Ted Meyer - Academia.edu (original) (raw)

Papers by Ted Meyer

Otolaryngology-Head and Neck Surgery, Apr 4, 2017

Objective. (1) To analyze reported speech perception outcomes in patients with inner ear malforma... more Objective. (1) To analyze reported speech perception outcomes in patients with inner ear malformations who undergo cochlear implantation, (2) to review the surgical complications and findings, and (3) to compare the 2 classification systems of Jackler and Sennaroglu. Data Sources. PubMed, Scopus (including Embase), Medline, and CINAHL Plus. Review Methods. Fifty-nine articles were included that contained speech perception and/or intraoperative data. Cases were differentiated depending on whether the Jackler or Sennaroglu malformation classification was used. A metaanalysis of proportions examined incidences of complete insertion, gusher, and facial nerve aberrancy. For speech perception data, weighted means and standard deviations were calculated for all malformations for short-, medium-, and long-term follow-up. Speech tests were grouped into 3 categoriesclosed-set words, open-set words, and open-set sentencesand then compared through a comparison-of-means t test. Results. Complete insertion was seen in 81.8% of all inner ear malformations (95% CI: 72.6-89.5); gusher was reported in 39.1% of cases (95% CI: 30.3-48.2); and facial nerve anomalies were encountered in 34.4% (95% CI: 20.1-50.3). Significant improvements in average performance were seen for closed-and open-set tests across all malformation types at 12 months postoperatively. Conclusions. Cochlear implantation outcomes are favorable for those with inner ear malformations from a surgical and speech outcome standpoint. Accurate classification of anatomic malformations, as well as standardization of postimplantation speech outcomes, is necessary to improve understanding of the impact of implantation in this difficult patient population.

Annals of Otology, Rhinology, and Laryngology, Dec 1, 2000

JAMA otolaryngology-- head & neck surgery, Oct 1, 2017

IMPORTANCE No instrument exists to assess quality of life (QOL) in adult cochlear implant (CI) us... more IMPORTANCE No instrument exists to assess quality of life (QOL) in adult cochlear implant (CI) users that has been developed and validated using accepted scientific standards. OBJECTIVE To develop a CI-specific QOL instrument for adults in accordance with the Patient Reported Outcomes Measurement Information System (PROMIS) guidelines. DESIGN, SETTING, AND PARTICIPANTS As required in the PROMIS guidelines, patient focus groups participated in creation of the initial item bank. Twenty-three adult CI users were divided into 1 of 3 focus groups stratified by word recognition ability. Three moderator-led focus groups were conducted based on grounded theory on December 3, 2016. Two reviewers independently analyzed focus group recordings and transcripts, with a third reviewer available to resolve discrepancies. All data were reviewed and reported according to the Consolidated Criteria for Reporting Qualitative Research. The setting was a tertiary referral center. MAIN OUTCOMES AND MEASURES Coded focus group data. RESULTS The 23 focus group participants (10 [43%] female; mean [range] age, 68.1 [46.2-84.2] years) represented a wide range of income levels, education levels, listening modalities, CI device manufacturers, duration of CI use, and age at implantation. Data saturation was determined to be reached before the conclusion of each of the focus groups. After analysis of the transcripts, the central themes identified were communication, emotion, environmental sounds, independence and work function, listening effort, social isolation and ability to socialize, and sound clarity. Cognitive interviews were carried out on 20 adult CI patients who did not participate in the focus groups to ensure item clarity. Based on these results, the initial QOL item bank and prototype were developed. CONCLUSIONS AND RELEVANCE Patient focus groups drawn from the target population are the preferred method of identifying content areas and domains for developing the item bank for a CI-specific QOL instrument. Compared with previously used methods, the use of patient-centered item development for a CI-specific QOL instrument will more accurately reflect patient experience and increase our understanding of how CI use affects QOL.

Annals of Otology, Rhinology, and Laryngology, Apr 1, 1999

Multichannel cochlear implants (CIs) allow many profoundly deaf children to achieve high levels o... more Multichannel cochlear implants (CIs) allow many profoundly deaf children to achieve high levels of speech perception. In order to develop optimal criteria for implantation, it is crucial to test representative samples (or, if possible, full populations) of CI users and compare their results to those of hearing aid (HA) users of the same age and communication mode (oral or total communication) to determine which subgroups of HA users may obtain more perceptual benefit from a CI than from an HA. Word and phoneme identification skills of deaf children who use either HAs or CIs were evaluated and compared. The CI group included all of the prelingually deaf children in the United States who were implanted with the CLARION® Multi-Strategy™ Cochlear Implant during the clinical trial (as of January 1998). Before implantation, the mean scores on the PB-K test (scored phonemically) were lower for prospective CI users than for HA users. However, by 12 to 18 months postimplantation, the average scores for the CI users were higher than those of HA users with residual hearing in the 101-to 110-dB hearing level (HL) range. The CI scores were similar to those of HA users with residual hearing in the 90-to 100-dB HL range. KEY WORDS-cochlear implant, hearing aid, prelingual deafness, speech perception.

