Cochlear Implants
by Cochlear Guest Author

Science Spotlight: Speech Understanding and Quality-of-Life Outcomes After Cochlear Implantation

November 16, 2020
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Assessment of Speech Understanding After Cochlear Implantation in Adult Hearing Aid Users

A Nonrandomized Controlled Trial

Buchman CA, Herzog JA, McJunkin JL, et al.

Hearing and Quality-of-Life Outcomes After Cochlear Implantation in Adult Hearing Aid Users 65 Years or Older

A Secondary Analysis of a Nonrandomized Clinical Trial

Wick CC, Kallogjeri D, McJunkin JL, et al.

Purpose

To measure speech understanding in quiet, speech understanding in noise, and health utility using a cochlear implant and hearing aid (bimodal hearing) in 96 subjects versus their pre-operative condition of two hearing aids (HAs).

Key messages

Significant improvement was seen at six months post-surgery in the areas of speech perception in quiet, speech perception in noise, perceived health utility and subjective assessment of disability in subjects with and without mild cognitive impairment. Of interest, the clinically meaningful audiometric and quality of life (QoL) benefits demonstrated by older adults suggest that cochlear implantation may facilitate healthy aging.

Methods

  • Non-randomized controlled trial, multicenter, prospective, repeated measures design
  • 13 clinical sites
  • 100 subjects age 18 years and older with postlinguistic onset of bilateral moderate sloping to profound sensorineural hearing loss with an aided CNC word score of ≤40% in the ear to be implanted and ≤50% in the contralateral ear

Subjects were experienced HA users and completed objective speech perception testing and subjective QoL surveys prior to implantation. All enrolled subjects were implanted with a CI532 electrode, and used a Nucleus® 7 Sound Processor on the implanted ear and a new ReSound hearing aid on the contralateral ear. Subjects were seen by their clinicians at 1m, 3m, 6m and 12m post-activation, with endpoint measurements collected at the 6m visit. Subjects also completed a post-operative high-resolution CT scan to confirm electrode placement.

Results

Ninety-six subjects completed the six-month endpoint visit. Three serious adverse events requiring revision surgery occurred and all resolved without sequelae. By six months after activation, the average pre-operative CNC word score of 14.6% more than quadrupled to 60.9% in the implanted ear (change of 46.3 percentage points), and AzBio sentence scores at +10 SNR improved from 14.8% to 42.7% (change of 27.9 percentage points). In the binaural condition (N=94) CNC word scores increased from 28.8% with HAs to 69.2% using the bimodal solution of the Nucleus 7 and Resound hearing aid together (change of 40.5 percentage points), and the average AzBio sentences +10 SNR score of 31.8% rose to 55.9% (change of 24.1 percentage points) as shown in Figure 1. 

Statistically significant and clinically important improvements in the Health Utility Index 3 (HUI3) and the Speech, Spatial and Qualities of Sound survey (SSQ49) were evident at six months. The HUI3, which evaluates a variety of health attributes, saw the largest average score increase in the Hearing domain (.30) which directly contributed to a boost in the overall health-related QoL score from .46 to .64. (change of .18 points). Improvements were seen on the SSQ49 in all three subcategories, with the total score shifting from 3.2 using HAs to 5.7 using the bimodal solution (change of 2.5 points).

Eighty-one subjects were evaluated with the Montreal Cognitive Assessment (MoCA), and 48 of those subjects demonstrated mild cognitive impairment prior to implantation; however, as a group, the speech perception improvements of this cohort trended similarly to that of the entire study sample (Figure 2and Figure 3). Likewise, the subjects age 65+ (N=70) showed a substantial increase in performance with a score gain of 44.1 and 24.5 percentage points on CNC words and AzBio sentences +10 respectively in the implanted ear, and 37.2 and 21.6 percentage points in the bimodal condition (Figure 4). It is important to note that there were no major adverse events reported in this group, indicating a similar and acceptable risk profile to that of younger subjects.   

Conclusions

Cochlear implantation surgery is safe and can greatly improve a person’s ability to understand speech in quiet and noise, thus improving QoL. These advantages were evident across the larger study group, as well as within the subgroups of those with mild cognitive impairment and those over the age of 65. The significant differences shown in performance and satisfaction scores when using a cochlear implant emphasize that individuals with moderate sloping to profound or worse sensorineural hearing loss should be offered a cochlear implant evaluation when their HAs are not providing enough benefit.

