Faculty Bibliography

OBJECTIVE/UNASSIGNED:Cochlear implant (CI) speech processors have undergone technological advancements. Therefore, patients upgrade speech processors when new features are available or when their previous device becomes broken and is no longer serviceable. This study aimed to identify factors that impact the time to a speech processor upgrade and to evaluate patient experiences with upgrading and following upgrade. METHODS/UNASSIGNED:In this retrospective cohort study, 46 CI surgeries at a single tertiary care center in 2017 and that subsequently received a speech processor upgrade were included. Data on patient demographics, hearing loss history, CI manufacturer, insurance type and status, and configuration were collected. Time to first upgrade, reasons for upgrade, patient-reported satisfaction, and speech perception scores were analyzed. RESULTS/UNASSIGNED:The mean time to a speech processor upgrade was 5.13 years after implantation. The most common reason for an upgrade was the device being over five years old, followed by the device being out of warranty. 45.7% of patients expressed satisfaction with speech processor upgrade, while 8.7% were not satisfied. There were no statistically significant associations between the time to upgrade and demographic factors such as age, sex, insurance type, or CI manufacturer. Following the upgrade, there were no significant changes in speech perception scores. CONCLUSION/UNASSIGNED:Speech processor upgrades at this center align with when insurance companies typically deem upgrades medically necessary. Demographic factors, insurance, and device manufacturer did not significantly influence time to upgrade. While objective speech perception measures did not significantly improve, many patients reported subjective satisfaction with the upgrade.

OBJECTIVE:We sought to apply a previously developed transimpedance (TIM) heatmap pattern classification scheme in patients with no known risk factors for cochlear anomalies, in addition to patients implanted in the revision setting, to better understand the incidence of pattern variants, and potential clinical implications. STUDY DESIGN/METHODS:Single-center retrospective review. SETTING/METHODS:Tertiary referral centre. PATIENTS/METHODS:Patients older than 6 months of age who underwent cochlear implantation between June 2020 and June 2024 with normal gross cochlear anatomy and no concern for fibrosis that had intraoperative TIM testing completed. Patients undergoing revision implantation were also included as a separate cohort. INTERVENTION/METHODS:None. MAIN OUTCOME MEASURES/METHODS:The number of patients with normal and variant TIM patterns was evaluated for each cohort. TIM patterns were subsequently compared with the electrode position found on intraoperative x-ray. RESULTS:There were 321 ears that underwent implantation and subsequent intraoperative TIM assessment meeting inclusion criteria. Of these, 310 (96.6%) were in the primary surgery setting, and 11 (3.4%) were in the revision surgical setting. In the primary surgical setting, 86.4% (n=268) of the implants demonstrated a normal TIM heatmap. Compared with the primary surgical setting, where only 45.5% (n=5) of revision surgery TIM heatmaps were interpreted as normal. One patient in the revision setting had a newly identified "double X" pattern corresponding to a normal electrode position on x-ray. CONCLUSIONS:There is a decreased incidence of previously developed TIM heatmap pattern variants in CI recipients with normal gross cochlear anatomy.