Laryngoscope, Aug 26, 2015

Objectives/Hypothesis: The primary objective of this study was to determine the safety profile of... more Objectives/Hypothesis: The primary objective of this study was to determine the safety profile of cochlear implantation (CI) in infants <12 months old. Study Design: Retrospective review of institutional (Medical University of South Carolina [MUSC]) and national data (Pediatric American College of Surgeons-National Surgical Quality Improvement Program [ACS-NSQIP]). Methods: Cases were subdivided into two groups according to age at CI: <12 months and 12 to 18 months. The primary outcome measure of interest was occurrence of a postoperative medical or surgical complication. Operative time, anesthesia time, time in the postoperative anesthesia care unit, and length of stay were also assessed. Results: In infants <12 months of age, the incidence of a 30-day postoperative surgical complication using the ACS-NSQIP database was 3.6%; this did not differ from the rate observed in the 12-to 18-month-old group (3.2%, P 5 1.0). In the MUSC series, the occurrence of a 30-day postoperative complication in children <12 months old was comparable (2.7%). At longer-term follow-up (mean 5 3.7 years), the incidence of a postoperative surgical complication in infants <12 months old using MUSC data was 13.5%. When compared to older children at longer-term follow-up, no difference was noted (12.7%, P 5 1.0). The incidence of a postoperative medical or anesthetic complication in children <12 months of age was extremely rare in both MUSC and ACS-NSQIP series (0% and 1.3%, respectively). Conclusions: Institutional and national data demonstrate that CI in children <12 months of age is a safe procedure. Although infants <12 months old are at risk for postoperative complications, the rates of surgical and medical complications were no different compared to children 12 to 18 months of age.

Journal of the Acoustical Society of America, May 1, 1998

Journal of the Acoustical Society of America, Nov 1, 1997

Despite advances in implant technology, cochlear implant (CI) users demonstrate a wide range in t... more Despite advances in implant technology, cochlear implant (CI) users demonstrate a wide range in the ability to perceive speech in the absence of visual or contextual cues. Some progress has been made recently in the ability to explain perceptual performance with a CI. A quantitative, psychophysically based model of vowel perception by CI users of the SPEAK processing strategy generated confusion matrices that were remarkably similar to actual data [M. A. Svirsky and T. A. Meyer, Assoc. Res. Otolaryngol. Abs. 20, 59 (1997)]. The three dimensions of the parameter space are the centers of gravity of stimulation in the cochlea in response to the first three vowel formants. The free parameter of the model is the subject’s ability to scale pitch percepts associated with different electrodes. Although this single-parameter model was not successful in predicting consonant confusions, when the model was expanded to incorporate psychophysical estimates of gap detection and high- versus low-frequency intensity difference discrimination, the model successfully predicted performance on a medial consonant test [Meyer et al., Conf. Implant. Aud. Prosthes. Abs. (1997)]. Relations between predicted and obtained performance on selected psychophysical tests will be discussed. [Work supported by NIH.]

Annals of Otology, Rhinology, and Laryngology, Dec 1, 2000

Annals of Otology, Rhinology, and Laryngology, Dec 1, 2000

Journal of the Acoustical Society of America, Apr 1, 2011

The multidimensional phoneme identification model is applied to consonant confusion matrices obta... more The multidimensional phoneme identification model is applied to consonant confusion matrices obtained from 28 postlingually deafened cochlear implant users. This model predicts consonant matrices based on these subjects' ability to discriminate a set of postulated spectral, temporal, and amplitude speech cues as presented to them by their device. The model produced confusion matrices that matched many aspects of individual subjects' consonant matrices, including information transfer for the voicing, manner, and place features, despite individual differences in age at implantation, implant experience, device and stimulation strategy used, as well as overall consonant identification level. The model was able to match the general pattern of errors between consonants, but not the full complexity of all consonant errors made by each individual. The present study represents an important first step in developing a model that can be used to test specific hypotheses about the mechanisms cochlear implant users employ to understand speech.

Annals of Otology, Rhinology, and Laryngology, Dec 1, 2000

Journal of the Acoustical Society of America, Feb 1, 2010

A simple mathematical model is presented that predicts vowel identification by cochlear implant u... more A simple mathematical model is presented that predicts vowel identification by cochlear implant users based on these listeners' resolving power for the mean locations of first, second, and/or third formant energies along the implanted electrode array. This psychophysically based model provides hypotheses about the mechanism cochlear implant users employ to encode and process the input auditory signal to extract information relevant for identifying steady-state vowels. Using one free parameter, the model predicts most of the patterns of vowel confusions made by users of different cochlear implant devices and stimulation strategies, and who show widely different levels of speech perception ͑from near chance to near perfect͒. Furthermore, the model can predict results from the literature, such as Skinner, et al. ͓͑1995͒. Ann. Otol. Rhinol. Laryngol. 104, 307-311͔ frequency mapping study, and the general trend in the vowel results of Zeng and Galvin's ͓͑1999͒. Ear Hear. 20, 60-74͔ studies of output electrical dynamic range reduction. The implementation of the model presented here is specific to vowel identification by cochlear implant users, but the framework of the model is more general. Computational models such as the one presented here can be useful for advancing knowledge about speech perception in hearing impaired populations, and for providing a guide for clinical research and clinical practice.

