Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study.

BACKGROUND: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. OBJECTIVE: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. METHODS: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. RESULTS: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. CONCLUSIONS: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician.

Adults' recollections of discussions with their audiologist: a qualitative study of what was and was not successfully communicated about listening difficulties.

OBJECTIVES: Some adults experience challenges in successfully communicating their listening difficulties to their audiologist, and report feeling that they are not always listened to or understood. This project examined adults' recollections of discussions with their audiologist to explore (1) how adults report describing their listening difficulties and (2) information that adults report they do not communicate, or do not communicate successfully, to their audiologist. DESIGN: Individual semi-structured interviews were conducted. Interview transcripts were analysed using a template analysis approach. STUDY SAMPLE: Fifteen adults who self-report listening difficulties, and who had previously consulted an audiologist. RESULTS: Four themes were identified from adults' recollections of how they describe their listening difficulties: (1) situation or context of listening difficulties, (2) behavioural responses, (3) impacts of listening difficulties and (4) contributing factors. Adults report not always successfully communicating (1) emotional concerns and impacts, (2) descriptions of sound quality and (3) descriptions of changed listening experiences. CONCLUSION: Results provide insights about the times when adults feel that communication with their audiologist is successful, or unsuccessful. The results are useful for informing interventions to help adults and audiologists communicate more effectively together. To further inform interventions, factors affecting adults' communication should be explored.

A scoping review exploring how adults self-describe and communicate about the listening difficulties they experience.

Objective: It is unknown how adults communicate about their experienced listening difficulties with their audiologist. This scoping review aims to explore how adults self-describe the listening difficulties that they experience, and how they communicate about them. Design: A scoping review was conducted between December 2020 and September 2022 to identify published journal articles in which adults described and communicated about their listening difficulties. Study sample: Database searches yielded 10,224 articles initially. After abstract screening and full text review, 55 articles were included for analysis. Results: The listening difficulties that adults described were varied, highlighting the fact that each person has individual experiences. Adults discussed reasons for their listening difficulties, impacts of their listening difficulties, and behavioural responses they adopted to cope with their listening difficulties. Conclusions: This review shows the broad impacts of listening difficulties, and the varied ways in which adults discuss their listening difficulties. There is no available literature reporting how adults communicate about their listening difficulties in a clinical context.

Awareness of Usher Syndrome and the Need for Multidisciplinary Care: A Cross-Occupational Survey of Allied Health Clinicians.

Background: Usher syndrome is the most common cause of deaf-blindness, affecting up to 1 in 6000 people. Multidisciplinary care is required to maximize outcomes for individuals and families. This study assessed awareness of Usher Syndrome amongst allied health clinicians who provide care related to the primarily affected senses of hearing and vision, ie, optometry, orthoptics and audiology. Methods: A prospective cross-sectional online survey of clinicians working in Australian university-affiliated clinics (7 optometry, 1 orthoptics and 4 audiology) was completed between September 2021 and January 2022. Questions were asked about the cause, common symptoms, and awareness of health professions who manage Usher syndrome. Results: The 27 audiologists, 40 optometrists, and 7 orthoptists who completed the survey included 53 females (71.6%), had an average age of 37 years (range 24-70), and had an average duration of clinical experience of 13 years (range 1-45 years). The majority of respondents correctly identified Usher syndrome as a genetic condition (86%), identified at least two of the affected senses (97%), and identified the progressive nature of the vision and hearing losses (>90%). Awareness of vestibular dysfunction and its characteristics was low, as was knowledge of the key treatment roles that speech pathologists, genetic counsellors and geneticists play in the management of Usher Syndrome. The majority of respondents also did not identify important aspects of care within their own discipline. Conclusion: This study has shown that there is a need for targeted education to be delivered to hearing and vision care allied health clinicians to raise awareness of the vestibular impacts and aspects of vision loss experienced by people with Usher syndrome. This education needs to target the broad range of clinicians who have a key role in providing multidisciplinary care (including speech pathologists, geneticists, and genetic counsellors) and to identify the key aspects of good-quality multidisciplinary care.

