Stefan Gräbel

Elderly patients benefit from cochlear implantation regarding auditory rehabilitation, quality of life, tinnitus, and stress.

To determine the effect of cochlear implantation on quality of life, speech performance, tinnitus, perceived stress, and coping strategy in patients aged ≥70 years in comparison with younger patients.

The impact of cochlear implantation on quality of life: The role of audiologic performance and variables

OBJECTIVE: The purpose of this study was to assess the impact of cochlear implantation (CI) on health-related quality of life (HRQOL), to correlate the results with audiologic performance, and to analyze the influence of variables that possibly affect the CI outcome. STUDY DESIGN: A retrospective study. SUBJECTS AND METHODS: Fifty-six adult CI users were evaluated by two HRQOL-questionnaires (the Nijmegen Cochlear Implant Questionnaire [NCIQ] and the Medical Outcome Study Short-Form 36 [SF-36]) and speech-perception tests (Freiburger monosyllable and Hochmair, Schulz, Moser (HSM) sentence test). RESULTS: The NCIQ showed significant improvements in the total score and in all subdomains after CI. The NCIQ total score and the advanced sound-perception and speech-production score correlated significantly with speech test results. Significant inverse relationships were noted between speech test results and duration of deafness. Significant associations were found between time since CI, NCIQ total score, and speech test results. CONCLUSION: The NCIQ was able to detect significant effects of CI on HRQOL and correlated with audiologic measures, supporting its use as a measurement tool in CI.

Cochlear implantation has a positive influence on quality of life, tinnitus, and psychological comorbidity.

To determine the effect of cochlear implantation (CI) on health‐related quality of life (HRQoL), tinnitus, and psychological comorbidity in patients with severe to profound postlingual hearing loss and to analyze the relationship between these parameters.

Extra benefit of a second cochlear implant with respect to health-related quality of life and tinnitus.

Objective To evaluate whether the second cochlear implant (CI) provides any extra benefit with respect to health-related quality of life, tinnitus, and auditory abilities. Design The data were evaluated using validated questionnaires before and after the first and second CI supply. Preimplantation data were collected retrospectively. Patients Forty postlingually deafened adults, 11 male and 29 female subjects were included in this study. All patients were sequentially bilaterally implanted with a multi-channel CI for at least 6 months. Results The health-related quality of life assessed with the Nijmegen Cochlear Implant Questionnaire further increased after the second CI. In patients with initially higher level of tinnitus annoyance measured with the Tinnitus Questionnaire, the scores decreased after the first CI and remained steady after the second CI. Patients with initially lower level of tinnitus annoyance had a further decrease of the Tinnitus Questionnaire score after the second CI. Additionally, the second CI induced further improvement of auditory abilities, as assessed by the Oldenburg Inventory and the Freiburg monosyllable test in quiet and the HSM and Oldenburg sentence tests in noise. The quality of life scores correlated with the auditory abilities, especially after the second CI. Conclusion The present study provides evidence that the second CI leads to further increase in quality of life and reduction of tinnitus annoyance in addition to improvement of auditory abilities as compared with the first CI. Patients with bilateral CIs benefit from additional positive effects in all these fields.

Impact of cochlear implantation on quality of life and mental comorbidity in patients aged 80 years

The objective of this study was to evaluate the outcome of cochlear implantation in elderly patients (80 or older) with progressive bilateral deafening. The measured outcomes included the quality of life, speech understanding, tinnitus distress, stress level, anxiety, and depressiveness.

