Holistic assessment of cochlear implant outcomes using the international classification of functioning disability and health model: data analysis of a longitudinal prospective multicenter study.

PURPOSE: To study outcome after cochlear implantation using the Cochlear Implant (CI) outcome assessment protocol based on the International Classification of Functioning, Disability and Health (ICF) model (CI-ICF). METHODS: Raw data of a prospective, longitudinal, multicenter study was analyzed. Seventy-two CI candidates were assessed preoperatively and six months postoperatively using the CI-ICF protocol. Following tools were used: (1) Work Rehabilitation Questionnaire (WORQ), (2) Abbreviated Profile of Hearing Aid Benefit (APHAB), (3) Audio Processor Satisfaction Questionnaire (APSQ), (4) Speech, Spatial, and Qualities of Hearing Scale (SSQ12), (5) Hearing Implant Sound Quality Index (HISQUI19), (6) Nijmegen CI Questionnaire (NCIQ) (7) pure tone audiometry, (8) speech audiometry, (9) sound localization. RESULTS: There was a significant improvement of speech discrimination in quiet (p = 0.015; p < 0.001) and in noise (p = 0.041; p < 0.001), sound detection (p < 0.001), tinnitus (p = 0.026), listening (p < 0.001), communicating with-receiving-spoken messages (p < 0.001), conversation (p < 0.001), family relationships (p < 0.001), community life (p = 0.019), NCIQ total score and all subdomain scores (p < 0.001). Subjective sound localization significantly improved (p < 0.001), while psychometric sound localization did not. There was no significant subjective deterioration of vestibular functioning and no substantial change in sound aversiveness. CI users reported a high level of implant satisfaction postoperatively. CONCLUSION: This study highlights the positive impact of cochlear implantation on auditory performance, communication, and subjective well-being. The CI-ICF protocol provides a holistic and comprehensive view of the evolution of CI outcomes.

A Good Practice Guide for Organizing the Scientific Program of International Conferences.

This paper provides a step-by-step guide for organizing the scientific program (OSP) of international conferences. Through informal discussions, a panel of experts organizing international conferences came up with this guide, which includes a flowchart, checklist, and detailed discussions of each step. Subsequently, additional specialists were invited to evaluate this synopsis and provide their input. All of the participants approved the final version after the outline was improved. This guide proposes the following six steps: 1) preparation, 2) recruitment, 3) building the agenda, 4) cross-checking the program, 5) reviewing and finalizing, and 6) in-conference refining. Thirteen items are specified across the six main steps in a detailed checklist. This OSP guide includes a flowchart and a checklist for providing a comprehensive manual for establishing, conducting, and organizing international scientific conferences. Understanding the procedures that are expected to be followed when holding a scientific conference enables the involved parties to organize and assign tasks to one another as well as create a schedule that allows them to finish their work on time. This guide can be used at any kind of scientific conference to describe an organized process, resulting in a professional and distinguished scientific program.

Towards a Consensus on an ICF-Based Classification System for Horizontal Sound-Source Localization.

The study aimed to develop a consensus classification system for the reporting of sound localization testing results, especially in the field of cochlear implantation. Against the background of an overview of the wide variations present in localization testing procedures and reporting metrics, a novel classification system was proposed to report localization errors according to the widely accepted International Classification of Functioning, Disability and Health (ICF) framework. The obtained HEARRING_LOC_ICF scale includes the ICF graded scale: 0 (no impairment), 1 (mild impairment), 2 (moderate impairment), 3 (severe impairment), and 4 (complete impairment). Improvement of comparability of localization results across institutes, localization testing setups, and listeners was demonstrated by applying the classification system retrospectively to data obtained from cohorts of normal-hearing and cochlear implant listeners at our institutes. The application of our classification system will help to facilitate multi-center studies, as well as allowing better meta-analyses of data, resulting in improved evidence-based practice in the field.

Psychometric properties of the English version of the Audio Processor Satisfaction Questionnaire (APSQ).

