Materiały źródłowe

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8764462/

  While cochlear implants have helped hundreds of thousands of individuals, it remains difficult to predict the extent to which an individuals hearing will benefit from implantation. […] Given the difficulty in predicting who will benefit from cochlear implantation, it has long been hoped that robust decision making tools could be constructed to provide further evidence to clinicians by combining multiple predictive factors. […] However, it is important to note that metrics such as accuracy or the proportion of variance explained do not give any indication of a models ability to make predictions on previously unseen new individuals, where predictions are typically less accurate. […] Given the limited utility of multivariate linear models to predict cochlear implant outcome, there have been numerous explorations of prognostic modelling of hearing outcome.

• #2 Preoperative variables affecting outcome of cochlear implant | The Egyptian Journal of Otolaryngology | Full Text

  https://ejo.springeropen.com/articles/10.1186/s43163-024-00563-y

  Age of the studied children at time of cochlear implantation was statistically significant predictor for CI outcome as regard receptive language quotient and also for N1 latency. Hearing age of the studied children was a statistically significant predictor for CI outcome as regards P1 latency. […] Based on our findings, two most important factors affecting outcome of cochlear implantation were the age at implantation and the hearing age. Other factors were important but did not affect the outcome significantly. […] Factors that are known to influence outcomes include three main categories: patient characteristics, the patients environment, and the baseline status of the auditory system. […] By classifying these factors, practitioners are able to provide informed preoperative prognosis and may be willing to manipulate factors in an effort to get the best results.

• #3 Preoperative variables affecting outcome of cochlear implant | The Egyptian Journal of Otolaryngology | Full Text

  https://ejo.springeropen.com/articles/10.1186/s43163-024-00563-y

  Age of the studied children at time of cochlear implantation was statistically significant predictor for CI outcome as regard receptive language quotient and also for N1 latency. Hearing age of the studied children was a statistically significant predictor for CI outcome as regards P1 latency. […] Based on our findings, two most important factors affecting outcome of cochlear implantation were the age at implantation and the hearing age. Other factors were important but did not affect the outcome significantly. […] Factors that are known to influence outcomes include three main categories: patient characteristics, the patients environment, and the baseline status of the auditory system. […] By classifying these factors, practitioners are able to provide informed preoperative prognosis and may be willing to manipulate factors in an effort to get the best results.

• #4 Preoperative variables affecting outcome of cochlear implant | The Egyptian Journal of Otolaryngology | Full Text

  https://ejo.springeropen.com/articles/10.1186/s43163-024-00563-y

  Poor performance has been linked to a number of known factors, including implantation at a late age, minimal nerve survival, inappropriate fitting, insufficient cognitive ability, social and educational circumstances that stress interpersonal interaction, and little parental support. […] This study was carried out to gain a better understanding of the prognostic factors that promote language development and auditory abilities after cochlear implantation. […] In this study, we discovered that there was statistically significant association (P<0.01) between age of implantation and different outcome measures (inversely correlated with receptive and expressive language quotient and positively correlated with aided FFA threshold and aided speech cortical auditory-evoked potential (univariate analysis)).

• #5 Preoperative variables affecting outcome of cochlear implant | The Egyptian Journal of Otolaryngology | Full Text

  https://ejo.springeropen.com/articles/10.1186/s43163-024-00563-y

  It was statistically significant predictor for CI outcome as regard receptive language scores and also for N1 latency (multivariate analysis). […] Our results were in agreement with a study done by Gaurav et al. who found that CI recipients implanted at age of 5 years or below had considerably better mean auditory perception results than those who implanted at more than 5 years of age. […] Age of implantation relates to the survival, physiology, and function of spiral ganglion cells. […] In this study, we found that the hearing age was highly significant predictor for language and auditory abilities as regards receptive language quotient and P1 latency (multivariate analysis), and this enhances the significance of cochlear implant usage duration when assessing the devices advantages.

• #6 Cochlear Implantation in Postlingually Deaf Adults is Time-sensitive Towards Positive Outcome: Prediction using Advanced Machine Learning Techniques | Scientific Reports

  https://www.nature.com/articles/s41598-018-36404-1

  Our advanced nonlinear regression combined with PCA best predicted the outcome with a high accuracy of 95.2%. This performance is superior to previously reported linear predictive models. […] In this study, in line with previous reports, DoD was the most important predictor of CI outcomes. The gradual decrease in spiral ganglion cell population by age may get worse due to a longer duration of deafness and a late operation of CI, leaving fewer spiral ganglion neurons available for stimulation by CIs. […] Therefore, these together suggest that the reversibility of central re-organization becomes partial in some patients after 10 years of deafness, implicating that this might be a sensitive period for postlingually deaf adults to obtain good postCI outcomes. […] Our machine learning model demonstrated a robust prediction performance for CI outcomes in postlingually deaf adults across different institutes, providing a reference value for counseling patients considering CI.