Otology & Neurotology, Feb 1, 2020

Objective: To determine demographic and audiologic factors associated with time to treatment with... more Objective: To determine demographic and audiologic factors associated with time to treatment with cochlear implantation. Methods: Retrospective review of a prospectively maintained adult cochlear implant database. A total of 492 patients were implanted from 2012 to 2017. Time to implantation, pre-implantation audiologic outcomes, and demographic data were collected. Multivariate analysis was undertaken to establish demographic/audiologic factors that predict time to cochlear implantation. Results: Using multivariate analysis, non-white race (HR 0.157, p=0.038) and increased age (HR 0.970, p=0.038) were associated with increased time to cochlear implantation. Non-white patients had significantly higher pure-tone averages and lower speech recognition scores (CNC words and AzBio sentences in quiet) and were less likely to use hearing aids as compared to white patients (all p<0.001). Sex (p=0.188), health insurance type (p=0.255), pre-operative hearing aid use (p=0.174), and audiologic outcomes were not significant predictors of time to implantation. Conclusion: Non-white patients have poorer preoperative hearing and speech recognition and lower hearing aid use and are at risk for delay in referral and treatment for severe to profound sensorineural hearing loss. Other demographic factors, notably health insurance status, did not significantly predict time to cochlear implantation. Given the observed hearing healthcare disparities, special outreach programs may be needed to ensure timely cochlear implantation and effective hearing screening and rehabilitation.

Journal of Speech Language and Hearing Research, Apr 1, 2009

Purpose-This study examined the ability of listeners using cochlear implants (CIs) and listeners ... more Purpose-This study examined the ability of listeners using cochlear implants (CIs) and listeners with normal-hearing (NH) to identify silent gaps of different duration, and the relation of this ability to speech understanding in CI users. Method-Sixteen NH adults and eleven postlingually deafened adults with CIs identified synthetic vowel-like stimuli that were either continuous or contained an intervening silent gap ranging from 15 to 90 ms. Cumulative d', an index of discriminability, was calculated for each participant. Consonant and CNC word identification tasks were administered to the CI group. Results-Overall, the ability to identify stimuli with gaps of different duration was better for the NH group than for the CI group. Seven CI users had cumulative d' scores that were no higher than those of any NH listener, and their CNC word scores ranged from 0 to 30%. The other four CI users had cumulative d' scores within the range of the NH group, and their CNC word scores ranged from 46% to 68%. For the CI group, cumulative d' scores were significantly correlated with their speech testing scores. Conclusions-The ability to identify silent gap duration may help explain individual differences in speech perception by CI users.

Otology & Neurotology, Oct 1, 2018

Objective-Determine the impact of electrode array selection on audiometric performance when contr... more Objective-Determine the impact of electrode array selection on audiometric performance when controlling for baseline patient characteristics. Study Design-Retrospective evaluation of a prospective cochlear implant (CI) database (1/1/12-5/31/17). Setting-Tertiary Care University Hospital Patients-328 adult CI recipients Interventions/Main Outcomes Measured-Hearing outcomes were measured through unaided/aided pure tone thresholds and speech recognition testing before and after cochlear implantation. All reported post-operative results were performed at least 6 months after CI activation. All device manufacturers were represented. Results-Of the 328 patients, 234 received lateral wall (LW) arrays, 46 received perimodiolar (PM) arrays, and 48 received mid-scalar (MS) arrays. Patients receiving PM arrays had significantly poorer pre-operative earphone and aided PTAs and SRTs, and aided CNC word and AzBio +10 SNR scores compared to patients receiving LW arrays (all p=<0.04), and poorer PTAs and AzBio +10 SNR scores compared to MS recipients (all p=<0.02). No pre-operative audiological variables were found to significantly differ between MS and LW patients. After controlling for pre-operative residual hearing and speech recognition ability in a hierarchical multiple regression analysis, no statistically significant difference in audiological outcomes was detected (CNC words, AzBio quiet, or AzBio +10 SNR) among the three electrode array types (all p>0.05).

Children who acquire language through a cochlear implant (CI) provide a unique opportunity to stu... more Children who acquire language through a cochlear implant (CI) provide a unique opportunity to study the physical and cognitive bases of speech perception, as the target language these children must acquire is the same as children without hearing loss, but the input to the nervous system from a cochlear implant is very different from normal hearing. Psycholinguistic models of speech perception in adults with normal hearing propose that the phonological lexicon is organized in a phonetic similarity space based on linguistic features and phonemes, and that these units are important for spoken word recognition. In this study, we examine software simulations of spoken word recognition using behavioral data on feature, phoneme, and word identification from children who use CIs. While the physical signal received through a CI is different from aurally perceived speech, we propose that the same abstract units of language are nonetheless a part of the linguistic knowledge of children who learn spoken language through CIs. Our results are consistent with the claim that children who use CIs recognize words in the context of perceptually similar words stored in a mental lexicon. In addition, while some feature distinctions are less adequately transmitted through their devices (e.g., place of articulation), children with CIs appear to utilize the available phonological contrasts to recognize spoken words.

Audiology and Neuro-otology, 2016

The objective of this study was to examine how age and implanted ear contribute to functional out... more The objective of this study was to examine how age and implanted ear contribute to functional outcomes with cochlear implantation (CI). A retrospective review was performed on 96 adults who underwent unilateral CI. Older adults with right-ear implants had higher Hearing in Noise Test (HINT) scores at 1 year by 10.3% (p = 0.06). When adjusted to rationalized arcsine units (rau), right-ear HINT scores in older adults were higher by 12.1 rau (p = 0.04). Older adults had an 8.9% advantage on the right side compared to the left in post- versus preimplant scores for consonant-vowel nucleus-consonant words (p = 0.05). No significant differences were observed for younger adults. In conclusion, although adults of all ages experience improvements in speech perception following CI, there might be a subtle but consistent right-ear advantage in older adults.