OBJECTIVE: The Audio Processor Satisfaction Questionnaire (APSQ) is a standardized tool to measure a user's satisfaction with their audio processor(s). It was first developed and validated in the German language. The purpose of the current study was to validate the English version of the APSQ. DESIGN: The 15 items of the APSQ were translated into English. Item and scale analyses assessed the quality of individual items and of the questionnaire in its entirety. STUDY SAMPLE: Sixty-seven adults with hearing implants participated. Forty-six of them completed the questionnaire twice within 2-4 weeks. RESULTS: High mean values were obtained with total scores and with scores of the comfort, social life, and usability domains, indicating that users are generally satisfied with their audio processors. The questionnaire achieved good test-retest reliability with high internal consistency. A significant positive correlation between time since implantation and user satisfaction was found. CONCLUSION: Results of the item and reliability analyses suggest that the English version of the APSQ is a valid and reliable tool to assess user satisfaction with their audio processor(s).

Evaluating the Revised Work Rehabilitation Questionnaire in Cochlear Implant Users Cochlear Implant Outcome Assessment Based on the International Classification of Functioning, Disability, and Health (ICF).

OBJECTIVES: The 59-item Work Rehabilitation Questionnaire (WORQ) was developed based on the International Classification of Functioning, Disability and Health (ICF) core set for vocational rehabilitation to assess work related functioning. It was revised to include 17 questions, assigned to 14 ICF categories relevant to cochlear implant (CI) users. This cross-sectional multicenter study aimed to evaluate CI users' responses on the WORQ questions to describe and generate ICF qualifiers for the revised WORQ in CI users, forming part of a broader framework of CI outcome measures linked to the ICF. METHODS: One hundred seventy-seven adults over the age of 18 years with a minimum of one year's device experience were included in the analysis. The WORQ was completed by the participants at a routine visit to the clinic, via email, or via post. RESULTS: Most of the CI users perceived no problem on the WORQ questions (53.7%-91%), finished secondary school (54.2%) or obtained a college or university degree (32.8%) and are either employed (41.2%) or retired (34.5%). CI users that are currently working mostly have a full-time position (34.5%). Subjects reported no problem (91%) with sensation of falling, while handling communication devices and techniques (10.9%) and tinnitus (9.6%) showed the highest number of subjects reporting a complete problem. CONCLUSIONS: Overall, most of the CI users experienced no impairment, restriction or limitation on the WORQ questions and their assigned ICF categories. Their education level resembles the education level of the general population and they seem to integrate or reintegrate well in professional life postoperatively.

Validation of LittlEARS® Early Speech Production Questionnaire in Arabic-speaking children with normal hearing.

OBJECTIVES: To validate an Arabic version of the LittlEARS® Early Speech Production Questionnaire (LEESPQ), which assesses the early development of speech and language in infants between 0 and 18 months, in Arabic-speaking children with normal hearing in Saudi Arabia. METHODS: This is a cross-sectional study conducted in the city of Riyadh, Saudi Arabia between September and December 2020. Parents completed the LEESPQ regarding their child's speech production development. To assess the ability of normal hearing children aged 0-18 months in developing speech and language production, a norm curve has been generated based on the standardized values that were calculated from the Arabic normal-hearing data set. RESULTS: A total of 198 questionnaires were analyzed. The total score on the LEESPQ correlated with age, gender, and bilingualism. A norm curve for early speech production in children with normal hearing was created. CONCLUSION: The Arabic version of LEESPQ appears to be a valid questionnaire that can be used in the assessment of early language and speech development of Arabic-speaking children with normal hearing in the age range of 0-18 months. The Arabic version of the LEESPQ might also be a useful tool to detect developmental delays and hearing disorders in young children.

Development and validation of the audio processor satisfaction questionnaire (APSQ) for hearing implant users.