• #7 Pre-, Per- and Postoperative Factors Affecting Performance of Postlinguistically Deaf Adults Using Cochlear Implants: A New Conceptual Model over Time | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0048739

  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. […] 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. […] 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. […] The aim of the present study was to confirm the new model of auditory performance over time proposed in Figure 1 and to find a sensitive analysis that could test and control the effect of the factors previously outlined, on a large sample of CI recipients (2251).

• #8

  https://link.springer.com/article/10.1007/s00405-022-07558-6

  Pre-operative assessments before cochlear implantation (CI) includes the examination of both tone hearing, and the level of the cochlear reserve indicated by speech understanding. […] Cochlear reserve represented by WRSmax may play the most important role as a predictive factor in outcomes after CI. […] Early rehabilitation with hearing aids and duration of hearing aid usage might play an important role in preserving cochlear reserve in adults. […] The goal of this study was to explore the predictive influence of tone hearing, as well the influence of the cochlear reserve, indicated by pre-operative speech understanding, on speech comprehension after hearing rehabilitation. […] The better the pre-operative speech understanding which signifies the cochlear reserve of the patient, the better the post-operative outcome after CI.

• #9 Pre-, Per- and Postoperative Factors Affecting Performance of Postlinguistically Deaf Adults Using Cochlear Implants: A New Conceptual Model over Time | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0048739

  The influence of several per- and postoperative factors, such as the surgical approach used (cochleostomy or round window approach), the depth or angle of insertion of the electrode array, the number of active electrodes, have already been addressed. However the samples were small leading to controversial results. The large sample size of 2251 patients in the present study offered the opportunity to investigate the influence of these factors on CI speech performance with greater certainty. […] The results from the 15 different five-factor GLM analyses are shown in Table 1. Only the results related to the new fifth factor are shown, the values for the four usual factors being stable across the 15 five-factor GLM analyses. […] The negative effect of duration of mHL on auditory processing was confirmed. The reduction of CI speech performance per year of mHL (0.23%) was smaller than the reduction during duration of s/p HL. Using HAs during the period of mHL may also slow this reduction. […] The percentage of active electrodes had a strong effect (F(2, 1894)=17.89, p0.001). Having more than 85% of active electrodes conferred a significant advantage in speech perception.

• #10 Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants

  https://www.mdpi.com/2077-0383/12/9/3262

  Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants […] Background: The outcome of cochlear implantation has improved over the last decades, but there are still patients with less benefit. […] The aim of this study was therefore to examine preoperative pure-tone audiogram and speech comprehension as well as aetiology, to investigate their relationship with postoperative speech comprehension in CI recipients. […] The strongest correlation with postoperative speech comprehension was seen for monosyllabic words with hearing aid at 80 dB. […] The multivariate model was able to explain 40% of postoperative variability. […] Speech comprehension with hearing aid at 80 dB can be used as a supplementary preoperative indicator of CI-aided speech comprehension and should be measured regularly in the clinical routine. […] Combining audiological and aetiological variables provides more insights into the variability of the CI outcome, allowing for better patient counselling.

• #11 Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants

  https://www.mdpi.com/2077-0383/12/9/3262

  Cochlear implantation has made a significant impact on the treatment of profound hearing loss in recent decades. […] While cochlear implants (CIs) were initially used for aiding profoundly deaf patients, the use of CIs has nowadays expanded to include the treatment of residual hearing. […] Nonetheless, the implantation of a CI remains an invasive procedure with the possibility of complications. […] It has been demonstrated that most patients show improved hearing with a CI. […] However, since in some cases little or no improvement in speech comprehension is observed, it is desirable to have valid criteria to weigh the risk-benefit profile in individual patients and to estimate the potential postoperative outcome before implantation. […] In clinical practice, preoperative diagnostics and anamnesis are used as a predictive basis for the postoperative result. […] The Freiburg monosyllabic test is a standardised, easy-to-use and critically reviewed test procedure. […] For that test, Hoppe et al. have shown that unaided maximum word recognition (WRSmax) can serve as a predictor for the minimum expected benefit with a CI. […] Furthermore, the monosyllabic speech comprehension at 65 dB with a hearing aid (WRS65(HA)) can be used as well. […] In their multicentre cohort, a positive correlation was found between the time elapsed since CI implantation and postoperative speech comprehension. […] Combining the duration of severe to profound hearing loss, age at onset of hearing loss, aetiology and duration of CI experience, Blamey et al. were able to explain 10% of the postoperative variation in their model. […] The model showed a positive correlation between the postoperative outcome and (i) preoperative speech comprehension with optimum hearing-aid fitting and (ii) age at onset of deafness.

