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August 2004 - Volume 25 - Issue 4

pp: 309-406

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Editorial

Matthies, Melanie L.; Svirsky, Mario A.

Matthies, Melanie L.; Svirsky, Mario A. Less

Ear and Hearing. 25(4):309, August 2004.

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RESEARCH ARTICLES

Criteria of Candidacy for Unilateral Cochlear Implantation in Postlingually Deafened Adults I: Theory and Measures of Effectiveness

UK Cochlear Implant Study Group

UK Cochlear Implant Study Group Less

Ear and Hearing. 25(4):310-335, August 2004.

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The criterion of candidacy for cochlear implantation has usually been specified as a maximum number of words that candidates can identify correctly in prerecorded sentences using acoustic hearing aids. That criterion has been relaxed considerably over the last 15 yr, driven by advances in the technology of implants that have led to better outcomes. This paper reports measures of the effectiveness of implantation for four groups of adult candidates representing a progressive relaxation of the criterion. Implantation was effective for each group overall. Within the groups, however, implantation was of limited effectiveness when patients who already benefited from acoustic hearing aids received implants in ears that had been profoundly deaf for more than 30 yr. These results indicate that criteria of candidacy for implantation should take duration of deafness into account along with pre-operative performance.

Criteria of Candidacy for Unilateral Cochlear Implantation in Postlingually Deafened Adults II: Cost-Effectiveness Analysis

UK Cochlear Implant Study Group

UK Cochlear Implant Study Group Less

Ear and Hearing. 25(4):336-360, August 2004.

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The results of economic analyses have been used to argue that cochlear implantation is sufficiently beneficial to justify its cost. Those analyses were based on data from patients who did not benefit from acoustic hearing aids prior to implantation. Since then, criteria of candidacy have been relaxed. This paper complements the previous paper in this series. It reports analyses of the cost-utility of implantation for the same four groups of candidates representing a progressive relaxation of the criterion of candidacy. Implantation was cost-effective for each group overall. Within the groups, however, implantation was not acceptably cost-effective when patients who already benefited from acoustic hearing aids received implants in ears that had been profoundly deaf for more than 30 yr. These results consolidate the idea that criteria of candidacy for implantation should take duration of deafness into account along with pre-operative performance.

Criteria of Candidacy for Unilateral Cochlear Implantation in Postlingually Deafened Adults III: Prospective Evaluation of an Actuarial Approach to Defining a Criterion

UK Cochlear Implant Study Group

UK Cochlear Implant Study Group Less

Ear and Hearing. 25(4):361-374, August 2004.

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This paper describes the derivation of a mathematical expression which calculates the odds that a patient will understand speech better with a cochlear implant than an acoustic hearing aid. The equation calculates the odds from a knowledge of a patient's performance with acoustic hearing aids and the duration of profound deafness in the ear that would be implanted. The equation was derived retrospectively and was evaluated prospectively, when it was shown to make accurate predictions of outcomes for new patients. Implantation was both effective and acceptably cost-effective when patients were implanted at odds of 4:1 or better. This statistical approach to defining the criterion of candidacy can guide the choice of ear for implantation, can inform patients of risks when consenting to implantation, and help ensure that implantation is effective and cost-effective.

Recognition of Speech Presented at Soft to Loud Levels by Adult Cochlear Implant Recipients of Three Cochlear Implant Systems

Firszt, Jill B.; Holden, Laura K.; Skinner, Margaret W.; More

Firszt, Jill B.; Holden, Laura K.; Skinner, Margaret W.; Tobey, Emily A.; Peterson, Ann; Gaggl, Wolfgang; Runge-Samuelson, Christina L.; Wackym, P. Ashley Less

Ear and Hearing. 25(4):375-387, August 2004.