Objective: The satisfaction experienced with using an audio processor is very important to hearing implant system users. Currently there are no measures that can be used to assess user satisfaction with an audio processor. This study aims to develop and validate a specific and standardised questionnaire that focuses on user satisfaction with their audio processor.Design: A preliminary version of the questionnaire was initially developed by experts in the field. Following validation of these results, the final version of the Audio Processor Satisfaction Questionnaire (APSQ) was developed consisting of 15 items. Item analyses and questionnaire validation measurements were assessed.Study sample: Sixty-nine subjects were recruited and asked to complete the APSQ twice within 2-4 weeks.Results: Subjects reported a high user satisfaction with the questionnaire and with their audio processor. The questionnaire had good reliability and results for test-retest reliability were high and significant across all items and across subscale analyses.Conclusion: Item analyses and reliability analyses show that the questionnaire is a valid and reliable tool to assess user satisfaction across different audio processors and hearing implant systems. The APSQ is a quick and easy tool to measure user satisfaction with their audio processor.

Microphone directionality and wind noise reduction enhance speech perception in users of the MED-EL SONNET audio processor.

Objectives: Speech understanding in noise remains a challenge for many cochlear implant users. To improve this, the SONNET audio processor features three microphone directionality (MD) settings and three wind noise reduction (WNR) settings. The primary aim of this study was to assess if speech understanding in noise and hearing in real life was superior with the SONNET or with the OPUS 2, which does not feature MD or WNR.Methods: 31 of 33 participants completed the study. Speech understanding was assessed in two types of acoustic noise, in wind noise, and in quiet. A 4-speaker setup was used and speech was presented from 0° and noise from 90°, 180°, and 270°. Wind noise was simulated with a fan. Sound quality and hearing-related abilities were assessed via two subjective questionnaires.Results: Speech understanding in acoustic noise with the SONNET was significantly better or equal to than with the OPUS 2. Speech understanding in wind with the OPUS 2 was significantly better than with the SONNET in some settings. Sound quality and hearing-related abilities were both significantly better with the SONNET.Conclusions: The SONNET provides the same or significantly improved speech understanding than the OPUS 2 in quiet and in noise. While OPUS 2 was superior in wind than the SONNET in some settings, this was offset by SONNET's superiority in real-life listening situations. We therefore conclude that the front-end processing of the SONNET provides users with better hearing than does the OPUS 2.

Introducing real-life listening features into the clinical test environment: Part I: Measuring the hearing performance and evaluating the listening effort of individuals with normal hearing.

OBJECTIVE: Controlled clinical test environments are very different from real-life listening situations in which speaker and background noise level variations can hinder a person's ability to hear and follow conversations. This study was performed to evaluate the ability of people with normal hearing to follow a single speaker in the presence of background noise, and to explore relations between those measures and the listeners' subjective assessments, listening effort, and sound quality judgements. METHODS: A group of adults with normal hearing were evaluated using the following battery of tests: (i) Roving Level Test, (ii) the Just Understanding Speech Test, (iii) Performance Perceptual Test, (iv) the Visual Analogue Scale to evaluate listening effort, and (iv) with a sound quality questionnaire. RESULTS: The results show that people with normal hearing tend to accurately estimate their hearing abilities, and both the listening effort required and speech recognition thresholds tend to increase with increasing background noise. DISCUSSION: Implementing a battery of tests that evaluate speech-in-noise listening abilities, listening effort, and subjective hearing perception might provide greater insight into hearing performance than traditional measures. Additionally, the data generated in this study can be used for comparison with measures obtained from hearing impaired and hearing device listeners, and as such, has the potential to guide counselling and rehabilitation to a range of clinical populations. CONCLUSION: The examination of both the self-estimated and verified performance measurements in simulated real-life listening situations can provide audiologists with a comprehensive and realistic profile of a person's hearing performance.

Development and validation of a questionnaire for hearing implant users to self-assess their auditory abilities in everyday communication situations: the Hearing Implant Sound Quality Index (HISQUI19).