BACKGROUND:Age-related hearing loss is highly prevalent, underrecognized, and consequently, undertreated. Hearing loss can have a substantial negative impact on communication and biopsychosocial health. We hypothesize that offering validated hearing assessments and a point-of-care counseling program in an older, underserved population will be more accessible and acceptable than the traditional pathway for audiology care, particularly in marginalized communities. METHODS:This convergent mixed methods feasibility study will assess the implementation of a hearing program embedded in a quality improvement initiative within the Geriatric Clinic of New York City Health and Hospital's Bellevue Hospital Center and the feasibility of recruiting for a future efficacy trial to test the intervention. Adult patients ≥ 60 years who are proficient in English or Spanish and not currently using hearing rehabilitation are eligible for initial screening. Hearing level, including individual ear severity, is identified using a validated tablet-based measure of pure tone audiometry and a self-report measure of hearing disability. We define hearing loss subjectively based on a score of 8 or greater on the Hearing Handicap Inventory-Screen (HHI-S) or using a four-frequency pure tone average > 25 dB hearing level in the better ear, representing at least a mild hearing loss. Patients who are determined to have measurable hearing loss and provide informed consent will be invited to participate in a pilot study and randomized to one of two approaches: (1) a counseling on alternative rehabilitation strategies intervention arm or (2) usual care with referral to the audiology pathway. Primary feasibility outcomes include recruitment and retention rates, intervention adherence, acceptability, and the ability to collect outcome measurements. We will also explore changes in HHI-S scores over 3 months and assess subsequent audiology service utilization in both groups. In addition to the quantitative data, we will include key participant interviews with staff and patients to assess feasibility from participant attitudes. DISCUSSION/CONCLUSIONS:This study will provide insights into the feasibility of offering hearing screening/assessments and counseling in primary care and its potential to improve access to hearing care for underserved older adults. Findings will inform the design of future trials evaluating the impact of primary care-based tailored hearing interventions on patient health and quality of life. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT05943509, Trial registration date: July 13, 2023, Protocol Version: 1.

OBJECTIVE:Bilateral cochlear implantation (CI) is not routinely recommended in patients of advanced age due to concerns regarding cost-effectiveness and the medical risks of multiple operations in this population. This study seeks to evaluate outcomes of bilateral CI in post-lingually deafened adults over 65 years old. STUDY DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:Tertiary referral center. PATIENTS/METHODS:Thirty-five post-lingually deafened adults over 65 years at the time of second implantation (CI2) and 11 post-lingually deafened adults over 65 years at the time of simultaneous implantation. INTERVENTIONS/METHODS:Bilateral cochlear implantation. MAIN OUTCOME MEASURES/METHODS:Bilateral CNC word scores at 1 year postoperatively. RESULTS:Bilateral CNC scores were significantly improved compared with preoperative scores 1 year postoperatively in both sequentially implanted patients (d=9.2%, P<0.001) and simultaneously implanted patients (d=44%, P=0.028). No significant correlations were observed between changes in bilateral CNC word scores at 1 year and age at the time of CI1 (r=0.095, P=0.665), age at the time of CI2 (r=0.034, P=0.879), or length of time between implantations (r=0.164, P=0.453) in sequentially implanted patients, nor was age at implantation correlated with changes in bilateral CNC scores at 1 year in simultaneously implanted patients (r=0.548, P=0.452). Finally, bilateral CNC scores of sequentially and simultaneously implanted patients were not found to be different at 1 year (d=4.5%, P=0.8905). CONCLUSIONS:Patients older than 65 years who underwent both sequential and simultaneous bilateral cochlear implantation showed similar and significant improvements in speech perception scores compared with preoperative scores. These outcomes were not correlated with age at the time of implantation or time between implantations in the case of sequentially implanted patients. This suggests that significant benefit can be seen even with advanced age at the time of implantation and longer time between implantations.

OBJECTIVE:Music, like all forms of art, seeks to communicate emotional content to its audience. The signal provided by cochlear implants (CI) does not faithfully represent the psychophysical relationships inherent in music; however, it is unknown whether targeted musical emotions are conveyed through electric only stimulation with a cochlear implant. METHODS:Twenty musical excerpts for which there was concordance among normal hearing (NH) listeners as to the emotion conveyed: (1) happy, (2) sad, (3) scary, or (4) peaceful were presented to cochlear implant (CI) subjects (n = 20) and age-matched NH controls (n = 8) through a specifically designed iPad application. The musical clips were original recordings of western music from various musical genres but not widely familiar to participants. Subjects also completed a music background questionnaire. RESULTS:CI users identified the target emotion in only 57% of excerpts compared with NH listeners who correctly identified the target emotion in 76.9% of excerpts. Musical excerpts with the target emotion of happy were recognized in 84% of cases by CI users compared with 75% among NH controls while the remaining target emotions were much more difficult for CI users compared with NH raters. Length of CI experience, speech perception scores, and musical training or listening habits did not correlate with performance on this task. CONCLUSIONS:Current CI technology and processing strategies do not convey the range of emotions conveyed in music as recognized by normal hearing subjects. This difficulty may explain the reported lack of interest many patients have in music after CI despite a passion for music before onset of hearing loss. LEVEL OF EVIDENCE/METHODS:3 Laryngoscope, 135:2112-2119, 2025.

