loneliness and a reduced quality of life (QoL). Objective: To explore the audiometric and holistic effects of cochlear implantation in a group of adults 65 years or older compared with an optimized bilateral hearing aid condition. Design, Setting, and Participants: This ad hoc secondary analysis of a prospective, single-subject, repeated-measures nonrandomized clinical trial included 13 cochlear implantation centers across the United States. Participants 65 years or older with postlingual bilateral moderate-to-profound sensorineural hearing loss with aided Consonant-Vowel Nucleus-Consonant (CNC) word scores in quiet of 40% or less in the ear to undergo implantation and 50% or less in the contralateral ear were included in the analysis. Baseline QoL testing was performed after 1 month of optimized bilateral hearing aid use. Participants were enrolled from February 20, 2017, to May 3, 2018, and follow-up was completed December 21, 2018. Data were analyzed from March 25, 2019, to March 31, 2020. Interventions: Unilateral implantation with a slim, modiolar cochlear implant device. Hearing aid use in the contralateral ear was required through the 6-month primary end-point interval. Main Outcomes and Measures: The primary objective was to evaluate speech perception before and 6 months after activation of a new cochlear implant. Secondary objectives were QoL metrics in the everyday listening condition before and 6 months after implantation. Results: Seventy participants (51 men [73%]) with a median age of 74 (range, 65-91) years were included in the analysis. No major adverse events occurred. Mixed-model analysis with estimated marginal means and 95% CIs compared preimplantation baseline performance with 6-month postimplantation performance. A clinically important improvement in CNC words was shown in the bimodal condition, with a mean difference of 37.2% (95% CI, 32.0%-42.4%), and in the unilateral (cochlear implant only) condition, with a mean difference of 44.1% (95% CI, 39.0%-49.2%). A clinically important improvement in noise (AzBio sentences signal-to-noise ratio of +10 dB) was also shown, with a mean difference of 21.6% (95% CI, 15.7%-27.5%) in the bimodal condition and 24.5% (95% CI, 18.3%-30.7%) in the unilateral condition. The Health Utilities Index Mark 3 multiple-attribute score improved by 0.186 (95% CI, 0.136-0.234); the Speech, Spatial, and Qualities of Hearing Scale total score improved by 2.58 (95% CI, 2.18-2.99); and a novel Device Use Questionnaire reported 94% of participants were satisfied with overall hearing in the everyday listening condition. Conclusions and Relevance: This subgroup analysis of patients 65 years or older enrolled in a within-subject clinical trial of cochlear implantation demonstrated clinically meaningful audiometric and QoL benefit with an acceptable risk profile. These findings suggest that cochlear implantation in older adults may facilitate the concept of healthy aging. Trial Registration: ClinicalTrials.gov Identifier: NCT03007472.

Postlingual adult performance in noise with HiRes 120 and ClearVoice Low, Medium, and High.

OBJECTIVES: The study's objectives were to evaluate speech recognition in multiple listening conditions using several noise types with HiRes 120 and ClearVoice (Low, Medium, High) and to determine which ClearVoice program was most beneficial for everyday use. METHODS: Fifteen postlingual adults attended four sessions; speech recognition was assessed at sessions 1 and 3 with HiRes 120 and at sessions 2 and 4 with all ClearVoice programs. Test measures included sentences presented in restaurant noise (R-SPACE), in speech-spectrum noise, in four- and eight-talker babble, and connected discourse presented in 12-talker babble. Participants completed a questionnaire comparing ClearVoice programs. RESULTS: Significant group differences in performance between HiRes 120 and ClearVoice were present only in the R-SPACE; performance was better with ClearVoice High than HiRes 120. Among ClearVoice programs, no significant group differences were present for any measure. Individual results revealed most participants performed better in the R-SPACE with ClearVoice than HiRes 120. For other measures, significant individual differences between HiRes 120 and ClearVoice were not prevalent. Individual results among ClearVoice programs differed and overall preferences varied. Questionnaire data indicated increased understanding with High and Medium in certain environments. DISCUSSION: R-SPACE and questionnaire results indicated an advantage for ClearVoice High and Medium. Individual test and preference data showed mixed results between ClearVoice programs making global recommendations difficult; however, results suggest providing ClearVoice High and Medium and HiRes 120 as processor options for adults willing to change settings. For adults unwilling or unable to change settings, ClearVoice Medium is a practical choice for daily listening.

Optimizing the perception of soft speech and speech in noise with the Advanced Bionics cochlear implant system.

