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Background: The Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline on cochlear implant (CI) treatment, which was updated in 2020, defined the entire process of CI care for the first time. In the present study, the feasibility and results of very early rehabilitation were examined.
Materials and methods: The intervention group (IG) comprised 54 patients in whom rehabilitation was initiated within 14 (maximally 28) days after implantation. Patients with a significantly longer waiting time were included in the control group (CG, n = 21). In addition to the start and duration of rehabilitation, the speech intelligibility achieved with CI was recorded at different timepoints within a 12-month period. In addition, questionnaires were used to assess the effort of fitting the CI processor and the patients’ satisfaction with the outcome as well as the timing of the start of rehabilitation.
Results: Median waiting time between implantation and start of rehabilitation was 14 days in the IG and 106 days in the CG; 92.6% of IG patients were able to start rehabilitation within 14 days. The effect of rehabilitation in the IG was 35 and in the CG 25 percentage points (Freiburg monosyllabic test). After 6 and 12 months of CI use, both groups showed comparable results in the test condition in quiet (IG/CG 6 months: 70%/70%; 12 months: 70%/60%, Freiburg monosyllabic test) and in noise (IG/CG 6 months: −1.1 dB SNR/–0.85 dB SNR; 12 months: −0.65 dB SNR/+0.3 dB SNR, Oldenburg sentence test). Hearing quality assessment scores collected by SSQ (Speech, Spatial and Qualities of Hearing Scale) questionnaire showed better scores in the IG at 6 months, which converged to CG scores at 12 months. The IG was significantly more satisfied with the timing of the start of rehab than the CG. All other data obtained from questionnaires showed no differences between the two groups.
Conclusion: A very early start of inpatient rehabilitation after cochlear implantation was successfully implemented. The rehabilitation was completed within 7 weeks of CI surgery. Comparison of speech recognition test results before and after rehabilitation showed a significant improvement. A clear rehabilitation effect can therefore be demonstrated. Inclusion of CI rehabilitation in the German catalog of follow-up treatments is thus scientifically justified and therefore strongly recommended.
Hintergrund: Mit der im Jahr 2020 aktualisierten AWMF-Leitlinie zur Versorgung mit einem Cochleaimplantat (CI) wurde erstmals der gesamte Prozess einer CI-Versorgung definiert. In der vorliegenden Studie wurden die Machbarkeit und die Ergebnisse einer sehr frühen Rehabilitationsmaßnahme (Reha) untersucht.
Methodik: Es wurden 54 Patienten in die Interventionsgruppe (IG) eingeschlossen, bei der die Reha innerhalb von 14 (maximal 28) Tagen nach der Implantation eingeleitet wurde. In eine Kontrollgruppe (KG, n = 21) wurden Patienten mit deutlich längerer Wartezeit eingeschlossen. Neben dem Beginn und der Dauer der Reha wurde das mit CI erreichte Sprachverstehen zu verschiedenen Zeitpunkten innerhalb von 12 Monaten erfasst. Zusätzlich wurde mit Fragebögen der Aufwand der Anpassung des CI-Prozessors und die Zufriedenheit der Patienten mit dem Ergebnis sowie dem Zeitpunkt des Beginns der Reha ermittelt.
Ergebnisse: Die Wartezeit zwischen Implantation und Beginn der Reha lag in der IG bei 14 Tagen und in der KG bei 106 Tagen (Mediane). Es konnten 92,6 % der Patienten der IG die Reha innerhalb von 14 Tagen antreten. Der Effekt der Reha lag in der IG bei 35 und in der KG bei 25 Prozentpunkten (Freiburger Einsilbertest). Nach 6 und 12 Monaten (M) CI-Nutzung zeigten beide Gruppen sowohl in der Testbedingung in Ruhe (IG/KG 6M: 70 %/70 %; 12M: 70 %/60 %, Freiburger Einsilbertest) als auch im Störgeräusch (IG/KG 6M: −1,1 dB SNR/–0,85 dB SNR; 12M: −0,65 dB SNR/+0,3 dB SNR, Oldenburger Satztest) vergleichbare Ergebnisse. Die mittels des Fragebogens Speech, Spatial and Qualities of Hearing Scale (SSQ) erfassten Ergebnisse für die Einschätzung der Hörqualität zeigten nach 6 Monaten eine bessere Bewertung in der IG, die sich nach 12 Monaten an die Ergebnisse der KG anglich. Die IG war mit dem Zeitpunkt des Beginns der Reha deutlich zufriedener als die KG. Alle anderen aus Fragebögen ermittelten Daten zeigten keine Unterschiede zwischen den beiden Gruppen.
