Providing Mindful and Informed Health Care for Patients Who Are LGBTQ+: Perspectives for Clinical Audiology.

PURPOSE: More than 7% of the U.S. population identifies as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other identities), meaning clinical audiologists in all settings are likely to encounter LGBTQ+ patients seeking audiological services. This conceptual clinical focus article (a) introduces contemporary LGBTQ+ terms, definitions, and pertinent issues; (b) summarizes the current state of knowledge on barriers to equitable hearing health care access and utilization for people who identify as LGBTQ+; (c) explores the legal, ethical, and moral obligations for audiologists to provide equitable care to people who identify as LGBTQ+; and (d) provides resources to continue to learn about salient LGBTQ+ issues. CONCLUSIONS: This clinical focus article provides actionable guidance to clinical audiologists on providing inclusive equitable care to LGBTQ+ patients. Practical actionable guidance on how clinical audiologists can make their clinical practice more inclusive for their patients who identify as LGBTQ+ is provided.

Speech perception abilities of adult cochlear implant listeners with single-sided deafness vs. bilateral hearing loss.

OBJECTIVES: The purpose of this study was to compare the speech perception abilities in adult cochlear implant recipients implanted for bilateral sensorineural hearing loss (BSNHL) with those implanted for single-sided deafness (SSD). DESIGN: A total of 12 adults with BSNHL and 12 adults with SSD participated. Each participant completed a battery of speech perception measures including monosyllabic words, sentences, and consonant recognition. RESULTS: Cochlear implant users with BSNHL performed higher on word and sentence recognition. Consonant recognition scores showed higher performance for CI listeners with BSNHL for voicing and manner, but not for place or articulation. CONCLUSIONS: Results of this study suggest that adults with SSD may have lower speech perception abilities with their cochlear implant when compared to adults implanted for BSNHL.

American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Cochlear Implantation in Children With Single-Sided Deafness.

More children with single-sided deafness (SSD) are receiving cochlear implants (CIs) due to the expansion of CI indications. This unique group of pediatric patients has different needs than the typical recipient with bilateral deafness and requires special consideration and care. The goal of cochlear implantation in these children is to provide bilateral input to encourage the development of binaural hearing. Considerations for candidacy and follow-up care should reflect and measure these goals. The purpose of this document is to review the current evidence and provide guidance for CI candidacy, evaluation, and management in children with SSD.

Assessment of Temporal Fine Structure Processing Among Older Adults With Cochlear Implants.

OBJECTIVES: The purpose of this study was to determine if older adults with cochlear implants are able to take advantage of coding schemes that preserve temporal fine structure (TFS) cues. DESIGN: A total of 19 older adults with cochlear implants participated in a prospective, repeated measures, A to B design. Participants entered the study using TFS. The participants used strategy A (high definition continuous interleaved sampling [HDCIS]) for 3 months and strategy B (TFS) for 3 months. Endpoint testing was administered at the end of each 3-month period. Testing included consonant recognition, speech understanding in noise, temporal modulation thresholds, and self-perceived benefit. RESULTS: Older adults were able to use TFS successfully. Speech perception performance was improved using TFS compared with HDCIS for voicing, but not manner or place of articulation. There were no differences between the two strategies for speech understanding in noise, temporal modulation detection, or self-perceived benefit. At the end of the study, 13 out of 19 (68%) of participants chose to continue using TFS processing. CONCLUSIONS: Advanced age does not prevent adults with cochlear implants from using TFS coding strategies. Performance outcomes using TFS and HDCIS were similar, with the exception of voicing which was improved when using TFS. The data support the idea of using various sound processing strategies with older adults.

Consensus practice parameter: audiological assessment and management of unilateral hearing loss in children.

Objective: Provide recommendations to audiologists for the management of children with unilateral hearing loss (UHL) and for needed research that can lend further insight into important unanswered questions.Design: An international panel of experts on children with UHL was convened following a day and a half of presentations on the same. The evidence reviewed for this parameter was gathered through web-based literature searches specifically designed for academic and health care resources, recent systematic reviews of literature, and new research presented at the conference that underwent peer review for publication by the time of this writing.Study sample: Expert opinions and electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Education Resources Information Centre (ERIC), Google Scholar, PsycINFO, PubMed, ScienceDirect, and Turning Research into Practice (TRIP) Database.Results: The resulting practice parameter requires a personalised, family-centred process: (1) routine surveillance of speech-language, psychosocial, auditory, and academic or pre-academic development; (2) medical assessments for determination of aetiology of hearing loss; (3) assessment of hearing technologies; and (4) considerations for family-centred counselling.Conclusions: This practice parameter provides guidance to clinical audiologists on individualising the management of children with UHL. In addition, the paper concludes with recommendations for research priorities.

