Cochlear Implants
by Cochlear Guest Author

New considerations for recommending a cochlear implant evaluation

March 11, 2021
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Every patient’s hearing loss journey is unique, and each patient may require a different treatment option. The continuum of care for hearing loss isn’t a linear pathway so being aware of all technologies to manage your patient’s hearing loss can help you find the best solution for them.

Hearing loss is seen by many to be a communication disorder; it is now known to have much wider-ranging consequences that can significantly impact a person’s quality-of-life. Age-related hearing loss has been shown to also lead to increased accidental falls, hospitalizations, loneliness and social isolation.1 A multi-faceted approach to the treatment of hearing for patients is needed from a collaborative network of providers to meet the needs of your patients.

Innovations in hearing health care have made the way for over-the-counter (OTC) hearing devices and personal sound-amplification products (PSAP’s) enabling patients access outside of the traditional clinical practice. However, hearing care providers are the best professionals to speak to the different hearing solutions for their patients. As a hearing care provider, you have the unique ability to

differentiate your practice by counseling on all hearing loss treatment options and providing comprehensive services to support optimal performance.

If hearing aid technology is not providing your patient the ability to hear and understand speech, a cochlear implant may be the next step. Traditionally, cochlear implants have been considered a treatment option only for those who have lost all of their hearing. Health benefits and improved hearing outcomes2 support the need to shorten the duration of hearing loss and consider cochlear implantation before hearing loss progresses to profound. For patients with hearing losses greater than or equal to 60 dB HL (pure tone average 0.5, 1k, 2kHz) and speech understanding less than or equal to 60%,3 referral for a cochlear implant evaluation should be pursued.

To learn more read this Journal Club or visit www.cochlear.us/THJ

* This provides a recommendation of when an adult may be referred for a cochlear implant

evaluation, but does not guarantee candidacy based on indications. For the approved Cochlear

Nucleus Indications, please refer to the important information booklet or physician’s guides.

References:

1. Deal JA, Reed NS, Kravetz AD, et al. Incident Hearing Loss and Comorbidity: A Longitudinal

Administrative Claims Study. JAMA Otolaryngol Head Neck Surg. 2019;145(1):36–43. doi:10.1001/

jamaoto.2018.2876.

2. Derinsu U, Yüksel M, Geçici CR, Çiprut A, Akdeniz E. Effects of residual speech and auditory deprivation

on speech perception of adult cochlear implant recipients.

3. Zwolan TA, Schvartz-Leyzac KC, Pleasant T. Development of a 60/60 guideline for referring adults for

a traditional Cochlear implant candidacy evaluation. Otol Neurotol 2020;41:895-900.

Author

Cochlear Guest Author

In an effort to keep our content fresh and reflective of a diverse industry, Cochlear Americas features a mix of employees and professional partners to contribute to Cochlear ProNews as Guest Authors.

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Surgical Outcomes of CI532 Clinical Study: Does electrode placement impact hearing performance?

July 8, 2019

In the spring of this year, sixty-five otology and audiology professionals came together for Cochlear NEXT – a program focused on learning and discussion regarding Cochlear’s CI532 Clinical Study and the respective implications of this emerging and impactful data.

The following information reviews the primary talking points and output from the day’s first topic.

 Surgical Outcomes of CI532 Clinical Study: Does electrode placement impact performance?

Presenters:

  • Wade Colburn, Biomedical Engineer and Product Manager, Cochlear Implants, Cochlear Americas
  • Jonathan McJunkin, MD, Surgeon and CI532 study Investigator, Washington University in St. Louis

A review of published (non-CI532) evidence demonstrates prevailing thought regarding the relationship between electrode placement and hearing performance, prior to the CI532 study:

  • Pre-curved arrays may be less likely to be placed in scala tympani 1
  • ERW and RW may lead to more consistent scala tympani placement 1, 2, 3
  • Electrode placement within scala tympani significantly impacts patient performance 4

When asked in a pre-event survey, only 66% of surgeons agreed that consistent placement in the scala tympani is as likely to occur with CI532 as it is with lateral wall electrode arrays. There was also some difference of opinion on the importance of electrode placement, with only 64% of surgeons agreeing that proximity of the array to the modiolus has an impact on hearing performance.

However, CI532 clinical study results demonstrate that rates of scala tympani placement of the CI532 electrode are on par with previously cited studies using lateral wall electrodes, with 89% of electrodes being successfully inserted in the scala tympani 5. A mean wrapping factor of 59.6% – which describes the proximity of the electrode to the modiolus – further illustrates the consistency of surgical outcomes using the Slim Modiolar electrode5.  For reference, Holden et al. showed that patients with a wrapping factor closer to 60% positively correlated with better hearing performance6.

 Following presentation of the data and dynamic group discussions, participant consensus shifted considerably according to the post-event survey, with now 86% of surgeons agreeing that consistent placement in the scala tympani is as likely to occur with CI532 as it is with lateral wall electrode arrays. Further, 82% supported that proximity of the electrode array to the modiolus has an impact on hearing performance.

Additional discussion focused on the topic of surgical approach, as one of the key design goals of CI532 was an electrode that is indicated for round window (RW), extended round window (ERW), and cochleostomy – allowing surgeons to utilize flexibility and preference when determining surgical technique.  Live polling during the NEXT program demonstrated a strong preference for the RW and ERW approaches confirming a perceived industry shift away from cochleostomy as surgeons strive to limit structural trauma caused by implant insertion.

In summary, a review of current and historical data, combined with dynamic large and small group discussions, drove a measurable change in participant perception regarding the positive correlation between electrode placement and hearing performance.

