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Purpose: Our aim was to make audible for normal-hearing listeners the Mickey Mouse™ sound quality of cochlear implants (CIs) often found following device activation. Method: The listeners were 3 single-sided deaf patients fit with a CI and who had 6 months or less of CI experience. Computed tomography imaging established the location of each electrode contact in the cochlea and allowed an estimate of the place frequency of the tissue nearest each electrode. For the most apical electrodes, this estimate ranged from 650 to 780 Hz. To determine CI sound quality, a clean signal (a sentence) was presented to the CI ear via a direct connect cable and candidate, and CI-like signals were presented to the ear with normal hearing via an insert receiver. The listeners rated the similarity of the candidate signals to the sound of the CI on a 1- to 10-point scale, with 10 being a complete match. Results: To make the match to CI sound quality, all 3 patients need an upshift in formant frequencies (300-800 Hz) and a metallic sound quality. Two of the 3 patients also needed an upshift in voice pitch (10-80 Hz) and a muffling of sound quality. Similarity scores ranged from 8 to 9.7. Conclusion: The formant frequency upshifts, fundamental frequency upshifts, and metallic sound quality experienced by the listeners can be linked to the relatively basal locations of the electrode contacts and short duration experience with their devices. The perceptual consequence was not the voice quality of Mickey Mouse™ but rather that of Munchkins in "The Wizard of Oz" for whom both formant frequencies and voice pitch were upshifted.

Purpose: The purpose of this exploratory study was to (a) construct a virtual reality (VR) test environment to measure speech recognition in noise (SIN) and localization, and (b) use the VR test environment to establish degree of binaural hearing benefit among a small number of adults with single-sided deafness (SSD) using a cochlear implant (CI). Method: This pilot study included five adults implanted for SSD. The test environment was composed of an eight-speaker array that delivered restaurant noise and Institute of Electrical and Electronics Engineers sentences. VR head-mounted display goggles delivered a video recording of a busy restaurant. Participants completed SIN and localization in two conditions: (a) normal-hearing ear and a CI on the contralateral SSD side (CI-ON) and (b) normal-hearing ear and unaided on the contralateral SSD side (CI-OFF). Results: Overall, CI benefits for SIN and localization within the VR test environment were improved for some participants, although not all. CI benefit for SIN and localization was dependent on speaker location. Conclusions: VR test environments present new opportunities for studying SIN and localization abilities in participants with CIs. This pilot study shows that, within a VR test environment, degree of CI benefit among SSD participants for SIN and localization varies across speaker location and across participants. [ABSTRACT FROM AUTHOR]

The indications for cochlear implantation have expanded over time due to evidence demonstrating identification and implantation of appropriate cochlear implant (CI) candidates lead to significant improvements in speech recognition and quality of life (QoL). However, clinical practice is variable, with some providers using outdated criteria and others exceeding current labeled indications. As a results, only a fraction of those persons who could benefit from CI technology receive it. This document summarizes the current evidence for determining appropriate referrals for adults with bilateral hearing loss into CI centers for formal evaluation by stressing the importance of treating each ear individually and a "revised 60/60 rule". By mirroring contemporary clinical practice and available evidence, these recommendations will also provide a standardized testing protocol for CI candidates using a team‐based approach that prioritizes individualized patient care. This manuscript was developed by the Adult Cochlear Implantation Candidacy Task Force of the American Cochlear Implant Alliance using review of the existing literature and clinical consensus. Level of Evidence: N/A Laryngoscope, 134:S1–S14, 2024 [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to train and test supervised machine‐learning classifiers to predict acoustic hearing preservation after CI using preoperative clinical data. Study Design: Retrospective predictive modeling study of prospectively collected single‐institution CI dataset. Methods: One hundred and seventy‐five patients from a REDCap database including 761 patients >18 years who underwent CI and had audiometric testing preoperatively and one month after surgery were included. The primary outcome variable was the lowest quartile change in acoustic hearing at one month after CI using various formulae (standard pure tone average, SPTA; low‐frequency PTA, LFPTA). Analysis involved applying multivariate logistic regression to detect statistical associations and training and testing supervised learning classifiers. Classifier performance was assessed with numerous metrics including area under the receiver operating characteristic curve (AUC) and Matthews correlation coefficient (MCC). Results: Lowest quartile change (indicating hearing preservation) in SPTA was positively associated with a history of meningitis, preoperative LFPTA, and preoperative SPTA. Lowest quartile change in SPTA was negatively associated with sudden hearing loss, noise exposure, aural fullness, and abnormal anatomy. Lowest quartile change in LFPTA was positively associated with preoperative LFPTA. Lowest quartile change in LFPTA was negatively associated with tobacco use. Random forest demonstrated the highest mean classification performance on the validation dataset when predicting each of the outcome variables. Conclusions: Machine learning demonstrated utility for predicting preservation of residual acoustic hearing in patients undergoing CI surgery, and the detected associations facilitated the interpretation of our machine‐learning models. The models and statistical associations together may be used to facilitate improvements in shared clinical decision‐making and patient outcomes. Level of Evidence: 3 Laryngoscope, 134:926–936, 2024 [ABSTRACT FROM AUTHOR]