Application of Kaizen Principles to a Large Cochlear Implant Practice: A Continuous Quality Improvement Initiative at Mayo Clinic.

OBJECTIVE: To remove barriers and improve access for patients seeking cochlear implantation. STUDY DESIGN: Prospective quality improvement study at a large tertiary academic care center. METHODS: A Kaizen quality improvement model was applied over the course of a year. Four weeklong meetings were used to identify areas for improvement and remediation. Data were collected at baseline, 90-days, and 1-year postcompletion of the project. Outcome measures included lead times, defined as the wait time between first contact with the clinic and the first appointment, and the wait time between surgery and activation, and cycle times defined as the total test time needed to determine cochlear implant candidacy, and total time needed to complete initial activation. The total inventory kept as clinic stock was also calculated RESULTS:: Kaizen team members collected data for each outcome measure. After the Kaizen principles were applied, the following outcomes were observed: median lead times between first contact with the clinic to candidacy testing, candidacy testing to surgery, and surgery to activation of the implant remained stable from baseline to 1-year follow-up. Median cycle time for candidacy testing decreased from 7.3 hours at baseline to 3.0 hours at 1-year follow-up. Cycle times for initial activation of the device did not change over time. The total inventory of clinic stock was reduced by 31%. CONCLUSIONS: Though outcomes for lead and cycle times varied, implementation of Kaizen principles was found to be an effective method for completing this quality improvement project at a large cochlear implant program overall. LEVEL OF EVIDENCE: 3a.

Mechanisms of Localization and Speech Perception with Colocated and Spatially Separated Noise and Speech Maskers Under Single-Sided Deafness with a Cochlear Implant.

OBJECTIVES: This study tested listeners with a cochlear implant (CI) in one ear and acoustic hearing in the other ear, to assess their ability to localize sound and to understand speech in collocated or spatially separated noise or speech maskers. DESIGN: Eight CI listeners with contralateral acoustic hearing ranging from normal hearing to moderate sensorineural hearing loss were tested. Localization accuracy was measured in five of the listeners using stimuli that emphasized the separate contributions of interaural level differences (ILDs) and interaural time differences (ITD) in the temporal envelope and/or fine structure. Sentence recognition was tested in all eight CI listeners, using collocated and spatially separated speech-shaped Gaussian noise and two-talker babble. Performance was compared with that of age-matched normal-hearing listeners via loudspeakers or via headphones with vocoder simulations of CI processing. RESULTS: Localization improved with the CI but only when high-frequency ILDs were available. Listeners experienced no additional benefit via ITDs in the stimulus envelope or fine structure using real or vocoder-simulated CIs. Speech recognition in two-talker babble improved with a CI in seven of the eight listeners when the target was located at the front and the babble was presented on the side of the acoustic-hearing ear, but otherwise showed little or no benefit of a CI. CONCLUSION: Sound localization can be improved with a CI in cases of significant residual hearing in the contralateral ear, but only for sounds with high-frequency content, and only based on ILDs. In speech understanding, the CI contributed most when it was in the ear with the better signal to noise ratio with a speech masker.

Cochlear implantation for single-sided deafness in children and adolescents.

