Lisa G. Potts

Factors affecting open-set word recognition in adults with cochlear implants.

Objective: A great deal of variability exists in the speech-recognition abilities of postlingually deaf adult cochlear implant (CI) recipients. A number of previous studies have shown that duration of deafness is a primary factor affecting CI outcomes; however, there is little agreement regarding other factors that may affect performance. The objective of the present study was to determine the source of variability in CI outcomes by examining three main factors, biographic/audiologic information, electrode position within the cochlea, and cognitive abilities in a group of newly implanted CI recipients. Design: Participants were 114 postlingually deaf adults with either the Cochlear or Advanced Bionics CI systems. Biographic/audiologic information, aided sentence-recognition scores, a high resolution temporal bone CT scan and cognitive measures were obtained before implantation. Monosyllabic word recognition scores were obtained during numerous test intervals from 2 weeks to 2 years after initial activation of the CI. Electrode position within the cochlea was determined by three-dimensional reconstruction of pre- and postimplant CT scans. Participants’ word scores over 2 years were fit with a logistic curve to predict word score as a function of time and to highlight 4-word recognition metrics (CNC initial score, CNC final score, rise time to 90% of CNC final score, and CNC difference score). Results: Participants were divided into six outcome groups based on the percentile ranking of their CNC final score, that is, participants in the bottom 10% were in group 1; those in the top 10% were in group 6. Across outcome groups, significant relationships from low to high performance were identified. Biographic/audiologic factors of age at implantation, duration of hearing loss, duration of hearing aid use, and duration of severe-to-profound hearing loss were significantly and inversely related to performance as were frequency modulated tone, sound-field threshold levels obtained with the CI. That is, the higher-performing outcome groups were younger in age at the time of implantation, had shorter duration of severe-to-profound hearing loss, and had lower CI sound-field threshold levels. Significant inverse relationships across outcome groups were also observed for electrode position, specifically the percentage of electrodes in scala vestibuli as opposed to scala tympani and depth of insertion of the electrode array. In addition, positioning of electrode arrays closer to the modiolar wall was positively correlated with outcome. Cognitive ability was significantly and positively related to outcome; however, age at implantation and cognition were highly correlated. After controlling for age, cognition was no longer a factor affecting outcomes. Conclusion: There are a number of factors that limit CI outcomes. They can act singularly or collectively to restrict an individual’s performance and to varying degrees. The highest performing CI recipients are those with the least number of limiting factors. Knowledge of when and how these factors affect performance can favorably influence counseling, device fitting, and rehabilitation for individual patients and can contribute to improved device design and application.

Relation Between Neural Response Telemetry Thresholds, T- and C-levels, and Loudness Judgments in 12 Adult Nucleus 24 Cochlear Implant Recipients