Willingness to consider and to pay for a variety of telehealth services amongst adult hearing clinic clients.

OBJECTIVE: To examine willingness to consider and to pay for various one-to-one telehealth appointments and online group training/information sessions amongst hearing service clients interested in future telehealth. DESIGN: Online survey exploring telehealth usage and attitudes more broadly. STUDY SAMPLE: One-hundred-and-sixty-eight (39.8%) of the 422 survey respondents who answered the question were interested in future hearing-related telehealth. Data were analysed for the 148 providing demographic information. RESULTS: At least some respondents were interested in each type of one-to-one appointment (∼30-60% for most types) and group training/information session (∼30-50% for most types). Some inconsistent associations were found between willingness to consider individual appointment types and a metropolitan location, younger age, and female gender. Associations with having a hearing device fitted may have been influenced by the different needs of those without devices. Younger respondents were more likely to consider a wide range of appointment types. Being younger was associated with an interest in 7 of the 9 different group session types. The acceptable price range was AUD$30-$86 (USD$22-$62) (n = 129) for one-to-one appointments and AUD$47-$103 (USD$34-$73) for three group sessions (n = 99). CONCLUSIONS: Despite additional communication needs, hearing service clients have a strong interest in a range of individual and group telehealth services.

Designing a Hearing Health Care Smartphone App With Ecological Momentary Assessment: A Qualitative Study of Audiologists' Perspectives.

PURPOSE: The purpose of this study was to explore the perspectives of audiologists to provide input into development of a smartphone application (app) to document the real-life listening difficulties and the listening environment of hearing aid candidates and users. METHOD: Two focus groups were conducted. Facilitators utilized a topic guide to generate participants' input and perspectives. The focus groups were audio-recorded and transcribed verbatim. The transcripts were then qualitatively analyzed using content analysis. STUDY SAMPLE: The study samples were 10 audiologists (seven females) with 2- to 10-plus years of hearing aid fitting experience. RESULTS: Three main categories were identified: (a) The mobile device app could provide meaningful information to help audiologists to counsel their clients, (b) the app could give clients an insight into their hearing difficulties, and (c) the app could help clients to self-manage their hearing condition. CONCLUSION: These findings suggest that audiologists may better understand their clients' real-life listening difficulties through the use of a mobile device app; however, further research is required to harness the benefits of such an app.

Effects of widespread community use of face masks on communication, participation, and quality of life in Australia during the COVID-19 pandemic.

The objective was to document the influence of face mask use by other people on communication experiences, participation in activities, and quality of life. Australian adults (n = 665) completed an online survey; 90.8% resided in a state with mandatory mask use outside the home and 44.1% self-reported hearing difficulties. Mask use was reported as negatively affecting communication quality in the community (90.2%) and workplace (91.8%), and with household members (59.1%), including an increased requirement for clarification and repetition, increased difficulty communicating, and decreased understanding. Masks influenced feelings when communicating in the community (74.1%) and workplace (76.7%), and with household members (43.6%), including increased fatigue and frustration, and decreased connection to others. Masks influenced the time spent communicating in the community (68.8%) and workplace (67.9%), and with household members (42.3%), including a decrease in the number of individuals communicated with, and the time spent communicating with each individual. Masks influenced participation in activities in the community (50.9%) and workplace (59.7%), and with household members (41.3%), including reduced participation in health-related activities, shopping, and socialising. Influences on quality of life included reduced physical and mental health, including increased loneliness. Female gender and greater self-reported hearing difficulties were significantly associated with increased influence of mask use. The wide-ranging influences of face mask use have implications for physical health and mental health, including social connectedness, and for employers and the economy. As an important measure for combatting disease spread, the negative impacts of mask use must be considered during policy formulation, and appropriate mitigating measures, such as educational campaigns, enacted.

