Neuropsychological functions and audiological findings in elderly cochlear implant users: the role of attention in postoperative performance

Objectives: The present study aimed to investigate in a group of elderly CI users working memory and attention, conventionally considered as predictors of better CI performance and to try to disentangle the effects of these cognitive domains on speech perception, finding potential markers of cognitive decline related to audiometric findings. Methods Thirty postlingually deafened CI users aged >60 underwent an audiological evaluation followed by a cognitive assessment of attention and verbal working memory. A correlation analysis was performed to evaluate the associations between cognitive variables while a simple regression investigated the relationships between cognitive and audiological variables. Comparative analysis was performed to compare variables on the basis of subjects’ attention performance. Results: Attention was found to play a significant role in sound field and speech perception. Univariate analysis found a significant difference between poor and high attention performers, while regression analysis showed that attention significantly predicted recognition of words presented at Signal/Noise +10. Further, the high attention performers showed significantly higher scores than low attentional performers for all working memory tasks. Conclusion: Overall findings confirmed that a better cognitive performance may positively contribute to better speech perception outcomes, especially in complex listening situations. WM may play a crucial role in storage and processing of auditory-verbal stimuli and a robust attention may lead to better performance for speech perception in noise. Implementation of cognitive training in auditory rehabilitation of CI users should be investigated in order to improve cognitive and audiological performance in elderly CI users

Music perception and speech intelligibility in noise performance by Italian-speaking cochlear implant users.

Funder: Università degli Studi di Roma La SapienzaOBJECTIVE: The goal of this study was to investigate the performance correlations between music perception and speech intelligibility in noise by Italian-speaking cochlear implant (CI) users. MATERIALS AND METHODS: Twenty postlingually deafened adults with unilateral CIs (mean age 65 years, range 46-92 years) were tested with a music quality questionnaire using three passages of music from Classical Music, Jazz, and Soul. Speech recognition in noise was assessed using two newly developed adaptive tests in Italian: The Sentence Test with Adaptive Randomized Roving levels (STARR) and Matrix tests. RESULTS: Median quality ratings for Classical, Jazz and Soul music were 63%, 58% and 58%, respectively. Median SRTs for the STARR and Matrix tests were 14.3 dB and 7.6 dB, respectively. STARR performance was significantly correlated with Classical music ratings (rs = - 0.49, p = 0.029), whereas Matrix performance was significantly correlated with both Classical (rs = - 0.48, p = 0.031) and Jazz music ratings (rs = - 0.56, p = 0.011). CONCLUSION: Speech with competitive noise and music are naturally present in everyday listening environments. Recent speech perception tests based on an adaptive paradigm and sentence materials in relation with music quality measures might be representative of everyday performance in CI users. The present data contribute to cross-language studies and suggest that improving music perception in CI users may yield everyday benefit in speech perception in noise and may hence enhance the quality of listening for CI users

Temporal coding and music perception in bimodal listeners

Objective: Limited low frequency (LF) pitch and temporal fine structure (TFS) sensitivity have been thought to contribute significantly to poor music perception in cochlear implant (CI) lis- teners. Thus, this study aimed to evaluate music perception in relation to LF pitch perception and temporal coding, specifically in people with bimodal stimulation as a promising approach to improve spectro-temporal sensitivity in CI listeners. Methods: Eleven postlingually deafened bimodal listeners participated in the study (mean age = 55.5 years, range 36–75 years, SD = 11.7). LF pitch/TFS sensitivity was evaluated by using two recently developed tests: Harmonic Intonation (HI) and Disharmonic Intonation (DI). The music perception protocol was based on three audio files in the genres of Classical, Jazz and Soul music and a music quality questionnaire regarding four subjective aspects: Clarity, Pleasantness, Naturalness and General Quality of Sounds. Results: CI alone and bimodal findings showed statistically significant differences for both temporal coding and music perception. DI findings showed statistically significant correlations with music quality ratings (p < 0.05). Conclusion: Bimodal music quality ratings were significantly better, indicating a significant improvement in the quality of music towards being significantly more clear, more natural, more pleasant, and better quality. Similarly, bimodal HI/DI findings improved significantly, although the amount of benefit was greater for the DI task with spectral information only below 300 Hz. Significant DI correlations with music quality ratings supported the test to be more indicative of better temporal coding of LF residual hearing and its effects on music perception

Audiometria vocale adattiva e abilità linguistiche ricettive in bambini con impianto cocleare: risultati a lungo termine.

