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Introduction: Optimal cochlear implant (CI) outcomes are due to, at least in part, appropriate device programming. Objective measures, such as electrically evoked stapedial reflex thresholds (ESRTs), can be used to more accurately set programming levels. However, underlying factors that contribute to ESRT levels are not well understood. The objective of the current study was to analyze how demographic variables of patient sex and age, along with CI electrode location, influence ESRTs in adult CI recipients. Methods: A single institution retrospective review was performed. Electronic medical records, CI programming records, and clinic database of postoperative computerized tomography were reviewed to gather information regarding patient demographics, ESRTs, and electrode array metrics including medial-lateral distance and scalar location. Linear mixed models were constructed to determine how demographic variables and electrode position influence ESRTs recorded in 138 adult CI recipients. Results: ESRTs were significantly affected by recipient age, with older listeners demonstrating higher ESRT levels. On average, males had higher ESRT levels when compared to females. In a subset of the study sample, ESRT levels increased with increasing medial-lateral distance; however, there was not a statistically significant effect of electrode type (lateral/straight arrays compared to perimodiolar arrays). ESRTs were not affected by scalar location. Discussion/Conclusions: The results suggest that key demographic and electrode position characteristics influence the level of ESRTs in adult CI recipients. While ESRTs are widely used to assist with CI programming, underlying factors are not well understood. The significant factors of aging and sex could be due to middle ear mechanics or neural health differences. However, further data are needed to better understand these associations. [ABSTRACT FROM AUTHOR]

To analyse the effects of auditory environments on receptive and expressive language outcomes in children with a CI. A single-institution retrospective review was performed. The auditory environments included Speech-Noise, Speech-Quiet, Quiet, Music, and Noise. Hearing Hour Percentage (HHP) and percent total hours were calculated for each environment. Generalised Linear Mixed Models (GLMM) analyses were used to study the effects of auditory environments on PLS Receptive and Expressive scores. Thirty-nine children with CI On GLMM, an increase in Quiet HHP and Quiet percent total hours were positively associated with PLS Receptive scores. Speech-Quiet, Quiet, and Music HHP were positively associated with PLS Expressive scores, with only Quiet being significant for percent total hours. In contrast, percent total hours of Speech-Noise and Noise had a significant negative association with PLS Expressive scores. This study suggests that more time spent in a quiet auditory environment positively influences PLS Receptive and Expressive scores and that more time listening to speech in quiet and music positively influences PLS Expressive scores. Time spent in environments recognised as Speech-Noise and Noise might negatively impact a child's expressive language outcomes with a CI. Future research is needed to better understand this association. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively compare frequency‐place mismatch among adult cochlear implant (CI) recipients with lateral wall (LW) and perimodiolar/Mid Scala (PM/MS) arrays, and to quantify the impact of these factors on early post‐activation (3 months) speech recognition abilities and CI‐specific quality of life. Method s : One hundred and twenty‐six adult participants were separated into two groups: (1) 83 participants who underwent CI with a PM/MS array and 43 patients who underwent CI with a LW array. All participants completed the Cochlear Implant Quality of Life Profile (CIQOL‐35 Profile) instrument. Angular insertion depth and semitone mismatch, which contribute to frequency‐place mismatch, were assessed using post‐operative CT scans. Word and speech recognition in quiet were determined using the Consonant‐Nucleus‐Consonant (CNC) and the AzBio tests, respectively (n = 82 patients). Results: LW arrays were more deeply inserted and exhibited less semitone mismatch compared to PM/MS arrays. No significant relationship was found between semitone mismatch and early post‐operative speech perception scores for either PM/MS or LW arrays. However, greater degrees of semitone mismatch were associated with lower CIQOL‐35 profile scores for PM/MS arrays. Conclusions and Relevance: The results of this study indicate that both the degree of frequency‐place mismatch, and its impact on CI‐specific quality of life, vary by CI array design. Level of Evidence: 4 Laryngoscope, 134:2898–2905, 2024 [ABSTRACT FROM AUTHOR]