The engagement of children in out-of-home care with nursing and allied health professionals: A scoping review.

BACKGROUND: Children living in out-of-home care (OOHC) have significant unmet health care needs and use more tertiary and specialist health care services compared with children from similar social and economic backgrounds. Allied health professionals and nurses have a central role in health care; however, very little is known about the engagement of children in OOHC with nursing and allied health professionals. This scoping review addresses this knowledge gap. METHODS: A scoping review methodology framework was used to search for relevant articles published between January 1970 and November 2019, identified using three databases: MEDLINE, CINAHL and ProQuest. Selection of studies was based on empirical research about the health of children in OOHC and their engagement with nursing or allied health services. A total of 37 relevant articles met the eligibility criteria for inclusion in this review. RESULTS: Findings could be summarized under five broad themes: (1) nursing and allied health professionals engaging with children in OOHC to support their health and development, (2) opportunities and challenges for nursing and allied health professionals to engage children in OOHC in healthcare, (3) identification and complexity of healthcare needs, (4) access to healthcare services and (5) coordination of healthcare. CONCLUSIONS: Children in OOHC have multiple healthcare needs that require monitoring and treatment by allied health professionals and the health and development of these children is best supported through comprehensive health screening on entry into OOHC, and community-based, multidisciplinary healthcare while children are living in OOHC. While nurses in hospitals and community settings were found to play a role in health assessment and care coordination targeted at children in OOHC, the literature was silent on the role of allied health professionals in this healthcare approach.

Engagement of Children who are Deaf or Hard-of-Hearing Attending Mainstream Schools.

This study compared the observed and the self-reported engagement of 16 students who are Deaf or hard-of-hearing (DHH) attending mainstream schools to that of matched controls with typical hearing. Observed engagement was measured through observations in the classroom setting using the Mainstream Version of the Code for Instructional Structure and Student Academic Reponses. Self-reported engagement was measured using the Classroom Participation Questionnaire. The results revealed no significant differences for either observed or self-reported engagement between the DHH and the control groups; however, three individual DHH participants had lower levels of observed engagement compared to their matched controls. As such, including engagement in the evaluation of students who are DHH may be important for some individuals to provide a better understanding of the daily challenges they experience at school. Where needs are identified, the support that students who are DHH receive should include a specific focus on engagement to assist with their successful inclusion.

Decision making biases in the allied health professions: A systematic scoping review.

OBJECTIVES: Cognitive and other biases can influence the quality of healthcare decision making. While substantial research has explored how biases can lead to diagnostic or other errors in medicine, fewer studies have examined how they impact the decision making of other healthcare professionals. This scoping review aimed to identify and synthesise a broad range of research investigating whether decisions made by allied health professionals are influenced by cognitive, affective or other biases. MATERIALS AND METHODS: A systematic literature search was conducted in five electronic databases. Title, abstract and full text screening was undertaken in duplicate, using prespecified eligibility criteria designed to identify studies attempting to demonstrate the presence of bias when allied healthcare professionals make decisions. A narrative synthesis was undertaken, focussing on the type of allied health profession, type of decision, and type of bias reported within the included studies. RESULTS: The search strategy identified 149 studies. Of these, 119 studies came from the field of psychology, with substantially fewer from social work, physical and occupational therapy, speech pathology, audiology and genetic counselling. Diagnostic and assessment decisions were the most common decision types, with fewer studies assessing treatment, prognostic or other clinical decisions. Studies investigated the presence of over 30 cognitive, affective and other decision making biases, including stereotyping biases, anchoring, and confirmation bias. Overall, 77% of the studies reported at least one outcome that represented the presence of a bias. CONCLUSION: This scoping review provides an overview of studies investigating whether decisions made by allied health professionals are influenced by cognitive, affective or other biases. Biases have the potential to seriously impact the quality, consistency and accuracy of decision making in allied health practice. The findings highlight a need for further research particularly in professional disciplines outside of psychology, using methods that reflect real life healthcare decision making.