Background: Single-sided deafness (SSD) has functional, psychological, and social consequences. Interventions for adults with SSD include hearing aids and auditory implants. Benefits and harms (outcome domains) of these interventions are until now reported inconsistently in clinical trials. Inconsistency in reporting outcome measures prevents meaningful comparisons or syntheses of trial results. The Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) international initiative used structured communication techniques to achieve consensus among healthcare users and professionals working in the field of SSD. The novel contribution is a set of core outcome domains that experts agree are critically important to assess in all clinical trials of SSD interventions.Methods: A long list of candidate outcome domains compiled from a systematic review and published qualitative data, informed the content of a two-round online Delphi survey. Overall, 308 participants from 29 countries were enrolled. Of those, 233 participants completed both rounds of the survey and scored each outcome domain on a 9-point scale. The set of core outcome domains was finalised via a web-based consensus meeting with 12 participants. Votes involved all stakeholder groups, with an approximate 2:1 ratio of professionals to healthcare users participating in the Delphi survey, and a 1:1 ratio participating in the consensus meeting.Results: The first round of the survey listed 44 potential outcome domains, organised thematically. A further five outcome domains were included in Round 2 based on participant feedback. The structured voting at round 2 identified 17 candidate outcome domains which were voted on at the consensus meeting. Consensus was reached for a core outcome domain set including three outcome domains: spatial orientation, group conversations in noisy social situations, and impact on social situations. Seventy-seven percent of the remaining Delphi participants agreed with this core outcome domain set.Conclusions: Adoption of the internationally agreed core outcome domain set would promote consistent assessment and reporting of outcomes that are meaningful and important to all relevant stakeholders. This consistency will in turn enable comparison of outcomes reported across clinical trials comparing SSD interventions in adults and reduce research waste. Further research will determine how those outcome domains should best be measured. [ABSTRACT FROM AUTHOR]

Objective: Review a single institution's vestibular schwannoma (VS) microsurgery experience to determine (1) correlations between demographics, comorbidities, and/or surgical approach on hospital length of stay (LOS) and discharge disposition and (2) trends in surgical approach over time. Methods: Retrospective case series from a multidisciplinary skull base program at a tertiary care, academic hospital. All adult (>18 years) patients undergoing primary microsurgery for VS between 2008 and 2018 were included. Results: A total of 147 subjects were identified. Surgical approach was split between middle fossa (MF) (16%), retrosigmoid (RS) (35%), and translabyrinthine (TL) (49%) craniotomies. For the 8% of patients had other than routine (OTR) discharge. Mean LOS was significantly longer for patients undergoing RS than either MF or TL. Brainstem compression by the tumor was associated with longer LOS as were diagnoses of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease (PVD). For all discharges, the 40 to 50- and 50 to 60-year-old subgroups had significantly shorter LOS than the 70-years-and-older patients. For the 92% of patients routinely discharged, there was a significantly shorter LOS in the 40 to 50-year-olds compared to the 70-years-and-older patients. There was a significant shift in surgical approach from RS to TL over the study period. Conclusion: Over 90% of VS microsurgery patients were routinely discharged with a median hospital LOS of 3.2 days, both of which are consistent with published data. There is an inverse relationship between age and LOS with patients older than 70 years having significantly longer LOS. Brainstem compression, COPD, PVD, and the RS approach negatively affect LOS. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Objective: Our aim was to determine the effect of acute changes in cochlear place of stimulation on cochlear implant (CI) sound quality.Design: In Experiment 1, 5 single-sided deaf (SSD) listeners fitted with a long (28-mm) electrode array were tested. Basal shifts in place of stimulation were implemented by turning off the most apical electrodes and reassigning the filters to more basal electrodes. In Experiment 2, 2 SSD patients fitted with a shorter (16.5-mm) electrode array were tested. Both basal and apical shifts in place of stimulation were implemented. The apical shifts were accomplished by current steering and creating a virtual place of stimulation more apical that that of the most apical electrode.Results: Listeners matched basal shifts by shifting, in the normal-hearing ear, the overall spectrum up in frequency and/or increasing voice pitch (F0). Listeners matched apical shifts by shifting down the overall frequency spectrum in the normal-hearing ear.Conclusion: One factor determining CI voice quality is the location of stimulation along the cochlear partition. [ABSTRACT FROM AUTHOR]