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

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

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.

Related collections

Most cited references 42

Record: found
Abstract: found
Article: not found

Role of electrode placement as a contributor to variability in cochlear implant outcomes.

Charles C Finley, Timothy Holden, Laura Holden … (2008)

Suboptimal cochlear implant (CI) electrode array placement may reduce presentation of coded information to the central nervous system and, consequently, limit speech recognition. Generally, mean speech reception scores for CI recipients are similar across different CI systems, yet large outcome variation is observed among recipients implanted with the same device. These observations suggest significant recipient-dependent factors influence speech reception performance. This study examines electrode array insertion depth and scalar placement as recipient-dependent factors affecting outcome. Scalar location and depth of insertion of intracochlear electrodes were measured in 14 patients implanted with Advanced Bionics electrode arrays and whose word recognition scores varied broadly. Electrode position was measured using computed tomographic images of the cochlea and correlated with stable monosyllabic word recognition scores. Electrode placement, primarily in terms of depth of insertion and scala tympani versus scala vestibuli location, varies widely across subjects. Lower outcome scores are associated with greater insertion depth and greater number of contacts being located in scala vestibuli. Three patterns of scalar placement are observed suggesting variability in insertion dynamics arising from surgical technique. A significant portion of variability in word recognition scores across a broad range of performance levels of CI subjects is explained by variability in scalar location and insertion depth of the electrode array. We suggest that this variability in electrode placement can be reduced and average speech reception improved by better selection of cochleostomy sites, revised insertion approaches, and control of insertion depth during surgical placement of the array.

0 comments Cited 111 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

In vivo estimates of the position of advanced bionics electrode arrays in the human cochlea.

Arne Voie, Barry Brunsden, Crystal J. Neely … (2007)

A new technique for determining the position of each electrode in the cochlea is described and applied to spiral computed tomography data from 15 patients implanted with Advanced Bionics HiFocus I, Ij, or Helix arrays. ANALYZE imaging software was used to register 3-dimensional image volumes from patients' preoperative and postoperative scans and from a single body donor whose unimplanted ears were scanned clinically, with micro computed tomography and with orthogonal-plane fluorescence optical sectioning (OPFOS) microscopy. By use of this registration, we compared the atlas of OPFOS images of soft tissue within the body donor's cochlea with the bone and fluid/ tissue boundary available in patient scan data to choose the midmodiolar axis position and judge the electrode position in the scala tympani or scala vestibuli, including the distance to the medial and lateral scalar walls. The angular rotation 0 degrees start point is a line joining the midmodiolar axis and the middle of the cochlear canal entry from the vestibule. The group mean array insertion depth was 477 degrees (range, 286 degrees to 655 degrees). The word scores were negatively correlated (r = -0.59; p = .028) with the number of electrodes in the scala vestibuli. Although the individual variability in all measures was large, repeated patterns of suboptimal electrode placement were observed across subjects, underscoring the applicability of this technique.

0 comments Cited 42 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

CT-derived estimation of cochlear morphology and electrode array position in relation to word recognition in Nucleus-22 recipients.

Joseph W. Harding, G Robert Kletzker, Barbara Blocker … (2002)

This study extended the findings of Ketten et al. [Ann. Otol. Rhinol. Laryngol. Suppl. 175:1-16 (1998)] by estimating the three-dimensional (3D) cochlear lengths, electrode array intracochlear insertion depths, and characteristic frequency ranges for 13 more Nucleus-22 implant recipients based on in vivo computed tomography (CT) scans. Array insertion depths were correlated with NU-6 word scores (obtained one year after SPEAK strategy use) by these patients and the 13 who used the SPEAK strategy from the Ketten et al. study. For these 26 patients, the range of cochlear lengths was 29.1-37.4 mm. Array insertion depth range was 11.9-25.9 mm, and array insertion depth estimated from the surgeon's report was 1.14 mm longer than CT-based estimates. Given the assumption that the human hearing range is fixed (20-20,000 Hz) regardless of cochlear length, characteristic frequencies at the most apical electrode (estimated with Greenwood's equation [Greenwood DD (1990) A cochlear frequency--position function of several species--29 years later. J Acoust. Soc. Am. 33: 1344-1356] and a patient-specific constant as) ranged from 308 to 3674 Hz. Patients' NU-6 word scores were significantly correlated with insertion depth as a percentage of total cochlear length (R = 0.452; r2 = 0.204; p = 0.020), suggesting that part of the variability in word recognition across implant recipients can be accounted for by the position of the electrode array in the cochlea. However, NU-6 scores ranged from 4% to 81% correct for patients with array insertion depths between 47% and 68% of total cochlear length. Lower scores appeared related to low spiral ganglion cell survival (e.g., lues), aberrant current paths that produced facial nerve stimulation by apical electrodes (i.e., otosclerosis), central auditory processing difficulty, below-average verbal abilities, and early Alzheimer's disease. Higher scores appeared related to patients' high-average to above-average verbal abilities. Because most patients' scores increased with SPEAK use, it is hypothesized that they accommodated to the shift in frequency of incoming sound to a higher pitch percept with the implant than would normally be perceived acoustically.