CONCLUSIONS: The Hearing Implant Sound Quality Index (HISQUI19) seems to be a valid tool for quantifying the self-perceived level of auditory benefit that cochlear implant (CI) users experience in everyday listening situations. Additional research is, however, required. OBJECTIVES: To develop and validate a user-friendly instrument for quantifying the self-perceived level of auditory benefit that CI users experience in everyday listening situations. METHODS: This was an explorative, uncontrolled, single-group, cross-sectional study. Items for the HISQUI19 were decided upon using user input and verified by professionals. The HISQUI19 was assessed on 75 CI users from hearing implant centres in Germany and Austria to determine the questions. RESULTS: The HISQUI19, consisting of 19 items scored on a 7-point Likert scale, was validated. Subjects older than 60 years at time of implantation did not have significantly higher mean values than subjects younger than 60 years. Gender and whether subjects are unilateral or bilateral implant CI users did not influence self-perceived functioning. Subjects with ≤20 years of hearing loss reported no significantly higher functioning than those with >20 years of hearing loss.

[European Portuguese EARS test battery adaptation]. / Adaptação da bateria de testes EARS ao Português Europeu.

INTRODUCTION: The use of adequate assessment tools in health care is crucial for the management of care. The lack of specific tools in Portugal for assessing the performance of children who use cochlear implants motivated the translation and adaptation of the EARS (Evaluation of Auditory Responses to Speech) test battery into European Portuguese. This test battery is today one of the most commonly used by (re)habilitation teams of deaf children who use cochlear implants worldwide. The goal to be achieved with the validation of EARS was to provide (re)habilitation teams an instrument that enables: (i) monitoring the progress of individual (re)habilitation, (ii) managing a (re)habilitation program according to objective results, comparable between different (re)habilitation teams, (iii) obtaining data that can be compared with the results of international teams, and (iv) improving engagement and motivation of the family and other professionals from local teams. MATERIAL AND METHODS: For the test battery translation and adaptation process, the adopted procedures were the following: (i) translation of the English version into European Portuguese by a professional translator, (ii) revision of the translation performed by an expert panel, including doctors, speech-language pathologists and audiologists, (iii) adaptation of the test stimuli by the team's speechlanguage pathologist, and (iv) further review by the expert panel. RESULTS: For each of the tests that belong to the EARS battery, the introduced adaptations and adjustments are presented, combining the characteristics and objectives of the original tests with the linguistic and cultural specificities of the Portuguese population. DISCUSSION: The difficulties that have been encountered during the translation and adaptation process and the adopted solutions are discussed. Comparisons are made with other versions of the EARS battery. CONCLUSION: We defend that the translation and the adaptation process followed for the EARS test battery into European Portuguese was correctly conducted, respecting the characteristics of the original instruments and adapting the test stimuli to the linguistic and cultural reality of the Portuguese population, thus meeting the goals that have been set.

Introdução: A utilização de instrumentos de avaliação em saúde adequados é fundamental na gestão da prestação de cuidados. A escassez, em Portugal, de instrumentos específicos para a avaliação do desempenho de crianças utilizadoras de implantes cocleares motivou o trabalho de tradução e de adaptação da bateria de testes EARS (Evaluation of Auditory Responses to Speech) para o português europeu. Esta bateria de testes é hoje um dos instrumentos mais comummente utilizados por equipas de (re)habilitação de crianças surdas com implantes cocleares em todo o mundo. O objetivo a atingir com a validação do EARS foi fornecer às equipas de (re)habilitação um instrumento que permita: (i) monitorizar a evolução individual da reabilitação; (ii) gerir um programa de (re)habilitação de acordo com resultados objetivos, comparáveis entre diferentes equipas de (re)habilitação; (iii) obter dados comparáveis comequipas internacionais; e (iv) melhorar a adesão e a motivação da família e restantes profissionais no ambulatório.Material e Métodos: No processo de tradução e de adaptação da bateria de testes, os procedimentos adotados foram os seguintes: (i) tradução da versão inglesa para português europeu por um tradutor profissional; (ii) revisão dessa tradução realizada por um painel de especialistas constituído por otorrinolaringologistas, terapeutas da fala e técnicos de audiologia; (iii) adaptação dos estímulos de teste pela equipa de terapeutas da fala; e (iv) nova revisão por parte do painel de especialistas.Resultados: São apresentados, para cada um dos instrumentos que compõem a bateria EARS, as adaptações introduzidas, conciliando as características e os objetivos originais dos instrumentos com as particularidades linguísticas e culturais da população portuguesa.Discussão: São discutidas as dificuldades encontradas durante o processo de tradução e de adaptação e as soluções adotadas. São feitas comparações com outras versões da bateria EARS.Conclusão: Considera-se que o processo de tradução e adaptação da bateria de testes EARS para o português europeu foi realizado de forma apropriada, respeitando as características dos instrumentos originais e adequando os estímulos de teste à realidade linguística e cultural da população portuguesa, cumprindo assim os objetivos propostos.