Schlussfolgerung: Der sehr frühe Beginn einer stationären Reha nach Cochleaimplantation ist erfolgreich umsetzbar. Die Reha konnte innerhalb von 7 Wochen nach der Implantation abgeschlossen werden. Der Vergleich der Ergebnisse der Tests des Sprachverstehens vor und nach der Reha zeigte eine deutliche Steigerung. Somit ist ein deutlicher Reha-Effekt nachweisbar. Die Aufnahme der CI-Rehabilitation in den Katalog der Anschlussheilbehandlungen ist somit wissenschaftlich begründet und damit dringend zu empfehlen.
Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care.
Hintergrund und Fragestellung: Die Severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2)-Pandemie hat die Ausbildung von Medizinstudierenden grundlegend verändert. Die Notwendigkeit von Kontaktbeschränkungen und die damit einhergehende Forderung nach Distanzunterricht hat dazu geführt, dass innerhalb kurzer Zeit digitale Lehrformate umgesetzt werden mussten. Ziel dieser Arbeit war die Auswertung der studentischen Evaluationsergebnisse für virtuellen Unterricht im Fach Hals-Nasen-Ohren-Heilkunde während der SARS-CoV-2-Pandemie und ein Vergleich mit den zuvor erhobenen Evaluationsergebnissen unter Präsenzbedingungen.
Material und Methoden: Untersucht wurden die Evaluationsergebnisse für die Blockpraktika im Wintersemester 2020/21 und im Sommersemester 2021, die in einem virtuellen Format mit kurzer Präsenzphase durchgeführt wurden, sowie die der komplett im konventionellen Präsenzformat durchgeführten Praktika von Sommersemester 2018 bis Wintersemester 2019/20. Die anonyme Befragung der Studierenden bezog sich auf verschiedene Aspekte der Lehrveranstaltung, wie z. B. Organisation, Didaktik und Lernatmosphäre.
Ergebnisse: Von 16 abgefragten Kategorien zeigten 14 (87,5%) signifikant bessere Evaluationsergebnisse für die virtuellen Praktika verglichen mit den zuvor im Präsenzformat durchgeführten Praktika. Diese sehr positive Bewertung des digitalen Lehrangebots zeigte im Pandemieverlauf über die Dauer von zwei Semestern keine signifikante Änderung.
Schlussfolgerung: Die vorliegenden Daten belegen die hohe Akzeptanz eines digitalen Lehrangebots im Fach HNO-Heilkunde für Studierende. Auch wenn unerlässliche Bestandteile der ärztlichen Ausbildung, wie der Unterricht am Patienten und das Erlernen klinisch-praktischer Fertigkeiten, weiterhin nur im Präsenzformat realisiert werden können, legen die Ergebnisse nahe, dass digitale Elemente auch nach der SARS-CoV-2-Pandemie eine Rolle im Medizinstudium spielen könnten.
Long-term effects on the quality of life following cochlear implant treatment in older patients
(2022)
Purpose: Even in older patients, hearing rehabilitation with a cochlear implant has become an established method for deafened or severely hearing-impaired patients. In addition to the hearing improvement, numerous other effects of CI treatment can be observed in clinical routine. In the literature, there is multiple evidence for a rapid and significant improvement in quality of life with CI treatment. The aim of this study was to evaluate the long-term effects of hearing rehabilitation using CI on the quality of life in older patients (≥ 65 years).
Methods: This prospective cross-sectional study examined 84 patients between the age of 65 and 101 years who received unilateral CI treatment for the first time between one and 10 years ago. The World Health Organization Quality-of-Life Scale-Old (WHOQL-OLD) was used to determine the quality of life. The study cohort was divided into three groups to compare the quality of life over time: group I (1–3 years after CI treatment), group II (4–6 years after CI treatment), and group III (7–10 years after CI treatment). In addition, the data from this study were compared with the results of our previous study (Issing et al. 2020) in which we focused on the first 6 months after CI treatment.
Results: In all three groups, there was a significant improvement in monosyllabic discrimination within 1 year after CI fitting (p > 0.001). No significant differences were found between the three groups. There were no significant differences between the three groups in the WHOQOL-OLD total score (p = 0.487) or any of the other six facets. Moreover, no significant differences were found compared to the study group of our previous study 6 months after CI treatment.