JAMA Otolaryngology–Head & Neck Surgery, 2021

IMPORTANCE Cochlear implantation is highly effective at improving hearing outcomes, but results h... more IMPORTANCE Cochlear implantation is highly effective at improving hearing outcomes, but results have been limited to groupwise analysis. That is, limited data are available for individual patients that report comparisons of preoperative aided speech recognition and postimplantation speech recognition. OBJECTIVE To assess changes in preoperative aided vs postoperative speech recognition scores for individual patients receiving cochlear implants when considering the measurement error for each speech recognition test. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used a prospectively maintained database of patients who received cochlear implants between January 1, 2012, and December 31, 2017, at a tertiary, university-based referral center. Adults with bilateral sensorineural hearing loss undergoing cochlear implantation with 6-or 12-month postoperative measures using 1 or more speech recognition tests were studied. EXPOSURES Cochlear implantation. MAIN OUTCOMES AND MEASURES Postoperative word recognition (consonant-nucleusconsonant word test), sentence recognition (AzBio sentences in quiet), and sentence recognition in noise (AzBio sentences in +10-dB signal-to-noise ratio) scores, and association of each speech recognition score change with aided preoperative score to each test's measurement error. RESULTS Analysis of data from a total of 470 implants from 323 patients included 253 male (53.8%) patients; the mean (SD) age was 61.2 (18.3) years. Most patients had statistically significant improvement in all speech recognition tests postoperatively beyond measurement error, including 262 (84.8%) for word recognition, 226 (87.6%) for sentence recognition, and 33 (78.6%) for sentence recognition in noise. A small number of patients had equivalent preoperative and postoperative scores, including 45 (14.5%) for word recognition, 28 (10.9%) for sentence recognition, and 9 (21.4%) for sentence recognition in noise. Four patients (1.6%) had significantly poorer scores in sentence recognition after implantation. The associations between age at implantation and change in speech recognition scores were-0.12 (95% CI,-0.23 to-0.01) for word recognition,-0.22 (95% CI,-0.34 to-0.10) for sentence recognition, and-0.10 (95% CI,-0.39 to 0.21) for sentence recognition in noise. Patients with no significant improvement were similarly distributed between all preoperative aided speech scores for word recognition (range, 0%-58%) and sentence recognition (range, 0%-56%) testing. CONCLUSIONS AND RELEVANCE In this cross-sectional study, with respect to preoperative aided speech recognition, postoperative cochlear implant outcomes for individual patients were largely encouraging. However, improvements in scores for individual patients remained highly variable, which may not be adequately represented in groupwise analyses and reporting of mean scores. Presenting individual patient data from a large sample of individuals with cochlear implants provides a better understanding of individual differences in speech recognition outcomes and contributes to more complete interpretations of successful outcomes after cochlear implantation.

The Annals of otology, rhinology, and laryngology, 2018

To characterize factors that affect outcomes for patients with malignant otitis externa (MOE). Re... more To characterize factors that affect outcomes for patients with malignant otitis externa (MOE). Retrospective review of inpatients with MOE was performed. Patient demographics, comorbid conditions, complications, procedures, and mortalities were analyzed. A total of 786 patients with MOE were identified. The mean hospitalization length of stay (LOS) was 18.6 days (SD = 19.7). The overall mortality rate was 2.5% (n = 20), and complication rate was 4.3% (n = 34). Increasing age significantly and positively correlated with the incidence of MOE (r = 0.979, P < .0001). Factors that were associated with an increased rate of mortality were sepsis (odds ratio [OR] = 18.5; ES = 0.94; 95% CI, 0.47-1.42), congestive heart failure (OR = 3.1; ES = 0.42; 95% CI, 0.02-0.82), weight loss (OR = 10.2; ES = 1.23; 95% CI, 0.61-1.85), and coagulopathy (OR = 8.8; ES = 1.84; 95% CI, 0.91-2.77). Surgical intervention was performed in 19.2% (n = 151) of patients. Facial nerve involvement was present in 15...

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2018

1. Describe publishing trends for otologic/neurotologic disorders over a 35-year span. 2) Compare... more 1) Describe publishing trends for otologic/neurotologic disorders over a 35-year span. 2) Compare trends in publishing with disease prevalence. 3) Evaluate changes in topic and journal specific ranking scores over time. PubMed searches were performed on 35 otologic/neurotologic disorders using medical subject headings (MeSH) terms from 1980 to 2015. Searches were limited in scope to the English language. A Mann-Kendall trend analysis evaluated changes in publication frequency as a discrete variable while correcting for total number of articles published per year. Scopus was used to identify SCImago Country and Journal Rank (SJR) indicator scores and weighted-averages used to calculate changes over time. The total number of publications on the 35 topics increased from 853 in 1980 to a peak of 3,068 in 2013. Otitis media (τ = -0.799, p < 0.001) and Menière's disease (τ = -0.724, p < 0.001) showed strong decreasing publication trends. Temporal bone encephaloceles (τ = 0.743, ...

