the word recognition score (WRS) achieved with cochlear implants (CIs) varies widely. To account for this, a predictive model was developed based on patients' age and their pre-operative WRS. This ...retrospective study aimed to find out whether the insertion depth of the nucleus lateral-wall electrode arrays contributes to the deviation of the CI-achieved WRS from the predicted WRS.
patients with a pre-operative maximum WRS > 0 or a pure-tone audiogram ≥80 dB were included. The insertion depth was determined via digital volume tomography.
fifty-three patients met the inclusion criteria. The median WRS achieved with the CI was 70%. The comparison of pre- and post-operative scores achieved with a hearing aid and a CI respectively in the aided condition showed a median improvement of 65 percentage points (pp). A total of 90% of the patients improved by at least 20 pp. The majority of patients reached or exceeded the prediction, with a median absolute error of 11 pp. No significant correlation was found between the deviation from the predicted WRS and the insertion depth.
our data support a previously published model for the prediction of the WRS after cochlear implantation. For the lateral-wall electrode arrays evaluated, the insertion depth did not influence the WRS with a CI.
The objective of this study was to assess hearing outcome after sequential cholesteatoma surgery stratified for exclusively transcanal technique (ETC), combined transcanal and transmastoidal ...technique (TCM) and canal wall down surgery (CWD) and to analyze the impact of ossicular reconstruction technique (partial ossicular replacement prostheses/PORP and total ossicular replacement prostheses/TORP) on hearing outcome. This study is a retrospective case review and clinical case study conducted in a tertiary referral center. Patients who underwent 376 cholesteatoma surgeries (2007–2009) and 92 ears in clinical re-examination at least 12 months postoperatively were included. Sequential cholesteatoma surgery with ETC, TCM, or CWD; ossiculoplasty with PORP or TORP were the interventions administered. Pre- and postoperative air–bone gap (ABG) and air conduction threshold (AC) for 0.5–3 kHz were the main outcome measures. Overall, the mean preoperative ABG decreased from 25.3 ± 1.3 to 19.8 ± 0.9 dB with a mean ABG closure of 5.4 ± 1.3 dB (
p
≤ 0.001). According to surgical technique, the postoperative ABG after CWD 23.5 ± 2.1 was significantly worse compared to ETC (17.3 ± 1.0 dB,
p
< 0.05) and TCM (19.4 ± 1.3 dB). A significant ABG closure was observed after ETC (6.8 ± 2.0 dB,
p
< 0.01) and TCM (6.5 ± 2.0 dB,
p
< 0.01) contrary to CWD (2.1 ± 2.9 dB,
p
> 0.05). Patients receiving PORP showed a significantly less ABG postoperatively (19.0 ± 0.9 dB,
p
≤ 0.05) compared to the TORP group (24.1 ± 2.5 dB). However, a significant hearing gain was assessed after PORP- (4.7 ± 1.6 dB,
p
≤ 0.01) and TORP- implantation (10.4 ± 3.7 dB,
p
≤ 0.01). Sequential cholesteatoma surgery allowed for an excellent hearing outcome postoperatively. An intact posterior canal wall and a present stapes suprastructure were identified to predict a significantly superior hearing result. In addition to the technical and prosthetic considerations, the audiological outcome was confounded by the attending middle ear pathology.
The provision of implantable hearing aids represents an area with high development and innovation potential. On the one hand, this review article provides an overview of current indication criteria ...for the treatment with active middle ear implants. On the other hand, outcome parameters as well as functional results after implantation of active middle ear implants are demonstrated and discussed. The focus is mainly placed on audiological results as well as the subjective health status. "Patient Reported Outcome Measures" (PROMs) have become an integral part of the evaluation of hearing implant treatment. Due to low evidence level criteria, the study situation regarding audiological as well as subjective outcome parameters is not satisfactory. The lack of an international consensus on accepted outcome parameters makes a meta-analytical analysis of results immensely difficult. In the studies published to date, patients with sensorineural hearing loss and patients with conductive or mixed hearing loss offered better speech recognition after implantation of an active middle ear implant compared to conventional hearing aids. Current analyses show a significant improvement in general as well as hearing-specific quality of life after implantation of an active middle ear implant. To date, no validated, hearing-specific quality-of-life measurement instruments exist for assessing the success of fitting in children. Especially in children with complex malformations of the outer ear and the middle ear, excellent audiological results were shown. However, these results need to be substantiated by quality-of-life measurements in future.
