Changes in sound-source localization for children with bilateral severe to profound hearing loss following simultaneous bilateral cochlear implantation

Background: Sound localization is a valuable skill that children can develop to some extent via bilateral cochlear implants (biCIs). However, little is known regarding the change that can be expected in sound-source localization accuracy (SLA) pre- and post-biCI for children with bilateral, severe-to-profound hearing impairment who spent their early years listening via bilateral hearing aids (biHAs). This study therefore aimed to prospectively assess SLA in a group of children before, and at one year after, receiving simultaneous biCIs. Methods: Ten children aged 5–18 years were tested. SLA was assessed using loudspeakers positioned at −60, −30, 0, +30, and +60 degrees azimuth. Root mean square (RMS) errors and percentage correct scores were calculated. Changes in SLA were analysed via paired t-tests and potential relationships between hearing threshold levels (HTLs) and SLA via correlation analyses. Response distributions via biHAs and biCIs were examined via scatterplots. Results: The mean within-subject changes in SLA were a significant improvement in RMS error of 11.9° (p < 0.05) and in per cent correct by 21.5% (p < 0.05). Scatterplots demonstrated a trend towards better localization of sounds from 0° azimuth via biCIs compared to via biHAs. No significant associations were found between any measures of SLA and HTLs. Conclusions: The findings of the present study demonstrate that simultaneous biCIs lead to improved sound localization in children with bilateral, severe to profound sensorineural hearing loss who previously used biHAs. SLA via biHAs or biCIs could not be predicted from children’s audiograms, and therefore should be measured directly

Telehealth rehabilitation for adults with cochlear implants in response to the Covid-19 pandemic: platform selection and case studies

BackgroundEffective information giving and goal setting before cochlear implantation and individualised rehabilitation following implantation are both crucial for shaping patients’ expectations and optimising outcomes. The Covid-19 pandemic led to temporary cessation of face to face clinic appointments. This created a need for telehealth rehabilitation for adults whose hearing loss presents unique communication challenges.AimsWe describe the piloting and implementation of telehealth rehabilitation within an adult cochlear implant service.MethodVideo conferencing and telehealth tools were assessed in terms of security, accessibility and functionality. Written support materials were developed. Telehealth sessions were piloted with lay volunteers. During service implementation, feedback was collected from patients and staff.Outcomes & resultsA video call platform was identified that was supported by the host Trust and also met the rehabilitation service’s needs. A telehealth service was successfully implemented, ensuring continuity of care during lockdown. We share the platform selection framework used, practical lessons learned and patient support materials.Conclusion.Telehealth rehabilitation facilitated a well-received, effective service for adult cochlear implant patients. It is predicted that the benefits of telehealth rehabilitation will last beyond the lockdown restrictions posed by Covid-19

Systematic review of outcome domains and instruments used in designs of clinical trials for interventions that seek to restore bilateral and binaural hearing in adults with unilateral severe to profound sensorineural hearing loss (‘single-sided deafness’)

Background: This systematic review aimed to identify, compare and contrast outcome domains and outcome instruments reported in studies investigating interventions that seek to restore bilateral (two-sided) and/or binaural (both ears) hearing in adults with Single Sided Deafness (SSD). Findings can inform the development of evidence-based guidance to facilitate design decisions for confirmatory trials.Methods: Records were identified by searching MEDLINE, EMBASE, PubMed, CINAHL, ClinicalTrials.gov, ISRCTN, CENTRAL, WHO ICTRP and the NIHR UK clinical trials gateway. The search included records published from 1946 to March 2020. Included studies were those: a) recruiting adults aged 18 years or older diagnosed with SSD of average threshold severity worse than 70 dB HL in the worse-hearing ear and normal (or near-normal) hearing in the better-hearing ear, b) evaluating interventions to restore bilateral and/or binaural hearing, and c) enrolling those adults in a controlled trial, before-and-after study, or cross-over study. Studies that fell just short of the participant eligibility criteria were included in a separate sensitivity analysis. Results: Ninety-six studies were included (72 full inclusion, 24 sensitivity analysis). For fully-included studies, 37 exclusively evaluated interventions to re-establish bilateral hearing and 29 exclusively evaluated interventions to restore binaural hearing. Overall, 520 outcome domains were identified (350 primary and 170 secondary). Speech-related outcome domains were the most common (74% of studies), followed by spatial-related domains (60% of studies). A total of 344 unique outcome instruments were reported. Speech-related outcome domains were measured by 73 different instruments and spatial-related domains by 43 different instruments. There was considerable variability in duration of follow-up, ranging from acute (baseline) testing to 10 years after the intervention. The sensitivity analysis identified no additional outcome domains.Conclusions: This review identified large variability in the reporting of outcome domains and instruments in studies evaluating the therapeutic benefits and harms of SSD interventions. Reports frequently omitted information on what domains the study intended to assess, and on what instruments were used to measure which domains.PROSPERO Registration: The systematic review protocol is registered on PROSPERO (International ProspectiveRegister of Systematic Reviews): Registration Number CRD42018084274. Registered on 13th of March 2018, last revised on 7th of May 2019