Alice van Zon

Cochlear Implantation for Patients With Single-Sided Deafness or Asymmetrical Hearing Loss: A Systematic Review of the Evidence

Objective A systematic review of the literature to evaluate the clinical outcome of cochlear implantation for patients with single-sided deafness (SSD) or asymmetrical hearing loss (AHL). Data Sources We searched the PubMed, Embase, Cochrane Library, and CINAHL databases from their inception up to December 10, 2013 for SSD or AHL and cochlear implantation or their synonyms. Study Selection In total, 781 articles were retrieved, of which 15 satisfied the eligibility criteria. Our outcomes of interest were speech perception in noise, sound localization, quality of life (QoL), and tinnitus. Data Extraction Critical appraisal showed that six studies reported on less than five patients or that they carried a low directness of evidence or a high risk of bias. Therefore, we extracted the data of nine studies (n = 112). Patient numbers, age, duration of deafness, classification of deafness, pure tone audiometry, follow-up duration, and outcome measurements were extracted from all nine articles. Data Synthesis Because of large heterogeneity between studies, we were not able to pool data in a meta-analysis. We therefore summarized the results of the studies specified per outcome. Conclusion There are no high-level-of-evidence studies concerning cochlear implantation in patients with SSD or AHL. Current literature suggests important benefits of cochlear implantation regarding sound localization, QoL, and tinnitus. Varying results were reported for speech perception in noise, possibly caused by the large clinical heterogeneity between studies. Larger and high-quality studies are certainly warranted.

Evaluation of Concordance Between the Microorganisms Detected in the Nasopharynx and Middle Ear of Children With Otitis Media

Studies of microorganisms involved in otitis media in children often use a nasopharyngeal sample as a proxy for the middle ear fluid to test for bacteria and viruses. The question is whether such studies provide an accurate estimate of the prevalence of microorganisms involved in otitis media. We performed a systematic review of the literature reporting on the concordance between test results of nasopharyngeal and middle ear fluid samples for the most prevalent microorganisms in children with otitis media. Our findings show that the concordances vary from 68% to 97% per microorganism. For the most prevalent microbes, positive predictive values are around 50%. Most negative predictive values are moderate to high, with a range from 68% up to 97%. These results indicate that test results from nasopharyngeal samples do not always provide an accurate proxy for those of the middle ear fluid. It is important to interpret and use results of such studies carefully.

The effect of cochlear implantation on tinnitus in patients with bilateral hearing loss: A systematic review

To present an overview of the effect of cochlear implantation on tinnitus in adults with bilateral sensorineural hearing loss.

Effect of unilateral and simultaneous bilateral cochlear implantation on tinnitus: A Prospective Study.

To determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation.

Stable benefits of bilateral over unilateral cochlear implantation after two years: A randomized controlled trial

To investigate hearing capabilities and self‐reported benefits of simultaneous bilateral cochlear implantation (BiCI) compared with unilateral cochlear implantation (UCI) after a 2‐year follow‐up and to evaluate the learning effect of cochlear implantees over time.

Validation of the U-STARR with the AB-York crescent of sound, a new instrument to evaluate speech intelligibility in noise and spatial hearing skills

The Advanced Bionics® (AB)-York crescent of sound is a new test setup that comprises speech intelligibility in noise and localization tests that represent everyday listening situations. One of its tests is the Sentence Test with Adaptive Randomized Roving levels (STARR) with sentences and noise both presented from straight ahead. For the Dutch population, we adopted the AB-York setup and replaced the English sentences with a validated set of Dutch sentences. The Dutch version of the STARR is called the Utrecht-STARR (U-STARR). This study primarily assesses the validity and reliability of the U-STARR compared to the Plomp test, which is the current Dutch gold standard for speech-in-noise testing. The outcome of both tests is a speech reception threshold in noise (SRTn). Secondary outcomes are the SRTn measured with sounds from spatially separated sources (SISSS) as well as sound localization capability. We tested 29 normal-hearing adults and 18 postlingually deafened adult patients with unilateral cochlear implants (CI). This study shows that the U-STARR is adequate and reliable and seems better suited for severely hearing-impaired persons than the conventional Plomp test. Further, CI patients have poor spatial listening skills, as demonstrated with the AB-York test.

