Bert Maat

Factors Affecting Auditory Performance of Postlinguistically Deaf Adults Using Cochlear Implants: An Update with 2251 Patients

Objective: To update a 15-year-old study of 800 postlinguistically deaf adult patients showing how duration of severe to profound hearing loss, age at cochlear implantation (CI), age at onset of severe to profound hearing loss, etiology and CI experience affected CI outcome. Study Design: Retrospective multicenter study. Methods: Data from 2251 adult patients implanted since 2003 in 15 international centers were collected and speech scores in quiet were converted to percentile ranks to remove differences between centers. Results: The negative effect of long duration of severe to profound hearing loss was less important in the new data than in 1996; the effects of age at CI and age at onset of severe to profound hearing loss were delayed until older ages; etiology had a smaller effect, and the effect of CI experience was greater with a steeper learning curve. Patients with longer durations of severe to profound hearing loss were less likely to improve with CI experience than patients with shorter duration of severe to profound hearing loss. Conclusions: The factors that were relevant in 1996 were still relevant in 2011, although their relative importance had changed. Relaxed patient selection criteria, improved clinical management of hearing loss, modifications of surgical practice, and improved devices may explain the differences.

Pre-, Per- and Postoperative Factors Affecting Performance of Postlinguistically Deaf Adults Using Cochlear Implants: A New Conceptual Model over Time

Objective To test the influence of multiple factors on cochlear implant (CI) speech performance in quiet and in noise for postlinguistically deaf adults, and to design a model of predicted auditory performance with a CI as a function of the significant factors. Study Design Retrospective multi-centre study. Methods Data from 2251 patients implanted since 2003 in 15 international centres were collected. Speech scores in quiet and in noise were converted into percentile ranks to remove differences between centres. The influence of 15 pre-, per- and postoperative factors, such as the duration of moderate hearing loss (mHL), the surgical approach (cochleostomy or round window approach), the angle of insertion, the percentage of active electrodes, and the brand of device were tested. The usual factors, duration of profound HL (pHL), age, etiology, duration of CI experience, that are already known to have an influence, were included in the statistical analyses. Results The significant factors were: the pure tone average threshold of the better ear, the brand of device, the percentage of active electrodes, the use of hearing aids (HAs) during the period of pHL, and the duration of mHL. Conclusions A new model was designed showing a decrease of performance that started during the period of mHL, and became faster during the period of pHL. The use of bilateral HAs slowed down the related central reorganization that is the likely cause of the decreased performance.

The effectiveness of bilateral cochlear implants for severe-to-profound deafness in children: a systematic review.

Objective: To assess the clinical effectiveness of bilateral cochlear implantation compared with unilateral cochlear implantation alone or with a contralateral hearing aid (bimodal stimulation), in children with severe-to-profound hearing loss. Recently, the National Institute for Health and Clinical Excellence (NICE) in the U.K. has conducted a systematic review on cochlear implantation. We decided to update the pediatric part of the NICE review. Data Sources: The electronic databases MEDLINE and Embase were searched for European, North American, and Australasian studies published between October 2006 and June 2009. Reference lists of the included articles were also searched for relevant articles. Study Selection: Studies were included if they comprised data on comparisons between bilateral cochlear implantation and unilateral cochlear implantation and/or bilateral cochlear implantation and bimodal stimulation, in children with severe-to-profound sensorineural hearing loss. The following outcome measures were analyzed: audiological, speech perception, speech production, functional capacities, health-related quality of life, and/or educational outcomes. Data Extraction: Characteristics of the participants, interventions, outcomes, and methodological comments were entered into data extraction forms and the level of evidence was assessed. Data Synthesis: Results were standardized for each outcome measure by calculating a standardized mean difference (effect size). Conclusion: Effect sizes could not be pooled because of the heterogeneity of the studies. Therefore, we presented the results qualitatively. Although the level of evidence was low, the advantages of bilateral cochlear implants corresponded with the primary benefits of bilateral hearing, that is, improved speech perception in quiet and noise. Localization results were less consistent. No data on audiologic, speech production, or educational outcomes were available.

