Barriers and facilitators to delivery of group audiological rehabilitation programs : a survey based on the COM-B model

OBJECTIVE : To canvas the views of Australia-based hearing healthcare clinicians regarding group audiological rehabilitation practices. DESIGN : A national cross-sectional self-report survey. Data were analysed using descriptive statistics and content analysis. STUDY SAMPLE : Sixty-two Australia-based hearing healthcare clinicians, with experience working in an adult rehabilitation setting. RESULTS : Clinicians appeared to positively view the provision of group audiological rehabilitation services, yet were limited in their ability to deliver these services due to organisational barriers. Although some organisational barriers were non-modifiable by the clinician (such as group AR services not prioritised within their workplace, a lack of support from colleagues/managers, lack of resources, and a lack of funding for the delivery of group AR services), others were within the clinicians’ ability to change (such as habit formation for recommending these services during clinical appointments). Participants expressed a desire for resources to assist them in delivering group AR, including downloadable lesson plans and information sheets for clients, clinician training videos and client educational videos. Clinicians called for increased diversity in program offerings, specifically relating to the emotional, relational and social impacts of hearing loss. CONCLUSIONS : These results provide a framework for the development of interventional studies to increase the utilisation of group audiological rehabilitation services.https://www.tandfonline.com/loi/iija202022-06-13hj2022Speech-Language Pathology and Audiolog

Binaural summation, binaural unmasking and fluctuating masker benefit in bimodal and bilateral adult cochlear implant users

OBJECTIVES : The number of bilateral adult cochlear implant (CI) users and bimodal CI users is expanding worldwide. The addition of a hearing aid (HA) in the contralateral non-implanted ear (bimodal) or a second CI (bilateral) can provide CI users with some of the benefits associated with listening with two ears. Our was to examine whether bilateral and bimodal CI users demonstrate binaural summation, binaural unmasking and a fluctuating masker benefit. METHODS : Direct audio input was used to present stimuli to 10 bilateral and 10 bimodal CochlearTM CI users. Speech recognition in noise (speech reception threshold, SRT) was assessed monaurally, diotically (identical signals in both devices) and dichotically (antiphasic speech) with different masking noises (steady-state and interrupted), using the digits-in-noise test. RESULTS : Bilateral CI users demonstrated a trend towards better SRTs with both CIs than with one CI. Bimodal CI users showed no difference between the bimodal SRT and the SRT for CI alone. No significant differences in SRT were found between the diotic and dichotic conditions for either group. Analyses of electrodograms created from bilateral stimuli demonstrated that substantial parts of the interaural speech cues were preserved in the Advanced Combination Encoder, an n-of-m channel selection speech coding strategy, used by the CI users. Speech recognition in noise was significantly better with interrupted noise than with steady-state masking noise for both bilateral and bimodal CI users. CONCLUSION : Bilateral CI users demonstrated a trend towards binaural summation, but bimodal CI users did not. No binaural unmasking was demonstrated for either group of CI users. A large fluctuating masker benefit was found in both bilateral and bimodal CI users.https://www.tandfonline.com/loi/ycii20hj2022Speech-Language Pathology and Audiolog

Analysis of a cochlear implant database : changes in tinnitus prevalence and distress after cochlear implantation

The aim of this study was to estimate the prevalence and distress of tinnitus pre- and post-cochlear implantation in patients with bilateral severe to profound hearing loss. In this retrospective study, we included patients from a cochlear implant clinic in Perth, Western Australia. Pre- and post-cochlear implantation data from 300 implant recipients were collected on self-reported presence of tinnitus, tinnitus distress using the Tinnitus Reaction Questionnaire (TRQ), hearing-related quality of life using the Abbreviated Profile of Hearing Aid Benefit (APHAB), and consonant-nucleus vowel-consonant (CNC) word recognition test scores. Retrospectively, patients were grouped into those with or without tinnitus, and the grade of tinnitus distress. The potential factors associated with post-implantation changes in the presence of tinnitus and its distress were evaluated. Tinnitus prevalence was 55.8% pre-operatively and 44.3% post-implantation with a median TRQ score respectively of 12.0 (IQR: 1.0–28.0) and 3.5 (IQR: 0.0–16.2) points. Among the 96 patients experiencing tinnitus pre-implantation, 14.6% patients experienced moderate to catastrophic tinnitus distress pre-implantation compared to 6.3% post-implantation. To conclude, the pre- and post-implantation median TRQ score for the cohort population showed that tinnitus was a “slight” handicap. Tinnitus prevalence and its associated tinnitus distress decreased post-implantation. Patients with tinnitus post-implantation were significantly younger and had less severe pre-implantation hearing loss in the non-implanted ear than patients without tinnitus. Further research is needed to understand the factors influencing changes in tinnitus.https://journals.sagepub.com/home/tiahj2023Speech-Language Pathology and Audiolog

A MultiCenter analysis of factors associated with hearing outcome for 2,735 adults with cochlear implants