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Speech perception measures used with cochlear implant candidates and recipients should reflect the listening challenges encountered in everyday communication situations, such as speakers ranging from soft- to loud-spoken and varying amounts of background noise. In this study, 78 adult cochlear implant recipients (Clarion, Med-El, and Nucleus devices) were administered word and sentence stimuli at 70, 60, and 50 dB SPL in quiet and sentences at 60 dB SPL in noise. Mean group performance in quiet was similar at 60 compared with 70 dB SPL, with lower but substantial performance at the softer level of 50 dB SPL. Speech perception scores for sentences were poorer in noise at the greater intensity of 60 dB SPL (+8 SNR) than when presented in quiet at a softer presentation level. A significant correlation was found between sound-field thresholds and speech recognition scores for presentation levels below 70 dB SPL. These data provide the basis for recommending new candidacy criteria based on speech recognition tests presented at lower intensity levels that reflect real-life listening.

Hearing Loss Associated With Ear Infections in Nord-Trøndelag, Norway

Tambs, Kristian; Hoffman, Howard J.; Engdahl, Bo; More

Tambs, Kristian; Hoffman, Howard J.; Engdahl, Bo; Borchgrevink, Hans M. Less

Ear and Hearing. 25(4):388-396, August 2004.

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A population-based cohort of 50,398 subjects, aged 20 yr or older, was examined with pure-tone audiometry in 1996–1998. The participants also reported if, and at what age, they had suffered from recurrent ear infections. We examined the effect of (mostly childhood) recurrent ear infections and the age at onset on adult hearing. Recurrent ear infections were associated with poorer hearing thresholds for all frequency ranges from 0.25 kHz to 8 kHz, regardless of age or gender. The effect increased with age from approximately 2 dB among younger (20–44 yr old) subjects to approximately 5–6 dB among older subjects (65 yr or older). Early age of onset for ear infections was associated with poorer hearing thresholds than late onset. The mean loss was close to 9–10 dB for all frequency ranges among older subjects reporting onset of ear infections before 2 yr of age. The strong effect among older subjects could reflect an age effect or a time trend; that is, less care taken to prevent ear infections and less efficient treatment during the first half of the nineteenth century than later.

Mean and Median Hearing Thresholds Among Children 6 to 19 Years of Age: The Third National Health and Nutrition Examination Survey, 1988 to 1994, United States

Holmes, Alice E.; Niskar, Amanda Sue; Kieszak, Stephanie M.; More

Holmes, Alice E.; Niskar, Amanda Sue; Kieszak, Stephanie M.; Rubin, Carol; Brody, Debra J. Less

Ear and Hearing. 25(4):397-402, August 2004.

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This study provides the first national representative values for mean and median hearing thresholds among U.S. children 6–19 years of age. Hearing thresholds were obtained from 6,166 children in the Third National Health and Nutrition Examination Survey (1988–1994), a national, population-based, crosssectional survey with household interview and audiometric testing at 0.5–8 kHz. Means, medians, and standard errors of the mean were obtained and reported by ear, frequency, sex, and age. These data indicate that the mean thresholds fall below the standard screening guidelines recommended by the American Speech-Language-Hearing Association. The results of this study suggest the need to include the test frequency of 6000 Hz in screening protocols for children.

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Resource Reviews

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Ear and Hearing. 25(4):403-406, August 2004.

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Table of Contents Sections

Editorial
RESEARCH ARTICLES
Resource Reviews

Secondary Logo

Journal Logo

Editorial

Editorial

RESEARCH ARTICLES

Criteria of Candidacy for Unilateral Cochlear Implantation in Postlingually Deafened Adults I: Theory and Measures of Effectiveness

In Brief:

Criteria of Candidacy for Unilateral Cochlear Implantation in Postlingually Deafened Adults II: Cost-Effectiveness Analysis

In Brief:

Criteria of Candidacy for Unilateral Cochlear Implantation in Postlingually Deafened Adults III: Prospective Evaluation of an Actuarial Approach to Defining a Criterion

In Brief:

Recognition of Speech Presented at Soft to Loud Levels by Adult Cochlear Implant Recipients of Three Cochlear Implant Systems

In Brief:

Hearing Loss Associated With Ear Infections in Nord-Trøndelag, Norway

In Brief:

Mean and Median Hearing Thresholds Among Children 6 to 19 Years of Age: The Third National Health and Nutrition Examination Survey, 1988 to 1994, United States

In Brief:

Resource Reviews

Resource Reviews

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