OBJECTIVE: This study aimed to provide guidelines to optimize perception of soft speech and speech in noise for Advanced Bionics cochlear implant (CI) users. DESIGN: Three programs differing in T-levels were created for ten subjects. Using the T-level setting that provided the lowest FM-tone, sound-field threshold levels for each subject, three additional programs were created with input dynamic range (IDR) settings of 50, 65 and 80 dB. STUDY SAMPLE: Subjects were postlinguistically deaf adults implanted with either the Clarion CII or 90K CI devices. RESULTS: Sound-field threshold levels were lowest with T-levels set higher than 10% of M-levels and with the two widest IDRs. Group data revealed significantly higher scores for CNC words presented at a soft level with an IDR of 80 dB and 65 dB compared to 50 dB. Although no significant group differences were seen between the three IDRs for sentences in noise, significant individual differences were present. CONCLUSIONS: Setting Ts higher than the manufacturer's recommendation of 10% of M-levels and providing IDR options can improve overall speech perception; however, for some users, higher Ts and wider IDRs may not be appropriate. Based on the results of the study, clinical programming recommendations are provided.

Evaluation of equivalency in two recordings of monosyllabic words.

Thirty "new" lists of monosyllabic words were created at the University of Melbourne and recorded by Australian and American English speakers. These new lists and the ten original CNC lists (Peterson and Lehiste, 1962) were used during the feasibility study of the Nucleus Research Platform 8 Cochlear Implant System (Holden et al, 2004). Performance was similar across original and new lists for six implanted Australian subjects; for four implanted U.S. subjects, mean performance was 23 percentage points lower with the new than with the original lists. To evaluate differences between original and new lists for the American English recording, 22 CI recipients were administered all 40 CNC lists (30 new and 10 original lists). The overall mean word score for the new lists was significantly lower (22.3 percentage points) than for the original lists. Acoustic analysis revealed that decreased performance was most likely due to reduced amplitudes of certain initial and final consonants. The new CNC lists can be used as more difficult test material for clinical research.

Speech recognition with the nucleus 24 SPEAK, ACE, and CIS speech coding strategies in newly implanted adults.

OBJECTIVE: The objective of this study was to determine whether 1) the SPEAK, ACE or CIS speech coding strategy was associated with significantly better speech recognition for individual subjects implanted with the Nucleus CI24M internal device who used the SPrint speech processor, and 2) whether a subject's preferred strategy for use in everyday life provided the best speech recognition. DESIGN: Twelve postlinguistically deaf, newly implanted adults participated. Initial preference for the three strategies was obtained with paired-comparison testing on the first day of implant stimulation with seven of eight U.S. subjects. During the first 12 wk, all subjects used each strategy alone for 4 wk to give them experience with the strategy and to identify preferred speech processor program parameters and settings that would be used in subsequent testing. For the next 6 wk, subjects used one strategy at a time for 2-wk intervals in the same order they had for the first 12 wk. At the end of each 2-wk interval, speech recognition testing was conducted with all three strategies. At the end of the 6 wk, all three strategies were placed on each subject's processor, and subjects were asked to compare listening with these three programs in as many situations as possible for the next 2 wk. When they returned, subjects responded to a questionnaire asking about their preferred strategy and responded to two lists of medial consonants using each of the three strategies. The U.S. subjects also responded to two lists of medial vowels with the three strategies. RESULTS: Six of the 12 subjects in the present study had significantly higher CUNY sentence scores with the ACE strategy than with one or both of the other strategies; one of the 12 subjects had a significantly higher score with SPEAK than with ACE. In contrast, only two subjects had significantly higher CNC word and phoneme scores with one or two strategies than with the third strategy. One subject had a significantly higher vowel score with the SPEAK strategy than with the CIS strategy; and no subjects had significantly higher consonant scores with any strategy. Seven of 12 subjects preferred the ACE strategy, three preferred the SPEAK strategy, and two preferred the CIS strategy. Subjects' responses on a questionnaire agreed closely with strategy preference from comparisons made in everyday life. There was a strong relation between the preferred strategy and scores on CUNY sentences but not for the other speech tests. For all subjects, except one, the preferred strategy was the one with the highest CUNY sentence score or was a strategy with a CUNY score not significantly lower than the highest score. CONCLUSIONS: Despite differences in research design, there was remarkably close agreement in the pattern of group mean scores for the three strategies for CNC words and CUNY sentences in noise between the present study and the Conversion study (Arndt, Staller, Arcaroli, Hines, & Ebinger, Reference Note 1). In addition, essentially the same percentage of subjects preferred each strategy. For both studies, the strategy with which subjects had the highest score on the CUNY sentences in noise evaluation was strongly related to the preferred strategy; this relation was not strong for CNC words, CNC phonemes, vowels or consonants (Skinner, Arndt, & Staller, 2002). These results must be considered within the following context. For each strategy, programming parameters preferred for use in everyday life were determined before speech recognition was evaluated. In addition, implant recipients had experience listening with all three strategies in many situations in everyday life before choosing a preferred strategy. Finally, 11 of the 12 subjects strongly preferred one of the three strategies. Given the results and research design, it is recommended that clinicians fit each strategy sequentially starting with the ACE strategy so that the preferred programming parameters are determined for each strategy before recipients compare pairs of strategies. The goal is to provide the best opportunity for individuals to hear in everyday life within a clinically acceptable time period (e.g., 6 wk).