Cost-Utility of Bilateral Versus Unilateral Cochlear Implantation in Adults: A Randomized Controlled Trial

Objective: To study the cost–utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI. Study Design: Randomized controlled trial (RCT). Setting: Five tertiary referral centers. Patients: Thirty-eight postlingually deafened adults eligible for cochlear implantation. Interventions: A cost–utility analysis was performed from a health insurance perspective. Main Outcome Measures: Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy. Results: Direct costs for unilateral and bilateral CI were &OV0556;43,883 ± &OV0556;11,513(SD) and &OV0556;87,765 ± &OV0556;23,027(SD) respectively. Annual costs from the second year onward were &OV0556;3,435 ± &OV0556;1,085(SD) and &OV0556;6,871 ± &OV0556;2,169(SD), respectively. A cost–utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing. Conclusion: This is the first study that describes a cost–utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5–10 years or longer.

Development of a Squelch Effect in Adult Patients After Simultaneous Bilateral Cochlear Implantation

Objectives: To investigate whether a squelch effect occurs in the first 3 years after simultaneous bilateral cochlear implantation and to investigate whether this effect increases during follow-up. Study Design: Prospective study as part of a multicenter randomized controlled trial that compares simultaneous bilateral cochlear implantation to sequential and unilateral cochlear implantation. Setting: Tertiary referral center. Patients: Nineteen postlingually deafened adults. Intervention: Simultaneous bilateral cochlear implantation. Main Outcome Measure: The squelch effect, measured yearly with a speech-intelligibility-in-noise test with spatially separated sources. Bilateral results were compared to unilateral results in which the cochlear implant at the noise side was turned off. The squelch effect was investigated for the patients’ best performing ear and for the left and right ears separately. Results: In 13 individual patients, a squelch effect was present after 1 year. This number increased during follow-up years. On group level, a squelch effect was present in patients’ best performing ear after 2 and 3 years (1.9 dB). A squelch effect was present in both ears after 3 years (AS: 1.7 dB, AD: 1.3 dB). Conclusion: Patients who underwent simultaneous bilateral cochlear implantation developed a measurable benefit from the squelch effect after 2 years in their best performing ear and after 3 years in both ears. These observations suggest that the brain learns to use interaural differences to segregate sound from noise after simultaneous bilateral cochlear implantation. The squelch effect increased over time which suggests a growth in cortical integration and differentiation of inputs from bilateral CIs due to brain plasticity. Trial Registration: Dutch Trial Register NTR1722. Level of evidence: 1b.

Effect of unilateral and simultaneous bilateral cochlear implantation on tinnitus: A randomized controlled trial

To determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation.

CINGLE-trial: cochlear implantation for siNGLE-sided deafness, a randomised controlled trial and economic evaluation

BackgroundIndividuals with single-sided deafness (SSD) have problems with speech perception in noise, localisation of sounds and with communication and social interaction in their daily life. Current treatment modalities (Contralateral Routing of Sound systems [CROS] and Bone Conduction Devices [BCD]) do not restore binaural hearing. Based on low level of evidence studies, CROS and BCD do not improve speech perception in noise or sound localisation. In contrast, cochlear implantation (CI) may overcome the limitations of CROS and BCD, as binaural input can be restored. Promising results have previously been achieved on speech perception in noise, sound localisation, tinnitus and quality of life.Methods and designA single-center Randomised Controlled Trial (RCT) was designed to compare all treatment strategies for SSD. One hundred and twenty adult single-sided deaf patients (duration of deafness >3 months and maximum 10 years; pure tone average at 0.5, 1, 2, 4 kHz, deaf ear: threshold equal to or more than 70 dB, better ear: threshold of maximum 30 dB) will be included in this trial and randomised to CI, ‘first BCD, then CROS’ or ‘first CROS, then BCD’-groups. After the trial period, patients in the two latter groups may choose with which treatment option they continue. Outcomes of interest are speech perception in noise, sound localization, tinnitus and quality of life. These outcomes will be measured during a baseline visit and at follow up visits, which will take place at 6, 12, 18, 24, 36, 48 and 60 months after onset of treatment. Furthermore, an economic evaluation will be performed and adverse events will be monitored.DiscussionThis RCT allows for a comparison between the two current treatment modalities for single-sided deafness and a new promising treatment strategy, CI, on a range of health outcomes: speech perception in noise, sound localization, tinnitus and quality of life. Additionally, we will be able to answer the question if the additional costs of CI are justified by increased benefits, when compared to current treatment strategies. This study will inform health policy makers with regard to reimbursement of CI.Trial registrationNetherlands Trial Register (www.trialregister.nl): NTR4580.