Otolaryngology-Head and Neck Surgery, Apr 4, 2017

Objective. (1) To analyze reported speech perception outcomes in patients with inner ear malforma... more Objective. (1) To analyze reported speech perception outcomes in patients with inner ear malformations who undergo cochlear implantation, (2) to review the surgical complications and findings, and (3) to compare the 2 classification systems of Jackler and Sennaroglu. Data Sources. PubMed, Scopus (including Embase), Medline, and CINAHL Plus. Review Methods. Fifty-nine articles were included that contained speech perception and/or intraoperative data. Cases were differentiated depending on whether the Jackler or Sennaroglu malformation classification was used. A metaanalysis of proportions examined incidences of complete insertion, gusher, and facial nerve aberrancy. For speech perception data, weighted means and standard deviations were calculated for all malformations for short-, medium-, and long-term follow-up. Speech tests were grouped into 3 categoriesclosed-set words, open-set words, and open-set sentencesand then compared through a comparison-of-means t test. Results. Complete insertion was seen in 81.8% of all inner ear malformations (95% CI: 72.6-89.5); gusher was reported in 39.1% of cases (95% CI: 30.3-48.2); and facial nerve anomalies were encountered in 34.4% (95% CI: 20.1-50.3). Significant improvements in average performance were seen for closed-and open-set tests across all malformation types at 12 months postoperatively. Conclusions. Cochlear implantation outcomes are favorable for those with inner ear malformations from a surgical and speech outcome standpoint. Accurate classification of anatomic malformations, as well as standardization of postimplantation speech outcomes, is necessary to improve understanding of the impact of implantation in this difficult patient population.

Annals of Otology, Rhinology, and Laryngology, Dec 1, 2000

JAMA otolaryngology-- head & neck surgery, Oct 1, 2017

IMPORTANCE No instrument exists to assess quality of life (QOL) in adult cochlear implant (CI) us... more IMPORTANCE No instrument exists to assess quality of life (QOL) in adult cochlear implant (CI) users that has been developed and validated using accepted scientific standards. OBJECTIVE To develop a CI-specific QOL instrument for adults in accordance with the Patient Reported Outcomes Measurement Information System (PROMIS) guidelines. DESIGN, SETTING, AND PARTICIPANTS As required in the PROMIS guidelines, patient focus groups participated in creation of the initial item bank. Twenty-three adult CI users were divided into 1 of 3 focus groups stratified by word recognition ability. Three moderator-led focus groups were conducted based on grounded theory on December 3, 2016. Two reviewers independently analyzed focus group recordings and transcripts, with a third reviewer available to resolve discrepancies. All data were reviewed and reported according to the Consolidated Criteria for Reporting Qualitative Research. The setting was a tertiary referral center. MAIN OUTCOMES AND MEASURES Coded focus group data. RESULTS The 23 focus group participants (10 [43%] female; mean [range] age, 68.1 [46.2-84.2] years) represented a wide range of income levels, education levels, listening modalities, CI device manufacturers, duration of CI use, and age at implantation. Data saturation was determined to be reached before the conclusion of each of the focus groups. After analysis of the transcripts, the central themes identified were communication, emotion, environmental sounds, independence and work function, listening effort, social isolation and ability to socialize, and sound clarity. Cognitive interviews were carried out on 20 adult CI patients who did not participate in the focus groups to ensure item clarity. Based on these results, the initial QOL item bank and prototype were developed. CONCLUSIONS AND RELEVANCE Patient focus groups drawn from the target population are the preferred method of identifying content areas and domains for developing the item bank for a CI-specific QOL instrument. Compared with previously used methods, the use of patient-centered item development for a CI-specific QOL instrument will more accurately reflect patient experience and increase our understanding of how CI use affects QOL.

Annals of Otology, Rhinology, and Laryngology, Apr 1, 1999

Multichannel cochlear implants (CIs) allow many profoundly deaf children to achieve high levels o... more Multichannel cochlear implants (CIs) allow many profoundly deaf children to achieve high levels of speech perception. In order to develop optimal criteria for implantation, it is crucial to test representative samples (or, if possible, full populations) of CI users and compare their results to those of hearing aid (HA) users of the same age and communication mode (oral or total communication) to determine which subgroups of HA users may obtain more perceptual benefit from a CI than from an HA. Word and phoneme identification skills of deaf children who use either HAs or CIs were evaluated and compared. The CI group included all of the prelingually deaf children in the United States who were implanted with the CLARION® Multi-Strategy™ Cochlear Implant during the clinical trial (as of January 1998). Before implantation, the mean scores on the PB-K test (scored phonemically) were lower for prospective CI users than for HA users. However, by 12 to 18 months postimplantation, the average scores for the CI users were higher than those of HA users with residual hearing in the 101-to 110-dB hearing level (HL) range. The CI scores were similar to those of HA users with residual hearing in the 90-to 100-dB HL range. KEY WORDS-cochlear implant, hearing aid, prelingual deafness, speech perception.