Objective: to review evidence on the efficacy of auditory training in adult cochlear implant recipients. Data Sources: PRISMA guidelines for a systematic review of the literature were followed. PubMed, Scopus, and CINAHL databases were queried on 29 June 2023 for terms involving cochlear implantation and auditory training. Studies were limited to the English language and adult patient populations. Study Selection: Three authors independently reviewed publications for inclusion in the review based on a priori inclusion and exclusion criteria. Inclusion criteria encompassed adult cochlear implant populations, an analysis of clinician- or patient-directed auditory training, and an analysis of one or more measures of speech recognition and/or patient-reported outcome. Exclusion criteria included studies with only pediatric implant populations, music or localization training in isolation, and single-sample case studies. Data Extraction: The data were collected regarding study design, patient population, auditory training modality, auditory training timing, speech outcomes, and data on the durability of outcomes. A quality assessment of the literature was performed using a quality metric adapted from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group guidelines. Data Synthesis and Meta-Analysis: Data were qualitatively summarized for 23 studies. All but four studies demonstrated significant improvement in at least one measured or patient-reported outcome measure with training. For 11 studies with sufficient data reporting, pre-intervention and post-intervention pooled means of different outcome measures were compared for 132 patients using meta-analysis. Patient-direct training was associated with significant improvement in vowel-phoneme recognition and speech recognition in noise (p < 0.05 and p < 0.001, respectively), and clinician-directed training showed significant improvement in sentence recognition in noise (p < 0.001). Conclusions: The literature on auditory training for adult cochlear implant recipients is limited and heterogeneous, including a small number of studies with limited levels of evidence and external validity. However, the current evidence suggests that auditory training can improve speech recognition in adult cochlear implant recipients. [ABSTRACT FROM AUTHOR]

Objective: Identify barriers and facilitating factors in cochlear implant (CI) utilization by comparing functional measures between CI candidates who undergo or forgo implantation. Methods: Forty‐three participants were separated into two groups: (1) 28 participants who underwent CI and (2) 15 participants who elected not to proceed with CI despite meeting eligibility criteria (no‐CI). Prior to implantation, all participants completed the CI Quality of Life (CIQOL)‐35 Profile and CIQOL‐Expectations instrument. They were also surveyed on factors contributing to their decision to either undergo or forgo CI. Word and speech recognition were determined using the Consonant‐Nucleus‐Consonant (CNC) and the AzBio tests, respectively. Results: CIQOL‐Expectations scores were indistinguishable between groups, but there were substantial differences in baseline CIQOL‐35 Profile scores. Compared to the CI group, the no‐CI group exhibited higher pre‐CI scores in the Emotional (Cohen's d [95% CI] = 0.8 [0.1, 1.5]) and Entertainment (Cohen's d [95% CI] = 0.8 [0.1, 1.5]) domains. Survey data revealed that the most commonly reported barriers to pursuing CI in the no‐CI cohort were fear of surgical complications (85%), cost associated with implantation (85%), and perception that hearing was not poor enough for CI surgery (85%). Conclusions and Relevance: The results of this study indicate that functional outcome expectations are similar between candidates who elect to receive or forgo CI, yet those who forgo CI have higher baseline CI‐specific QOL abilities. Level of Evidence: 4 Laryngoscope, 133:3548–3553, 2023 [ABSTRACT FROM AUTHOR]

Objectives: To examine patterns of change and plateau in speech recognition scores in postlingually hearing impaired adult cochlear implant recipients. The study also examines variations in change patterns for different speech materials and testing conditions. Study Design: Used systematic review with meta‐analysis. Methods: Articles in English reporting speech recognition scores of adults with postlingual hearing loss at pre‐implantation and at least two post‐implantation time points were included. Statistically significant changes were determined by meta‐analysis and the 95% confidence interval. Results: A total of 22 articles representing 1954 patients were included. Meta‐analysis of mean difference demonstrated significant improvements in speech recognition score for words in quiet (37.4%; 95% confidence interval [34.7%, 40.7%]), sentences in quiet (49.4%; 95% confidence interval [44.9%, 53.9%]), and sentences in noise (30.8%; 95% confidence interval [25.2%, 36.4%]) from pre‐op to 3 months. Scores continued to increase from 3 to 12 months but did not reach significance. Similarly, significant improvements from pre‐op to 3 months were observed for consonant nucleus consonant (CNC) words in quiet (37.1%; 95% confidence interval [33.8%, 40.4%]), hearing in noise test (HINT) sentences in quiet (46.5%; 95% confidence interval [37.0%, 56.0%]), AzBio sentences in quiet (45.9%; 95% confidence interval [44.2%, 47.5%]), and AzBio sentences in noise (26.4%; 95% confidence interval [18.6%, 34.2%]). HINT sentences in noise demonstrated improvement from pre‐op to 3 months (35.1%; 95% confidence interval [30.0%, 40.3%]) and from 3 to 12 months (15.5%; 95% confidence interval [7.2%, 23.8%]). Conclusions: Mean speech recognition scores demonstrate significant improvement within the first 3 months, with no further statistically significant improvement after 3 months. However, large individual variation should be expected and future research is needed to explain the sources of these individual differences. Laryngoscope, 133:1014–1024, 2023 [ABSTRACT FROM AUTHOR]

The article presents a study which examined the factors that affect the effectiveness of cochlear implants (CI) in hearing impaired people, particularly the influence of the health of the auditory nerve (AN). The research focused on the use of combined animal and human experiments to better assess the factors that influence CI performance. Also cited is the use of auditory brainstem response (ABR) testing in the objective measurement of hearing.