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Citation:

  1. Buchman CA, Herzog JA, McJunkin JL, et al. Assessment of Speech Understanding After Cochlear Implantation in Adult Hearing Aid Users: A Nonrandomized Controlled Trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.1584
  2. Wick CC, Kallogjeri D, McJunkin JL, et al. Hearing and Quality-of-Life Outcomes After Cochlear Implantation in Adult Hearing Aid Users 65 Years or Older: A Secondary Analysis of a Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.1585

Authors & Affiliations:

Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri

Craig A. Buchman, MD (1,2)

Jacques A. Herzog, MD (1,2)

Jonathan L. McJunkin, MD (1,2)

Cameron C. Wick, MD (1,2)

Nedim Durakovic, MD (1,2)

Jill B. Firszt, PhD (1,2)

Laura K. Holden, AuD (2)

Dorina Kallogjeri, MD, MPH (1,2)

Statistics Editor, JAMA Otolaryngology–Head & Neck Surgery

Dorina Kallogjeri, MD, MPH (1,2)

This article is intended to serve as a resource for clinicians to help keep up to date with current clinical literature and is intended for professionals only. Clinical literature is based on research, which may include the experimental use of new or currently available products and technologies. Therefore, literature presented on this blog may represent use of Cochlear products that does not align with the intended use or indications approved by regulatory bodies, also known as off-label use. Cochlear does not condone any off-label use of its products, and it is not Cochlear’s intent to promote off-label use by providing this blog as a resource to clinicians.

This content is meant for professional use. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information. Views expressed are those of the individual. Consult your health professional to determine if you are a candidate for Cochlear technology.

All figures are our own.

For compatibility information and devices visit www.Cochlear.com/compatibility and resound.com/compatibility. For a list of compatible ReSound hearing aids visit www.Cochlear.com/nucleus/compatibility

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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Dr. Tribulski

Inclusivity in video games

July 8, 2022

By Kathryn Tribulski, AuD

Why those with hearing loss can be left behind in the video game world

Below is a timeline of world events that led to a realization that as providers, we can do so much more in terms of access for our patients:

● March 11th, 2020 the World Health Organization (WHO) declares COVID-19 a global pandemic

            ● March 13th, 2020 COVID-19 is declared a National Emergency

            ● March 19th, 2020 the first state orders a stay at home order[i]

            ● March 20th, 2020 Animal Crossing New Horizons from Nintendo has its world-wide

release[ii]

● March 24th, 2020 Kat Tribulski, AuD, tries desperately to find a Nintendo Switch™…. but there is nothing in a 100-mile radius.

In 2020, many like myself searched for the latest and greatest in escapism through video games.  But those with hearing loss, particularly cochlear implant users, seemed to be left behind. With the world locked down, many turned to technology as a social outlet in addition to a form of escapism.  It was at this point I realized how many of my patients were at yet another deficit with their devices. Hearing loss professionals are often asked to educate device users on integrating technology with phones/tablets and it’s time that we expand this to video game systems.

The psychosocial benefits of video games have been debated; however, recent studies show that video games do not cause harm in terms of psychosocial development.[iii] The unfortunate truth is that those with hearing loss are not granted the same access to this form of escapism and outlet for socialization – video games currently have rating systems including the rating “E for everyone”, which isn’t necessarily true. 

In an article from October 2020, Melanie Ashford shares, “Unlike many other gamers, I am immediately at a disadvantage,” citing footstep noise, bonus level/item noises and chat functions without captions, therefore limiting access to some with hearing loss. It seems that even with the increased technological innovation such as the Nucleus® 7 iPhone compatibility and Bluetooth® streaming capability, there is still more work to be done. 

While I don’t personally have hearing loss, I approached my own video game experience and started to specifically look to see how my cochlear implant patients could access all the auditory functions some games have to offer. In many single player games remote technology like a TV Streamer or a Mini Microphone 2+ allow for auditory access; however, that access can be dependent on the patient’s access to and understanding based on their MAPping and rehabilitation model.

As video games become even more engrained in our culture, all ages of users should have some equity in terms of ability to play. In a recent Captel blog post from December 2021, hearing loss friendly adjustments to game development were shared including touch feedback (vibratory control features), visual cues, dialogue to background noise adjustment options, subtitles and captioning as some integration options to allow access.[iv]  The industry is changing and trying to address these issues; for example in a June 2020 article to The Verge, lead game designer for The Last of Us Part II Emilia Schatz is quoted as stating, “accessibility for us is about removing barriers that are keeping players from completing a game. It’s not about dumbing down a game or making a game easy. What do our players need in order to play the game in parity with everyone else?”.[v]  This game won 43 of the 94 nominations for game awards, so the disability access did not seem to negatively impact its reception – if anything it helped.

Video games are quickly becoming engrained into our culture and research has shown that they are tools used by a variety of generations for connection and growth.[vi] As the world continues to change, those with hearing loss shouldn’t be left behind and it’s our duty as hearing loss professionals to embrace those changes and assist, advocate and educate so that they are not.

Read this Cochlear ProNews article to read more from professionals on increasing access for those with hearing loss.

[i] Staff A. A Timeline of COVID-19 Developments in 2020. AJMC. https://www.ajmc.com/view/a-timeline-of-covid19-developments-in-2020. Published 2022. Accessed May 1, 2022.

[ii] Pearce K, Yip J, Lee J et al. Families Playing Animal Crossing Together: Coping With Video Games During the COVID-19 Pandemic. Games Cult. 2021:155541202110561. doi:10.1177/15554120211056125 and Donald P. Bellisario College of Communications at Penn State. Bellisario.psu.edu. https://www.bellisario.psu.edu/medialab/research-article/animal-crossing-usage-during-the-covid-19-pandemic1. Published 2022. Accessed May 1, 2022.