Conclusion: This study demonstrates the long-term stability of the improved quality of life following unilateral CI treatment in patients aged 65 years or older.
Purpose: The treatment with a cochlear implant (CI) is the gold standard in therapy of patients with profound hearing loss or deafness. Successful hearing rehabilitation with a CI is a complex, multi-stage process. In medicine, “Clinical Practice Guidelines” (CPG) are widely accepted for the standardization of such processes. These are supplemented by medical registries in which data regarding the treatment can be collected and evaluated. The aim of this paper is to identify currently existing CI-related CPGs and registries in Europe.
Methods: Between 01/2021 and 06/2021, 42 countries on the European continent, including the United Kingdom, Russia and Turkey, were screened using an internet search (search engine: Google) and a key word search in the Pubmed database. Search terms were the respective country name combined with the following terms: “Cochlear Implant”, “CI”, “Cochlear implant clinical practice guideline”, “CI Guideline”, “Cochlear Implant Registry”, “CI Registry”, “Ear nose throat society”. The internet search was conducted in English as well as in the corresponding national language. The objective was to identify a CI-related CPG or registry.
Results: A CPG was found in 16 of 42 (38%) countries. In terms of population, this accounts for 645 million out of 838 million people (77%). A registry existed in 4 of the 42 (10%) countries assessed. This corresponds to 102 million out of 838 million (12%) people. In total, 4 out of 42 countries (10%) had both a CPG and a registry.
Conclusion: Our work shows numerous efforts in Europe to standardize CI care at the national level. While most people in Europe already live in countries with a CPG, this is not the case for CI registries. European-wide consensus on CPGs or registries does not yet exist. The present study thus provides a first assessment of the distribution of CI-related CPGs and registries.
Hearing loss in old age, which often goes untreated, has far-reaching consequences. Furthermore, reduction of cognitive abilities and dementia can also occur, which also affects quality of life. The aim of this study was to investigate the hearing performance of seniors without hearing complaints with respect to speech perception in noise and the ability to localize sounds. Results were tested for correlations with age and cognitive performance. The study included 40 subjects aged between 60 and 90 years (mean age: 69.3 years) with not self-reported hearing problems. The subjects were screened for dementia. Audiological tests included pure-tone audiometry and speech perception in two types of background noise (continuous and amplitude-modulated noise) which was either co-located or spatially separated (multi-source noise field, MSNF) from the target speech. Sound localization ability was assessed and hearing performance was self-evaluated by a questionnaire. Speech in noise and sound localization was compared with young normal hearing adults. Although considering themselves as hearing normal, 17 subjects had at least a mild hearing loss. There was a significant negative correlation between hearing loss and dementia screening (DemTect) score. Speech perception in noise decreased significantly with age. There were significant negative correlations between speech perception in noise and DemTect score for both spatial configurations. Mean SRTs obtained in the co-located noise condition with amplitude-modulated noise were on average 3.1 dB better than with continuous noise. This gap-listening effect was severely diminished compared to a younger normal hearing subject group. In continuous noise, spatial separation of speech and noise led to better SRTs compared to the co-located masker condition. SRTs in MSNF deteriorated in modulated noise compared to continuous noise by 2.6 dB. Highest impact of age was found for speech perception scores using noise stimuli with temporal modulation in binaural test conditions. Mean localization error was in the range of young adults. Mean amount of front/back confusions was 11.5% higher than for young adults. Speech perception tests in the presence of temporally modulated noise can serve as a screening method for early detection of hearing disorders in older adults. This allows for early prescription of hearing aids.
Clinical speech perception tests with simple presentation conditions often overestimate the impact of signal preprocessing on speech perception in complex listening environments. A new procedure was developed to assess speech perception in interleaved acoustic environments of different complexity that allows investigation of the impact of an automatic scene classification (ASC) algorithm on speech perception. The procedure was applied in cohorts of normal hearing (NH) controls and uni- and bilateral cochlear implant (CI) users. Speech reception thresholds (SRTs) were measured by means of a matrix sentence test in five acoustic environments that included different noise conditions (amplitude modulated and continuous), two spatial configurations, and reverberation. The acoustic environments were encapsulated in a randomized, mixed order single experimental run. Acoustic room simulation was played back with a loudspeaker auralization setup with 128 loudspeakers. 18 NH, 16 unilateral, and 16 bilateral CI users participated. SRTs were evaluated for each individual acoustic environment and as mean-SRT. Mean-SRTs improved by 2.4 dB signal-to-noise ratio for unilateral and 1.3 dB signal-to-noise ratio for bilateral CI users with activated ASC. Without ASC, the mean-SRT of bilateral CI users was 3.7 dB better than the SRT of unilateral CI users. The mean-SRT indicated significant differences, with NH group performing best and unilateral CI users performing worse with a difference of up to 13 dB compared to NH. The proposed speech test procedure successfully demonstrated that speech perception and benefit with ASC depend on the acoustic environment.