OBJECTIVE: To evaluate outcomes in pediatric and adolescent patients with single-sided deafness (SSD) undergoing cochlear implantation. METHODS: A retrospective cohort design at two tertiary level academic cochlear implant centers. The subjects included nine children ages 1.5 to 15 years-old with single-sided deafness (SSD) who had undergone cochlear implantation in the affected ear. Objective outcome measures included were speech reception testing in quiet and noise, bimodal speech reception threshold testing in noise, tinnitus suppression, and device usage. RESULTS: Nine pediatric and adolescent patients with SSD were implanted between 2011 and 2017. The median age at implantation was 8.9 years (range, 1.5-15.1) and the children had a median duration of deafness 2.9 years (range, 0.8-9.5). There was variability in testing measures due to patient age. Median pre-operative aided word recognition scores on the affected side were <30% regardless of the testing paradigm used. Six patients had pre-operative word testing (4 CNC, median score 25%; 2 MLNT, 8% and 17%). Four patients had pre-operative sentence testing (3 AzBio, median score 44%; 1 HINT-C, 57%). Median post-implantation follow-up interval was 12.3 months (range, 3-27.6 months). Six subjects had post-operative word recognition testing (CNC median, 70%; MLNT 50%, 92%) with a median improvement of 45.5% points. Five subjects had post-operative sentence testing (AzBio, median 82%; HINT, median 76%), with a median improvement of 40.5% points. Eight patients are full time users of their device. Tinnitus and bimodal speech reception thresholds in noise were improved. CONCLUSION: Pediatric subjects with SSD benefit substantially from cochlear implantation. Objective speech outcome measures are improved in both quiet and noise, and bimodal speech reception thresholds in noise are greatly improved. There is a low rate of device non-use.

Cochlear Implantation in Adults With Asymmetric Hearing Loss: Speech Recognition in Quiet and in Noise, and Health Related Quality of Life.

OBJECTIVE: To examine the possible speech recognition and health related quality of life (HRQoL) benefits of cochlear implantation among adults with asymmetric sensorineural hearing loss. STUDY DESIGN: Retrospective chart review, single-subject design. METHODS: A total of 45 adult cochlear implant recipients with asymmetric sensorineural hearing loss where performance for the best-aided condition exceeded 60% correct open set sentence recognition in quiet, and the implanted ear met traditional candidacy criteria. End point testing of the implanted ear was evaluated with use of the Consonant-Vowel Nucleus-Consonant (CNC) word test and AzBio sentence test materials in quiet, and bimodally with the AzBio sentence test materials in noise at +5 dB signal-to-noise ratio (SNR). HRQoL was measured using the Nijmegen Cochlear Implant Questionnaire (NCIQ). RESULTS: Measured in quiet, with the non-implanted ear plugged, the average CNC word scores increased from 9.1% preoperatively to 55.7% (p < 0.01) at the 6-month post-activation test interval. Similarly, average AzBio sentence scores in quiet, with the non-implanted ear plugged, increased from 13.9% preoperatively to 73.4% (p < 0.01) at the 6-month post-activation test interval. Finally, in the bilateral/bimodal condition, the AzBio sentence score in +5 dB SNR improved from an average of 26.8% preoperatively to 52.4% (p < 0.01) at the 6-month test interval. Results of the NCIQ showed improved scores on all six subdomains. CONCLUSIONS: These data demonstrate significant benefit of cochlear implantation among a group of postlingually deafened adults whose preoperative hearing and aided speech recognition fell outside of the currently specified Food and Drug Administration candidacy guidelines. Results of this study support the evaluation of a candidate's speech recognition in noise in the best-aided condition to adequately assess candidacy for a cochlear implant.

Investigating Speech Recognition and listening effort with different device configurations in adult cochlear implant users.

OBJECTIVES: The purpose of this study was to investigate speech recognition in noise and listening effort among a group of adults with cochlear implants (CIs). Two main research questions were addressed. First, what are the effects of omni versus directional microphone configuration on speech recognition and listening effort for noisy conditions? Second, what is the effect of unilateral versus bimodal or bilateral CI listening on speech recognition and listening effort in noisy conditions? DESIGN: Sixteen adults (mean age 58 years) with CIs participated. Listening effort was measured using a dual-task paradigm and also using a self-reported rating of difficulty scale. In the dual-task measure, participants were asked to repeat monosyllabic words while at the same time press a button in response to a visual stimulus. Participants were tested in two baseline conditions (speech perception alone and visual task alone) and in the following experimental conditions: (1) quiet with an omnidirectional microphone, (2) noise with an omnidirectional microphone, (3) noise with a directional microphone, and (4) noise with a directional microphone and with a second sided CI or hearing aid. When present, the noise was fixed with a +5 dB signal-to-noise ratio. After each listening condition, the participants rated the degree of listening difficulty. RESULTS: Changing the microphone from omni to directional mode significantly enhanced speech recognition in noise performance. There were no significant changes in speech recognition between the unilateral and bimodal/bilateral CI listening conditions. Listening effort, as measured by reaction time, increased significantly between the baseline and omnidirectional quiet listening condition though did not change significantly across the remaining listening conditions. Self-perceived listening effort revealed a greater effort for the noisy conditions, and reduced effort with the move from an omni to a directional microphone. CONCLUSIONS: Directional microphones significantly improve speech in noise recognition over omnidirectional microphones and allowed for decreased self-perceived listening effort. The dual task used in this study failed to show any differences in listening effort across the experimental conditions and may not be sensitive enough to detect changes in listening effort.

