Setting and Reaching Targets with Computer-Assisted Cochlear Implant Fitting (original) (raw)
Related papers
Evaluation of the ‘Fitting to Outcomes eXpert’ (FOX ® ) with established cochlear implant users
Cochlear Implants International, 2015
Objectives: To evaluate the possible impact of 'Fitting to Outcomes eXpert (FOX ®)' on cochlear implant (CI) fitting in a clinic with extensive experience of fitting a range of CI systems, as a way to assess whether a software tool such as FOX is able to complement standard clinical procedures. Methods: Ten adult post-lingually deafened and unilateral long-term users of the Advanced Bionics TM CI system (Clarion CII or HiRes 90K TM) underwent speech perception assessment with their current clinical program. One cycle 'iteration' of FOX optimization was performed and the program adjusted accordingly. After a month of using both clinical and FOX programs, a second iteration of FOX optimization was performed. Following this, the assessments were repeated without further acclimatization. Results: FOX prescribed programming modifications in all subjects. Soundfield-aided thresholds were significantly lower for FOX than the clinical program. Group speech scores in noise were not significantly different between the two programs but three individual subjects had improved speech scores with the FOX MAP, two had worse speech scores, and five were the same. Conclusion: FOX provided a standardized approach to fitting based on outcome measures rather than comfort alone. The results indicated that for this group of well-fitted patients, FOX improved outcomes in some individuals. There were significant changes, both better and worse, in individual speech perception scores but median scores remained unchanged. Soundfield-aided thresholds were significantly improved for the FOX group.
Cochlear Implants International, 2014
Objective: To compare the fitting time requirements and the efficiency in achieving improvements in speech perception during the first 6 months after initial stimulation of computer-assisted fitting with the Fitting to Outcome eXpert' (FOX™) and a standard clinical fitting procedure. Method: Twenty-seven post-lingually deafened adults, newly implanted recipients of the Advanced Bionics HiRes 90K™ cochlear implant from Germany, the UK, and France took part in a controlled, randomized, clinical study. Speech perception was measured for all participants and fitting times were compared across groups programmed using FOX and conventional programming methods. Results: The fitting time for FOX was significantly reduced at 14 days (P < 0.001) but equivalent over the 6month period. The groups were not well matched for duration of deafness; therefore, speech perception could not be compared across groups. Discussion: Despite including more objective measures of performance than a standard fitting approach and the adjustment of a greater range of parameters during initial fitting, FOX did not add to the overall fitting time when compared to the conventional approach. FOX significantly reduced the fitting time in the first 2 weeks and by providing a standard fitting protocol, reduced variability across centres. Conclusions: FOX computer-assisted fitting can be successfully used at switch on, in different clinical environments, reducing fitting time in the first 2 weeks and is efficient at providing a usable program.
Cochlear Implants International, 2015
In Norway, about one out of 2000 babies born is deaf, which means up to 20-30 children are born deaf every year. Some become deaf later due to diseases like meningitis or because of disease during pregnancy. In recent years, in particular, the Cochlear Implant (CI) has become a well-established treatment for deaf children and adults. The Department of Otorhinolaryngology at Oslo University Hospital (OUS) is responsible nationally for all deaf children in Norway. A CI offers the possibility to deaf people of partially restoring their hearing. A CI consists of two major parts-a sound processor (SP) and a stimulator/implant. The SP's microphone picks up sound and analyses it in terms of frequencies and volume. This information is sent via radio frequencies to the implant inside the head. The implant stimulator transfers a biphasic pulse to one of its electrodes along the electrode array inside the inner ear (cochlea). These pulses bypass damaged hair cells and directly stimulate the hearing nerve sections/fibres. Objective Measurements in Cochlear Implants: During electrical stimulation and when sending information via radio frequencies to the implant, a huge electrical artefact is caused. The artefact is several 1000 times larger than the small electroencephalogram (EEG) response of a few µV that we want to measure. Use of filters, triggering, averaging of the signal, and subtraction methods make it possible to also measure these responses for CI recipients. None of these objective measurements are regularly implemented in the clinical routine or frequently used for SP programming. So far, no objective measurement method has been found to find out how much a patient is hearing, or how loudly. For CIs, two further objective measures were implemented which are only possible with a CI, because an implant is required to take these measurements. Electrically evoked stapedius reflex threshold (ESRT) is a measurement carried out during surgery. Certain electrodes get stimulated while the surgeon observes the reflexes of the stapes muscle. The threshold can be determined by lowering the current or charge delivered to the electrodes and therewith to the hearing nerve fibres. The other measurement is the Evoked Compound Action Potential (ECAP) which measures the response of the nerve fibres inside the cochlea after electrical stimuli from the implant. Imaging in Cochlear Implants: Before surgery, all paediatric and adult patients with expected complications at OUS have