Laryngoscope, Aug 26, 2015

Objectives/Hypothesis: The primary objective of this study was to determine the safety profile of... more Objectives/Hypothesis: The primary objective of this study was to determine the safety profile of cochlear implantation (CI) in infants <12 months old. Study Design: Retrospective review of institutional (Medical University of South Carolina [MUSC]) and national data (Pediatric American College of Surgeons-National Surgical Quality Improvement Program [ACS-NSQIP]). Methods: Cases were subdivided into two groups according to age at CI: <12 months and 12 to 18 months. The primary outcome measure of interest was occurrence of a postoperative medical or surgical complication. Operative time, anesthesia time, time in the postoperative anesthesia care unit, and length of stay were also assessed. Results: In infants <12 months of age, the incidence of a 30-day postoperative surgical complication using the ACS-NSQIP database was 3.6%; this did not differ from the rate observed in the 12-to 18-month-old group (3.2%, P 5 1.0). In the MUSC series, the occurrence of a 30-day postoperative complication in children <12 months old was comparable (2.7%). At longer-term follow-up (mean 5 3.7 years), the incidence of a postoperative surgical complication in infants <12 months old using MUSC data was 13.5%. When compared to older children at longer-term follow-up, no difference was noted (12.7%, P 5 1.0). The incidence of a postoperative medical or anesthetic complication in children <12 months of age was extremely rare in both MUSC and ACS-NSQIP series (0% and 1.3%, respectively). Conclusions: Institutional and national data demonstrate that CI in children <12 months of age is a safe procedure. Although infants <12 months old are at risk for postoperative complications, the rates of surgical and medical complications were no different compared to children 12 to 18 months of age.

Journal of the Acoustical Society of America, May 1, 1998

Journal of the Acoustical Society of America, Nov 1, 1997

Despite advances in implant technology, cochlear implant (CI) users demonstrate a wide range in t... more Despite advances in implant technology, cochlear implant (CI) users demonstrate a wide range in the ability to perceive speech in the absence of visual or contextual cues. Some progress has been made recently in the ability to explain perceptual performance with a CI. A quantitative, psychophysically based model of vowel perception by CI users of the SPEAK processing strategy generated confusion matrices that were remarkably similar to actual data [M. A. Svirsky and T. A. Meyer, Assoc. Res. Otolaryngol. Abs. 20, 59 (1997)]. The three dimensions of the parameter space are the centers of gravity of stimulation in the cochlea in response to the first three vowel formants. The free parameter of the model is the subject’s ability to scale pitch percepts associated with different electrodes. Although this single-parameter model was not successful in predicting consonant confusions, when the model was expanded to incorporate psychophysical estimates of gap detection and high- versus low-frequency intensity difference discrimination, the model successfully predicted performance on a medial consonant test [Meyer et al., Conf. Implant. Aud. Prosthes. Abs. (1997)]. Relations between predicted and obtained performance on selected psychophysical tests will be discussed. [Work supported by NIH.]

Annals of Otology, Rhinology, and Laryngology, Dec 1, 2000

Annals of Otology, Rhinology, and Laryngology, Dec 1, 2000

Journal of the Acoustical Society of America, Apr 1, 2011

The multidimensional phoneme identification model is applied to consonant confusion matrices obta... more The multidimensional phoneme identification model is applied to consonant confusion matrices obtained from 28 postlingually deafened cochlear implant users. This model predicts consonant matrices based on these subjects' ability to discriminate a set of postulated spectral, temporal, and amplitude speech cues as presented to them by their device. The model produced confusion matrices that matched many aspects of individual subjects' consonant matrices, including information transfer for the voicing, manner, and place features, despite individual differences in age at implantation, implant experience, device and stimulation strategy used, as well as overall consonant identification level. The model was able to match the general pattern of errors between consonants, but not the full complexity of all consonant errors made by each individual. The present study represents an important first step in developing a model that can be used to test specific hypotheses about the mechanisms cochlear implant users employ to understand speech.

Annals of Otology, Rhinology, and Laryngology, Dec 1, 2000

Journal of the Acoustical Society of America, Feb 1, 2010

A simple mathematical model is presented that predicts vowel identification by cochlear implant u... more A simple mathematical model is presented that predicts vowel identification by cochlear implant users based on these listeners' resolving power for the mean locations of first, second, and/or third formant energies along the implanted electrode array. This psychophysically based model provides hypotheses about the mechanism cochlear implant users employ to encode and process the input auditory signal to extract information relevant for identifying steady-state vowels. Using one free parameter, the model predicts most of the patterns of vowel confusions made by users of different cochlear implant devices and stimulation strategies, and who show widely different levels of speech perception ͑from near chance to near perfect͒. Furthermore, the model can predict results from the literature, such as Skinner, et al. ͓͑1995͒. Ann. Otol. Rhinol. Laryngol. 104, 307-311͔ frequency mapping study, and the general trend in the vowel results of Zeng and Galvin's ͓͑1999͒. Ear Hear. 20, 60-74͔ studies of output electrical dynamic range reduction. The implementation of the model presented here is specific to vowel identification by cochlear implant users, but the framework of the model is more general. Computational models such as the one presented here can be useful for advancing knowledge about speech perception in hearing impaired populations, and for providing a guide for clinical research and clinical practice.