Don’t miss the next installment of our Cochlear NEXT proceedings: Clinical Outcomes of CI532 Clinical Study: A new clinical care approach. Subscribe to our ProNews Blog using the panel to the left to ensure you receive future updates!

 

© Cochlear Limited 2019. All rights reserved. Hear now. And always and other trademarks and registered trademarks are the property of Cochlear Limited or Cochlear Bone Anchored Solutions AB. The names of actual companies and products mentioned herein may be the trademarks of their respective owners.

 References

  1. O’Connell BP, Hunter JB, Wanna GB. The importance of electrode location in cochlear implantation. Laryngoscope Investig Otolaryngol. 2016;1(6):169–174. Published 2016 Nov 29. doi:10.1002/lio2.42
  2. Wanna GB, Noble JH, Carlson ML, et al. Impact of electrode design and surgical approach on scalar location and cochlear implant outcomes. Laryngoscope. 2014;124 Suppl 6(0 6):S1–S7. doi:10.1002/lary.24728
  3. Briggs RJ1, Tykocinski M, Stidham K, Roberson JB. Cochleostomy site: implications for electrode placement and hearing preservation. Acta Otolaryngol. 2005 Aug;125(8):870-6.
  4. Shaul C, Dragovic AS, Stringer AK, O’Leary SJ, Briggs RJ. Scalar localization of peri-modiolar electrodes and speech perception outcomes. J Laryngol Otol 2018; 1- https://doi.org/10.1017/S0022215118001871
  5. Preliminary Data on File: US Multicenter CI532 Study. 2018.
  6. Holden et al. Factors affecting open-set word recognition in adults with cochlear implants. Ear and Hearing. 2013; 34:342-60. https://www.ncbi.nlm.nih.gov/pubmed/23348845

 

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Auditory perception and training for adults with cochlear implants

June 29, 2021

Review Prepared by: Janette Oliver, Global Outcomes & Rehabilitation Manager, Cochlear Limited

BA., Dip Teach., M.Ed., PG Dip.Ed(Hearing Impaired) Dip.Aud., MA., MAudSA,CCP, Cert AVT ®

Adults with cochlear implants experience a wide variety of outcomes which may be partly explained by differences in auditory perception and the way they process information. New research casts light on how outcomes in adults with cochlear implants may be improved.

Auditory perception processes

There are two general processes involved in auditory perception. Bottom-up processing is about processing information as it is received and refers to the way perception is built up from small pieces of sensory input.

Top-down processing, however, refers to perception that is driven by cognition and how the brain considers context and applies what is known and what the individual is expecting to perceive and fills in the gaps.

In considering outcomes for adult cochlear implant recipients, research indicates that only about 50% of the variability in outcomes observed in this population can be satisfactorily explained. Furthermore, those factors that have been confirmed to contribute to variability seem largely concerned with “bottom up” auditory sensitivity processes associated with the cochlear implant signal or the peripheral auditory system.1-4

However, it is highly likely that “top-down” cognitive and linguistic factors critically assist cochlear implant users to recognize speech and these factors may well help explain additional variability in outcomes for adults.

Drouin and Theodore (2020) take an interdisciplinary perspective in their research which seeks to bridge findings from the clinical rehabilitation literature with findings from the psycholinguistics domain, highlighting the role of top-down lexical feedback on adaptation to atypical speech input such as a cochlear implant signal.

Adults continue to learn new skills, but often require more exposure or practice to do so. Even extended passive exposure may therefore be insufficient for adult cochlear implant listeners.

Active auditory training

The authors argue that lexically-oriented active auditory training may be necessary to optimally target the plasticity mechanisms underlying improvements in speech perception for listeners adapting to a CI. 

In a recent state-of-the-art review, Stropahl et al (2020) conclude that intensive auditory-cognitive training protocols are a valid tool to improve auditory communication skills.

Individuals with hearing loss seem to benefit the most using a combination of sensory rehabilitation (device fitting) and training to enhance holistic auditory rehabilitation.

The variability experienced in adults with hearing loss is potentially explained by differences in cognitive abilities such memory, speed of processing and executive function.

As such, active training of auditory and cognitive skills in combination is emerging as a path to enhance communication skills for adults with hearing loss.

Read more on Cochlear ProNews.

References

1. Dornhoffer JR, Reddy P, Meyer TA, Schvartz-Leyzac KC, Dubno JR, McRackan TR.(2021) Individual Differences in Speech Recognition Changes After Cochlear Implantation. JAMA Otolaryngol Head Neck Surg. Published online January 07, 2021. doi:10.1001/jamaoto.2020.5094

2.Drouin, J. R., & Theodore, R. M. (2020). Leveraging interdisciplinary perspectives to optimize auditory training for cochlear implant users. Language and Linguistics Compass. https://doi.org/10.1111/lnc3.12394 

3.Glennon E, Svirsky MA, Froemke RC. (2020) Auditory cortical plasticity in cochlear implant users. Curr Opin Neurobiol. 2020 Feb;60:108-114. doi: 10.1016/j.conb.2019.11.003. Epub 2019 Dec 18. PMID: 31864104; PMCID: PMC7002179.

4.Moberly AC, Bates C, Harris MS, Pisoni DB. (2016) The Enigma of Poor Performance by Adults with Cochlear Implants. Otol Neurotol. 2016 Dec;37(10):1522-1528. doi: 10.1097/MAO.0000000000001211. PMID: 27631833; PMCID: PMC5102802.

5. Strophal, M., Besser, J., & Launer, S. (2020). Auditory Training Supports Auditory Rehabilitation: A State-of-the-Art Review [Review]. Ear and Hearing, 41(4), 697-704. https://doi.org/10.1097/aud.0000000000000806

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