Background: A history of hearing loss is associated with lower scores on cognitive tests, as well as with incident Mild Cognitive Impairment and Alzheimer's disease. In order to compare hearing adaptation in older age, we used iPad‐based testing to assess older healthy controls and older persons with two distinct approaches to hearing correction: one group with cochlear implants and another comprised of individuals with hearings aids awaiting cochlear implants. Speech recognition in noise is a common measure of hearing accuracy and reflects effectiveness of both hearing aids and implants. We expected to find that better speech recognition scores would relate to higher levels of cognitive performance across the groups. Method: Participants were 54 individuals over 65 years of age (cochlear implants, n = 28; implant candidates using hearing aids n = 12; and normal hearing, n = 14), recruited through the University of Michigan Medical Center. All participants completed a speech in noise task and the NIH Toolbox‐Cognition battery (NIHTB‐CB) adapted for individuals with hearing loss. All scores from the NIHTB‐CB were corrected for education, age, race, and gender. Result: For speech recognition, all groups performed significantly differently from each other (F = 57.408, p < 0.001), with the normal hearing group performing the best and the pre‐implant group performing the worst. For NIHTB‐CB scores, the only difference found was lower performance for the cochlear implant group compared to the normal‐hearing group on the Picture Vocabulary subtest (F = 3.417, p = 0.041). Duration of hearing loss was not correlated with cognitive performance on any of the tasks. Conclusion: Overall, as expected, there were significant differences between groups on speech recognition. However, controls and all groups with hearing loss performed essentially equally well on all aspects of the adapted NIHTB‐CB. This suggests that in cases where hearing is partially corrected with a hearing aid or cochlear implant and tests are adapted for patients with hearing loss, group differences in cognition are not clearly evident, even when groups differed in speech perception. We hypothesized that duration of hearing loss may have driven the differences noted in vocabulary knowledge, however this was not supported in the results. Supported by NIH#R01DC015809‐03S1 and P30AG072931. [ABSTRACT FROM AUTHOR]

Importance: Many cochlear implant centers screen patients for cognitive impairment as part of the evaluation process, but the utility of these scores in predicting cochlear implant outcomes is unknown., Objective: To determine whether there is an association between cognitive impairment screening scores and cochlear implant outcomes., Design, Setting, and Participants: Retrospective case series of adult cochlear implant recipients who underwent preoperative cognitive impairment screening with the Montreal Cognitive Assessment (MoCA) from 2018 to 2020 with 1-year follow-up at a single tertiary cochlear implant center. Data analysis was performed on data from January 2018 through December 2021., Exposures: Cochlear implantation., Main Outcomes and Measures: Preoperative MoCA scores and mean (SD) improvement (aided preoperative to 12-month postoperative) in Consonant-Nucleus-Consonant phonemes (CNCp) and words (CNCw), AzBio sentences in quiet (AzBio Quiet), and Cochlear Implant Quality of Life-35 (CIQOL-35) Profile domain and global scores., Results: A total of 52 patients were included, 27 (52%) of whom were male and 46 (88%) were White; mean (SD) age at implantation was 68.2 (13.3) years. Twenty-three (44%) had MoCA scores suggesting mild and 1 (2%) had scores suggesting moderate cognitive impairment. None had been previously diagnosed with cognitive impairment. There were small to medium effects of the association between 12-month postoperative improvement in speech recognition measures and screening positive or not for cognitive impairment (CNCw mean [SD]: 48.4 [21.9] vs 38.5 [26.6] [d = -0.43 (95% CI, -1.02 to 0.16)]; AzBio Quiet mean [SD]: 47.5 [34.3] vs 44.7 [33.1] [d = -0.08 (95% CI, -0.64 to 0.47)]). Similarly, small to large effects of the associations between 12-month postoperative change in CIQOL-35 scores and screening positive or not for cognitive impairment were found (global: d = 0.32 [95% CI, -0.59 to 1.23]; communication: d = 0.62 [95% CI, -0.31 to 1.54]; emotional: d = 0.26 [95% CI, -0.66 to 1.16]; entertainment: d = -0.005 [95% CI, -0.91 to 0.9]; environmental: d = -0.92 [95% CI, -1.86 to 0.46]; listening effort: d = -0.79 [95% CI, -1.65 to 0.22]; social: d = -0.51 [95% CI, -1.43 to 0.42])., Conclusions and Relevance: In this case series, screening scores were not associated with the degree of improvement of speech recognition or patient-reported outcome measures after cochlear implantation. Given the prevalence of screening positive for cognitive impairment before cochlear implantation, preoperative screening can be useful for early identification of potential cognitive decline. These findings support that screening scores may have a limited role in preoperative counseling of outcomes and should not be used to limit candidacy.