Middle ear influence on otoacoustic emissions. I: Noninvasive investigation of the human transmission apparatus and comparison with model results

Evoked otoacoustic emissions (EOAEs) are generated within the cochlea in response to external sounds, and they can be acoustically detected in the external auditory meatus after backward propagation through the middle ear. In addition to being used to probe the cochlear mechanisms, they are expected to be sensitive to minute changes in middle ear impedance. Systematic measurements of the changes in the vectorial components of EOAEs were carried out after various manipulations of the human middle ear in order to characterize the influence of stiffness and inertia of the stapes and tympanic-membrane systems. For this purpose, stapedius muscle contractions were elicited by high-level contralateral sound, controlled changes in middle ear pressure (range +/-100 daPa) were produced and the tympanic membrane was loaded with water droplets. A computer model of the middle ear network was implemented using a standard lumped-element electric analog of the middle ear (Zwislockis model). Forward and backward transmission changes were simulated and model predictions were compared to experimental data. Apart from the case of positive middle ear pressures, a close qualitative correspondence was found between model and real-ear results. Each of the effects was characterized by a unique pattern of phase and magnitude changes as a function of frequency, in relation to the mechanical characteristics of the involved subsystem (i.e. stapes stiffness, tympanic-membrane stiffness or mass) and its resonance properties. Owing to their high sensitivity, EOAEs could be helpful for an accurate individual multifrequency analysis of middle ear impedance by comparisons under rest and test conditions.

The musician effect: does it persist under degraded pitch conditions of cochlear implant simulations?

Cochlear implants (CIs) are auditory prostheses that restore hearing via electrical stimulation of the auditory nerve. Compared to normal acoustic hearing, sounds transmitted through the CI are spectro-temporally degraded, causing difficulties in challenging listening tasks such as speech intelligibility in noise and perception of music. In normal hearing (NH), musicians have been shown to better perform than non-musicians in auditory processing and perception, especially for challenging listening tasks. This “musician effect” was attributed to better processing of pitch cues, as well as better overall auditory cognitive functioning in musicians. Does the musician effect persist when pitch cues are degraded, as it would be in signals transmitted through a CI? To answer this question, NH musicians and non-musicians were tested while listening to unprocessed signals or to signals processed by an acoustic CI simulation. The task increasingly depended on pitch perception: (1) speech intelligibility (words and sentences) in quiet or in noise, (2) vocal emotion identification, and (3) melodic contour identification (MCI). For speech perception, there was no musician effect with the unprocessed stimuli, and a small musician effect only for word identification in one noise condition, in the CI simulation. For emotion identification, there was a small musician effect for both. For MCI, there was a large musician effect for both. Overall, the effect was stronger as the importance of pitch in the listening task increased. This suggests that the musician effect may be more rooted in pitch perception, rather than in a global advantage in cognitive processing (in which musicians would have performed better in all tasks). The results further suggest that musical training before (and possibly after) implantation might offer some advantage in pitch processing that could partially benefit speech perception, and more strongly emotion and music perception.

A retrospective Multicenter Study comparing Speech Perception outcomes for Bilateral Implantation and Bimodal rehabilitation

Objectives: To compare speech perception outcomes between bilateral implantation (cochlear implants [CIs]) and bimodal rehabilitation (one CI on one side plus one hearing aid [HA] on the other side) and to explore the clinical factors that may cause asymmetric performances in speech intelligibility between the two ears in case of bilateral implantation. Design: Retrospective data from 2247 patients implanted since 2003 in 15 international centers were collected. Intelligibility scores, measured in quiet and in noise, were converted into percentile ranks to remove differences between centers. The influence of the listening mode among three independent groups, one CI alone (n = 1572), bimodal listening (CI/HA, n = 589), and bilateral CIs (CI/CI, n = 86), was compared in an analysis taking into account the influence of other factors such as duration of profound hearing loss, age, etiology, and duration of CI experience. No within-subject comparison (i.e., monitoring outcome modifications in CI/HA subjects becoming CI/CI) was possible from this dataset. Further analyses were conducted on the CI/CI subgroup to investigate a number of factors, such as implantation side, duration of hearing loss, amount of residual hearing, and use of HAs that may explain asymmetric performances of this subgroup. Results: Intelligibility ranked scores in quiet and in noise were significantly greater with both CI/CI and CI/HA than with a CI-alone group, and improvement with CI/CI (+11% and +16% in quiet and in noise, respectively) was significantly better than with CI/HA (+6% and +9% in quiet and in noise, respectively). From the CI/HA group, only subjects with ranked preoperative aided speech scores >60% performed as well as CI/CI participants. Furthermore, CI/CI subjects displayed significantly lower preoperative aided speech scores on average compared with that displayed by CI/HA subjects. Routine clinical data available from the present database did not explain the asymmetrical results of bilateral implantation. Conclusions: This retrospective study, based on basic speech audiometry (no lateralization cues), indicates that, on average, a second CI is likely to provide slightly better postoperative speech outcome than an additional HA for people with very low preoperative performance. These results may be taken into consideration to refine surgical indications for CIs.

