Pre-, Per- and Postoperative Factors Affecting Performance of Postlinguistically Deaf Adults Using Cochlear Implants: A New Conceptual Model over Time

TLDR

The study aimed to evaluate how various pre‑, peri‑, and postoperative factors affect cochlear‑implant speech performance in quiet and noise, and to develop a predictive model of auditory outcomes. The authors conducted a retrospective multi‑centre analysis of 2251 CI recipients, converting speech scores to percentile ranks and statistically testing 15 pre‑, peri‑, and postoperative variables—including hearing‑loss duration, surgical approach, insertion angle, electrode activity, device brand, and established predictors such as age and CI experience. The analysis identified better‑ear pure‑tone average, device brand, electrode activity, hearing‑aid use during profound‑HL, and moderate‑HL duration as significant predictors, and the resulting model demonstrated a progressive decline in performance starting in moderate‑HL and accelerating in profound‑HL, with bilateral HAs slowing central reorganization.

Abstract

Objective To test the influence of multiple factors on cochlear implant (CI) speech performance in quiet and in noise for postlinguistically deaf adults, and to design a model of predicted auditory performance with a CI as a function of the significant factors. Study Design Retrospective multi-centre study. Methods Data from 2251 patients implanted since 2003 in 15 international centres were collected. Speech scores in quiet and in noise were converted into percentile ranks to remove differences between centres. The influence of 15 pre-, per- and postoperative factors, such as the duration of moderate hearing loss (mHL), the surgical approach (cochleostomy or round window approach), the angle of insertion, the percentage of active electrodes, and the brand of device were tested. The usual factors, duration of profound HL (pHL), age, etiology, duration of CI experience, that are already known to have an influence, were included in the statistical analyses. Results The significant factors were: the pure tone average threshold of the better ear, the brand of device, the percentage of active electrodes, the use of hearing aids (HAs) during the period of pHL, and the duration of mHL. Conclusions A new model was designed showing a decrease of performance that started during the period of mHL, and became faster during the period of pHL. The use of bilateral HAs slowed down the related central reorganization that is the likely cause of the decreased performance.