• #12 Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10889101/

  The predictive model could also be extended, including the etiology and duration of deafness as potential predictors, as these parameters were not assessed in the present work. […] The word recognition in quiet outcome in the presented study strongly supports the results found in the previous studies for outcome prediction after cochlear implantation. Different from other studies, the word recognition scores with a hearing aid prior to surgery had no impact on outcome after CI provision. For most of the CI recipients in the included study, speech perception in noise could be predicted only based on the factor age.

• #13 Cochlear Implantation in Postlingually Deaf Adults is Time-sensitive Towards Positive Outcome: Prediction using Advanced Machine Learning Techniques | Scientific Reports

  https://www.nature.com/articles/s41598-018-36404-1

  Our advanced nonlinear regression combined with PCA best predicted the outcome with a high accuracy of 95.2%. This performance is superior to previously reported linear predictive models. […] In this study, in line with previous reports, DoD was the most important predictor of CI outcomes. The gradual decrease in spiral ganglion cell population by age may get worse due to a longer duration of deafness and a late operation of CI, leaving fewer spiral ganglion neurons available for stimulation by CIs. […] Therefore, these together suggest that the reversibility of central re-organization becomes partial in some patients after 10 years of deafness, implicating that this might be a sensitive period for postlingually deaf adults to obtain good postCI outcomes. […] Our machine learning model demonstrated a robust prediction performance for CI outcomes in postlingually deaf adults across different institutes, providing a reference value for counseling patients considering CI.

• #14 Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures

  https://www.mdpi.com/2077-0383/13/4/994

  Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data and a predictive model for postoperative speech perception in noise (SPiN) after CI provision. About two-thirds of the recipients achieved the expected outcome in quiet or were better than expected. The mean absolute error of the prediction was 13.5 percentage points. Age at implantation was the only predictive factor for SPiN showing a significant correlation (r = 0.354; p = 0.007). Outcome prediction accuracy for speech in quiet was comparable to previous studies. For CI recipients in the included study population, the SPiN outcome could be predicted only based on the factor age.

• #15 Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants

  https://www.mdpi.com/2077-0383/12/9/3262

  In the present study we examined preoperative pure-tone audiogram and speech comprehension as well as aetiology, in order to investigate their relationship with postoperative speech comprehension in CI recipients. […] The aims of this work were: To assess whether including preoperative word comprehension at 80 dB with a hearing aid improved the prediction of postoperative speech comprehension with a CI. […] To set up a multivariate model based on an extended dataset of preoperative audiometric diagnostics and thus to predict postoperative speech comprehension with a CI. […] The outcome WRS70(CI) was investigated in two different ways. […] The first approach has the advantage of incorporating all the data and using all information from the measured values but cannot be analysed by a standard multiple linear regression model due to the lack of a normal distribution. […] The second one focuses on well-separated groups of ‘good’ and ‘poor’ performers and can be used by the established logistic regression model. […] The primary outcome of this study was the Word recognition score at 70 dB(SPL) with CI (WRS70(CI)). […] The median absolute error indicating the average of the absolute difference between speech comprehension as predicted and as measured postoperatively was 13.5 percentage points.

• #16 Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10889101/

  (1) Background: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data and a predictive model for postoperative speech perception in noise (SPiN) after CI provision. […] (4) Conclusions: Outcome prediction accuracy for speech in quiet was comparable to previous studies. For CI recipients in the included study population, the SPiN outcome could be predicted only based on the factor age. […] The implementation of a prediction model for SRTs in noise was restricted to only two-thirds of the patient population. For the remaining one-third of subjects, there was no SRT data after surgery available.

• #17

  https://link.springer.com/article/10.1007/s10162-019-00729-z

  Currently, it is not possible to accurately predict how well a deaf individual will be able to understand speech when hearing is (re)introduced via a cochlear implant. […] The results showed that stronger pre-operative cross-modal activation of auditory brain regions by visual speech was predictive of poorer auditory speech understanding after implantation. […] Nonetheless, pre-operative cortical imaging provided additional prognostic value above that of influential clinical characteristics, including the age-at-onset and duration of auditory deprivation, suggesting that objectively assessing the physiological status of the brain using fNIRS imaging pre-operatively may support more accurate prediction of individual CI outcomes. […] Bivariate linear regression analysis revealed that bilateral STC activation to visual speech before implantation was significantly predictive of future CI outcome.

