Hearing outcomes following reimplantation of functional legacy cochlear implants.

OBJECTIVES: Recently, patients with certain legacy cochlear implants (CIs) have sought out reimplantation to enjoy the benefits offered by newer processor technology. This decision can be difficult, especially when the individual relies exclusively on the device for communication and scores at the ceiling of performance metrics. To date, most outcome data is derived from reimplantation of a non-functioning CI-a relatively easy decision. The aim of this study is to report hearing outcomes following reimplantation of legacy implants to guide surgeons and patients approaching this high-stakes clinical situation. PATIENTS AND INTERVENTION: Four patients implanted with Advanced Bionics Clarion C1 devices over 20 years ago underwent reimplantation. RESULTS: Three reimplanted patients demonstrated a maintenance or improvement in their audiometric performance with one patient experiencing only a 5 % decrease in AzBioQ score. Each patient expressed satisfaction with the expansion of technological capabilities including improved battery life, and device connectivity. There were no failed reimplantations or other adverse effects. CONCLUSIONS: Reimplantation of a functioning legacy CI result in stability or improvement in auditory performance. All individuals in this series report that they enjoy the new connectivity and programming technologies. As the rate advancement in CI technology continues to increase and newer device architectures emerge, these data will help to inform the decision to reimplant functioning devices.

Electrode Impedance Fluctuations and Sudden Decline in Cochlear-Implant Benefit.

OBJECTIVE: The main objective of this clinical capsule was to outline the narrative of three teen cochlear implant (CI) users who experienced a sudden increase in their CI electrode impedance values, which coincided with decreased overall speech perception ability. In addition, the study explored the following questions: Are there any similarities between cases? What recommendations should be made for continuing treatment regarding these cases? PATIENTS: Three teenagers who reported sudden change in CI benefit were included in this study. INTERVENTIONS: Electrode impedance values and speech identification scores were obtained routinely during the CI mapping appointments. Specifically, word and sentence recognition scores were obtained using the Consonant-Nucleus-Consonant word list and the AZBio sentence test, respectively. Both patient 1 and patient 2 underwent CI reimplantation operations as a result of their perceived difficulties and decreased impedances. Patient 3 did not undergo reimplantation surgery. MAIN OUTCOMES: All three patients' CI electrode impedances and speech perception scores eventually stabilized over time. No relationship could be drawn between revision surgery and stabilization of CI electrode impedances and speech perception scores. CONCLUSIONS: Overall, we found no similarities between cases that could potentially explain the sudden electrode impedance value increase or the decrease in speech perception scores. Each case should be evaluated uniquely and carefully for CI revision operations by frequent monitoring, including mapping and speech perception testing. The most common factor contributing to each teen's eventual resolution of electrode impedance values and speech perception scores was time.

The Long-Term Stability of the Electrical Stapedial Reflex Threshold.

OBJECTIVES: To 1) describe changes in the electrical stapedial reflex threshold (eSRT), within and across patients over time and 2) to identify the clinical relationship between eSRT and an individual's upper limit of loudness. STUDY DESIGN: Retrospective chart review and analysis using a multilevel modeling approach to describe changes in eSRT over time. SETTING: Secondary care center. PATIENTS: Two-hundred five cochlear implant recipients treated at the cochlear implant center during a 3-year time period. INTERVENTION(S): Cochlear implantation, eSRT testing, and, electrical upper limits of loudness. MAIN OUTCOME MEASURE(S): The eSRT over multiple appointments and the cochlear implant recipients' final upper limits of loudness. RESULTS: Analysis of the eSRT testing indicated stability over time; no global trend was seen in trajectory across the population, b = -0.010, p = 0.899. The relationship between eSRT and user upper limits of loudness revealed a mean decrease of 19.47, units for manufacturer 1, 30.53 units for manufacturer 2, and 0.7 units for manufacturer 3. CONCLUSION: Electrical stapedial reflex thresholds remain consistent for individual subjects over time with implant experience being the only variable correlated with eSRT stability (increase in 5% of one standard deviation with each year of experience). In addition, a clinical relationship between eSRT and behaviorally set upper limits of loudness was identified for all three cochlear implant manufacturers available in the United States.

Family Involvement in Adult Hearing Evaluation Appointments: Patient Perspectives.