Zusammenfassung
Die Versorgung mit implantierbaren Hörgeräten stellt einen Bereich mit hohem Entwicklungs- und Innovationspotenzial dar. Der vorliegende Übersichtsartikel gibt einerseits einen ...Überblick über derzeitige Indikationskriterien für die Versorgung mit aktiven Mittelohrimplantaten. Andererseits werden Zielparameter sowie Ergebnisse nach der Versorgung mit aktiven Mittelohrimplantaten beleuchtet. Hierbei liegt der Fokus auf audiologischen Ergebnissen sowie dem vom Patienten bewerteten Gesundheitszustand. Sogenannte „Patient Reported Outcome Measures“ (PROMs) nehmen mittlerweile auch in der Hörimplantatversorgung einen festen Stellenwert in der Evaluierung des Versorgungserfolges ein. Bisher ist die Studienlage sowohl hinsichtlich audiologischer als auch subjektiver Erfolgsparameter gemessen an den Evidenz-Level-Kriterien nicht befriedigend. Ein bislang fehlender internationaler Konsens über akzeptierte Outcomeparameter erschwert eine metaanalytische Aufarbeitung der Ergebnisse immens. In den bislang publizierten Untersuchungen konnte sowohl für Patienten mit einer Schallempfindungsschwerhörigkeit als auch für Patienten mit einer Schallleitungs- oder kombinierten Schwerhörigkeit ein besseres Sprachverstehen mit dem aktiven Mittelohrimplantat im Vergleich zur konventionellen Hörsystemversorgung ermittelt werden. Aktuelle Analysen zeigen eine signifikante Verbesserung der allgemeinen sowie der hörspezifischen Lebensqualität nach Versorgung mit einem aktiven Mittelohrimplantat. Zur Beurteilung des Versorgungserfolges bei Kindern existieren bislang keine validierten, hörspezifischen Lebensqualitätsmessinstrumente. Insbesondere bei Kindern mit komplexen Fehlbildungen des äußeren Ohres sowie des Mittelohres zeigen sich audiologisch zufriedenstellende Ergebnisse, welche zukünftig jedoch durch Lebensqualitätsmessungen untermauert werden müssen.
Objective The objective of our study was to check the documentation of hearing outcome parameters and influencing factors (surgical, pathological, and methodological) in published literature ...evaluating hearing outcome after tympanoplasty. We aimed to assess how effectively the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1995 guidelines were applied. Study Design Retrospective noncontrolled study. Setting Ear research center. Subjects and Methods This study was based on a PubMed research, including peer-reviewed English-speaking original studies published from January 2005 to December 2015. In total, 169 studies were checked for correct description of study population, surgical methodology, study design, and documentation of the hearing outcome. In addition, the correct application of AAO-HNS 1995 criteria was checked. Results Pre- and postoperative air-bone gap were shown as mean ± standard deviation in half of all series (52% vs 56%). The recommended frequency spectrum (0.5-3 kHz) was used in 46%, while a documentation of frequency spectrum was available in 85%. Whereas a statement on presence of stapes suprastructure (81%) and initial pathology was usually available, mucosa status (17%) and aeration (8%) were only shown in few series. Revision cases, staged cases, and myringoplasty graft material were documented in 46% to 57%. Type and material of prosthesis were represented in 74% to 82%. None of the publications analyzed fulfilled all 10 AAO-HNS criteria. In 10%, 7 to 9 criteria were used correctly. Conclusion A heterogeneous description of surgical and pathological findings and the application of minimal reporting standards are essential preconditions to enable comparisons between different studies and to generate meta-analysis.
Purpose
This study aimed to determine whether preoperative depressiveness, stress, and personality influence quality of life (QOL) after cochlear implant (CI) surgery.
Methods
In this prospective ...study, 79 patients undergoing CI surgery were evaluated preoperatively and 12 months postoperatively. Disease-specific QOL was assessed with the Nijmegen Cochlear Implant Questionnaire (
NCIQ
) and general QOL with the WHOQOL-BREF. Depressiveness and stress were assessed with the Patient Health Questionnaire (PHQ-D). The Charlson Comorbidity Index (CCI) was used to classify comorbidities. The Big Five Personality Test (B5T) was used to assess the basic personality dimensions. Speech comprehension was evaluated in quiet with the Freiburg monosyllable test and in noise with the Oldenburg sentence test.
Results
After CI surgery, the total NCIQ score improved significantly (Δ 17.1 ± 14.7,
p
< 0.001). General QOL (WHOQOL-BREF, Δ 0.4 ± 9.9,
p
= 0.357), stress (Δ 0.25 ± 3.21,
p
= 0.486), and depressiveness (Δ 0.52 ± 3.21,
p
= 0.121) were unaffected by CI surgery. Patients without elevated depressiveness (
p
< 0.01) or stress (
p
< 0.001) had significantly better total NCIQ scores. The results of the multiple regression analyses show that, after adjusting for the CCI, personality, age, and mental health stress (ß = − 0.495,
p
< 0.001) was significantly associated with postoperative NCIQ outcome scores. Depressiveness and neuroticism had the strongest influence on the generic QOL (ß = − 0.286 and ß = − 0.277,
p
< 0.05).
Conclusion
Stress symptoms and personality traits are significant predictive factors for disease-specific QOL, as well as hearing status. This should be considered in the preoperative consultation and in optimizing the rehabilitation process.