Intraoperative Cochlear Implant Device Testing Utilizing an Automated Remote System: A Prospective Pilot Study.

INTRODUCTION: Intraoperative cochlear implant device testing provides valuable information regarding device integrity, electrode position, and may assist with determining initial stimulation settings. Manual intraoperative device testing during cochlear implantation requires the time and expertise of a trained audiologist. The purpose of the current study is to investigate the feasibility of using automated remote intraoperative cochlear implant reverse telemetry testing as an alternative to standard testing. METHODS: Prospective pilot study evaluating intraoperative remote automated impedance and Automatic Neural Response Telemetry (AutoNRT) testing in 34 consecutive cochlear implant surgeries using the Intraoperative Remote Assistant (Cochlear Nucleus CR120). In all cases, remote intraoperative device testing was performed by trained operating room staff. A comparison was made to the "gold standard" of manual testing by an experienced cochlear implant audiologist. Electrode position and absence of tip fold-over was confirmed using plain film x-ray. RESULTS: Automated remote reverse telemetry testing was successfully completed in all patients. Intraoperative x-ray demonstrated normal electrode position without tip fold-over. Average impedance values were significantly higher using standard testing versus CR120 remote testing (standard mean 10.7 kΩ, SD 1.2 vs. CR120 mean 7.5 kΩ, SD 0.7, p < 0.001). There was strong agreement between standard manual testing and remote automated testing with regard to the presence of open or short circuits along the array. There were, however, two cases in which standard testing identified an open circuit, when CR120 testing showed the circuit to be closed. Neural responses were successfully obtained in all patients using both systems. There was no difference in basal electrode responses (standard mean 195.0 µV, SD 14.10 vs. CR120 194.5 µV, SD 14.23; p = 0.7814); however, more favorable (lower µV amplitude) results were obtained with the remote automated system in the apical 10 electrodes (standard 185.4 µV, SD 11.69 vs. CR120 177.0 µV, SD 11.57; p value < 0.001). CONCLUSION: These preliminary data demonstrate that intraoperative cochlear implant device testing using a remote automated system is feasible. This system may be useful for cochlear implant programs with limited audiology support or for programs looking to streamline intraoperative device testing protocols. Future studies with larger patient enrollment are required to validate these promising, but preliminary, findings.

Survey of the American Neurotology Society on Cochlear Implantation: Part 1, Candidacy Assessment and Expanding Indications.