A Systematic Review of Interventions to Reduce the Effects of Cognitive Biases in the Decision-Making of Audiologists.

BACKGROUND: Audiologists are constantly making decisions that are key to optimizing client/patient outcomes, and these decisions may be vulnerable to cognitive biases. PURPOSE: The purpose was to determine the present state of knowledge within the field of audiology regarding the potential impact of cognitive biases on clinical decision-making and the use of interventions to reduce such impact. RESEARCH DESIGN: A systematic review was conducted to identify and consider the outcomes of all studies in which an intervention, strategy, or procedure was implemented with the aim of reducing the impact of cognitive biases on the decision-making of audiologists. DATA COLLECTION: The review was part of a larger scale search which included the broader disciplines of health science and medicine. Electronic database searches were supplemented by citation searches of relevant reviews and a gray literature search. Following title and abstract screening, 201 full-text studies were considered for inclusion. RESULTS: No studies were found which fulfilled the eligibility criteria. CONCLUSIONS: Despite initial calls to respond to these types of cognitive biases being made three decades ago, no peer-reviewed scientific studies testing strategies to reduce the impact of cognitive biases on the decision-making of audiologists were found. There is a clear need for a more concerted research effort in this area if audiologists are to consistently deliver truly evidence-based care.

Interventions to Mitigate Cognitive Biases in the Decision Making of Eye Care Professionals: A Systematic Review.

SIGNIFICANCE: Cognitive biases, systematic errors in thinking that impact a person's choices and judgments, can influence decision making at various points during patient care provision. These biases can potentially result in misdiagnoses, delayed clinical care, and/or patient mismanagement. A range of interventions exists to mitigate cognitive biases. There is a need to understand the relative efficacy of these interventions within the context of eye care practice. PURPOSE: The aim of this systematic review was to synthesize the evidence relating to interventions for mitigating cognitive biases associated with clinical decision making by eye care professionals. DATA SOURCES: Electronic databases (including Ovid MEDLINE, Embase, Scopus, PsycINFO) were searched from inception to October 2017 for studies investigating interventions intended to mitigate cognitive biases in the clinical decision making of eye care professionals. This review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. STUDY ELIGIBILITY CRITERIA: To ensure inclusion of all relevant literature, a wide range of study designs was eligible for inclusion, such as randomized controlled trials, nonrandomized trials, interrupted time series and repeated measures, controlled before-after studies, and qualitative studies that were a component of any of these quantitative study designs. STUDY APPRAISAL AND SYNTHESIS METHODS: Two review authors independently screened titles, abstracts, and full-text articles in duplicate, applying a priori eligibility criteria. RESULTS: After screening 2759 nonduplicate records, including full-text screening of 201 articles, no relevant studies were identified. CONCLUSIONS AND IMPLICATIONS OF FINDINGS: Given that cognitive biases can significantly impact the accuracy of clinical decision making and thus can have major effects on clinical care and patient health outcomes, the lack of studies identified in this systematic review indicates a critical need for research within the area of cognitive bias mitigation for decision making within eye care practice.

A Comparison of Electrical Stimulation Levels Across Ears for Children With Sequential Bilateral Cochlear Implants.