Objective: The primary purpose of this study was to determine if the contour of visual (vNRT) or predicted (tNRT) neural response telemetry (NRT) thresholds across electrodes could predict the contour of behaviorally programmed T-levels (minimum stimulation) and/or C-levels (maximum stimulation) across electrodes for well-fit MAPs. The secondary purpose was to determine the relation between NRT thresholds and loudness judgments obtained at the subjects MAP rate (250, 900, 1200, or 1800 pulses per second [pps]) and the NRT stimulus rate (80 pps). Design: Twelve adult Nucleus 24 cochlear implant recipients participated in the study. The T- and C-levels from a preferred MAP, which had been worn for a minimum of 3 mo, were used in this study. Electrically evoked compound action potentials were measured on 11 active electrodes with NRT software (v3.0). Ascending loudness judgments from first hearing to maximum acceptable loudness were completed on these electrodes with the subjects preferred MAP rate stimulus, using the R126 (v.2.0) software and with an 80 pps rate stimulus, using the NRT software (v3.0). All measures were repeated approximately 1 mo later to determine their reliability. Results: The reliability of the behavioral and objective measures was very high from the first to the second half of the study. The mean tNRT thresholds had a lower reliability (r = 0.73) than vNRT thresholds (r = 0.91). The loudness judgment dynamic range was notably different between rates. The NRT rate (80 pps) stimulus resulted in the narrowest dynamic range followed by increasingly wider dynamic range as the MAP rate increased. The NRT thresholds had a stronger correlation with loudness judgments made with the NRT rate stimulus than with the MAP rate stimulus. The group mean NRT thresholds were significantly correlated with C-levels (vNRT r = 0.69) (tNRT r = 0.66) but not T-levels. The relation between NRT thresholds and T- and C-levels varied for different MAP rates, with the NRT thresholds being closest to the C-levels for the 250 pps MAP rate. Each subjects vNRT thresholds and MAP levels were examined by fitting a third-order polynomial to the data. This analysis revealed significant variability demonstrating that no one fit predicts T- and C-levels well for all subjects. Conclusions: The results of this study provide important insight into the relation between NRT thresholds and loudness judgments for different stimulation rates and T- and C-levels at various MAP rates. The loudness judgment dynamic range and MAP dynamic range (T- and C-levels) varied notably for different stimulation rates. As a result, the relation of NRT thresholds to these measures also varied with stimulation rate. Overall, the mean vNRT thresholds fell higher in the loudness judgment dynamic range than the tNRT thresholds. Mean NRT thresholds fell between the judgments of medium soft and maximum acceptable loudness for all stimulation rates. Mean vNRT thresholds fell above C-levels, whereas almost half of tNRT thresholds fell just below C-levels. However, the relation between NRT thresholds and C-levels varied substantially for different MAP stimulation levels. In addition, there is substantial individual variability in the relation between NRT thresholds and MAP levels that is not reflected in the group data. The prediction of the contour of T- and C-levels from the contour of NRT thresholds across electrodes would not be appropriate for half of the subjects. Therefore, great care should be taken when applying a fitting rule that incorporates NRT thresholds without considering these individual differences. For adults who can provide appropriate loudness judgments and threshold responses it appears to be most efficient to primarily use behavioral measures to create MAPs.

Cognitive predictors of improvements in adults' spoken word recognition six months after cochlear implant activation.

This study investigated whether cognitive measures obtained prior to cochlear implant surgery activation could predict improvements in spoken word recognition in adult cochlear implant recipients 6 months after activation. In addition to noncognitive factors identified by previous studies (i.e. younger age, shorter duration of hearing loss), the present results indicated that improvement in spoken word recognition was associated with higher verbal learning scores and better verbal working memory. Contrary to expectation, neither general cognitive ability nor processing speed was significantly correlated with outcome at 6 months. Multiple regression analyses revealed that a combination of verbal learning scores and lip-reading skill accounted for nearly 72% of the individual differences in improvement in spoken word recognition (i.e. the variance in spoken word recognition scores at 6 months that remained unexplained after controlling for baseline spoken word recognition scores). These findings have relevance for research on auditory processing with cochlear implants as well as implications for clinical interventions.

Wireless CROS Versus Transcranial CROS for Unilateral Hearing Loss

Eight subjects with unilateral hearing loss were fitted with wireless CROS and transcranial BTE CROS hearing aids. Results revealed that two subjects preferred the BTE transcranial CROS; four subje...

Conductive Component After Cochlear Implantation in Patients With Residual Hearing Conservation

PURPOSE Changes in auditory thresholds following cochlear implantation are generally assumed to be due to damage to neural elements. Theoretical studies have suggested that placement of a cochlear implant can cause a conductive hearing loss. Identification of a conductive component following cochlear implantation could guide improvements in surgical techniques or device designs. The purpose of this study is to characterize new-onset conductive hearing losses after cochlear implantation. METHOD In a prospective study, air- and bone-conduction audiometric testing were completed on cochlear implant recipients. An air-bone gap equal to or greater than 15 dB HL at 2 frequencies determined the presence of a conductive component. RESULTS Of the 32 patients with preoperative bone-conduction hearing, 4 patients had a new-onset conductive component resulting in a mixed hearing loss, with air-conduction thresholds ranging from moderate to profound and an average air-bone gap of 30 dB HL. One had been implanted through the round window, 2 had an extended round window, and 1 had a separate cochleostomy. CONCLUSIONS Loss of residual hearing following cochlear implantation may be due in part to a conductive component. Identifying the mechanism for this conductive component may help minimize hearing loss. Postoperative hearing evaluation should measure both air- and bone-conduction thresholds.