Clinical trial results with the MED-EL fine structure processing coding strategy in experienced cochlear implant users.

OBJECTIVES: To assess the subjective and objective performance of the new fine structure processing strategy (FSP) compared to the previous generation coding strategies CIS+ and HDCIS. METHODS: Forty-six adults with a minimum of 6 months of cochlear implant experience were included. CIS+, HDCIS and FSP were compared in speech perception tests in noise, pitch scaling and questionnaires. The randomized tests were performed acutely (interval 1) and again after 3 months of FSP experience (interval 3). The subjective evaluation included questionnaire 1 at intervals 1 and 3, and questionnaire 2 at interval 2, 1 month after interval 1. RESULTS: Comparison between FSP and CIS+ showed that FSP performed at least as well as CIS+ in all speech perception tests, and outperformed CIS+ in vowel and monosyllabic word discrimination. Comparison between FSP and HDCIS showed that both performed equally well in all speech perception tests. Pitch scaling showed that FSP performed at least as well as HDCIS. With FSP, sound quality was at least as good and often better than with HDCIS. CONCLUSIONS: Results indicate that FSP performs better than CIS+ in vowel and monosyllabic word understanding. Subjective evaluation demonstrates strong user preferences for FSP when listening to speech and music.

The listening cube: a three dimensional auditory training program.

OBJECTIVES: Here we present the Listening Cube, an auditory training program for children and adults receiving cochlear implants, developed during the clinical practice at the KIDS Royal Institute for the Deaf in Belgium. We provide information on the content of the program as well as guidance as to how to use it. METHODS: The Listening Cube is a three-dimensional auditory training model that takes the following into consideration: the sequence of auditory listening skills to be trained, the variety of materials to be used, and the range of listening environments to be considered. During auditory therapy, it is important to develop training protocols and materials to provide rapid improvement over a relatively short time period. Moreover, effectiveness and the general real-life applicability of these protocols to various users should be determined. RESULTS: Because this publication is not a research article, but comes out of good daily practice, we cannot state the main results of this study. We can only say that this auditory training model is very successful. Since the first report was published in the Dutch language in 2003, more than 200 therapists in Belgium and the Netherlands followed a training course elected to implement the Listening Cube in their daily practice with children and adults with a hearing loss, especially in those wearing cochlear implants. CONCLUSION: The Listening Cube is a tool to aid in planning therapeutic sessions created to meet individual needs, which is often challenging. The three dimensions of the cube are levels of perception, practice material, and practice conditions. These dimensions can serve as a visual reminder of the task analysis and of other considerations that play a role in structuring therapy sessions.

EARS® (Evaluation of Auditory Responses to Speech): an internationally validated assessment tool for children provided with cochlear implants.

