Responsible Imputation of Missing Speech Perception Testing Data & Analysis of 4,739 Observations and Predictors of Performance.

Objective: To address outcome heterogeneity in cochlear implant (CI) research, we built imputation models using multiple imputation by chained equations (MICEs) and K-nearest neighbors (KNNs) to convert between four common open-set testing scenarios: Consonant-Nucleus-Consonant word (CNCw), Arizona Biomedical (AzBio) in quiet, AzBio +5, and AzBio +10. We then analyzed raw and imputed data sets to evaluate factors affecting CI outcome variability.
Study Design: Retrospective cohort study of a national CI database (HERMES) and a nonoverlapping single-institution CI database.
Setting: Multi-institutional (32 CI centers).
Patients: Adult CI recipients (n = 4,046 patients).
Main Outcome Measures: Mean absolute error (MAE) between imputed and observed speech perception scores.
Results: Imputation models of preoperative speech perception measures demonstrate a MAE of less than 10% for feature triplets of CNCw/AzBio in quiet/AzBio +10 (MICE: MAE, 9.52%; 95% confidence interval [CI], 9.40-9.64; KNN: MAE, 8.93%; 95% CI, 8.83-9.03) and AzBio in quiet/AzBio +5/AzBio +10 (MICE: MAE, 8.85%; 95% CI, 8.68-9.02; KNN: MAE, 8.95%; 95% CI, 8.74-9.16) with one feature missing. Postoperative imputation can be safely performed with up to four of six features missing in a set of CNCw and AzBio in quiet at 3, 6, and 12 months postcochlear implantation using MICE (MAE, 9.69%; 95% CI, 9.63-9.76). For multivariable analysis of CI performance prediction, imputation increased sample size by 72%, from 2,756 to 4,739, with marginal change in adjusted R2 (0.13 raw, 0.14 imputed).
Conclusions: Missing data across certain sets of common speech perception tests may be safely imputed, enabling multivariate analysis of one of the largest CI outcomes data sets to date.
Competing Interests: Conflicts of Interest: C.P. and D.S.L. do not have conflicts of interest. J.A.H. is a consultant for Cochlear Ltd. C.A.B. is a consultant for Advanced Bionics, Cochlear Ltd., Envoy, and IotaMotion, and has equity interest in Advanced Cochlear Diagnostics, LLC. M.A.S. is a consultant for Cochlear Ltd.
(Copyright © 2023, Otology & Neurotology, Inc.)