INTRODUCTION/BACKGROUND:This study investigates factors that relate to long-term educational and occupational outcomes of adults who received cochlear implants (CIs) during childhood. METHODS:A retrospective chart review was conducted on 109 adults who received a CI before the age of 15 between 2000 and 2012 at a US tertiary medical center. Demographic variables, speech perception scores, and educational and vocational achievements were analyzed. Current US Census and Bureau of Labor Statistics data were used for comparison. RESULTS:The median age at implantation was 2.81 years, and the median age at data collection was 27.30 years. Most subjects were unilaterally implanted (63.3%) and used an oral communication approach (89.0%). Educational outcomes showed that 17% completed a high school diploma or less, and 9% completed an associates or technical degree. Seventy-two percent of the subjects achieved a bachelor's degree or higher, significantly higher than the general US population (37.9%). Occupational outcomes indicated that subjects were employed across various job categories, with a higher proportion in jobs requiring considerable preparation (job zone 4) compared to the general population. There was a significant negative correlation between age at implantation and speech perception scores. Better word recognition scores were also associated with better educational and occupational outcomes. CONCLUSIONS:Adults who received CIs as children demonstrate excellent educational and occupational outcomes, surpassing those of the general US population. Early implantation and the absence of additional disabilities positively influence these outcomes. Continued investigation of nonspeech outcomes and the factors that influence them is essential to provide better support services for future cohorts.

INTRODUCTION/BACKGROUND:Prior studies have demonstrated that comorbid conditions can negatively impact cochlear implantation (CI) outcomes in elderly patients, but few have examined how comorbidities affect younger adult CI recipients. This study examines the relationship between comorbidities and CI outcomes in adults under 60 years old. METHODS:We reviewed all CI recipients between 20 and 60 years old from 2015 to 2019 at a tertiary academic medical center. Patient data were collected including comorbidities, demographics, etiology, and length of deafness (LOD). Patients' Charlson Comorbidity Index (CCI) was calculated. The primary outcome was speech perception scores at 1 year on the consonant-nucleus-consonant (CNC) word test. RESULTS:There were 118 patients who underwent CI (20-29 years [15%], 30-39 years [22%], 40-49 years [21%], 50-60 years [42%]), averaging 1.8 comorbidities. Mean LOD was 19.7 years, and most etiologies were unknown (53.4%). 34% had no comorbidities, and the most frequent comorbidities were hypertension (14%), asthma (10%), anxiety (8%), acoustic neuroma (8%), and arthritis (7%). Comorbidity frequency was similar across ages, but cardiovascular comorbidities varied by patient decade (50-60 years: 41% vs. 20-49 years: 12-22%, p = 0.004). Compared to studies on elderly CI outcomes, our cohort had fewer comorbidities with reduced cardiac events and neurological conditions. We did not find differences in 1-year CNC scores or complications based on the number of comorbidities or any single comorbidity. However, there was a difference in individual improvement in CNC word scores by age group (p = 0.024). Patients' CCI did not correlate to post-op scores. CONCLUSION/CONCLUSIONS:Subjects showed improved speech understanding post-CI. The number and type of comorbidities were not meaningful predictors of 1-year speech perception scores, suggesting adult CI users under 60 years with comorbidities can expect comparable outcomes to those without comorbidities.