Background Many adults suffer from an array of consequences due to their hearing loss (e.g., self-efficacy, mastery, psychosocial challenges). Family involvement can help improve their outcomes. Purpose This study aimed to determine audiology adult patients hearing experiences and inquired about their perspectives on family involvement in appointments. Research Design A cross-sectional survey was completed. Descriptive statistics, item analyses, and quantitative analyses were used to examine patient's characteristics and perspectives. Study Sample Three hundred eighty-two adult audiology patients participated in the study. Data Collection and Analysis A 15-item survey was created with 4 sections, including patient demographic information, general hearing questions, hearing experiences, and family interactions and involvement. Descriptive statistics were used to examine patient's characteristics and perspectives on family involvement in audiology appointments. Chronbach's alpha was used to reveal good internal consistency of difficult feelings related to hearing and perceived negative family member reactions. Quantitative analyses were used to determine patient perspectives on family involvement. Results Though patients reported difficulties due to their hearing loss, more than half reported that they did not want family involvement or they were unsure of the benefit that the involvement would provide. Patients who were interested in having family involved reported benefits such as educational opportunities and support. Few barriers of family involvement were reported by patients. Conclusions Patients had a mixed desire about family involvement in their adult audiology appointments. Education of patients about the benefits of family involvement may need to happen for this shift in audiologic practice.

Audiologist Practices: Parent Hearing Aid Education and Support.

BACKGROUND: Early identification of hearing loss has led to routine fitting of hearing aids in infants and young children. Amplification provides opportunities to optimize child development, although it also introduces challenges for parents to navigate. Audiologists have a central role in providing parents with support to achieve effective management strategies and habits. PURPOSE: The purpose of this study was to explore current practices of pediatric audiologists who work with children birth to 5 yr of age, regarding their support of parent learning in achieving effective hearing aid management, identify existing gaps in service delivery, and to determine if audiologists were receptive to receiving training related to effective approaches to provide counseling and support to parents. RESEARCH DESIGN: A cross-sectional, population-based survey was used. STUDY SAMPLE: Three hundred and forty-nine surveys were analyzed from pediatric audiologists who provided services to children birth to 5 yr of age. Responses were received from 22 states in the United States. DATA COLLECTION AND ANALYSIS: Responses were collected through the mail and online. Descriptive statistics were used to analyze the information. RESULTS: More than half (61%) of the audiologists in the study had been providing pediatric hearing aid services to children birth to 5 yr of age for >10 yr. Of the audiologists who reported monitoring hours of hearing aid use, the majority reported that they used data logging (90%). More than half of the audiologists (57%) who shared data logging with parents reported that they encountered defensiveness from parents when addressing hearing aid use. Information and skills that were not routinely provided by one-third to one-half of the audiologists included the following: how to get access to loaner hearing aids (30%), available hearing aid options/accessories (33%), available financial assistance (36%), how to teach hearing aid management to other caregivers (38%), how to do hearing aid maintenance (44%), and how to do a Ling 6 sound check (52%). Many audiologists reported they did not frequently collaborate with speech-language pathologists (48%), early interventionists (47%), or physicians (68%). More than half of the audiologists indicated a desire for more training in counseling skills, for all 14 items queried, to support parents with hearing aid management (53-79%), regardless of their previous training experience. CONCLUSIONS: For young children with hearing loss to achieve optimal benefit from auditory experiences for speech and language development, they need evidence-based, comprehensive, and coordinated hearing aid management. Audiologists have an important role for teaching information and skills related to hearing aids, supporting parent learning, and collaborating with other providers. Pediatric audiologists in this study recognized and desired the need for further training in counseling skills that can better prepare them to meet the emotional needs of parents in the hearing aid management process.

Apparent cochlear nerve aplasia: to implant or not to implant?

OBJECTIVE: To describe the imaging findings and clinical outcomes of children with apparent cochlear nerve aplasia undergoing cochlear implantation. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care center. PATIENTS: Three patients with imaging findings consistent with absent cochlear nerve canal on diagnostic imaging and questionable audiometric responses on testing who underwent promontory stimulation and subsequent cochlear implantation. INTERVENTION(S): Magnetic resonance imaging and computed tomography, audiologic assessment, and cochlear implantation. MAIN OUTCOME MEASURE(S): Audiologic performance after cochlear implantation. RESULTS: Three patients were identified to have hearing loss on newborn hearing screening and underwent auditory brainstem response testing revealing absent brainstem responses. ASSR testing was inconclusive when performed. Imaging in all cases identified 1 ear with a small internal auditory canal with 2 nerves present, one of which seems to enter the vestibule in each case and the other is assumed to be the functioning facial nerve. There was a bony plate present over the entrance to the cochlea in 2 of the 3 patients. Over time, 2 of the families reported responses to auditory stimuli with amplification. Promontory stimulation testing showed reproducible responses to electrical stimuli in the ears in question. After cochlear implantation, all 3 patients have shown responses to auditory stimuli. CONCLUSION: The absence of a visible cochlear nerve or cochlear nerve canal on radiologic imaging does not preclude auditory innervation of the cochlea. Cochlear implantation can be a viable option for patients with apparent cochlear nerve aplasia who have undergone appropriate testing. Electronically evoked auditory brainstem response is critical in the evaluation of this patient group.