Otology & Neurotology, Feb 1, 2020

Objective: To determine demographic and audiologic factors associated with time to treatment with... more Objective: To determine demographic and audiologic factors associated with time to treatment with cochlear implantation. Methods: Retrospective review of a prospectively maintained adult cochlear implant database. A total of 492 patients were implanted from 2012 to 2017. Time to implantation, pre-implantation audiologic outcomes, and demographic data were collected. Multivariate analysis was undertaken to establish demographic/audiologic factors that predict time to cochlear implantation. Results: Using multivariate analysis, non-white race (HR 0.157, p=0.038) and increased age (HR 0.970, p=0.038) were associated with increased time to cochlear implantation. Non-white patients had significantly higher pure-tone averages and lower speech recognition scores (CNC words and AzBio sentences in quiet) and were less likely to use hearing aids as compared to white patients (all p<0.001). Sex (p=0.188), health insurance type (p=0.255), pre-operative hearing aid use (p=0.174), and audiologic outcomes were not significant predictors of time to implantation. Conclusion: Non-white patients have poorer preoperative hearing and speech recognition and lower hearing aid use and are at risk for delay in referral and treatment for severe to profound sensorineural hearing loss. Other demographic factors, notably health insurance status, did not significantly predict time to cochlear implantation. Given the observed hearing healthcare disparities, special outreach programs may be needed to ensure timely cochlear implantation and effective hearing screening and rehabilitation.

Journal of Speech Language and Hearing Research, Apr 1, 2009

Purpose-This study examined the ability of listeners using cochlear implants (CIs) and listeners ... more Purpose-This study examined the ability of listeners using cochlear implants (CIs) and listeners with normal-hearing (NH) to identify silent gaps of different duration, and the relation of this ability to speech understanding in CI users. Method-Sixteen NH adults and eleven postlingually deafened adults with CIs identified synthetic vowel-like stimuli that were either continuous or contained an intervening silent gap ranging from 15 to 90 ms. Cumulative d', an index of discriminability, was calculated for each participant. Consonant and CNC word identification tasks were administered to the CI group. Results-Overall, the ability to identify stimuli with gaps of different duration was better for the NH group than for the CI group. Seven CI users had cumulative d' scores that were no higher than those of any NH listener, and their CNC word scores ranged from 0 to 30%. The other four CI users had cumulative d' scores within the range of the NH group, and their CNC word scores ranged from 46% to 68%. For the CI group, cumulative d' scores were significantly correlated with their speech testing scores. Conclusions-The ability to identify silent gap duration may help explain individual differences in speech perception by CI users.

Otology & Neurotology, Oct 1, 2018

Objective-Determine the impact of electrode array selection on audiometric performance when contr... more Objective-Determine the impact of electrode array selection on audiometric performance when controlling for baseline patient characteristics. Study Design-Retrospective evaluation of a prospective cochlear implant (CI) database (1/1/12-5/31/17). Setting-Tertiary Care University Hospital Patients-328 adult CI recipients Interventions/Main Outcomes Measured-Hearing outcomes were measured through unaided/aided pure tone thresholds and speech recognition testing before and after cochlear implantation. All reported post-operative results were performed at least 6 months after CI activation. All device manufacturers were represented. Results-Of the 328 patients, 234 received lateral wall (LW) arrays, 46 received perimodiolar (PM) arrays, and 48 received mid-scalar (MS) arrays. Patients receiving PM arrays had significantly poorer pre-operative earphone and aided PTAs and SRTs, and aided CNC word and AzBio +10 SNR scores compared to patients receiving LW arrays (all p=<0.04), and poorer PTAs and AzBio +10 SNR scores compared to MS recipients (all p=<0.02). No pre-operative audiological variables were found to significantly differ between MS and LW patients. After controlling for pre-operative residual hearing and speech recognition ability in a hierarchical multiple regression analysis, no statistically significant difference in audiological outcomes was detected (CNC words, AzBio quiet, or AzBio +10 SNR) among the three electrode array types (all p>0.05).

Children who acquire language through a cochlear implant (CI) provide a unique opportunity to stu... more Children who acquire language through a cochlear implant (CI) provide a unique opportunity to study the physical and cognitive bases of speech perception, as the target language these children must acquire is the same as children without hearing loss, but the input to the nervous system from a cochlear implant is very different from normal hearing. Psycholinguistic models of speech perception in adults with normal hearing propose that the phonological lexicon is organized in a phonetic similarity space based on linguistic features and phonemes, and that these units are important for spoken word recognition. In this study, we examine software simulations of spoken word recognition using behavioral data on feature, phoneme, and word identification from children who use CIs. While the physical signal received through a CI is different from aurally perceived speech, we propose that the same abstract units of language are nonetheless a part of the linguistic knowledge of children who learn spoken language through CIs. Our results are consistent with the claim that children who use CIs recognize words in the context of perceptually similar words stored in a mental lexicon. In addition, while some feature distinctions are less adequately transmitted through their devices (e.g., place of articulation), children with CIs appear to utilize the available phonological contrasts to recognize spoken words.

Audiology and Neuro-otology, 2016

The objective of this study was to examine how age and implanted ear contribute to functional out... more The objective of this study was to examine how age and implanted ear contribute to functional outcomes with cochlear implantation (CI). A retrospective review was performed on 96 adults who underwent unilateral CI. Older adults with right-ear implants had higher Hearing in Noise Test (HINT) scores at 1 year by 10.3% (p = 0.06). When adjusted to rationalized arcsine units (rau), right-ear HINT scores in older adults were higher by 12.1 rau (p = 0.04). Older adults had an 8.9% advantage on the right side compared to the left in post- versus preimplant scores for consonant-vowel nucleus-consonant words (p = 0.05). No significant differences were observed for younger adults. In conclusion, although adults of all ages experience improvements in speech perception following CI, there might be a subtle but consistent right-ear advantage in older adults.