The Effectiveness of Bilateral Cochlear Implants for Severe-to-Profound Deafness in Children

Objective Assessment of the clinical effectiveness of bilateral cochlear implantation compared with unilateral cochlear implantation or bimodal stimulation, in adults with severe-to-profound hearing loss. In 2007, the National Institute for Health and Clinical Excellence (NICE) in the U.K. conducted a systematic review on cochlear implantation. This study forms an update of the adult part of the NICE review. Data Sources The electronic databases MEDLINE and Embase were searched for English language studies published between October 2006 and March 2011. Study Selection Studies were included that compared bilateral cochlear implantation with unilateral cochlear implantation and/or with bimodal stimulation, in adults with severe-to-profound sensorineural hearing loss. Speech perception in quiet and in noise, sound localization and lateralization, speech production, health-related quality of life, and functional outcomes were analyzed. Data Extraction Data extraction forms were used to describe study characteristics and the level of evidence. Data Synthesis The effect size was calculated to compare different outcome measures. Conclusion Pooling of data was not possible because of the heterogeneity of the studies. As in the NICE review, the level of evidence of the included studies was low, although some of the additional studies showed less risk of bias. All studies showed a significant bilateral benefit in localization over unilateral cochlear implantation. Bilateral cochlear implants were beneficial for speech perception in noise under certain conditions and several self-reported measures. Most speech perception in quiet outcomes did not show a bilateral benefit. The current review provides additional evidence in favor of bilateral cochlear implantation, even in complex listening situations.

Noise-evoked otoacoustic emissions in humans

Click-evoked otoacoustic emissions (CEOAEs) and acoustical responses evoked by bandlimited Gaussian noise (noise-evoked otoacoustic emissions; NEOAEs) were measured in three normal-hearing subjects. For the NEOAEs the first- and second-order Wiener kernel and polynomial correlation functions up to the sixth order were calculated by cross correlating the noise stimulus and the emission response. Emission components were only found in the first-order Wiener kernel. These kernels were dependent on the stimulus level, indicative of the nonlinear response of the cochlea. For each subject the frequency contents of the CEOAE and the first-order Wiener kernel were nearly identical. In the second-order Wiener kernels and higher-order polynomial correlation functions no significant contributions were identified. Apparently, odd and even order nonlinearities cannot be detected by Wiener kernel analysis.

Music and quality of life in early-deafened late-implanted adult cochlear implant users.

Hypothesis and Background The early-deafened, late-implanted (EDLI) CI users constitute a relatively new and understudied clinical population. To contribute to a better understanding of the implantation outcome, this study evaluated this population for self-reported enjoyment and perception of music. Additionally, correlations of these measures with the self-reported quality of life and everyday hearing ability and a behaviorally measured word recognition test were explored. Materials and Methods EDLI CI users from the Northern Netherlands were sent 4 questionnaires: 1) Dutch Musical Background Questionnaire (enjoyment and perception of music), 2) Nijmegen Cochlear Implant Questionnaire (quality of life), 3) Cochlear Implant Functioning Index (auditory-related functioning), and 4) Speech, Spatial and Qualities of Hearing Scale (hearing ability). Complementary, behavioral word recognition in quiet tests (phoneme score) were completed. Results Twelve (60%) of 20 participants reported music to sound pleasant. In general, the self-perceived quality of music was scored positively. No correlations were observed between enjoyment and perception of music, quality of life, hearing ability, and word recognition. Conclusion The results indicate that, differently than postlingually deafened, EDLI CI users enjoy music and rate the quality of music positively. Potential explanations for the absence of correlations between the music measures and the other outcomes could be that other factors, such as speech perception, contribute more to quality of life of EDLI CI users or that this group simply lacks previous exposure to music with acoustic hearing. Overall, these positive findings may give extra support for implant candidacy of early-deafened individuals, but further studies should be conducted.

The Effect of Static Ear Canal Pressure on Human Spontaneous Otoacoustic Emissions: Spectral Width as a Measure of the Intra-cochlear Oscillation Amplitude

Spontaneous otoacoustic emissions can be detected as peaks in the Fourier spectrum of a microphone signal recorded from the ear canal. The height, center frequency, and spectral width of SOAE peaks changed when a static pressure was applied to the ear canal. Most commonly, with either increasing or decreasing static pressure, the frequency increased, the amplitude decreased, and the width increased. These changes are believed to result from changes in the middle ear properties. Specifically, reduced middle ear transmission is assumed to attenuate the amplitude of emissions. We reconsidered this explanation by investigating the relation between peak height and width. We showed that the spectral width of SOAE peaks is approximately proportional to