Audiology and Neurotology 2022-01-17

Using Clinical Audiologic Measures to Determine Cochlear Implant Candidacy

Publication date 17-01-2022

Introduction: Only a small percentage (6–10%) of patients who are candidates receive cochlear implants (CIs). One potential reason contributing to low usage rates may be confusion regarding which patients to refer for CI evaluation. The extent to which information provided by standard clinical audiologic assessments is sufficient for selecting appropriate CI evaluation referrals is uncertain. The objective of this study is to evaluate the capacity of standard clinical audiologic measures to differentiate CI candidates from noncandidates.
Method: The study design is a retrospective review of a prospectively maintained CI database from a university-based tertiary medical center of 518 patients undergoing CI evaluations from 2012 to 2020. Each ear of each patient was treated as an independent value. Receiver operating characteristic (ROCs) curves were constructed using aided Az Bio sentence recognition scores in quiet and aided Az Bio +10 dB signal-to-noise ratio scores #x3c;60% as binary classifiers for CI candidacy. For each ROC, we examined the capacity of multiple pure-tone thresholds, pure-tone average (PTA), and CNC word recognition scores (WRSs) measured under earphones to determine CI candidacy. Area under the curve ROC (AUC-ROC) values were calculated to demonstrate the capacity of each model to differentiate CI candidates from noncandidates.
Results: Variables with the greatest capacity to accurately differentiate CI candidates from noncandidates using aided Az Bio in quiet scores were earphone CNC WRS, earphone pure-tone threshold at 1,000 Hz, and earphone PTA (AUC-ROC values = 0.86–0.88). Using aided Az Bio +10 scores as the measure for candidacy, only CNC word recognition had a fair capacity to identify candidates (AUC-ROC value = 0.73). Based on the ROCs, a 1,000 Hz pure-tone threshold #x3e;50 dB HL, PTA #x3e;57 dB HL, and a monosyllabic WRS #x3c;60% can each serve as individual indicators for referral for CI evaluations.
Conclusion: The current study provides initial indicators for referral and a first step at developing evidence-based criteria for CI evaluation referral using standard audiologic assessments. Audiol Neurotol

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Three-Dimensional High-Resolution Temporal Bone Histopathology Identifies Areas of Vascular Vulnerability in the Inner Ear

B Büki,A Mair,JM Pogson,NS Andresen,BK Ward

Publication date 29-12-2021

Objectives: Hypothesized causes of vestibular neuritis/labyrinthitis include neuroinflammatory or vascular disorders, yet vascular disorders of the inner ear are poorly understood. Guided by known microvascular diseases of the retina, we developed 2 hypotheses: (1) there exist vascular vulnerabilities of artery channels in cases of hypothetical nerve swelling for the superior, inferior, and vestibulocochlear artery and (2) there are arteriovenous crossings that could compromise vascular flow in disease states.
Methods: Two fully mounted and stained temporal bones were used to render three-dimensional reconstructions of the labyrinth blood supply. Using these maps, areas of potential vascular compression were quantified in 50 human temporal bones.
Results: Although inner ear arteries and veins mostly travel within their own bony channels, they may be exposed (1) at the entrance into the otic capsule, and (2) where the superior vestibular vein crosses the inferior vestibular artery. At the entry into the otic capsule, the ratio of the soft tissue to total space for the superior vestibular artery was significantly greater than the inferior vestibular artery/cochleovestibular artery (median 44, interquartile range 34–55 vs. 14 9–17, p #x3c; 0.0001).
Conclusions: Three-dimensional reconstruction of human temporal bone histopathology can guide vascular studies of the human inner ear. Studies of retinal microvascular disease helped identify areas of vascular vulnerability in cases of hypothetical nerve swelling at the entrance into the otic capsule and at an arteriovenous crossing near the saccular macula. These data may help explain patterns of clinical findings in peripheral vestibular lesions. Audiol Neurotol

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Speech-in-Noise Audiometry in Adults: A Review of the Available Tests for French Speakers