Razionale: I risultati a lungo termine in bambini con impianto cocleare (IC) sono importanti per guidare le famiglie e i professionisti nel processo terapeutico e di consulenza sulle aspettative e sui fattori coinvolti nei processi di sviluppo delle capacità comunicative, educative e occupazionali dei bambini che cresceranno con IC. Pochi studi in letteratura correlano gli esiti audiologici e il vocabolario recettivo e/o morfosintassi a lungo termine con i risultati all’ audiometria vocale adattiva. Materiali e metodi: Studio osservazionale retrospettivo su 52 soggetti con uso di IC a lungo termine, 34 unilaterali e 18 bilaterali (età media 19,5 anni; età media all’IC 33 mesi); follow-up medio 14,8. 34 soggetti sono stati impiantati con Advanced Bionics, 12 con Cochlear e 6 con dispositivi MedEl. I dati personali e audiologici sono stati correlati con l'audiometria vocale in quiete e con SNR +10/+5 e con i risultati dell' It-Matrix Sentence Test (It-MST). Il vocabolario ricettivo (PPVT) e la morfosintassi (TROG 2) sono stati correlati ai risultati dell' It-MST. Risultati: 51/52 soggetti sono stati valutati con It-MST, 7/52 con It-Matrix semplificato. L'età all'impianto era correlata positivamente agli esiti all’It-MST (r=0,3; p=0,032). Età all’It-MST e FF non erano correlati al It-MST mentre, come aspettato erano correlati all’età all’IC. I risultati dell' It-MST erano correlati negativamente a parole e frasi in silenzio (r=-5 / -0,7) e solo nel rumore con SNR +10 (r=-4). Il vocabolario ricettivo e la morfosintassi erano correlati negativamente ai risultati di It-MST (TROG 2 r=-0,6; p<0,001) (PPVT r=-0,5; p<0,001). Conclusioni: Questi dati a lungo termine contribuiscono ad aumentare la conoscenza degli effetti di variabili quali l’età all’IC sugli outcomes della riabilitazione uditiva con IC, e di come questo a lungo termine influenzi le abilità linguistiche

Transcutaneous bone conductive implants in patients with conductive/mixed hearing loss: audiological outcomes in noise condition

Background: Recently, the use of transcutaneous bone conduction implants (BCIs) has been increased. However, scarce data about BCI hearing recovery in noise conditions have been reported. Objectives: To investigate the audiological benefits obtained with transcutaneous BCI-Sophono Alpha System in noise conditions. To evaluate post-implantation clinical outcomes and patient satisfaction levels. Materials and methods: Fourteen patients suffering from conductive or mixed hearing loss implanted with the Sophono Alpha System were evaluated. Patients underwent physical examination, free-field pure-tone and speech audiometry both in unaided and aided conditions. The matrix sentence test was employed with fixed noise at 65 dB, and with a fluctuating primary signal, in three different conditions of noise presentations (S0/N0, S0/Ncontra, S0/Nipsi). Results: Hearing gain, expressed as the difference between pre-implant AC and post-implant SAS free field, was on average 26.7 dB. The unaided speech recognition score in quiet conditions had a mean value of 64.6%, and improved after SAS implantation, achieving mean values of 98.2%. SRT50 with the matrix sentence test improved in all three conditions of noise presentation. Conclusions: Sophono Alpha System devices represent a valid treatment option for hearing rehabilitation of patients with conductive or mixed hearing loss. The audiological results regarding hearing gain in noise conditions were good

Effects of the “Active Communication Education” program on hearing-related quality of life in a group of Italian cochlear implant elderly users

The present study was designed to evaluate the effects of the Active Communication Education (ACE) program on the social/emotional impacts of hearing loss (HL) in a group of older adults with cochlear implant (CI). Design: prospective cohort study design with a “within-subject” control procedure. Study sample: Twenty over-65 adults post-lingually deafened CI users. All subjects were required to be native Italian speakers, to have normal cognitive levels, no significant psychiatric conditions and/or diagnosed incident dementia and at least nine months of CI experienc. Materials and Methods: 20 participants were assessed using the Hearing Handicap Inventory for the Elderly (HHIE), the Geriatric Depression Scale (GDS) and the Speech, Spatial and Qualities of Hearing Scale (SSQ) before, during and afterwards with a one and six month follow up. The evaluation of cognitive and audiological characteristics was carried out prior to commencing the ACE program. Results: The ACE program had a positive impact by reducing the social/emotional impacts of HL. Participants seemed to benefit from a rehabilitative approach aimed at improving multilevel skills - such as, comprehension of audiological and hearing dimensions, acquisition of communicative, pragmatic and problem-solving strategiesand interaction and sharing of experiences with peers. Conclusion: The ACE program, although targeting older adults with moderate HL, also seemed to be of benefit for older adults with severe/profound HL CI users. An improvement in social and emotional adaptation to hearing difficulties can in turn significantly promote optimal use of CI in older adults, thereby possibly reducing the risk of losing motivation and engagement in their use and with rehabilitation protocols. Contribution to the field The present study represents the first attempt to evaluate the benefits of a group rehabilitation program with a holistic approach to deafness adapted to a group of elderly cochlear implantees. Considering the challenge that CI users face in daily communication, this study and the existing literature underline the need for rehabilitation programs that approach both audiological and extra-audiological variables. This program supported the participants in the retrieval and acquisition of multilevel skills such as understanding the audiological and auditory dimensions, the acquisition of communication, pragmatic, and problemsolving strategies. The results of the present study show how a communicative / rehabilitation program, which uses a problem solving and interactive methodology, can also be used with severe / profoundly deaf elderly IC users who still have the resources to cope with difficulties and get back into positive social relations. Effectively, the program has improved their level of socioemotional adaptation giving rise to positive feelings of self-acceptance, responsibility, and assertiveness, ultimately improving socio-emotional reactions to hearing difficulties