While the majority of cochlear implant recipients benefit from the device, it remains difficult to estimate the degree of benefit for a specific patient prior to implantation. Using data from 2,735 cochlear-implant recipients from across three clinics, the largest retrospective study of cochlear-implant outcomes to date, we investigate the association between 21 preoperative factors and speech recognition approximately one year after implantation and explore the consistency of their effects across the three constituent datasets. We provide evidence of 17 statistically significant associations, in either univariate or multivariate analysis, including confirmation of associations for several predictive factors, which have only been examined in prior smaller studies. Despite the large sample size, a multivariate analysis shows that the variance explained by our models remains modest across the datasets (R2 = 0.12–0.21). Finally, we report a novel statistical interaction indicating that the duration of deafness in the implanted ear has a stronger impact on hearing outcome when considered relative to a candidate’s age. Our multicenter study highlights several real-world complexities that impact the clinical translation of predictive factors for cochlear implantation outcome. We suggest several directions to overcome these challenges and further improve our ability to model patient outcomes with increased accuracy.The collection of the VUMC dataset was supported by a research project grant no. NIH NIDCD R01 DC13117 (principal investigator: Gifford).http://journals.sagepub.com/home/tiadm2022Speech-Language Pathology and Audiolog

Predictive models for cochlear implant outcomes : performance, generalizability, and the impact of cohort size

While cochlear implants have helped hundreds of thousands of individuals, it remains difficult to predict the extent to which an individual’s hearing will benefit from implantation. Several publications indicate that machine learning may improve predictive accuracy of cochlear implant outcomes compared to classical statistical methods. However, existing studies are limited in terms of model validation and evaluating factors like sample size on predictive performance. We conduct a thorough examination of machine learning approaches to predict word recognition scores (WRS) measured approximately 12 months after implantation in adults with post-lingual hearing loss. This is the largest retrospective study of cochlear implant outcomes to date, evaluating 2,489 cochlear implant recipients from three clinics. We demonstrate that while machine learning models significantly outperform linear models in prediction of WRS, their overall accuracy remains limited (mean absolute error: 17.9-21.8). The models are robust across clinical cohorts, with predictive error increasing by at most 16% when evaluated on a clinic excluded from the training set. We show that predictive improvement is unlikely to be improved by increasing sample size alone, with doubling of sample size estimated to only increasing performance by 3% on the combined dataset. Finally, we demonstrate how the current models could support clinical decision making, highlighting that subsets of individuals can be identified that have a 94% chance of improving WRS by at least 10% points after implantation, which is likely to be clinically meaningful. We discuss several implications of this analysis, focusing on the need to improve and standardize data collection.http://journals.sagepub.com/home/tiadm2022Speech-Language Pathology and Audiolog

Binaural summation, binaural unmasking and fluctuating masker benefit in bimodal and bilateral adult cochlear implant users

OBJECTIVES: The number of bilateral adult cochlear implant (CI) users and bimodal CI users is expanding worldwide. The addition of a hearing aid (HA) in the contralateral non-implanted ear (bimodal) or a second CI (bilateral) can provide CI users with some of the benefits associated with listening with two ears. Our was to examine whether bilateral and bimodal CI users demonstrate binaural summation, binaural unmasking and a fluctuating masker benefit. METHODS: Direct audio input was used to present stimuli to 10 bilateral and 10 bimodal CochlearTM CI users. Speech recognition in noise (speech reception threshold, SRT) was assessed monaurally, diotically (identical signals in both devices) and dichotically (antiphasic speech) with different masking noises (steady-state and interrupted), using the digits-in-noise test. RESULTS: Bilateral CI users demonstrated a trend towards better SRTs with both CIs than with one CI. Bimodal CI users showed no difference between the bimodal SRT and the SRT for CI alone. No significant differences in SRT were found between the diotic and dichotic conditions for either group. Analyses of electrodograms created from bilateral stimuli demonstrated that substantial parts of the interaural speech cues were preserved in the Advanced Combination Encoder, an n-of-m channel selection speech coding strategy, used by the CI users. Speech recognition in noise was significantly better with interrupted noise than with steady-state masking noise for both bilateral and bimodal CI users. CONCLUSION: Bilateral CI users demonstrated a trend towards binaural summation, but bimodal CI users did not. No binaural unmasking was demonstrated for either group of CI users. A large fluctuating masker benefit was found in both bilateral and bimodal CI users

Barriers and facilitators to delivery of group audiological rehabilitation programs: a survey based on the COM-B model