[iii] Lobel A, Engels R, Stone L, Burk W, Granic I. Video Gaming and Children’s Psychosocial Wellbeing: A Longitudinal Study. J Youth Adolesc. 2017;46(4):884-897. doi:10.1007/s10964-017-0646-z

[iv] Hearing Loss Accessibility Features in Video Games. CapTel. https://www.captel.com/2021/12/hearing-loss-accessibility-features-in-video-games/#:~:text=One%20of%20the%20most%20common%20hearing%20loss%20accessibility,well%20they%20are%20subtitled%20%28among%20other%20accessibility%20questions%29. Published 2022. Accessed May 1, 2022.

[v] The Last of Us Part II isn’t just Naughty Dog’s most ambitious game — it’s the most accessible, too. The Verge. https://www.theverge.com/21274923/the-last-of-us-part-2-accessibility-features-naughty-dog-interview-ps4. Published 2022. Accessed May 1, 2022.https://www.theverge.com/21274923/the-last-of-us-part-2-accessibility-features-naughty-dog-interview-ps4

[vi] Marston H, Kowert R. What role can videogames play in the COVID-19 pandemic?. Emerald Open Research. 2020;2:34. doi:10.35241/emeraldopenres.13727.1

The Bluetooth® word mark and logos are registered trademarks owned by Bluetooth SIG, Inc. and any use of such marks by Cochlear is under license.

For compatibility information visit www.cochlear.com/compatibility

About the author:

Dr. Kat Tribulski is the Cochlear Implant Coordinator at Nemours Children’s Health in Orlando, FL.  In addition to her role as implant coordinator she is a full-time pediatric audiologist at Nemour’s.  Prior to working at Nemour’s Dr. Tribulski was the Pediatric Cochlear Implant director and Tufts Medical Center and Tufts Children’s Hospital in Boston, MA.  She is currently a member of the ASHA and the ACIA. Dr. Tribulski earned her doctorate in Audiology at Salus University in 2016.  She completed her externship at Eastern Virginia Medical School and The Children’s Hospital of the King’s Daughter in Norfolk, VA with a focus on cochlear implants.  In her free time she enjoys video games, board games and her dog Lilly.

Hearing 20/20

20/20 hearing makes it to Hollywood – The importance of knowing your PTA

August 2, 2021

By Patti Trautwein, MA, AuD, Vice President, Market Access & Reimbursement

What is normal hearing? When I asked that question among family, friends, and colleagues in early 2019 the answer was a sobering “I do not know.”  Yet, most could quickly rattle off measures for normal vision, blood pressure, cholesterol and body mass index. 1   

As hearing health professionals, we know how important the sense of hearing is to communicate and engage with others throughout one’s life. The COVID-19 pandemic requiring masking and social distancing has further highlighted the relevance of hearing health.2 Unfortunately, the lack of a common metric for hearing health, limits the understanding of consumers and primary care providers on how to prevent and treat hearing loss.

In a recent JAMA Otolaryngology–Head & Neck Surgery publication, Frank Lin, MD, PhD and Nicholas Reed, AuD, suggest that the otolaryngology and audiology community converge on the 4-frequency pure-tone average (PTA) as a universal metric for hearing health.3 Further, the 2021  World Report on Hearing from the World Health Organization defined grades of hearing loss using the PTA. 4

On world hearing day last year, a Hearing 20/20 campaign initiated public education on normal hearing using the PTA as a standard metric.

So, imagine the thrill receiving notes from family, friends and colleagues who recently watched the new movie The Hitman’s Wife’s Bodyguard with Samuel L Jackson, Salma Hayek and Ryan Reynolds where character Michael Bryce played by Ryan Reynolds states,“ I have 20/20 hearing, I can hear you.”

While diagnostically, we need a comprehensive battery to assess hearing function, the PTA as a simple, universal metric can help raise awareness of hearing health in the public vernacular on the big screen and hopefully off!

Read more about Hearing 20/20 here!

Patti

Patricia’s 25 years in the hearing healthcare industry includes roles in research and clinical studies, product management, education and training, sales and marketing. As Cochlear America’s VP of Market Access, Patricia is responsible for the reimbursement strategy of our product and service innovations, value-based evidence and economics, government affairs and related advocacy. Prior to her role in Market Access, Patricia served as the VP of Marketing, where she was responsible for the Marketing Strategy, Communications and Public Relations, Brand Ambassador Program and Product Management.

References:

  1. https://pronews.cochlear.com/what-is-normal-hearing-why-a-simple-and-consistent-answer-is-needed/
  2. https://www.hearingloss.org/hearing-loss-pandemic-survey/
  3. Lin FR, Reed NS. The Pure-Tone Average as a Universal Metric-Knowing Your Hearing. JAMA Otolaryngol Head Neck Surg. 2020 Dec 23. doi: 10.1001/jamaoto.2020.4862. Epub ahead of print. PMID: 33355634.
  4. https://www.who.int/publications/i/item/world-report-on-hearing
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This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

 

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