• #18

  https://link.springer.com/article/10.1007/s10162-019-00729-z

  The current findings indicated that pre-operative activation to visual speech measured using fNIRS was able to provide significantly more and unique predictive value above the age-at-onset of bilateral HL, duration of deafness and pre-implant speechreading ability. […] Thus, pre-implant imaging using fNIRS could offer objective, supplementary prognostic information that could help to improve upon the accuracy and reliability of current clinical predictions of CI outcome.

• #19

  https://journals.lww.com/ear-hearing/abstract/2021/01000/prediction_of_the_functional_status_of_the.16.aspx

  This study aimed to create an objective predictive model for assessing the functional status of the cochlear nerve (CN) in individual cochlear implant (CI) users. […] The functional status of the CN for individual CI users was estimated by our newly developed analytical models. Model predictions of CN function for individual adult CI users were positively and significantly correlated with speech perception performance. The models presented in this study may be useful for understanding and/or predicting CI outcomes for individual patients.

• #20 Cochlear Implants and Auditory Brainstem Implants – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/1_99/0013.html

  Aetna considers uniaural (monaural) or binaural (bilateral) cochlear implantation a medically necessary prosthetic for infants and children with bilateral sensorineural hearing impairment who meet all of the following criteria: Child has profound, bilateral sensorineural hearing loss determined by an air conduction pure tone average of 70 dB or greater at 500 Hz, and 90 dB or greater at 1000 and 2000 Hz; and Child has limited benefit from appropriately fitted binaural hearing aids. […] Aetna considers vestibular evoked myogenic potential (VEMP) medically necessary for predicting post-operative complication to cochlear implantation. […] A cochlear implant is an electronic device that can provide improved speech and hearing communication abilities for people who have severe to profound hearing loss in both ears.

• #21 Benefits and Risks of Cochlear Implants | FDA

  https://www.fda.gov/medical-devices/cochlear-implants/benefits-and-risks-cochlear-implants

  Hearing ranges from near normal ability to understand speech to no hearing benefit at all. […] Adults often benefit immediately and continue to improve for about 3 months after the initial tuning sessions. […] Cochlear implant users’ performances may continue to improve for several years. […] Children may improve at a slower pace. […] Many understand speech without lip-reading. […] Many can make telephone calls and understand familiar voices over the telephone. […] Some can enjoy music. […] The implant may destroy any remaining hearing in the implanted ear. […] There is no test a person can take before surgery that will predict how well he or she will understand language after surgery. […] In this situation, a person with an implant would need to have additional surgery to resolve this problem and would be exposed to the risks of surgery again.

• #22 Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures

  https://www.mdpi.com/2077-0383/13/4/994

  The results of this retrospective study strongly support the indication criteria for CI provision according to the German guideline in patients with considerable preoperative word recognition scores up to 60%. In our study group of CI recipients, preoperative maximum word recognition scores of up to 90% were observed. In this group, a mean improvement from WRS65(HA) to WRS65(CI) of 45.9 percentage points was achieved, with only one case showing a significant decrement. In 86% of all cases, speech perception in quiet with CI improved by at least 20 percentage points compared to the pre-surgery performance with a hearing aid, which is in the order of results described in other studies. […] Up to now, guidelines for CI candidacy typically only refer to speech in quiet scores, with some including pure-tone thresholds as a criterion. Even though some clinics in CI candidacy evaluation already refer to SpiN performance, this is not common clinical practice yet. The availability of a predictive model for SpiN could have an effect on both the preoperative candidacy evaluation and patient counseling. Furthermore, a model could impact the post-operative evaluation of hearing performance in such a way that, for example, hearing therapy is continued or intensified if hearing success is too poor compared to the prediction. As speech perception in noise is usually the main problem in everyday life for people with hearing loss, this is often the reason for them to ask about possible options for hearing improvement.

• #23 Preoperative variables affecting outcome of cochlear implant | The Egyptian Journal of Otolaryngology | Full Text

  https://ejo.springeropen.com/articles/10.1186/s43163-024-00563-y

  In this study, we discovered that there was no statistically significant distinction among preoperative regular use of HA and regular enrollment in speech therapy in the studied children and different outcome measures (P>0.05). […] These results indicate that postponing cochlear implantation to prolong hearing aid usage for kids with severe-to-profound hearing impairment may be harmful to the development of language and may lead to substantial loss in language development. […] In conclusion, spoken language learning relies on effective hearing. Close monitoring of performance with hearing aids can determine whether speech is effectively amplified to allow spoken language acquisition to progress or not. […] Age of the studied children at time of cochlear implantation and hearing age were the most important predictors that affect speech and language development. Other preoperative variables studied were not significant predictors for CI outcome.