OBJECTIVES: To compare threshold and comfortable levels between a first and second cochlear implant (CI) for children, and to consider if the degree of difference between CIs was related to the age at bilateral implantation or the time between implants. A secondary objective was to examine the changes in levels over time for each CI. DESIGN: Fifty-seven participants were selected from the 146 children and young adults who received a first Nucleus CI as a child, and received a second implant at the Royal Victorian Eye and Ear Hospital between September 2003 and December 2011. Exclusion criteria included an older implant type, incomplete array insertion, incomplete data available, and a pulse width higher than the default. Using measurements from clinical sessions, the threshold levels, comfortable levels, and dynamic range of electrical stimulation were compared at three electrode array regions and at the "initial" (first 10 weeks), 2-year, and 5-year postoperative time points. The T-ratio and C-ratio for each array region and each time point were calculated by dividing each mean (n = 3 electrodes) level for the second implant by that for the first implant. RESULTS: The T-ratio was generally not significantly different to one, indicating no differences in threshold levels between the second and first implants; however, threshold levels were lower for the second implant in the apical region at the initial time point, and there was a significant difference in threshold levels in the apical region for children with a Contour Advance array for the second implant and an older-style array (i.e., Contour) for the first implant. For each implant individually, there were no significant changes in threshold levels across time. The C-ratio was significantly <1 at all electrode array regions at all time points, indicating lower comfortable levels for the second implant. The difference between implants was greater for children with variable array type (i.e., a Contour Advance array for the second implant and an older-style Contour or Straight array for the first implant). There was a significant increase in the C-ratio between the initial and 2-year time points, driven by an increase in comfortable levels for the second implant over this time period. A longer time between implants was associated with a narrower dynamic range, due to lower comfortable levels, for the second implant. CONCLUSIONS: For this sequentially implanted group, threshold levels were similar between implants, with some differences in cases with a newer array type for the second implant. Comfortable levels were lower for the second implant; although this difference decreased between the initial and 2-year postoperative time points, it was still evident at 5 years postoperative. A longer time between implants was associated with a narrower dynamic range. These findings are likely to apply to children using other brands of implant. Knowing what to expect in terms of programming children with a second implant will help clinicians to recognize and respond to unexpected outcomes. The work raises important questions to be addressed in future research regarding the implications of the programming outcomes for actual listening performance.

Benefits of upgrading to the Nucleus® 6 sound processor for a wider clinical population.

OBJECTIVES: To determine whether a large clinical group of cochlear implant (CI) recipients demonstrated a difference in sentence recognition in noise when using their pre-upgrade sound processor compared to when using the Nucleus 6 processor, and to examine the impact of the following factors: implant type, sound processor type, age, or onset of hearing loss. METHODS: A file review of 154 CI recipients (aged 7-92 years old) who requested an upgrade to the Nucleus 6 sound processor at the Cochlear Care Centre Melbourne was conducted. 105 recipients had complete data collected according to the protocol. A repeated measures, single subject design was used. Performance of CI recipients was compared with their pre-upgrade sound processor versus the Nucleus 6 processor using the Australian Sentence Test in Noise. RESULTS: Group performance of CI recipients improved by 4.7 dB with the Nucleus 6 compared with the pre-upgrade sound processor. The benefit was not affected by pre-upgrade sound processor type or implant type (including older implant types and sound processors), age or onset of hearing loss (pre-lingual versus post-lingual). CONCLUSION: This study confirmed that a clinical group of CI recipients obtained a significant benefit when upgrading to the Nucleus 6 sound processor.

Social Development in Children With Early Cochlear Implants: Normative Comparisons and Predictive Factors, Including Bilateral Implantation.

OBJECTIVES: There are mixed results regarding psychosocial development in children with cochlear implants (CIs) compared with children with normal hearing (NH), and the effect of bilateral CIs has not yet been investigated. This study aimed to investigate whether social development differed between NH children and those with early CIs, and to identify new predictors of psychosocial development in children with early CIs. DESIGN: The psychosocial development, cognitive and language abilities of 159 children were measured as part of a longitudinal outcomes study of children with CIs. Parental involvement was also assessed. RESULTS: The children in this study did not differ significantly from their peers with NH in terms of their psychosocial development, except with regard to Prosocial Behavior, with parents reporting significantly poorer development in this area. Having bilateral CIs predicted significantly fewer difficulties with psychosocial development, with earlier age at implantation increasing the effect size of the second CI for Emotional Symptoms and Peer Problems. Receptive language ability, higher parent education, later birth order, high parent involvement, and female gender predicted significantly fewer parent reports of psychosocial problems. Higher child cognitive ability and greater screen time predicted significantly greater reported psychosocial difficulties. Marginal effects modeling quantified the effects of changes in the predictive factors examined. CONCLUSIONS: Psychosocial development in these children with early CIs was found to be similar to that for peers with NH, with the exception of delayed Prosocial Behavior development. Having bilateral CIs predicted significantly better emotional outcomes. A number of new predictive factors were found for psychosocial development. The results of the marginal effects modeling should be shared with parents and professionals to increase their understanding of the impact of changes in predictive factors, particularly in terms of their own contribution to psychosocial outcomes for children with CIs.