Long-term speech perception and morphosyntactic outcomes in adolescents and young adults implanted in childhood

Background: Long-term assessments of children with cochlear implants (CI) are important inputs to help guide families and professionals in therapeutic and counselling processes. Based on these premises, the primary aim of the present study was to assess the long-term speech and language outcomes in a sample of prelingually deaf or hard of hearing (DHH) adolescents and young adults with unilateral or bilateral implantation in childhood. The secondary aim was to investigate the correlations of age at implantation with long-term speech and language outcomes. Materials and Methods: Retrospective observational study on 54 long-term CI users, 33 unilateral and 21 bilateral (mean age at CI surgery 38.1 ± 24.6 months; mean age at last follow-up assessment 19.1 ± 4.3 years of age and mean follow-up time 16 ± 3.7 years). Means and standards were used to describe speech perception (in quiet, in fixed noise and in adaptive noise using It-Matrix) and morphosyntactic comprehension (TROG-2) outcomes. A univariate analysis was used to evaluate outcome differences between unilateral and bilateral patients. Bivariate analysis was performed to investigate the relationships between age at CI, audiological variables, and language outcomes. Finally, multivariate analysis was performed to quantify the relationship between It-Matrix, sentence recognition in quiet and at SNR+10 and TROG-2. Results: The participants showed good speech recognition performance in quiet (94% for words and 89% for sentences) whilst their speech-in-noise scores decreased significantly. For the It- Matrix, only 9.2% of the participants showed scores within the normative range. This value was 60% for TROG-2 performance. For both auditory and language skills, group differences for unilateral versus bilateral CI users were not statistically significant (p >0.05). Bivariate analysis showed that age at CI correlated significantly with overall results at TROG-2 (r = -0.6; p <0.001) and with It-Matrix (r =0.5; p <0.001). TROG-2 was negatively correlated with results for It-Matrix (r = -0.5; p <0.001). In the multivariate analysis with It-Matrix as a dependent variable, the model explained 63% of the variance, of which 60% was related to sentence recognition and 3% to morphosyntax. Conclusions: These data contribute to the definition of average long-term outcomes expected in subjects implanted during childhood whilst increasing our knowledge of the effects of variables such as age at CI and morphosyntactic comprehension on speech perception. Although the majority of this prelingually DHH cohort did not achieve scores within a normative range, remarkably better It-Matrix scores were observed when compared to those from postlingually deafened adult CI users

Cochlear implant and tinnitus: a narrative literature review and evidence for clinical use

INTRODUCTION: Tinnitus is one of the major complaints in patients with bilateral hearing loss or single-sided deafness (SSD). Several studies describe that cochlear implantation may play a role in tinnitus suppression. Results in the literature are heterogeneous for the role and level of success that Cochlear Implants (CI) plays in tinnitus suppression. The purpose of this review is to summarize all of the significant evidence and outcomes documented as to CI effects on tinnitus perception in unilateral/bilateral CI users and SSD patients, as well as to report on tinnitus findings and fitting strategies currently used to optimize the results for supporting a clear counselling process. EVIDENCE ACQUISITION: A comprehensive literature search was undertaken using the following databases: PubMed, Embase, Cochrane Library, Scopus, CINAHL and Web of Science. Included articles are published through to November 2022 and referenced by relevant literature. The eligible studies and data results were summarized in this narrative review. EVIDENCE SYNTHESIS: The review was organized to deliver a summary of: CI pathophysiologic mechanisms and prognostic factors in- volved in tinnitus suppression; CI outcomes for both unilateral and bilateral implantation in bilateral symmetrical hearing loss, as well as in asymmetrical hearing loss and in SSD patients; the relevant findings concerning CI fitting in managing tinnitus suppression. Finally, the effects of CI on quality of life and psychological status of patients with tinnitus were addressed. CONCLUSIONS: The present review is a targeted contribution to support clinical procedures regarding the applicability and the outcomes of CI in tinnitus treatment. Further studies and specific guidelines are needed to broaden knowledge and understanding in this specific research field