P Reynard,J Lagacé,CA Joly,L Dodelé,E Veuillet,H Thai-Van

Publication date 22-12-2021

Background: Difficulty understanding speech in background noise is the reason of consultation for most people who seek help for their hearing. With the increased use of speech-in-noise (SpIN) testing, audiologists and otologists are expected to evidence disabilities in a greater number of patients with sensorineural hearing loss. The purpose of this study is to list validated available SpIN tests for the French-speaking population.
Summary: A review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pub Med and Scopus databases were searched.
Search strategies used a combination of 4 keywords: speech, audiometry, noise, and French. There were 10 validated SpIN tests dedicated to the Francophone adult population at the time of the review. Some tests use digits triplets as speech stimuli and were originally designed for hearing screening. The others were given a broader range of indications covering diagnostic or research purposes, determination of functional capacities and fitness for duty, as well as assessment of hearing amplification benefit.
Key Messages: As there is a SpIN test for almost any type of clinical or rehabilitation needs, both the accuracy and duration should be considered for choosing one or the other. In an effort to meet the needs of a rapidly aging population, fast adaptive procedures can be favored to screen large groups in order to limit the risk of ignoring the early signs of forthcoming presbycusis and to provide appropriate audiological counseling. Audiol Neurotol

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Increased Monocyte Chemotactic Protein-1 Accompanying Pro-Inflammatory Processes are Associated with Progressive Hearing Impairment and Bilateral Disability of Meniere’s Disease

R Iinuma,H Okuda,N Obara,Y Matsubara,M Aoki,T Ogawa

Publication date 13-12-2021

Background: The progression of hearing impairment and the bilateral involvement of Meniere’s disease (MD) may depend on the disease duration and aging. Recent studies reported that MD might involve dysfunction of the microvascular circulation damaged due to inflammatory changes.
Objectives: The aim of this study was to determine that the progress of the MD’s hearing impairment and bilateral disability may be associated with the pathogenesis of several pro-inflammatory processes.
Patients and Methods: We recruited 30 unilateral MD patients (56.8 ± 14.7 years old), 7 bilateral MD patients (65.3 ± 13.9 years old), and 17 age-matched control subjects (53.5 ± 14.4 years old, p #x3e; 0.05). We measured the plasma vascular endothelial growth factor (VEGF), plasma interleukin-6 (IL-6), plasma tumor-necrosis factor α (TNFα), and plasma monocyte chemotactic protein-1 (MCP-1).
Results: The bilateral MD group and the unilateral MD group had higher plasma MCP-1 (204.7 ± 41.0 pg/mL and 169.5 ± 32.0 pg/mL) than the control group (149.2 ± 30.7 pg/mL) (p #x3c; 0.05). There was no significant difference in plasma TNFα, IL-6, and VEGF among 3 groups (p #x3e; 0.05). There was a strong correlation between the plasma MCP-1 and age in MD patients (r = 0.58, p #x3c; 0.01); however, no significant correlation between the plasma MCP-1 and age was found in control subjects (p #x3e; 0.05). The plasma MCP-1 significantly correlated with the average hearing level of 500, 1,000, 2,000, and 4,000 Hz, and the maximum slow phase eye velocity in caloric test in the better side (p #x3c; 0.05). Also, the plasma MCP-1 showed significant positive correlations with the plasma IL-6 (r = 0.49, p #x3c; 0.01) and plasma TNFα (r = 0.32, p #x3c; 0.05) in MD group.
Conclusions: Our results suggest that the increased plasma MCP-1 accompanying pro-inflammatory processes are associated with the progression of the hearing impairment and the bilateral disability of MD. Audiol Neurotol

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Publication date 23-11-2021

Audiol Neurotol 2021;26:I–VI

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Acknowledgement to the Reviewers

Publication date 23-11-2021

Audiol Neurotol 2021;26:487–488

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Influence of Postponed Follow-Up after Cochlear Implant Activation during the COVID-19 Pandemic on Aided Sound Field Detection and Speech Recognition

TG Vos,KD Brown,E Buss,AL Bucker,MM Dedmon,BP O'Connell,J Raymond,MT Dillon

Publication date 22-11-2021

Introduction: The objective of this study was to assess the influence of postponing the first post-activation follow-up due to the COVID-19 pandemic on the aided sound field detection thresholds and speech recognition of cochlear implant (CI) users.
Methods: A retrospective review was performed at a tertiary referral center.
Two groups of adult CI recipients were evaluated: (1) patients whose first post-activation follow-up was postponed due to COVID-19 closures (postponed group; n = 10) and (2) a control group that attended recommended post-activation follow-ups prior to the COVID-19 pandemic (control group; n = 18). For both groups, electric thresholds were estimated at initial activation based on comfort levels and were measured behaviorally at subsequent post-activation follow-ups. For the control group, behavioral thresholds were measured at the 1-month follow-up. For the postponed group, behavioral thresholds were not measured until 3 months post-activation since the 1-month follow-up was postponed. The aided pure-tone average (PTA) and word recognition results were compared between groups at the 3-month follow-up and at an interim visit 2–9 weeks later.
Results: At the 3-month follow-up, the postponed group had significantly poorer word recognition (23 vs. 42%, p = 0.027) and aided PTA (42 vs. 37 dB HL, p = 0.041) than the control group. No significant differences were observed between 3-month data from the control group and interim data from the postponed group.
Conclusions: The postponed follow-up after CI activation was associated with poorer outcomes, both in terms of speech recognition and aided audibility. However, these detrimental effects were reversed following provision of an individualized map, with behaviorally measured electric threshold and comfort levels. While adult CI recipients demonstrate an improvement in speech recognition with estimated electric thresholds, the present results suggest that behavioral mapping within the initial weeks of device use may support optimal outcomes. Audiol Neurotol