to undergo a Magnet Resonance Imaging (MRI) and all patients a Computed Tomography (CT) scan, which gives the surgeons an anatomical overview. After surgery, an intra-operative X-ray picture is performed to verify the correct placement of the electrode array inside the cochlea. Conventional X-ray imaging gives a general overview ii without an exact picture of electrode placement, such as for example displacement into scala vestibule. Project Outline: This project shall investigate if the combination of various objective measures for CI programming can be of help or even improve the programming. Hereby the following investigations need to be done. Starting with the surgery ESRT, ECAP and electrical evoked auditory brainstem responses (EABR) measurements can be carried out. The ESRT can give information if the whole auditory loop is functioning. ECAP measurements may indicate more sensitive regions, flip over and distance to the modiolus or nerve fibres. An intra-operative X-ray examination can give only an approximate indication about the electrode placement. A post-operative flat panel CT scan may give more detail about the electrode placement. The combination of ECAP measurements, such as sweep, spread of excitation and recovery function and flat panel CT scans may make it possible to detect problem areas or an electrode dislocation. This could provide valuable information, because problem electrodes may be excluded during SP programming or handled with special care. EABR measurements may indicate the coupling of the electrodes to the nerve fibres. In addition, this could be a valuable measurement for auditory neuropathy spectrum disorder (ANSD) patients, where a dissynchrony of the nerve fibres is assumed. Data Analysis: ECAP, EABR, and ESRT levels will be compared with subjective speech recognition tests, in quiet and noisy conditions. Flat panel CT scans and electrode placement will be compared to speech performance and objective measure levels. Project Goal: This project aims to find new procedures/implementations for programming a CI SP. Better programming produces better hearing, which leads to better social integration. There is a need for research on whether objective measures can be a predictor of speech recognition performance. This could be used to suggest different therapy approaches. Conclusion: The studies have shown that there is a significant relationship between observed intra-operative EABR measures and post-operative speech recognition. Both the FD-CT scan and per-operative fluoroscopy improved the CI electrode placement during CI surgery. These methods have helped us minimize poor clinical results by monitoring the exact position of the electrode array during surgery. ECAP and EABR measurements can also help identify in correct placement of the electrode array. Unfortunately intra-operative objective measures in our study, such as ECAP, ESRT, and electrode impedances did not provide statistically significant correlations that may help to predict the programming T-and C-levels for all patients. iii Preface This thesis has been submitted to the Faculty of Mathematics and Natural Sciences at University of Oslo in partial fulfilment of the requirements for the degree of Philosophiae Doctor (Ph.D.
Cochlear Implants International, 2014
Objective: To compare the fitting time requirements and the efficiency in achieving improvements in speech perception during the first 6 months after initial stimulation of computer-assisted fitting with the Fitting to Outcome eXpert' (FOX™) and a standard clinical fitting procedure. Method: Twenty-seven post-lingually deafened adults, newly implanted recipients of the Advanced Bionics HiRes 90K™ cochlear implant from Germany, the UK, and France took part in a controlled, randomized, clinical study. Speech perception was measured for all participants and fitting times were compared across groups programmed using FOX and conventional programming methods. Results: The fitting time for FOX was significantly reduced at 14 days (P < 0.001) but equivalent over the 6month period. The groups were not well matched for duration of deafness; therefore, speech perception could not be compared across groups. Discussion: Despite including more objective measures of performance than a standard fitting approach and the adjustment of a greater range of parameters during initial fitting, FOX did not add to the overall fitting time when compared to the conventional approach. FOX significantly reduced the fitting time in the first 2 weeks and by providing a standard fitting protocol, reduced variability across centres. Conclusions: FOX computer-assisted fitting can be successfully used at switch on, in different clinical environments, reducing fitting time in the first 2 weeks and is efficient at providing a usable program.
Audiometric evaluation short and medium term in cochlear implants
Revista De Investigacion Clinica, 2014
Objetivo. La finalidad del presente estudio es reportar los resultados audiometricos obtenidos en el Servicio de Audiologia, en el Instituto Nacional de Rehabilitacion, con la colocacion del implante coclear de noviembre 2007, en que se realizo el primer implante en este instituto, hasta diciembre 2012. Material y metodos. Estudio transversal, observacional, descriptivo, analizando los umbrales de audicion, pre y postimplante coclear, mediante revision de expedientes (diagnostico, edad de instauracion de la hipoacusia, potenciales provocados auditivos de tallo cerebral (PPATC), tomografia computarizada (TC), resonancia magnetica (RM), lateralidad del oido implantado, marca y modelo de los implantes cocleares (IC), estudios audiometricos previos y posteriores al IC. Resultados. Se reporta la evolucion de 68 pacientes, teniendo un rango de edad de un ano-ocho meses a 39 anos-tres meses de edad. El 94% de los pacientes (n = 64) presento hipoacusia pre-lingual, siendo la hipoacusia here...