Objective: Vertigo is a common side effect of cochlear implant (CI) treatment. This prospective study examines the incidence of postoperative vertigo over time and aims to analyze influencing factors such as electrode design and insertion angle (IA).
Study Design and Setting: This is a prospective study which has been conducted at a tertiary referral center (academic hospital).
Patients: A total of 29 adults were enrolled and received a unilateral CI using one of six different electrode carriers, which were categorized into “structure-preserving” (I), “potentially structure-preserving” (II), and “not structure-preserving” (III).
Intervention: Subjective vertigo was assessed by questionnaires at five different time-points before up to 6 months after surgery. The participants were divided into four groups depending on the time of the presence of vertigo before and after surgery. Preoperatively and at 6 months postoperatively, a comprehensive vertigo diagnosis consisting of Romberg test, Unterberger test, subjective visual vertical, optokinetic test, video head impulse test, and caloric irrigation test was performed. In addition, the IA was determined, and the patients were divided in two groups (<430°; ≥430°).
Main Outcome Measures: The incidence of vertigo after CI surgery (group 1) was reported, as well as the correlation of subjective vertigo with electrode array categories (I–III) and IA.
Results: Among the participants, 45.8% experienced new vertigo after implantation. Based on the questionnaire data, a vestibular origin was suspected in 72.7%. The results did not show a significant correlation with subjective vertigo for any of the performed tests. In group 1 with postoperative vertigo, 18% of patients showed conspicuous results in a quantitative analysis of caloric irrigation test despite the fact that the category I or II electrodes were implanted, which are suitable for structure preservation. Average IA was 404° for the overall group and 409° for group 1. There was no statistically significant correlation between IA and perceived vertigo.
Conclusions: Though vertigo after CI surgery seems to be a common complication, the test battery used here could not objectify the symptoms. Further studies should clarify whether this is due to the multifactorial cause of vertigo or to the lack of sensitivity of the tests currently in use. The proof of reduced probability for vertigo when using atraumatic electrode carrier was not successful, nor was the proof of a negative influence of the insertion depth.
Objectives: In this study, localization accuracy and sensitivity to acoustic interaural time differences (ITDs) in subjects using cochlear implants with combined electric-acoustic stimulation (EAS) were assessed and compared with the results of a normal hearing control group. Methods: Eight CI users with EAS (2 bilaterally implanted, 6 unilaterally implanted) and symmetric binaural acoustic hearing and 24 normal hearing subjects participated in the study. The first experiment determined mean localization error (MLE) for different angles of sound incidence between ± 60° (frontal and dorsal presentation). The stimuli were either low-pass, high-pass or broadband noise bursts. In a second experiment, just noticeable differences (JND) of ITDs were measured for pure tones of 125 Hz, 250 Hz and 500 Hz (headphone presentation). Results: Experiment 1: MLE of EAS subjects was 8.5°, 14.3° and 14.7°, (low-, high-pass and broadband stimuli respectively). In the control group, MLE was 1.8° (broadband stimuli). In the differentiation between sound incidence from front and back, EAS subjects performed on chance level. Experiment 2: The JND-ITDs were 88.7 μs for 125 Hz, 48.8 μs for 250 Hz and 52.9 μs for 500 Hz (EAS subjects). Compared to the control group, JND-ITD for 125 Hz was on the same level of performance. No statistically significant correlation was found between MLE and JND-ITD in the EAS cohort. Conclusions: Near to normal ITD sensitivity in the lower frequency acoustic hearing was demonstrated in a cohort of EAS users. However, in an acoustic localization task, the majority of the subjects did not reached the level of accuracy of normal hearing. Presumably, signal processing time delay differences between devices used on both sides are deteriorating the transfer of precise binaural timing cues.