Rapid Positive Influence of Cochlear Implantation on the Quality of Life in Adults 70 Years and Older

The deteriorating ability to communicate has a negative impact on quality of life in the aging population. Cochlear implantation is increasingly used to treat hearing impairment and to restore the ability to communicate. Here, in a sample of 79 adults (70 years and older), we explored the effect of cochlear implantation on the health-related quality of life via the Nijmegen Cochlear Implant Questionnaire, auditory performance for speech recognition comparing scores on the Freiburg Monosyllabic Test and Oldenburg Inventory and tinnitus-related distress using the German version of the Tinnitus Questionnaire. We observed that the health-related quality of life and auditory performance increased significantly after cochlear implantation for the study cohort. After implantation, tinnitus-related distress declined significantly for the group. Our results support the concept of cochlear implantation treatment positively influencing the quality of life, restoring the auditory performance in older adults and reducing stress related to tinnitus. Importantly, positive effects were seen as early as 6 months after cochlear implantation, corroborating the rationale for cochlear implantation in adults 70 years and older.

In Patients Undergoing Cochlear Implantation, Psychological Burden Affects Tinnitus and the Overall Outcome of Auditory Rehabilitation

Cochlear implantation (CI) is increasingly being used in the auditory rehabilitation of deaf patients. Here, we investigated whether the auditory rehabilitation can be influenced by the psychological burden caused by mental conditions. Our sample included 47 patients who underwent implantation. All patients were monitored before and 6 months after CI. Auditory performance was assessed using the Oldenburg Inventory (OI) and Freiburg monosyllable (FB MS) speech discrimination test. The health-related quality of life was measured with Nijmegen Cochlear implantation Questionnaire (NCIQ) whereas tinnitus-related distress was measured with the German version of Tinnitus Questionnaire (TQ). We additionally assessed the general perceived quality of life, the perceived stress, coping abilities, anxiety levels and the depressive symptoms. Finally, a structured interview to detect mental conditions (CIDI) was performed before and after surgery. We found that CI led to an overall improvement in auditory performance as well as the anxiety and depression, quality of life, tinnitus distress and coping strategies. CIDI revealed that 81% of patients in our sample had affective, anxiety, and/or somatoform disorders before or after CI. The affective disorders included dysthymia and depression, while anxiety disorders included agoraphobias and unspecified phobias. We also diagnosed cases of somatoform pain disorders and unrecognizable figure somatoform disorders. We found a positive correlation between the auditory performance and the decrease of anxiety and depression, tinnitus-related distress and perceived stress. There was no association between the presence of a mental condition itself and the outcome of auditory rehabilitation. We conclude that the CI candidates exhibit high rates of psychological disorders, and there is a particularly strong association between somatoform disorders and tinnitus. The presence of mental disorders remained unaffected by CI but the degree of psychological burden decreased significantly post-CI. The implants benefitted patients in a number of psychosocial areas, improving the symptoms of depression and anxiety, tinnitus, and their quality of life and coping strategies. The prevalence of mental disorders in patients who are candidates for CI suggests the need for a comprehensive psychological and psychosomatic management of their treatment.

Evaluation of a novel, noninvasive, objective test of auditory nerve function in cochlear implant candidates.

Objective: To investigate whether the objective noninvasive recording of the electrically evoked amplitude modulation following response (EAMFR) can be applied for the assessment of auditory nerve function before cochlear implant surgery. Study Design: Prospective clinical study from January 2005 to August 2008. Setting: Cochlear Implant Program at the Charité University Hospital (Berlin, Germany). Patients: One hundred twenty-one patients with severe to total bilateral sensorineural hearing impairment. Intervention: Diagnostic. Main Outcome Measures: All EAMFR thresholds were correlated with the mean intraoperative electrically evoked compound action potential (ECAP) thresholds. In a subgroup of 16 patients, the objective thresholds of the EAMFR were compared with the subjective auditory thresholds for the electrical stimuli applied. The intraindividual left-right concordance of the EAMFR and ECAP thresholds was investigated in 22 patients with bilateral implants. Results: The EAMFR-auditory nerve function test produced clear responses in all patients examined. The threshold of auditory perception for the applied stimuli correlated highly significantly with the EAMFR threshold (r = 0.89, p < 0.01). The correlation between the EAMFR and mean ECAP thresholds was again highly significant (r = 0.49, p < 0.01). In all patients with bilateral implants, the ear with the lower preoperative EAMFR threshold was also the one with the lower intraoperative mean ECAP threshold. Conclusion: These results indicate that the objective noninvasive recording of EAMFR seems to be a useful diagnostic tool for the evaluation of the auditory nerve function in cochlear implant candidates, especially in children or in adult patients who require objective examination.