Suitability of Auditory Speech Sound Evaluation (A§E®) in German cochlear implant patients
European Archives of Oto-Rhino-Laryngology, 2011
A §E Ò is an audiological evaluation tool based on speech sounds as stimuli and was developed by The Eargroup, Antwerp. It consists of three levels: detection, discrimination and identification of phonemes and is a sufficient tool to measure supraliminal auditory capacities in Flemish language of children 10 months and older as well as adults. The aim of this study was to test the suitability of patients for cochlear implant in Germany, using 245 consecutive measurements (141 adults, 79 children, 25 controls) in a standard test protocol for phoneme detection and discrimination, Mainzer and Göttinger in children and Freiburger in adults pre-, 3 and 6 months and 1 year after implantation. Results in detection and discrimination regarding frequency spectrum and fitting parameters were evaluated using the following statistical methods: t test and correlation analysis. Detection improves first, followed by numbers, phoneme discrimination and monosyllables. Test results compared pre-to 3, 6 months and later, postoperatively, differ significantly (p \ 0.05). A ''ceiling-effect'' is obtained between 6 months and 1 year (reproduction in A §E Ò [90%). Development of detection and discrimination correlates directly with results in numbers and monosyllables (r = 0.92). Non-German speaking patients cope better with A §E Ò than with numbers and monosyllables. Evaluation of phoneme discrimination enables better frequency specific fitting. Results indicated that A §E Ò is a valuable diagnostic supplement in fitting and therapy of cochlear implant patients regardless of cognitive level, age and language. Important information on frequency-resolving power of cochlear nerve after implantation is gained. Use of A §E Ò enables comparability and evaluation of study results in different countries.
Comparisons of electrophysiological and psychophysical fitting methods for cochlear implants
International Journal of Audiology, 2021
Objective: This study compared two different versions of an electrophysiology-based softwareguided cochlear implant fitting method with a procedure employing standard clinical software. The two versions used electrically evoked compound action potential (ECAP) thresholds for either five or all twenty-two electrodes to determine sound processor stimulation level profiles. Objective and subjective performance results were compared between software-guided and clinical fittings. Design: Prospective, double-blind, single-subject repeated-measures with permuted ABCA sequences. Study sample: 48 post linguistically deafened adults with 15 years of severe-to-profound deafness who were newly unilaterally implanted with a Nucleus device. Results: Speech recognition in noise and quiet was not significantly different between software-guided and standard methods, but there was a visit/learning-effect. However, the 5-electrode method gave scores on the SSQ speech subscale 0.5 points lower than the standard method. Clinicians judged usability for all methods as acceptable, as did subjects for comfort. Analysis of stimulation levels and ECAP thresholds suggested that the 5-electrode method could be refined. Conclusions: Speech recognition was not inferior using either version of the electrophysiology-based software-guided fitting method compared with the standard method. Subject-reported speech perception was slightly inferior with the five-electrode method. Software-guided methods saved about 10 min of clinician's time versus standard fittings.
Early fitting in cochlear implant surgery: preliminary results
European Archives of Oto-Rhino-Laryngology
Purpose Cochlear implants are usually activated 3–5 weeks after surgery; to date, no universal protocol exists regarding switch on and fitting of these devices. The aim of the study was to assess safety and functional results of activation and fitting of cochlear implant within 24 h following surgery. Methods In this retrospective case–control study, 15 adult patients who underwent cochlear implant surgery, for a total of 20 cochlear implant procedures were analyzed. In particular, clinical safety and feasibility were investigated by examinating patients at activation and at each follow-up. Values of electrodes’ impedance and most comfortable loudness (MCL) were analyzed from the time of surgery to 12 months after activation. Free-field pure tone average (PTA) was also recorded. Results No major or minor complications were reported and all patients could perform the early fitting. Activation modality influenced impedance values only in the short term but the differences were not sta...
12th International Conference on Cochlear Implants and Other Implantable Auditory Technologies
2012
Background and aims: State-of-the-art cochlear implant programming software is essentially technical. It exposes many control parameters, such as strategy options, electrical mapping levels, audio input control,... to the CI expert audiologist. The role of the CI audiologist is to know how to set these parameters in order to optimize the hearing performance of the CI user. The FOX® fitting system, developed by the Eargroup takes a different approach: it proposes an audiological workflow with specific hearing milestones such as detection of soft sounds, phoneme discrimination and speech in quiet. The FOX agent proposes fitting recommendations based on the outcomes. Multicentric study is ongoing to evaluate this approach in new users and to evaluate its efficacy and time efficiency.Methods: Two subject groups, the control and the FOX group are being investigated from the initial switch on over a period of six months. Fitting time requirements, learning trajectory and overall performan...
Statistical Analysis of Various Factors Affecting the Results of Cochlear Implantation
2014
analysis of several factors was performed to reveal any significant effect of the outcome of the procedure. RESULTS: The duration of deafness in adults showed a significant linear yet non-monotonic correlation with the postoperative average auditory thresholds as revealed by Pearson’s correlation coefficient (r=0.839, p=0.009) and a linear regression model (f=14.211, p=0.009), which showed that the increase in the duration of deafness led to an increase in hearing thresholds and accounted for 70.3% of the variance in the outcome (β=0.839, t=3.770, and p=0.009). Age at implantation in children showed a positive linear, monotonic relation with the postoperative receptive (r=0.725, p<0.001, r S =0.354, p=0.010) and was a significant predictor of outcome (β=0.440, t=2.961; p=0.005) according to multiple linear regression. Mann-Whitney U-test was performed to evaluate the difference in medians of outcomes in relation to the regularity of attendance to speech rehabilitation. We found a...