OBJECTIVE: To examine practice variance of cochlear implant candidacy assessment and off-label indications across centers in the United States. METHODS: Cross-sectional survey of the American Neurotology Society (ANS). RESULTS: A total of 81 surveys were returned from ANS members who report regular involvement in cochlear implant care. Overall there was a broad distribution in age and clinical experience, with most respondents reporting ACGME accreditation in neurotology and employment at an academic center. The annual volume of cochlear implant surgeries varied considerably across centers.Seventy-eight percent of respondents performed cochlear implantation for at least one of the following indications within the last 2 years: profound hearing loss in children less than 12 months of age (35, 43%), children with asymmetrical hearing loss where at least one ear was better than performance cutoff for age (25, 31%), adults with asymmetrical hearing where at least one ear was better than the performance cutoff for adult criteria (49, 61%), single-sided deafness (37, 46%), and ipsilateral vestibular schwannoma (28, 35%). Centers with a higher annual implant volume more frequently performed off-label implantation in all queried populations (all, p≤0.001), and performed surgery on infants with congenital deafness at a younger age (p = 0.013), compared with centers with lower surgical volume.When surveyed regarding speech perception testing practices for adult candidacy assessment, 75 (100%) respondents who answered this question reported routine use of AzBio sentences, 42 (56%) CNC word scores, and 26 (35%) HINT testing; only 7 (9%) reported using BKB-SIN testing and 6 (8%) reported using CUNY scores. Fifty-one (68%) reported routine use of speech-in-noise testing to determine adult cochlear implant candidacy, 21 (28%) reported selective use only when patient scores were borderline in quiet, and 3 (4%) reported that their center does not currently use testing in noise for candidacy determination. Nineteen (26%) solely used +10 dB signal-to-noise ratio (SNR), 12 (16%) solely used +5 dB SNR, and 41 (55%) used both +10 and +5 dB SNR. Overall, 19% (N = 14) only perform unilateral implantation in the Medicare population, while 81% (N = 58) consider bilateral implantation. CONCLUSION: Significant variation in cochlear implant candidacy assessment and off-label implantation exists across centers and providers in the United States resulting in healthcare inequities. The high percentage of surgeons performing implantations for off-label or nontraditional indications reflects the overly restrictive and dated status of current implant guidelines. With greater adoption of more difficult speech perception testing in noise, careful clinical judgment is needed to maintain a favorable risk-benefit balance for prospective implant candidates.

Health-related quality of life outcomes following adult cochlear implantation: A prospective cohort study.

INTRODUCTION: The benefits of cochlear implantation extend beyond improved speech recognition and into overall health-related quality of life (HRQoL). Several measures of HRQoL, categorized as generic or disease specific, have been used in the cochlear implant literature. The clinical utility of generic HRQoL measures have been reported to be variable by previous investigators. The degree to which HRQoL correlates to speech perception is largely unknown. METHODS: A prospective single-subject design at a large tertiary care center. Self-reported HRQoL was measured at the preoperative and 12-month post-activation test intervals. The measures of HRQoL included a generic form, (Medical Outcome Study Short Form; SF-36), and disease specific form (Nijmegen Cochlear Implant Questionnaire; NCIQ). Speech recognition was measured at the preoperative, 6- and 12-months post-activation test intervals using the Consonant-Nucleus-Consonant (CNC) monosyllabic word test. RESULTS: A total of 61 patients (mean 67 years; range 30-87 years) were included in the final analysis. Average speech recognition on the CNC word test was 10% pre-operatively, and 66.7% at 12-months post-activation. The HRQoL scores improved significantly for seven of the eight subdomains of the NCIQ, and one of the nine domains of the SF-36. CONCLUSION: Cochlear implantation significantly improves HRQoL, regardless of age. Disease specific measures, such as the NCIQ, are better able to demonstrate differences in HRQoL compared to general health surveys.

Evaluation of a revised indication for determining adult cochlear implant candidacy.

OBJECTIVE: To evaluate the use of monosyllabic word recognition versus sentence recognition to determine candidacy and long-term benefit for cochlear implantation. STUDY DESIGN: Prospective multi-center single-subject design. METHODS: A total of 21 adults aged 18 years and older with bilateral moderate to profound sensorineural hearing loss and low monosyllabic word scores received unilateral cochlear implantation. The consonant-nucleus-consonant (CNC) word test was the central measure of pre- and postoperative performance. Additional speech understanding tests included the Hearing in Noise Test sentences in quiet and AzBio sentences in +5 dB signal-to-noise ratio (SNR). Quality of life (QoL) was measured using the Abbreviated Profile of Hearing Aid Benefit and Health Utilities Index. RESULTS: Performance on sentence recognition reached the ceiling of the test after only 3 months of implant use. In contrast, none of the participants in this study reached a score of 80% on CNC word recognition, even at the 12-month postoperative test interval. Measures of QoL related to hearing were also significantly improved following implantation. CONCLUSION: Results of this study demonstrate that monosyllabic words are appropriate for determining preoperative candidate and measuring long-term postoperative speech recognition performance. LEVEL OF EVIDENCE: 2c. Laryngoscope, 127:2368-2374, 2017.

Cochlear implantation for single-sided deafness: A multicenter study.