JAMA Otolaryngology–Head & Neck Surgery, 2021

IMPORTANCE Cochlear implantation is highly effective at improving hearing outcomes, but results h... more IMPORTANCE Cochlear implantation is highly effective at improving hearing outcomes, but results have been limited to groupwise analysis. That is, limited data are available for individual patients that report comparisons of preoperative aided speech recognition and postimplantation speech recognition. OBJECTIVE To assess changes in preoperative aided vs postoperative speech recognition scores for individual patients receiving cochlear implants when considering the measurement error for each speech recognition test. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used a prospectively maintained database of patients who received cochlear implants between January 1, 2012, and December 31, 2017, at a tertiary, university-based referral center. Adults with bilateral sensorineural hearing loss undergoing cochlear implantation with 6-or 12-month postoperative measures using 1 or more speech recognition tests were studied. EXPOSURES Cochlear implantation. MAIN OUTCOMES AND MEASURES Postoperative word recognition (consonant-nucleusconsonant word test), sentence recognition (AzBio sentences in quiet), and sentence recognition in noise (AzBio sentences in +10-dB signal-to-noise ratio) scores, and association of each speech recognition score change with aided preoperative score to each test's measurement error. RESULTS Analysis of data from a total of 470 implants from 323 patients included 253 male (53.8%) patients; the mean (SD) age was 61.2 (18.3) years. Most patients had statistically significant improvement in all speech recognition tests postoperatively beyond measurement error, including 262 (84.8%) for word recognition, 226 (87.6%) for sentence recognition, and 33 (78.6%) for sentence recognition in noise. A small number of patients had equivalent preoperative and postoperative scores, including 45 (14.5%) for word recognition, 28 (10.9%) for sentence recognition, and 9 (21.4%) for sentence recognition in noise. Four patients (1.6%) had significantly poorer scores in sentence recognition after implantation. The associations between age at implantation and change in speech recognition scores were-0.12 (95% CI,-0.23 to-0.01) for word recognition,-0.22 (95% CI,-0.34 to-0.10) for sentence recognition, and-0.10 (95% CI,-0.39 to 0.21) for sentence recognition in noise. Patients with no significant improvement were similarly distributed between all preoperative aided speech scores for word recognition (range, 0%-58%) and sentence recognition (range, 0%-56%) testing. CONCLUSIONS AND RELEVANCE In this cross-sectional study, with respect to preoperative aided speech recognition, postoperative cochlear implant outcomes for individual patients were largely encouraging. However, improvements in scores for individual patients remained highly variable, which may not be adequately represented in groupwise analyses and reporting of mean scores. Presenting individual patient data from a large sample of individuals with cochlear implants provides a better understanding of individual differences in speech recognition outcomes and contributes to more complete interpretations of successful outcomes after cochlear implantation.

The Annals of otology, rhinology, and laryngology, 2018

To characterize factors that affect outcomes for patients with malignant otitis externa (MOE). Re... more To characterize factors that affect outcomes for patients with malignant otitis externa (MOE). Retrospective review of inpatients with MOE was performed. Patient demographics, comorbid conditions, complications, procedures, and mortalities were analyzed. A total of 786 patients with MOE were identified. The mean hospitalization length of stay (LOS) was 18.6 days (SD = 19.7). The overall mortality rate was 2.5% (n = 20), and complication rate was 4.3% (n = 34). Increasing age significantly and positively correlated with the incidence of MOE (r = 0.979, P < .0001). Factors that were associated with an increased rate of mortality were sepsis (odds ratio [OR] = 18.5; ES = 0.94; 95% CI, 0.47-1.42), congestive heart failure (OR = 3.1; ES = 0.42; 95% CI, 0.02-0.82), weight loss (OR = 10.2; ES = 1.23; 95% CI, 0.61-1.85), and coagulopathy (OR = 8.8; ES = 1.84; 95% CI, 0.91-2.77). Surgical intervention was performed in 19.2% (n = 151) of patients. Facial nerve involvement was present in 15...

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2018

1. Describe publishing trends for otologic/neurotologic disorders over a 35-year span. 2) Compare... more 1) Describe publishing trends for otologic/neurotologic disorders over a 35-year span. 2) Compare trends in publishing with disease prevalence. 3) Evaluate changes in topic and journal specific ranking scores over time. PubMed searches were performed on 35 otologic/neurotologic disorders using medical subject headings (MeSH) terms from 1980 to 2015. Searches were limited in scope to the English language. A Mann-Kendall trend analysis evaluated changes in publication frequency as a discrete variable while correcting for total number of articles published per year. Scopus was used to identify SCImago Country and Journal Rank (SJR) indicator scores and weighted-averages used to calculate changes over time. The total number of publications on the 35 topics increased from 853 in 1980 to a peak of 3,068 in 2013. Otitis media (τ = -0.799, p < 0.001) and Menière's disease (τ = -0.724, p < 0.001) showed strong decreasing publication trends. Temporal bone encephaloceles (τ = 0.743, ...