Investigation of Electrical Stimulation Levels Over 8 to 10 Years Postimplantation for a Large Cohort of Adults Using Cochlear Implants.

OBJECTIVES: This study examined electrical stimulation levels over 8 to 10 years postimplantation in adult Nucleus implant users. The first aim was to investigate long-term trends and amount of change in electrical stimulation levels for each of four electrode array segments. The second aim was to determine long-term trends and amount of change for particular participants who previously showed greater change (i.e., >20% of dynamic range [DR]) in each of the threshold (T) and comfort (C) levels within the first 3 to 6 months postimplantation. The third aim was to determine whether demographic characteristics were predictive of the long-term trends and amount of change in each of the T and C levels. DESIGN: For 128 adults implanted with Nucleus implants, T levels, C levels, and DR were extracted for the following postimplant time points: 6, 9, 12, 18, 24, 48, 72, 96, and 120 months. For each time point, the mean T levels, C levels, and DR were calculated for each of four electrode array segments. For each participant, regression analyses were conducted for each of the levels and DR, separately for each of the four electrode array segments. Proportions of participants with and without statistically significant trends were identified, and the amount of change was determined for all participants. RESULTS: No significant differences in trends and amount of change were evident across segments for either of the T or C levels. On average across the four segments, 42% of participants showed nonsignificant trends in each of the T and C levels; 24% and 18% of the participants showed a significant trend only in C levels or only in T levels, respectively. Only 16% of the participants showed a significant trend in both T and C levels. Separately, 73% of the participants showed a nonsignificant trend in DR. In terms of current levels (CLs), the mean amount of change over 10 years for all participants was 10.4 (SD = 8.2) and 10.8 (SD = 9.8) for T and C levels, respectively. For both T and C levels, approximately 95% of the participants showed <25 CLs of change over the 10 years. For both T and C levels, at least 75% of the participants showed less than 6% change each year as a function of their average DR across the 8 to 10 years. For the participants who were previously reported to show >20% change in levels as a function of DR in the first 3 to 6 months postimplantation, nonsignificant long-term trend in levels was shown for 70% of these participants over the first 8 to 10 years postimplantation. Etiology, onset of hearing loss, and age at implantation were not significant factors in predicting change in levels. Duration of hearing loss and hearing aid use before implantation were both predictive of long-term change in T and C levels, respectively. In terms of the amount of change in CLs, both these factors showed a very small amount of change in CLs. CONCLUSIONS: The majority of adults using Nucleus implants showed a nonsignificant trend in T levels, C levels, and DR over 8 to 10 years postimplantation. The present study provides strong evidence that only a small amount of change in levels should be expected for most adults from 6 months out to 10 years postimplantation. A large proportion of the subgroup of participants who previously showed more change in the first 3 to 6 months showed consistent long-term results with the overall group. The trends in levels and the amount of change in levels in the long term were not significantly associated with the demographic characteristics investigated. For implant users with consistent levels over a number of sessions after the first 6 months postimplantation, the frequency of programming in the long term can be reduced. The translation of the findings from the present study into clinical practice will enable more efficient programming services to be provided to implant users in the long term.

Speech Detection in Noise for Young Bilaterally Implanted Children: Is There Evidence of Binaural Benefit Over the Shadowed Ear Alone?