0 comments Cited 37 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Manuel S. Malmierca: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2012

Publication date (Electronic): 9 November 2012

Volume: 7

Issue: 11

Electronic Location Identifier: e48739

Affiliations

[1 ]Bionics Institute, Melbourne, Australia

[2 ]Service d'otologie et d'otoneurologie, Hôpital R.-Salengro, CHRU de Lille, Lille, France

[3 ]CHU Gui de Chauliac, Service d'ORL et Chirurgie Cervico-Faciale, Montpellier, France

[4 ]Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium

[5 ]Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d'ORL, de Chirurgie Cervico-Maxillo-Faciale et d'Audiophonologie, Lyon, France

[6 ]AP-HP, Hôpital Beaujon, Service d'ORL et Chirurgie Cervico-Faciale, Clichy, France

[7 ]Institute of Physiology and Pathology of Hearing, Warsaw, Poland

[8 ]Institute of Sensory Organs, Kajetany, Poland

[9 ]The Eargroup, Antwerp, Belgium

[10 ]Department of Otolaryngology, The University of Melbourne Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia

[11 ]University of Manchester, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom

[12 ]University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology/Head and Neck Surgery, Cochlear Implant Center Northern Netherlands, Groningen, The Netherlands

[13 ]Department of Otorhinolaryngology, University Hospital of Zurich, Zurich, Switzerland

[14 ]Hôpital Universitaire Purpan, Service d'ORL et Chirurgie Cervico-Faciale, Toulouse, France

[15 ]St Thomas' Hospital, Auditory Implants Department, London, United Kingdom

[16 ]Otorhinolaryngology, Radboud University Nijmegen Medical Center, Mijmegen, The Netherlands

[17 ]Faculté de médecine, Université Laval, Québec City, Québec, Canada

[18 ]Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands

[19 ]Institut Saint Pierre, Service d'Audiophonologie et ORL, Palavas les flots, France

University of Salamanca-Institute for Neuroscience of Castille and Leon and Medical School, Spain

Author notes

* E-mail: dianelazard@ 123456yahoo.fr

Competing Interests: Most of the authors of this paper are involved in the purchase and application of cochlear implants from one or more of the four largest manufacturers (Advanced Bionics, Cochlear Limited, Med-El, and Neurelec). Peter Blamey is a co-inventor of technologies used in the device manufactured by Cochlear Limited and formerly received a share of royalties from the University of Melbourne. He is not a shareholder in Cochlear and no longer receives royalties. The hearing aid company, Blamey & Saunders Hearing Pty Ltd, regularly refers people with severe-to-profound hearing loss to cochlear implant clinics whenever it seems likely that a CI will provide a better clinical outcome than a HA. The Bionics Institute has a small shareholding in Cochlear Limited. DL received travel support from Cochlear in 2010/11. Neurelec partially funded her PhD work in 2009/10, but was not involved in the research project (fMRI). This dataset is a very rare resource enabling comparison of different devices from different manufacturers and from different cochlear implant clinics and the data analysts (Blamey and Lazard) designed the study and analysis in a way that treats data for these different devices equivalently to avoid any possibility of bias. Statistically significant differences between the device brands were found in the analysis, and the device brands have been de-identified in the manuscript to avoid use of the data for commercial advantage. This has been a difficult decision because de-identification of the brands is also withholding important information about clinical outcomes from potential patients and clinicians. The authors agree to share the (de-identified) data on request for academic, non-commercial purposes if the paper is published.

Conceived and designed the experiments: DL CV FV PVdH ET OS PHS HS KS SO DM BM AKP AMH KG PJG BF RD ND EB AB FB DB FA PJB. Analyzed the data: DL PJB. Contributed reagents/materials/analysis tools: DL PJB. Wrote the paper: DL PJB. Critically revised the manuscript: DL CV FV PVdH ET OS PHS HS KS SO DM BM AKP AMH KG PJG BF RD ND EB AB FB DB FA PJB.

Article

Publisher ID: PONE-D-12-13190

DOI: 10.1371/journal.pone.0048739

PMC ID: 3494723

PubMed ID: 23152797

SO-VID: 3837be70-798d-47be-9c66-dfe26f1761b0

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 3 May 2012

Date accepted : 28 September 2012

Page count

Pages: 11

Funding

DL was funded by Fondation Bettencourt-Schueller. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

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

Read this article at

Abstract

Objective

Study Design

Methods

Results

Conclusions

Related collections

PLOS Climate

Most cited references 42

Role of electrode placement as a contributor to variability in cochlear implant outcomes.

In vivo estimates of the position of advanced bionics electrode arrays in the human cochlea.

CT-derived estimation of cochlear morphology and electrode array position in relation to word recognition in Nucleus-22 recipients.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Page count

Funding

Categories

Comments

Comment on this article

Similar content 98

Cited by 118