OBJECTIVES: The use of cochlear implants in the rehabilitation of hearing-impaired patients is now widely established and offers great benefits for children. To evaluate these benefits, the Evaluation of Auditory Responses to Speech (EARS®) assessment tool was designed in 1995. The objectives of this study were to assess the auditory perceptual skills in a large paediatric population over time, as well as to provide standardised values. METHODS: An international multicentre study was conducted in 35 clinics from 1996 to 2009. During this period, 765 children were assessed with the EARS in 10 test intervals: pre-operative, first fitting and then 1, 3, 6, and 12 months after the first fitting and annually thereafter, up to a maximum period of 5 years. RESULTS: The auditory skills improved significantly over time for all speech perception tests and questionnaires as well as between single test intervals: pre-operative to 6 months, 6 months to 1 year and 1 year to 2 years. Standardised values of the children stratified according to their age at implantation were calculated. CONCLUSIONS: The auditory perceptual skills significantly improved over time. The standardised values will help professionals set therapeutic goals and counsel parents accordingly.

The Listening Cube: A Three Dimensional Auditory Training Program

OBJECTIVES: Here we present the Listening Cube, an auditory training program for children and adults receiving cochlear implants, developed during the clinical practice at the KIDS Royal Institute for the Deaf in Belgium. We provide information on the content of the program as well as guidance as to how to use it. METHODS: The Listening Cube is a three-dimensional auditory training model that takes the following into consideration: the sequence of auditory listening skills to be trained, the variety of materials to be used, and the range of listening environments to be considered. During auditory therapy, it is important to develop training protocols and materials to provide rapid improvement over a relatively short time period. Moreover, effectiveness and the general real-life applicability of these protocols to various users should be determined. RESULTS: Because this publication is not a research article, but comes out of good daily practice, we cannot state the main results of this study. We can only say that this auditory training model is very successful. Since the first report was published in the Dutch language in 2003, more than 200 therapists in Belgium and the Netherlands followed a training course elected to implement the Listening Cube in their daily practice with children and adults with a hearing loss, especially in those wearing cochlear implants. CONCLUSION: The Listening Cube is a tool to aid in planning therapeutic sessions created to meet individual needs, which is often challenging. The three dimensions of the cube are levels of perception, practice material, and practice conditions. These dimensions can serve as a visual reminder of the task analysis and of other considerations that play a role in structuring therapy sessions.

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%.

A music quality rating test battery for cochlear implant users to compare the FSP and HDCIS strategies for music appreciation.

OBJECTIVE: The purpose of this study was to develop a music quality rating test battery (MQRTB) and pilot test it by comparing appraisal ratings from cochlear implant (CI) recipients using the fine-structure processing (FSP) and high-definition continuous interleaved sampling (HDCIS) speech processing strategies. DESIGN: The development of the MQRTB involved three stages: (1) Selection of test items for the MQRTB; (2) Verification of its length and complexity with normally-hearing individuals; and (3) Pilot testing with CI recipients. STUDY SAMPLE: Part 1 involved 65 adult listeners, Part 2 involved 10 normally-hearing adults, and Part 3 involved five adult MED-EL CI recipients. RESULTS: The MQRTB consisted of ten songs, with ratings made on scales assessing pleasantness, naturalness, richness, fullness, sharpness, and roughness. Results of the pilot study, which compared FSP and HDCIS for music, indicated that acclimatization to a strategy had a significant effect on ratings (p < 0.05). When acclimatized to FSP, the group rated FSP as closer to 'exactly as I want it to sound' than HDCIS (p < 0.05), and that HDCIS sounded significantly sharper and rougher than FSP. However when acclimatized to HDCIS, there were no significant differences between ratings. There was no effect of song familiarity or genre on ratings. CONCLUSIONS: Overall the results suggest that the use of FSP as the default strategy for MED-EL recipients would have a positive effect on music appreciation, and that the MQRTB is an effective tool for assessing music sound quality.

The MED-EL SONATATI 100 cochlear implant: an evaluation of its safety in adults and children.