Cochlear Implantation of Bilaterally Deafened Patients with Tinnitus Induces Sustained Decrease of Tinnitus-Related Distress

Objective Tinnitus is a common symptom of hearing impairment. Patients who are bilaterally hard of hearing are often affected by tinnitus. However, they cannot undergo any of the standard tinnitus therapies, since they rely on hearing. Cochlear implantation (CI) used to treat severe hearing disabilities, such as bilateral hearing loss, was also shown to reduce tinnitus. Our goal was to determine if CI induces sustained reduction of tinnitus. We performed prospective, longitudinal analyses of tinnitus-related distress in a uniform group of bilaterally deafened patients after CI. Patients and Methods The homogenous sample consisted of 41 patients who met the inclusion criteria and were consecutively included in this study. The impact of unilateral CI on tinnitus-related distress, health-related quality of life (HRQoL), and hearing abilities was studied with validated instruments. The follow-up appointments were scheduled at 6, 12, and 24 months after CI surgery. During the appointments, hearing abilities were estimated with monosyllabic Freiburg test, whereas the tinnitus-related distress, the HRQoL, and the subjective hearing were measured with standard questionnaires [Tinnitus Questionnaire (TQ), Nijmegen Cochlear Implantation Questionnaire, and Oldenburg Inventory, respectively]. Results Tinnitus-related distress decreased significantly from the mean TQ score of 35.0 (SD = 19.6) prior to surgery to the mean TQ = 27.54 (SD = 20.0) 6 months after surgery and remained sustained low until the end of follow-up period. In addition, CI significantly improved the hearing abilities and the HRQoL of all patients. Conclusion The results from our prospective study suggest that in a homogenous sample of bilaterally deafened, implanted patients who report having tinnitus prior to surgery, CI alone not only improves the hearing abilities but also significantly reduces the tinnitus-related distress and improves the HRQoL in a sustained way.

Electrically evoked amplitude modulation following response in cochlear implant candidates: comparison with auditory nerve response telemetry, subjective electrical stimulation, and speech perception.

Objective To establish the objective, noninvasive recording of the electrically evoked amplitude modulation following response (EAMFR) for the assessment of auditory nerve function in cochlear implant candidates. Study Design Prospective clinical study from 2007 to 2010. Setting Cochlear Implant Programme at the Charité–Universitätsmedizin Berlin (Germany). Patients Thirty-eight patients with severe-to-total bilateral sensorineural hearing impairment. Intervention Diagnostic. Main Outcome Measures The EAMFR thresholds were correlated with the mean thresholds of the intraoperative electrically evoked compound action potential (ECAP) derived by auditory nerve response telemetry and with the subjective electrical stimulation test. The intraindividual left-right similarity of the EAMFR and ECAP thresholds was investigated in 9 bilaterally implanted patients. Additionally, the correlation between auditory performance and EAMFR thresholds was investigated. Results The EAMFR auditory nerve function test produced clear responses in all patients. The EAMFR thresholds correlated significantly with the mean ECAP thresholds (r = 0.58, p < 0.01) and the subjective electrical stimulation test (r = 0.32, p < 0.05). In the bilaterally implanted patients, there was either no side difference, or the ear with the lower preoperative EAMFR threshold also was the one with the lower intraoperative mean ECAP threshold. No correlation was found between EAMFR thresholds and postoperative speech recognition scores. Conclusion These novel results support the notion that the EAMFR auditory nerve function test is a useful objective and noninvasive tool to provide information about the responsiveness of the auditory nerve to electrical stimulation in cochlear implant candidates.