A predictive model of cochlear implant performance in postlingually deafened adults
Faculty AdvisorSarah Poissant
Document TypeJournal Article
Aged, 80 and over
Persons With Hearing Impairments
Predictive Value of Tests
80 and over
Persons With Hearing Impairments
Predictive Value of Tests
Speech and Hearing Science
MetadataShow full item record
AbstractOBJECTIVE: To develop a predictive model of cochlear implant (CI) performance in postlingually deafened adults that includes contemporary speech perception testing and the hearing history of both ears. STUDY DESIGN: Retrospective clinical study. Multivariate predictors of speech perception after CI surgery included duration of any degree of hearing loss (HL), duration of severe-to-profound HL, age at implantation, and preoperative Hearing in Noise Test (HINT) sentences in quiet and HINT sentences in noise scores. Consonant-nucleus-consonant (CNC) scores served as the dependent variable. To develop the model, we performed a stepwise multiple regression analysis. SETTING: Tertiary referral center. PATIENTS: Adult patients with postlingual severe-to-profound HL who received a multichannel CI. Mean follow-up was 28 months. Fifty-five patients were included in the initial bivariate analysis. INTERVENTION(S): Multichannel cochlear implantation. MAIN OUTCOME MEASURES(S): Predicted and measured postoperative CNC scores. RESULTS: The regression analysis resulted in a model that accounted for 60% of the variance in postoperative CNC scores. The formula is (pred)CNC score = 76.05 + (-0.08 x DurHL(CI ear)) + (0.38 x pre-HINT sentences in quiet) + (0.04 x long sev-prof HL(either ear)). Duration of HL was in months. The mean difference between predicted and measured postoperative CNC scores was 1.7 percentage points (SD, 16.3). CONCLUSION: The University of Massachusetts CI formula uses HINT sentence scores and the hearing history of both ears to predict the variance in postoperative monosyllabic word scores. This model compares favorably with previous studies that relied on Central Institute for the Deaf sentence scores and uses patient data collected by most centers in the United States.
SourceRoditi RE, Poissant SF, Bero EM, Lee DJ. A predictive model of cochlear implant performance in postlingually deafened adults. Otol Neurotol. 2009 Jun;30(4):449-54. doi:10.1097/MAO.0b013e31819d3480. PubMed PMID: 19415041.
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/49261
Rachel Roditi participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.
Related ResourcesLink to article in PubMed
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Determining cochlear implant users' true noise tolerance: use of speech reception threshold in noise testingPoissant, Sarah F.; Bero, Eva M.; Busekroos, Lauren; Shao, Weiru (2014-03-01)OBJECTIVE: The speech perception abilities of cochlear implant (CI) recipients have significantly improved over the past decade. At the same time, clinical test batteries to measure their performance in noise remain mostly unchanged, resulting in ceiling-level performance for the most successful recipients. The goal of this study is to determine the true noise tolerance abilities of CI recipients using adaptive speech reception threshold (SRT) in noise testing. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary care hospital; CI program. PATIENTS: Ten CI users, either unilateral or bilateral, with HINT scores that equaled or exceeded 80% when administered with a fixed +10 dB signal-to-noise (SNR) ratio (i.e., HINT(+10dB)). INTERVENTION: The HINT with adaptive SNR levels and QuickSIN test were administered to measure noise tolerance at speech thresholds where 50% of the stimuli were correctly perceived. MAIN OUTCOME MEASURE(S): SRTs were measured for both the adaptive SNR HINT (i.e., HINT(50%)) and the QuickSIN test. These SRTs were compared with the fixed noise level HINT(+10dB) scores as well as to CNC monosyllable word perception scores. RESULTS: Despite small variance in performance levels on the HINT(+10dB), results of the HINT(50%) ( approximately 16 dB range) and QuickSIN ( approximately 12 dB range) tests demonstrate significant differences in noise tolerance levels among these CI recipients. CONCLUSION: For excellent CI users, use of adaptive speech threshold tests in noise better defines a user's actual ability to perceive speech than do fixed SNR level tests. SRT-in-noise tests have the advantage of being quick to administer, and the same stimuli can be used over a very wide range of performance levels. The use of adaptive SRT-in-noise tests should be considered a viable and valuable replacement of fixed SNR tests in the CI clinical test battery.
Cochlear implant electrode failure secondary to silicone touch-up during device manufacturingShao, Weiru (2013-09-01)STUDY DESIGN: Retrospective case report. SETTING: Tertiary referral cochlear implant center. PATIENT: A 21-year-old woman was implanted with Advanced Bionics HiFocus Clarion device without complication. Five years later, the patient presented with dizziness, fluctuating implant performance, and facial pain. INTERVENTION: Surgical exploration revealed a torn electrode silicon casing in conjunction with scar contraction bending the electrode against bony facial nerve canal at the facial recess. Suspension of the electrode such that the damaged portion was not in contact with mastoid cavity led to temporary resolution of symptoms. Explantation and reimplantation procedures were carried out 2 months later. RESULTS: Postexplantation device analysis by the manufacturer demonstrated silicone touch-up at the site of failure. Six years since reimplantation, the patient has remained symptom-free. It is very likely that the touch-up silicon weakened the electrode and, in conjunction with chronic scar contraction, led to the tear on the silicon casing. CONCLUSION: Isolated cochlear implant electrode failure is a rare but possible long-term complication in older generation devices. The author reports 1 case of implant device failure partly because of silicon touch-up that was applied at the location of electrode failure during its manufacturing process.
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