Background
With the Chronic Ear Survey (CES), a validated measurement instrument for the assessment of disease-specific health-related quality of life (HRQoL) has been available internationally since ...2000. The aim of this study was to provide a validated German version of this international instrument and to compare it with the German Chronic Otitis Media Outcome Test 15 (COMOT-15).
Methodology
The CES was translated into German via a forward-backward translation process. For validation, 79 patients with COM undergoing middle ear surgery were prospectively included. HRQoL was determined preoperatively and 6 months postoperatively using the CES and the COMOT-15. Pure tone audiometry was also performed at both measurement time points. In the control examination, an additional retrospective assessment of the preoperative situation was additionally performed using the CES and the COMOT-15 to assess the response shift. The determined psychometric characteristics were internal consistency, test–retest reliability, discrimination validity, agreement validity, responsiveness, and response shift for both measurement instruments. Convergent validity of both measurement instruments was assessed using linear regression.
Results
On the basis of the CES, patients with COM could be reliably distinguished from patients with healthy ears. The CES showed satisfactory reliability with high internal consistency (Cronbach α 0.65–0.85) and high retest reliability (r > 0.8). The global assessment of HRQoL impairment correlated very well with the scores of the CES (r = 0.51). In addition, it showed a high sensitivity to change (standardized response mean −0.86). Compared to the COMOT-15, it showed a lower response shift (effect size −0.17 vs. 0.44). Both measurement instruments correlated only slightly with air conduction hearing threshold (r = 0.29 and r = 0.24, respectively). The concordant validity of both measurement instruments was high (r = 0.68).
Conclusion
The German version of the CES shows satisfactory psychometric characteristics, so that its use can be recommended. The CES focuses on the influence of ear symptoms on HRQoL, whereas the COMOT-15 also includes functional and psychological aspects. Due to only minor response shift effects, the CES is particularly suitable for studies with multiple repeat measurements.
Zusammenfassung
Hintergrund
Mit dem Chronic Ear Survey (CES) steht seit 2000 ein validiertes Messinstrument zur Erfassung der krankheitsspezifischen bzw. gesundheitsbezogenen Lebensqualität (HRQoL) ...international zur Verfügung. Ziel der Studie war es, für dieses internationale Messinstrument eine validierte deutschsprachige Fassung zur Verfügung zu stellen und diese mit dem deutschen Chronic Otitis Media Outcome Test 15 (COMOT-15) zu vergleichen.
Methodik
Der CES wurde über einen Vorwärts-rückwärts-Übersetzungsprozess in die deutsche Sprache transferiert. Zur Validierung wurden 79 Patient:innen mit einer COM, bei denen eine Mittelohroperation durchgeführt wurde, prospektiv in die Studie eingeschlossen. Die HRQoL wurde präoperativ und 6 Monate postoperativ mit dem CES und dem COMOT-15 bestimmt. Zu beiden Messzeitpunkten erfolgte auch eine Reintonaudiometrie. In der Kontrolluntersuchung wurde zusätzlich eine rückwirkende Beurteilung der präoperativen Situation anhand des CES und des COMOT-15 zur Bestimmung des Response-Shifts durchgeführt. Als psychometrische Kenndaten wurden die interne Konsistenz, die Test-Retest-Reliabilität, die Diskriminationsvalidität, die Übereinstimmungsvalidität, die Responsivität für beide Messinstrumente bestimmt. Die konvergente Validität beider Messinstrumente wurde anhand einer linearen Regression bewertet.
Ergebnisse
Anhand des CES konnten Patient:innen mit COM von Ohrgesunden sicher unterschieden werden. Der CES zeigte eine sehr gute Reliabilität mit hoher interner Konsistenz (Cronbach‑α 0,65–0,85) und hoher Retest-Reliabilität (r > 0,8). Die globale Einschätzung der Beeinträchtigung der HRQoL korrelierte sehr gut mit den Scores des CES (r = 0,51). Zudem zeigte er eine hohe Änderungssensitivität („standardized response mean“ −0,86). Im Vergleich zum COMOT-15 zeigte sich ein geringerer Response-Shift (Effektstärke −0,17 vs. 0,44). Beide Messinstrumente korrelierten nur gering mit der Luftleitungshörschwelle (r = 0,29 bzw. r = 0,24). Die konkordante Validität beider Messinstrumente war hoch (r = 0,68).
Schlussfolgerung
Die deutsche Version des CES weist zufriedenstellende psychometrische Kenndaten auf, sodass das Einsatz empfohlen werden kann. Der CES legt hierbei den Fokus auf den Einfluss der Ohrsymptomatik auf die HRQoL, wohingegen der COMOT-15 auch funktionelle und psychologische Aspekte miteinschließt. Aufgrund nur geringer Response-Shift-Effekte eignet sich der CES insbesondere für Untersuchungen mit mehreren Wiederholungsmessungen.