OBJECTIVES/HYPOTHESIS: To report the preliminary outcomes of patients with single-sided deafness and asymmetric hearing loss undergoing cochlear implantation at two centers. STUDY DESIGN: Retrospective review and prospective data collection. METHODS: Patients with single-sided deafness who underwent cochlear implantation at two centers were included. Pre- and postoperative measures included monosyllabic word and sentence recognition in quiet for the ear implanted, and sentence recognition in noise in the best-aided bilateral condition. RESULTS: Average monosyllabic word recognition scores in quiet improved significantly from 11.3% (standard deviation [SD] 15.6%) preoperatively to 48.7% (SD 24.2%) at the 3-month postactivation interval, although they did not increase significantly between the 3-month and 6-month intervals. Sentence recognition scores in quiet increased significantly from 18.4% (SD 28.5%) preoperatively to 65.9% (SD 17.9%) at the 3-month postactivation interval, but not between the 3-month and 6-month intervals. Sentence recognition in noise in the best-aided bilateral condition increased from 59% (SD 16.3%) preoperatively to 72% (SD 16.0%) at 6-months postactivation, though the difference was not statistically significant. Thirteen of the participants reported tinnitus prior to surgery. Of those, 12 reported that tinnitus was improved after implantation, and one reported that tinnitus was unchanged. CONCLUSION: Preliminary results suggest that speech recognition in a singly deafened ear is significantly improved after cochlear implantation, although speech recognition in noise measured in the bilateral condition remains the same at 6-months postactivation. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:223-228, 2017.

Early outcomes after cochlear implantation for adults and children with unilateral hearing loss.

OBJECTIVES/HYPOTHESIS: This study was designed to examine speech recognition and self-perceived health-related quality of life (HRQoL) received from cochlear implantation among a cohort of adults and children with a short duration of unilateral hearing loss greater than 6 months, but less than 2 years. STUDY DESIGN: Single-subject repeated measures prospective study. METHODS: This study assessed changes in speech recognition and self-perceived quality of life by prospectively analyzing data at the preoperative evaluation and at the 3-month and 6-month postactivation intervals. Measurement tools included Medical Outcomes Study Questionnaire Short Form 36, Nijmegen Cochlear Implant Questionnaire, Speech Spatial and Qualities of Hearing-Comparative, and speech recognition measures in quiet and in noise. RESULTS: Results indicated significant improvement in speech recognition, both in quiet and noise. Quality-of-life measures showed a significant increase in self-perceived benefit with disease-specific instruments, but remained constant with a generic HRQoL instrument. CONCLUSIONS: Cochlear implantation was a successful intervention for improved hearing in quiet and noise, and a self-perceived benefit for this group of adults and children with a short duration of unilateral hearing loss. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:1683-1688, 2017.

Cochlear Implantation in Patients With Intracochlear and Intralabyrinthine Schwannomas.

OBJECTIVE: Schwannomas may arise primarily within the inner ear, or invade the cochlea or labyrinth from the distal internal auditory canal through transmodiolar or transmacular extension, respectively. To date, very limited data exists regarding cochlear implant (CI) outcomes in this unique population. STUDY DESIGN: Retrospective case review. PATIENTS: Ten ears (nine patients) with inner ear schwannomas that underwent CI at a single tertiary referral center. INTERVENTION(S): Cochlear implantation. MAIN OUTCOME MEASURE(S): Surgical approach, CI performance. RESULTS: Ten ears (nine patients) were implanted with conventional CI arrays. Three cases had primary inner ear schwannomas, while seven were in patients with neurofibromatosis type 2 (NF2) having transmodiolar invasion of the inner ear from a vestibular schwannoma (VS). In all cases, intracochlear tumor was left in situ to preserve cochlear anatomy and a full electrode insertion was achieved. Use of a styleted electrode with late deployment aided advancement through the intracochlear tumor. In all cases, the ipsilateral internal auditory canal and inner ear could be visualized on postoperative magnetic resonance imaging (MRI) for tumor surveillance. Eight ears achieved good open-set word recognition (median, Consonant-Nucleus-Consonant [CNC] 50% [range, 28-88%], median, AzBio 73% [range, 60-91%]); two patients with NF2 and prolonged deafness (15 and 22 years) received limited benefit. CONCLUSIONS: Cochlear implantation in patients with inner ear schwannomas and an intact cochlear nerve is feasible. Leaving intracochlear schwannoma in situ preserves cochlear architecture and use of a styleted electrode may aid in achieving a full insertion when obstructing tumor is present. Postoperative MRI surveillance is still adequate after CI and a high percentage of patients achieve good open-set speech perception performance.