OBJECTIVES: To measure binaural benefit over the shadowed ear alone for young bilateral cochlear implant (CI) users. It was hypothesized that children who received bilateral CIs at a young age (<4 years), and had significant bilateral experience, would demonstrate lower detection thresholds for speech sounds in background noise in the bilateral CI over the unilateral CI condition when the added CI was ipsilateral to the noise source. DESIGN: Children receiving bilateral CIs at the Eye and Ear Hospital Clinic in Melbourne were invited to participate in a wider research project evaluating outcomes; those participating in the wider project who were bilaterally implanted by 4 years and were approximately 2 years postoperative were included in the present study. For 20 participants, detection signal to noise ratios (SNRs) were measured for speech presented from in front and noise from 90° in at least 3 of 4 device/noise conditions, namely left CI/noise right and right CI/noise left, plus bilateral CIs/noise right and bilateral CIs/noise left. RESULTS: As some participants could only complete testing in 3 conditions within the 1 test block, the unilateral versus bilateral comparison was performed for 1 CI (i.e., 1 noise direction) for 15 participants and for both CIs (i.e., noise left and noise right) for 5 participants. Group analysis indicated no significant difference in detection SNR between the unilateral and bilateral CI conditions when adding the left CI or right CI (for the overall group) or when adding the first or second CI (for the 15 participants with sequential bilateral CIs). Separate analyses indicated no significant difference in detection SNR between the unilateral and bilateral CI conditions for the majority of individuals; this occurred irrespective of whether the analysis indicated that the CI added in the bilateral condition was poorer-performing, better-performing, or not significantly different compared with the other CI. Four individuals demonstrated a significant improvement in the bilateral condition when the CI added in the bilateral condition was a better-performing (n = 1), poorer-performing (n = 2), or not significantly different CI (n = 1). There was no relationship between the detection SNR difference between each CI and the detection SNR difference between the unilateral and bilateral conditions. CONCLUSIONS: The hypothesis of a lower detection SNR in the bilateral condition was not supported by the group results or by the results for the majority of individuals. For the 4 participants who did demonstrate benefit over the shadowed ear alone, that benefit cannot be separated from the potential benefit gained as a result of the CI added in the bilateral condition being the better-performing CI for 1 of the 4. Variation in outcomes could not be related to demographic factors for this group, which was relatively homogeneous for age at bilateral CI and experience; an older, more experienced group may demonstrate greater binaural benefit in these conditions. These results can be used during counseling for families regarding postoperative expectations for young children, especially in the first 2 years.

The Change in Electrical Stimulation Levels During 24 Months Postimplantation for a Large Cohort of Adults Using the Nucleus® Cochlear Implant.

OBJECTIVES: To examine electrical stimulation data over 24 months postimplantation in adult implant users. The first aim was to calculate mean T and C levels for seven time points, for four cochlear segments, and two array types. The second aim was to (a) analyze the degree of change in each of the T and C levels as a function of dynamic range for six consecutive time point comparisons, for the four segments, and (b) to determine the proportion of participants with an acceptable degree of change. The third aim was to examine relationships between demographic factors and degree of change. DESIGN: T levels, C levels, and dynamic ranges were extracted for 680 adults using Nucleus implants for the following postimplant time points: 2-, 3-, 6-, 9-, 12-, 18-, and 24-month. For each time point, mean levels were calculated for the four segments. The degree of change in each of the levels was analyzed for six consecutive time point comparisons. The criterion for an acceptable degree of change was ≤20% of DR. RESULTS: Mean T level was significantly lower for the 2-month time point compared with all time points after the 3-month time point. Mean C level was significantly lower for the 2- and 3-month time points compared with all other time points. Mean T level was significantly lower for the apical compared with all other segments and for the lower-basal compared with the upper-basal segment. Mean C level was significantly different across all four segments. Mean C level for the basal segments was 4 CLs higher for the perimodiolar array compared with the straight array. No significant differences were evident for the mean degree of change between consecutive time point comparisons. For all segments, approximately 65 to 75% of the participants showed an average acceptable degree of change in levels from the 3- to 6-month comparison. The mean degree of change in T levels was significantly greater for the basal segments compared with all other segments. The mean degree of change in levels was significantly greater for the otosclerosis group compared with all other groups, and for the prelingual onset of deafness group compared with the postlingual group. CONCLUSION: Given the very large cohort, this study provides evidence for the mean levels and the degree of change in these levels that should be expected for four segments in the first 24 months postimplantation for adults using Nucleus implants. The mean T and C levels were consistent after the 3- and 6-month time points postimplant, respectively. The degree of change was variable between individuals. For each segment, however, a large percentage of participants showed an average change of ≤20% in each of the T and C levels from the 3- to 6-month comparison. Given the large degree of change in levels for some groups, the results provide strong evidence in favor of frequent monitoring of levels in the first 24 months postimplantation for patients with otosclerosis, prelingual onset of deafness, and those who exhibit >20% change in levels after 3 months postimplantation.