Importance: The association between cognitive function and outcomes in cochlear implant (CI) users is not completely understood, partly because some cognitive tests are confounded by auditory status. It is important to determine appropriate cognitive tests to use in a cohort of CI recipients., Objective: To provide proof-of-concept for using an adapted version of the National Institutes of Health (NIH) Toolbox Cognition Battery in a cohort of patients with CIs and to explore how hearing in noise with a CI is affected by cognitive status using the adapted test., Design, Setting, and Participants: In this prognostic study, participants listened to sentences presented in a speech-shaped background noise. Cognitive tests consisted of 7 subtests of the NIH Toolbox Cognition Battery that were adapted for hearing impaired individuals by including written instructions and visual stimuli. Participants were prospectively recruited from and evaluated at a tertiary medical center. All participants had at least 6 months' experience with their CI., Main Outcomes and Measures: The main outcomes were performance on the adapted cognitive test and a speech recognition in noise task., Results: Participants were 20 adult perilingually or postlingually deafened CI users (50% male participants; median [range] age, 66 [26-80] years old). Performance on a sentence recognition in noise task was negatively associated with the chronological age of the listener (R2 = 0.29; β = 0.16; standard error, SE = 0.06; t = 2.63; 95% confidence interval, 0.03-0.27). Testing using the adapted version of the NIH Toolbox Cognition Battery revealed that a test of processing speed was also associated with performance, using a standardized score that accounted for contributions of other demographic factors (R2 = 0.28; 95% confidence interval, -0.42 to -0.05)., Conclusions and Relevance: In this prognostic study, older CI users showed poorer performance on a sentence-in-noise test compared with younger users. This poorer performance was correlated with a cognitive deficit in processing speed when cognitive function was assessed using a test battery adapted for participants with hearing loss. These results provide initial proof-of-concept results for using a standardized and adapted cognitive test battery in CI recipients.

Importance: Cochlear implantation is highly effective at improving hearing outcomes, but results have been limited to groupwise analysis. That is, limited data are available for individual patients that report comparisons of preoperative aided speech recognition and postimplantation speech recognition., Objective: To assess changes in preoperative aided vs postoperative speech recognition scores for individual patients receiving cochlear implants when considering the measurement error for each speech recognition test., Design, Setting, and Participants: This cross-sectional study used a prospectively maintained database of patients who received cochlear implants between January 1, 2012, and December 31, 2017, at a tertiary, university-based referral center. Adults with bilateral sensorineural hearing loss undergoing cochlear implantation with 6- or 12-month postoperative measures using 1 or more speech recognition tests were studied., Exposures: Cochlear implantation., Main Outcomes and Measures: Postoperative word recognition (consonant-nucleus-consonant word test), sentence recognition (AzBio sentences in quiet), and sentence recognition in noise (AzBio sentences in +10-dB signal-to-noise ratio) scores, and association of each speech recognition score change with aided preoperative score to each test's measurement error., Results: Analysis of data from a total of 470 implants from 323 patients included 253 male (53.8%) patients; the mean (SD) age was 61.2 (18.3) years. Most patients had statistically significant improvement in all speech recognition tests postoperatively beyond measurement error, including 262 (84.8%) for word recognition, 226 (87.6%) for sentence recognition, and 33 (78.6%) for sentence recognition in noise. A small number of patients had equivalent preoperative and postoperative scores, including 45 (14.5%) for word recognition, 28 (10.9%) for sentence recognition, and 9 (21.4%) for sentence recognition in noise. Four patients (1.6%) had significantly poorer scores in sentence recognition after implantation. The associations between age at implantation and change in speech recognition scores were -0.12 (95% CI, -0.23 to -0.01) for word recognition, -0.22 (95% CI, -0.34 to -0.10) for sentence recognition, and -0.10 (95% CI, -0.39 to 0.21) for sentence recognition in noise. Patients with no significant improvement were similarly distributed between all preoperative aided speech scores for word recognition (range, 0%-58%) and sentence recognition (range, 0%-56%) testing., Conclusions and Relevance: In this cross-sectional study, with respect to preoperative aided speech recognition, postoperative cochlear implant outcomes for individual patients were largely encouraging. However, improvements in scores for individual patients remained highly variable, which may not be adequately represented in groupwise analyses and reporting of mean scores. Presenting individual patient data from a large sample of individuals with cochlear implants provides a better understanding of individual differences in speech recognition outcomes and contributes to more complete interpretations of successful outcomes after cochlear implantation.