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Publication date 15-11-2021

Audiol Neurotol

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Identifying Subclinical Hearing Loss: Extended Audiometry and Word Recognition in Noise

WR Drennan

Publication date 02-11-2021

Introduction: Normal-hearing people often have complaints about the ability to recognize speech in noise. Such disabilities are not typically assessed with conventional audiometry. Suprathreshold temporal deficits might contribute to reduced word recognition in noise as well as reduced temporally based binaural release of masking for speech. Extended high-frequency audibility (#x3e;8 k Hz) has also been shown to contribute to speech perception in noise. The primary aim of this study was to compare conventional audiometric measures with measures that could reveal subclinical deficits.
Methods: Conventional and extended high-frequency audiometry was done with 119 normal-hearing people ranging in age from 18 to 72. The ability to recognize words in noise was evaluated with and without differences in temporally based spatial cues. A low-uncertainty, closed-set word recognition task was used to limit cognitive influences.
Results: In normal-hearing listeners, word recognition in noise ability decreases significantly with increasing pure-tone average (PTA). On average, signal-to-noise ratios worsened by 5.7 and 6.0 dB over the normal range, for the diotic and dichotic conditions, respectively. When controlling for age, a significant relationship remained in the diotic condition. Measurement error was estimated at 1.4 and 1.6 dB for the diotic and dichotic conditions, respectively. Controlling for both PTA and age, EHF-PTAs showed significant partial correlations with SNR50 in both conditions (ρ = 0.30 and 0.23). Temporally based binaural release of masking worsened with age by 1.94 dB from 18 to 72 years old but showed no significant relationship with either PTA.
Conclusions: All three assessments in this study demonstrated hearing problems independently of those observed in conventional audiometry. Considerable degradations in word recognition in noise abilities were observed as PTAs increased within the normal range. The use of an efficient words-in-noise measure might help identify functional hearing problems for individuals that are traditionally normal hearing. Extended audiometry provided additional predictive power for word recognition in noise independent of both the PTA and age. Temporally based binaural release of masking for word recognition decreased with age independent of PTAs within the normal range, indicating multiple mechanisms of age-related decline with potential clinical impact. Audiol Neurotol

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Efficacy of Hyperbaric Oxygen on Idiopathic Sudden Sensorineural Hearing Loss and Its Correlation with Treatment Course: Prospective Clinical Research

C Huang,G Tan,J Xiao,G Wang

Publication date 28-09-2021

Objectives: This study was conducted to explore the effectiveness of hyperbaric oxygen (HBO) in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) and recommend the appropriate course of treatment.
Methods: 102 patients (105 diseased ears) with ISSNHL were recruited from the Department of Neurology and Otorhinolaryngology, West China Fourth Hospital, Sichuan University, between January 2018 and September 2020. Of them, 45 patients (group A) received intravenous steroid (IVS), and the remaining patients (group B) received IVS and HBO therapy (HBOT). Pure-tone audiometry (PTA) was performed twice at baseline and 10 days after treatment. Patients in group B were subdivided into group 1 (≤10 sessions) and group 2 (#x3e;11 sessions) to verify the correlation between the efficacy and course of HBOT, at the follow-up endpoint, the PTA was performed again. The multivariate logistical regression model was used to analyze the related factors of prognosis.
Results: Compared with the control group, significantly larger hearing gains and better hearing recovery rate were observed in the IVS + HBOT group (p #x3c; 0.05). The time of treatment and course of HBOT were significantly correlated with the hearing threshold after treatment (p #x3c; 0.05) and had no significant relationship with tinnitus and age (p #x3e; 0.05).
Conclusion: HBOT + IVS is an effective method for ISSNHL, especially for the recovery of low-frequency hearing and initial hearing levels of severe and profound. Tinnitus is the most common concomitant symptom of ISSNHL, and prolonging the course of HBOT did not significantly improve it. Initiating HBOT within 7 days for 10–25 sessions of treatment was more beneficial. Audiol Neurotol 2021;26:479–485

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