Frequency Importance Functions in Quiet and Noise for Adults With Cochlear Implants.

PURPOSE: Several studies have been devoted to understanding the frequency information available to adult users of cochlear implants when listening in quiet. The objective of this study was to construct frequency importance functions for a group of adults with cochlear implants and a group of adults with normal hearing both in quiet and in a +10 dB signal-to-noise ratio. METHOD: Two groups of adults, 1 with cochlear implants and 1 with normal hearing, were asked to identify nonsense syllables in quiet and in the presence of 6-talker babble while "holes" were systematically created in the speech spectrum. Frequency importance functions were constructed. RESULTS: Results showed that adults with normal hearing placed greater weight on bands 1, 3, and 4 than on bands 2, 5, and 6, whereas adults with cochlear implants placed equal weight on all bands. The frequency importance functions for each group did not differ between listening in quiet and listening in noise. CONCLUSIONS: Adults with cochlear implants assign perceptual weight toward different frequency bands, though the weight assignment does not differ between quiet and noisy conditions. Generalizing these results to the broader population of adults with implants is constrained by a small sample size.

Accuracy of a Tablet Audiometer for Measuring Behavioral Hearing Thresholds in a Clinical Population.

OBJECTIVE: To examine the validity of a tablet computer-based audiometer for measuring hearing thresholds in a moderately noisy environment. STUDY DESIGN: A prospective single-cohort repeated measures study. SETTING: Tertiary care institution providing hearing health care to a diverse population. SUBJECTS AND METHODS: Subjects included 49 participants (44 adults, 5 children) with all degrees of hearing sensitivity. Potential participants were excluded if they were <4 years old or had cognitive deficits or ear drainage. Participants were tested with established audiometric tests and a tablet audiometer. Threshold values were measured for both ears using various stimuli (500, 1000, 2000, and 4000 Hz). Testing with the tablet audiometer was conducted in a non-sound-treated room; room properties were characterized by ambient noise level and reverberation testing. Calibration assessment of the tablet audiometer was performed on 3 occasions. RESULTS: Within the test thresholds for hearing level, results from the tablet device were within 10 dB of those determined by conventional audiometry for 164 of 172 hearing levels and did not show proportional bias over the testing range. Calibration assessment showed accurate proximity between output and target values, though crosstalk and linearity failed initial assessments. CONCLUSION: The tablet-based automated audiometer presents a new method for threshold hearing assessment outside conventional sound booths.

Hearing preservation among patients undergoing cochlear implantation.

INTRODUCTION: Despite successful preservation of low-frequency hearing in patients undergoing cochlear implantation (CI) with shorter electrode lengths, there is still controversy regarding which electrodes maximize hearing preservation (HP). The thin straight electrode array (TSEA) has been suggested as a full cochlear coverage option for HP. However, very little is known regarding its HP potential. METHODS: A retrospective review was performed at two tertiary academic medical centers, reviewing the electronic records for 52 patients (mean, 58.2 yr; range, 11-85 yr) implanted with the Cochlear Nucleus CI422 Slim Straight (Centennial, CO, USA) electrode array, referred to herein as the thin straight electrode array or TSEA. All patients had a preoperative low-frequency pure-tone average (LFPTA) of 85 dB HL or less. Hearing thresholds were measured at initial activation (t1) and 6 months after activation (t2). HP was assessed by evaluating functional HP using a cutoff level of 85 dB HL PTA. RESULTS: At t1, 54% of the subjects had functional hearing; 33% of these subjects had an LFPTA between 71 and 85 dB HL, and 17% had an LFPTA between 56 and 70 dB HL. At t2, 47% of the patients had functional hearing, with 31% having an LFPTA between 71 and 85 dB HL. DISCUSSION: Preliminary research suggests that the TSEA has the potential to preserve functional hearing in 54% of patients at t1. However, 22% (n = 6) of the patients who had functional hearing at t1 (n = 28) lost their hearing between t1 and t2. Further studies are needed to evaluate factors that influence HP with the TSEA electrode and determine the speech perception benefits using electric and acoustic hearing over electric alone.