• #24

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8764462/

  These results highlight the potential of machine learning, while simultaneously demonstrating the need for robust evaluations across multiple datasets. […] Observations from these models highlight several future directions that might help improve predictive accuracy, focusing on the need to improve and standardize data collection, and raise questions about how such modelling might best be translated into clinical practice. […] The overall predictive performance is relatively weak, with a mean absolute error between 18 and 24 points. […] While these analyses indicate that predicting hearing outcome for all individuals remains difficult to do with high precision, current models may be able to identify subsets of patients that have a very high probability of substantial improvement, highlighting a possible direction for translating this modelling approach towards clinical decision support.

• #25

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8764462/

  The identification of groups of individuals who are highly likely to obtain weak, or conversely strong, hearing outcomes after implantation is one possible path for using such models to aid clinical interpretation. […] The results indicate that we can make more definitive statements about positive outcomes with further work required to more accurately identify those individuals who will not substantially improve from implantation.

• #26 Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants

  https://www.mdpi.com/2077-0383/12/9/3262

  Overall, the positive association between preoperative speech comprehension and postoperative outcome observed by other research groups was confirmed in this study. […] The predictive value is limited by the high proportion of patients with 0% word comprehension. […] The search for variables that can explain and predict interindividual differences in postoperative outcomes is a task for future research.

• #27 Predictive Study on Hearing Rehabilitation After Cochlear Implant | Clinical Research Trial Listing

  https://www.centerwatch.com/clinical-trials/listings/NCT06086041/predictive-study-on-hearing-rehabilitation-after-cochlear-implant

  Multiple integration of clinical data to propose a predictive model can now be done using both supervised (Deep Learning) and unsupervised (Manifold Learning) Machine Learning techniques, including for predicting auditory recovery. […] The objective is to better select patients who can benefit from a cochlear implant in order to implant them in an optimal timing and to improve indications for cochlear implant.

• #28 Predictive Study on Hearing Rehabilitation After Cochlear Implant | Clinical Research Trial Listing

  https://www.centerwatch.com/clinical-trials/listings/NCT06086041/predictive-study-on-hearing-rehabilitation-after-cochlear-implant

  The aim of this study is to display the predictive factors of hearing rehabilitation after cochlear implant surgery in severely to profoundly deaf adults. […] The results of cochlear implants are in favour of a benefit in speech comprehension compared to hearing aids in cases of severe to profound deafness. However, there is a strong disparity in hearing performance after cochlear implantation from one patient to another, whether in silence or in noise. […] At present, it is very difficult to predict the outcome of cochlear implants in deaf patients with a cochlear implant indication prior to implantation. The results remain variable from one patient to another and, to date, both the etiology and the state of the central auditory pathways are not taken into account in the indication for cochlear implantation.

• #29 Policies & GuidelinesprintBack

  https://al-policies.exploremyplan.com/portal/web/medical-policies/do-not-link/-/asset_publisher/f9HtrOoNEvPj/content/mp-169

  Semi-implantable middle ear hearing aids for moderate to severe sensorineural hearing loss are considered investigational. […] Fully implantable middle ear hearing aids (e.g. Esteem implantable hearing system) are considered investigational. […] The data have suggested implantable middle ear hearing aids may provide some improvement in hearing compared with conventional external acoustic hearing aids in patients with sensorineural hearing loss. […] However, given the safety and effectiveness of external acoustic hearing aids and the increased risks inherent in a surgical procedure, the semi- and fully implantable device must be associated with clinically significant improvement in various hearing parameters compared with external hearing aids. […] While safety concerns appear to be minimal, only a limited number of patients have been included in the clinical trials, and with a median duration of follow-up less than 5 years.

• #30 Policies & GuidelinesprintBack

  https://al-policies.exploremyplan.com/portal/web/medical-policies/do-not-link/-/asset_publisher/f9HtrOoNEvPj/content/mp-169

  Therefore, conclusions on the safety and effectiveness of semi-implantable hearing aids are limited. […] The evidence is insufficient to determine that the technology results in an improvement in the net health outcome. […] The American Academy of Otolaryngology-Head and Neck Surgery considers active middle ear implants as appropriate treatment for adults with moderate to severe hearing loss when performed by a qualified otolaryngologist-head and neck surgeon. […] Based on available literature demonstrating that clinically selected adults receive substantial benefit, implanting active middle ear implants is accepted medical practice in those who benefit from amplification but are unable to benefit from the amplification provided by conventional hearing aids.

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