OBJECTIVE : To canvas the views of Australia-based hearing healthcare clinicians regarding group audiological rehabilitation practices. DESIGN : A national cross-sectional self-report survey. Data were analysed using descriptive statistics and content analysis. STUDY SAMPLE : Sixty-two Australia-based hearing healthcare clinicians, with experience working in an adult rehabilitation setting. RESULTS : Clinicians appeared to positively view the provision of group audiological rehabilitation services, yet were limited in their ability to deliver these services due to organisational barriers. Although some organisational barriers were non-modifiable by the clinician (such as group AR services not prioritised within their workplace, a lack of support from colleagues/managers, lack of resources, and a lack of funding for the delivery of group AR services), others were within the clinicians’ ability to change (such as habit formation for recommending these services during clinical appointments). Participants expressed a desire for resources to assist them in delivering group AR, including downloadable lesson plans and information sheets for clients, clinician training videos and client educational videos. Clinicians called for increased diversity in program offerings, specifically relating to the emotional, relational and social impacts of hearing loss. CONCLUSIONS : These results provide a framework for the development of interventional studies to increase the utilisation of group audiological rehabilitation services.https://www.tandfonline.com/loi/iija202022-06-13hj2022Speech-Language Pathology and Audiolog

The effect of hearing loss configuration on cochlear implantation uptake rates : an Australian experience

OBJECTIVE : Recent changes to cochlear implant (CI) candidacy criteria have led to the inclusion of candidates with greater levels of hearing in the contralateral and/or implanted ear. This study assessed the impact of various hearing loss configurations on CI uptake rates (those assessed as eligible for CI, who proceed to CI). DESIGN : Retrospective cohort study. STUDY SAMPLE : Post-lingually deaf adult CI candidates (n = 619) seen at a Western Australian cochlear implant clinic. RESULTS : An overall CI uptake rate of 44% was observed. Hearing loss configuration significantly impacted uptake rates. Uptake rates of 62% for symmetrical hearing loss, 48% for asymmetrical hearing loss (four-frequency average hearing loss (4FAHL) asymmetry ≤60 dB), 25% for highly asymmetrical hearing loss (4FAHL asymmetry >60 dB), 38% for hearing losses eligible for electric-acoustic stimulation, and 22% for individuals with single-sided hearing loss were observed. Hearing loss configuration and age were both significant factors in relation to CI uptake although the impact of age was limited. CONCLUSION : CI clinics who apply or are considering applying expanded CI candidacy criteria within their practice should be aware that candidates with greater levels of residual hearing in at least the contralateral ear are less likely to proceed to CI.https://www.tandfonline.com/loi/iija20hj2021Speech-Language Pathology and Audiolog

Development of a core outcome set to evaluate remote technologies for cochlear implant users

Background: the use of telehealth for CI service provision has the potentialto significantly improve the ability for CI services to provide efficient,effective, equitable services, and personalized care to CI users. It is essential todemonstrate that remote service provision provides at least equivalent care toface-to-face clinical care for regulatory purposes, as well as ensuring the trustand confidence of all stakeholders in the outcomes of the telehealth service.Using relevant and sensitive outcome measures to evaluate remote CI servicesis vital to facilitate evidence-based health care services.We aimed to develop a Core Outcome Set to evaluate remote CI servicesto maximise the potential benefits of remote care, and ensure optimal andpersonalised care.Methods: a systematic review of literature and online scoping workshopswith key stakeholders (CI users, their partners, and CI professionals) wereconducted to identify core elements and outcome domains to measuremarkers of service quality. These informed two parallel three-round Delphireviews (CI users and CI professionals surveyed separately), to determine an≥80% consensus of core outcome domains. Participants were recruited fromAustralia, the US and UK and included adult CI users (≥18 years old), and CIprofessionals. Round one is complete, with 119 participants (76 CI users, 43 CIprofessionals). The final round of surveys will be completed in August 2023.Results: the systematic review specified eight core elements (Physiological andClinical; Physical Functioning; Cognitive Functioning; Emotional Functioningand Wellbeing; Delivery of care – device; Delivery of Care – service; ResourceUse; Adverse Events). A total of 57 outcome domains were identified. The mostrelevant domains will be surveyed in Rounds 2 and 3 to obtain consensus.Conclusion: this ongoing study will identify a minimum core set of outcomes to be usedto assess benefits of remote technologies for CI users

Remote technologies to enhance service delivery for adults : clinical research perspectives

There are many examples of remote technologies that are clinically effective and provide numerous benefits to adults with hearing loss. Despite this, the uptake of remote technologies for hearing healthcare has been both low and slow until the onset of the COVID-19 pandemic, which has been a key driver for change globally. The time is now right to take advantage of the many benefits that remote technologies offer, through clinical, consumer, or hybrid services and channels. These include greater access and choice, better interactivity and engagement, and tailoring of technologies to individual needs, leading to clients who are better informed, enabled, and empowered to self-manage their hearing loss. This article provides an overview of the clinical research evidence-base across a range of remote technologies along the hearing health journey. This includes qualitative, as well as quantitative, methods to ensure the end-users' voice is at the core of the research, thereby promoting person-centered principles. Most of these remote technologies are available and some are already in use, albeit not widespread. Finally, whenever new technologies or processes are implemented into services, be they clinical, hybrid, or consumer, careful consideration needs to be given to the required behavior change of the key people (e.g., clients and service providers) to facilitate and optimize implementation.https://www.thieme.com/books-main/audiology/product/2188-seminarsin-hearing2024-07-21hj2023Speech-Language Pathology and Audiolog