OBJECTIVE:To better understand cochlear implant (CI) performance after reimplantation with a different device manufacturer. STUDY DESIGN/METHODS:Multisite retrospective review. SETTING/METHODS:Tertiary referral centers. PATIENTS/METHODS:Patients older than 4 years who received a CI and subsequently underwent CI reimplantation with a different manufacturer over a 20-year period. INTERVENTION/METHODS:Reimplantation. MAIN OUTCOME MEASURE/METHODS:The primary outcome was difference in the best CNC score obtained with the primary CI, compared with the most recent CNC score obtained after reimplantation. RESULTS:Twenty-nine patients met the criteria at three centers. The best average CNC score achieved by adult patients after primary cochlear implantation was 46.2% (n = 16), measured an average of 14 months (range: 3-36 mo) postoperatively. When looking at the most recent CNC score of adult patients before undergoing reimplantation, the average CNC score dropped to 19.2% (n = 17). After reimplantation, the average 3- to 6-month CNC score was 48.3% (n = 12), with most recent average CNC score being 44.4% (n = 17) measured an average of 19 months (range: 3-46 mo) postoperatively. There was no statistically significant difference (p = 0.321; t11 = 0.48) identified in performance between the best CNC score achieved by adult patients after primary cochlear implantation, and the most recent score achieved after reimplantation (n = 12). Analysis of prerevision and postrevision speech performance was not possible in pediatric patients (<18 yr old) because of differences in tests administered. CONCLUSION/CONCLUSIONS:Patients undergoing reimplantation with a different manufacturer achieved CNC score performance comparable to their best performance with their original device.

OBJECTIVE:To characterize transimpedance matrix (TIM) heatmap patterns in patients at risk of labyrinthine abnormality to better understand accuracy and possible TIM limitations. STUDY DESIGN/METHODS:Retrospective review of TIM patterns, preoperative, and postoperative imaging. SETTING/METHODS:Tertiary referral center. PATIENTS/METHODS:Patients undergoing cochlear implantation with risk of labyrinthine abnormality. INTERVENTION/METHODS:None. RESULTS:Seventy-seven patients were evaluated. Twenty-five percent (n = 19) of patients had a TIM pattern variant identified. These variants were separated into 10 novel categories. Overall, 9% (n = 6) of electrodes were malpositioned on intraoperative x-ray, of which 50% (n = 3) were underinserted, 17% (n = 1) were overinserted, 17% (n = 1) had a tip foldover, and 17% (n = 1) had a coiled electrode. The number of patients with a variant TIM pattern and normal x-ray was 18% (n = 14), and the number of patients with normal TIM pattern and malposition noted on x-ray was 3% (n = 2; both were electrode underinsertions that were recognized due to open circuits and surgical visualization).A newly defined skip heat pattern was identified in patients with IP2/Mondini malformation and interscalar septum width <0.5 mm at the cochlear pars ascendens of the basal turn. CONCLUSIONS:This study defines novel patterns for TIM heatmap characterization to facilitate collaborative and comparative research moving forward. In doing so, it highlights a new pattern termed skip heat, which corresponds with a deficient interscalar septum of the cochlea pars ascendens of the basal turn in patients with IP2 malformation. Overall, the data assist the surgeon in better understanding the implications and limitations of TIM patterns within groups of patients with risk of labyrinthine abnormalities.

INTRODUCTION/BACKGROUND:The aim of this study was to examine how bimodal stimulation affects quality of life (QOL) during the postoperative period following cochlear implantation (CI). These data could potentially provide evidence to encourage more bimodal candidates to continue hearing aid (HA) use after CI. METHODS:In this prospective study, patients completed preoperative and 1-, 3-, and 6-month post-activation QOL surveys on listening effort, speech perception, sound quality/localization, and hearing handicap. Fifteen HA users who were candidates for contralateral CI completed the study (mean age 65.6 years). RESULTS:Patients used both devices at a median rate of 97%, 97%, and 98% of the time at 1, 3, and 6 months, respectively. On average, patients' hearing handicap scores decreased by 16% at 1 month, 36% at 3 months, and 30% at 6 months. Patients' listening effort scores decreased by a mean of 10.8% at 1 month, 12.6% at 3 months, and 18.7% at 6 months. Localization significantly improved by 24.3% at 1 month and remained steady. There was no significant improvement in sound quality scores. CONCLUSION/CONCLUSIONS:Bimodal listeners should expect QOL to improve, and listening effort and localization are generally optimized using CI and HA compared to CI alone. Some scores improved at earlier time points than others, suggesting bimodal auditory skills may develop at different rates.