CONCLUSIONS: Data from 50 patients suggest that the SONATATI(100) cochlear implant (CI) is a safe and effective device. OBJECTIVE: MED-EL has developed and tested a CI with titanium housing (the SONATATI(100)), which has the same internal components as the PULSARCI(100). Implant surgery should be less traumatic, as with these CIs smaller incisions and less drilling are involved. The study aimed to assess surgical issues pertaining to the implantation of the device, patient compatibility with the titanium of the implant housing, and other patient-related issues. METHODS: Fifty patients were recruited into this multicenter study. In phase 1, 30 adults and in phase 2, 20 children received a SONATATI(100) cochlear implant. An intraoperative survey was completed by the surgeons for all patients. A postoperative survey was completed by the audiologists/fitting engineers at first fitting and 3 and 6 months after the first fitting to evaluate the safety and the efficacy of the device. RESULTS: The device was proven to be effective in that it was stable in the implant bed and that minimally invasive surgery could be carried out. The device was proven to be safe after medium-term use and no unexpected adverse events were reported.

Combined electric acoustic stimulation with the PULSARCI(100) implant system using the FLEX(EAS) electrode array.

CONCLUSION: This study demonstrates that electric acoustic stimulation (EAS(®)) using the FLEX(EAS) electrode is a successful treatment method for preservation and stability of low frequency hearing, and results in significant improvements in speech perception. OBJECTIVES: Low frequency hearing preservation and stability following EAS surgery with the MED-EL PULSARCI(100) implant using the FLEX(EAS) electrode and a combined processor in a multicentre setting, and the efficacy and benefits of EAS over time were evaluated. METHODS: Eighteen subjects with normal to moderate hearing loss in the low frequencies and severe to profound hearing loss in the high frequencies were implanted with the FLEX(EAS) electrode. Implantation was performed by different surgeons at three participating centres using either the cochleostomy or the round window approach. Preoperatively, hearing was measured; a battery of speech perception tests and the subjective benefit questionnaire were administered. These tests were subsequently repeated: first at EAS fitting, which was due 3 months after surgery, and then again 3, 6 and 12 months after EAS fitting. RESULTS: Hearing could be preserved in all subjects. Speech understanding showed significant improvement in all tests over time with the EAS condition outperforming the cochlear implant-only condition at all intervals. These considerable effects were also reflected in the subjective benefit outcome.

Site of cochlear stimulation and its effect on electrically evoked compound action potentials using the MED-EL standard electrode array.

BACKGROUND: The standard electrode array for the MED-EL MAESTRO cochlear implant system is 31 mm in length which allows an insertion angle of approximately 720 degrees . When fully inserted, this long electrode array is capable of stimulating the most apical region of the cochlea. No investigation has explored Electrically Evoked Compound Action Potential (ECAP) recordings in this region with a large number of subjects using a commercially available cochlear implant system. The aim of this study is to determine if certain properties of ECAP recordings vary, depending on the stimulation site in the cochlea. METHODS: Recordings of auditory nerve responses were conducted in 67 subjects to demonstrate the feasibility of ECAP recordings using the Auditory Nerve Response Telemetry (ART) feature of the MED-EL MAESTRO system software. These recordings were then analyzed based on the site of cochlear stimulation defined as basal, middle and apical to determine if the amplitude, threshold and slope of the amplitude growth function and the refractory time differs depending on the region of stimulation. RESULTS: Findings show significant differences in the ECAP recordings depending on the stimulation site. Comparing the apical with the basal region, on average higher amplitudes, lower thresholds and steeper slopes of the amplitude growth function have been observed. The refractory time shows an overall dependence on cochlear region; however post-hoc tests showed no significant effect between individual regions. CONCLUSIONS: Obtaining ECAP recordings is also possible in the most apical region of the cochlea. However, differences can be observed depending on the region of the cochlea stimulated. Specifically, significant higher ECAP amplitude, lower thresholds and steeper amplitude growth function slopes have been observed in the apical region. These differences could be explained by the location of the stimulating electrode with respect to the neural tissue in the cochlea, a higher density, or an increased neural survival rate of neural tissue in the apex. TRIAL REGISTRATION: The Clinical Investigation has the Competent Authority registration number DE/CA126/AP4/3332/18/05.