Everyday Listening Performance of Children Before and After Receiving a Second Cochlear Implant: Results Using the Parent Version of the Speech, Spatial, and Qualities of Hearing Scale.

OBJECTIVES: To evaluate change in individual children's performance in general areas of everyday listening following sequential bilateral implantation, and to identify the specific types of listening scenarios in which performance change occurred. The first hypothesis was that parent performance ratings for their child would be higher in the bilateral versus unilateral implant condition for each section of the speech, spatial and qualities of hearing scale for parents, viz.: speech perception, spatial hearing, and qualities of hearing. The second hypothesis was that the rating for the participant group would be higher in the bilateral condition for speech perception items involving group conversation or background noise, spatial hearing items, and qualities of hearing items focused on sound segregation or listening effort. DESIGN: Children receiving sequential bilateral implants at the Royal Victorian Eye and Ear Hospital and fulfilling selection criteria (primarily no significant cognitive or developmental delays, and oral English language skills of child and parent sufficient for completing assessments) were invited to participate in a wider project evaluating outcomes. The assessment protocol for older children included the speech, spatial, and qualities of hearing scale for parents. All children (n = 20; ages 4 to 15 years) whose parents completed the scale preoperatively and at 24-months postoperatively were included in this study. Ratings obtained preoperatively in the unilateral implant condition (or unilateral implant plus hearing aid for 4 participants) were compared with those obtained postoperatively in the bilateral implant condition. RESULTS: Bilateral ratings were significantly higher than unilateral ratings on the speech section for 12 children (W ≥ 7.0; p ≤ 0.03), on the spatial section for 13 children (W ≥ 15.0; p ≤ 0.03), and on the qualities of hearing section for 9 children (W ≥ 15.0; p ≤ 0.047). The difference between conditions was unrelated to time between implants or age at bilateral implantation (r ≤ 0.4; p ≥ 0.082). The median bilateral ratings for the participant group were higher for all eight speech perception items, including, as predicted, those involving group conversation and/or background noise (W ≥ 37.5; p ≤ 0.043). Also, as predicted, the median bilateral ratings for the participant group were higher for all six spatial hearing items (W ≥ 88.0; p ≤ 0.014), and for qualities of hearing items related to sound segregation (W ≥ 94.0; p ≤ 0.029), but not for those related to listening effort (W ≤ 92.0; p ≥ 0.112). CONCLUSIONS: Seventy-five percentage of parents perceived change in their child's daily listening performance postoperatively, and 25% perceived change across all three listening areas. For the overall participant group, the parents perceived a change in performance in the majority of specific listening scenarios, although change was limited in the qualities of hearing section, including no change in listening effort. Previous research suggests postoperative change was likely due to the headshadow effect and improved spatial hearing. Additional contributions may have been made by binaural summation, redundancy, and unmasking. For these participants, differences between device conditions may have been limited by their relatively old age at implantation, delay between implants, and limited bilateral experience. These results will provide valuable information to families during preoperative counseling and postoperative discussions about expected progress and evident benefit.