Cochlear implant in immune mediated inner ear diseases: impedance variations and clinical outcomes

OBJECTIVE: Immune-mediated inner ear disease (IMIED) is characterized by severe/profound hearing loss. Although IMIED might lead to cochlear disorders with modification of electrode impedance these patients are ideal candidates for cochlear implant (CI). The aim of the study was to evaluate whether impedance values and impedance fluctuations over time were significantly higher in IMIED patients treated with CI compared to the control group. METHOD: The sample was composed of CI patients with severe/profound hearing loss: a study group (SG) of IMIED patients (31 ears) and a control group (CG) of patients with hearing loss not related to their immune system (31 ears). Audiological performance and impedance values were measured and compared amongst groups at 3, 6, 12 and 18 months following the fitting sessions. RESULTS: Speech perception was significantly better for SG in word and sentence recognition in quiet. Impedance values were, on average, significantly higher for apical and middle electrode segments in SG compared to CG at the 3 month follow-up and were maintained over a longer time period. Additionally, a subset of SG patients ( active patients ) experienced significantly greater impedance fluctuation corresponding to clinical symptom reactivation. DISCUSSION AND CONCLUSION: IMIED patients achieved good audiological performance. However, the surgical intervention could change the inner ear environment, causing impedance fluctuations and, consequently, more frequent CI fittings. Additionally, impedance evaluation could be utilised as an early warning sign of IMIED recurrence and as an aid to therapeutic decision-making

Validazione dello STARR-IT in relazione a reattivi verbali alternativi in ambito audiologico: dati normativi e risultati in pazienti adulti portatori di impianto cocleare

scopo dello studio:Nel presente studio sono riportati i risultati ottenuti in un gruppo di pazienti con impianto cocleare sottoposti ad un nuovo test di comprensione verbale nel rumore: la versione italiana del Sentence Test with Adaptive Randomized Roving Levels (STARR). Questo test si inserisce nel contesto audiologico attuale che vede la necessità di sviluppare nuovi reattivi verbali in grado di mimare in modo più realistico le condizioni di ascolto quotidiane, caratterizzate da un continuo fluttuare delle caratteristiche e dell’intensità del segnale primario e del rumore. Lo STARR test utilizza un approccio caratterizzato da un livello adattivo variabile del segnale primario e del rumore di competizione per raggiungere il 50% di risposte corrette (SRT50). Metodologia: Sono stati inclusi nello studio 39 adulti portatori di impianto cocleare, valutati utilizzando lo STARR test e in aggiunta le liste di Cutugno et al (2000) in quiete e con rumore fisso (SNR+10) ed il test adattivo Matrix (Puglisi, 2015), seguendo una somministrazione randomizzata. Tutti i test sono stati eseguiti in cabina silente con una presentazione S0/N0, gli altoparlanti posti ad 1 metro dal paziente. risultati e Conclusioni: I risultati ottenuti nei pazienti con IC hanno messo in evidenza una notevole difficoltà di comprensione nel rumore, con livelli medi di 12.5 dB SRT (SD= 9.5). I risultati dello STARR test erano significativamente correlati con quelli ottenuti con un SNR+10 e con il test Matrix, mostrando quindi una buona affidabilità. La struttura tipica del SRT50 e la maggiore ridondanza del materiale verbale se paragonato al test Matrix ha fatto si che lo STARR test indica un numero minore di pazienti non-responders.Aim of the Study: This study is an analysis of findings obtained in a group of CI recipients who underwent a new speech perception test in noise: the Italian version of the Sentence Test with Adaptive Randomized Roving levels (STARR). This procedure is now part of our audiological protocol and confirms the need to make use of new tools able to represent more realistic daily listening conditions, characterized by the continuous fluctuation of acoustic parameters of both primary signal and noise. Based on patient responses, adaptive roving intensity levels (sentences) and SNRs are both presented randomly, and the outcome is expressed in 50% correct responses (SRT50). Method: 39 adult CI recipients took part in this study. They were assessed via the STARR test as well as Speech in Quiet and fixed level Speech/Noise procedures (Cutugno et al., 2000) and the adaptive Matrix test (Puglisi, 2015) applied on a randomized basis. All procedures were carried out in a silent booth with loudspeakers positioned at S0/N0 at 1 meter in front of the patient. Results and Conclusions: Findings for this group of patients showed a noticeable difficulty for comprehension in noise, with mean levels of 12.5 SRT (SD=9.5). Results for STARR proved to be reliable and this was confirmed by a significant correlation with those found for SNR+10 and Matrix tests. However, the intrinsic structure of SRT50 and the greater redundancy of the verbal content when compared to the Matrix test resulted in a greater number of elder subjects able to perform the test