Cochlear Implants in Single-Sided Deafness. Comparison Between Children and Adult Populations With Post-lingually Acquired Severe to Profound Hearing Loss

Objective: To determine audiological and clinical results of cochlear implantation (CI) comparing two populations with single-sided deafness (SSD): post-lingually deaf children between 6 and 12 years of age, and post-lingually deaf adults, in order to evaluate the effect of CI in different age groups.Design: Retrospective case review.Setting: Tertiary clinic.Patients and Method: Twenty-three children and twenty-one adult patients that were candidates for CI with single-side deafness were included. In all cases we evaluate: Speech perception thresholds; disyllabic words test (65 dB SPL) were performed in the modalities S0–SCI–SNH and Auditory Lateralization Test. The Speech, Spatial, and Qualities of Hearing Scale (SSQ) questionnaire was also used. All results were obtained after 12 months of CI activation.Results: In children, the most common etiology was idiopathic sensory-neural hearing loss. They showed positive results in the Auditory Lateralization Test. In the Speech Test, word recognition in noise improved from 2% preoperatively to 61.1% at a mean follow-up of 1 year (S0 condition) in children [test with signal in CI side 60% and signal normal hearing side (plugged) 31%]. The processor was used for >12 h in all cases. With respect to the SSQ questionnaire, parents were more satisfied within the postoperative period than within the preoperative period. For adults, the most common etiology was idiopathic sudden sensorineural hearing loss (SNHL). Positive results in the Auditory Lateralization Test were found. With respect to the Speech Test in quiet conditions: Word recognition in noise improved from 5.7% preoperatively to 71.8% at a mean follow-up of 1 year [test with signal in CI side 68% and signal normal hearing side (plugged) 41%]. The processor was used for >12 h. In the SSQ questionnaire, the post-operative results showed a beneficial effect of the CI. No adverse events were reported during the study period. No differences were found between children and adults in all tests in this study.Conclusions: Cochlear implantation in post-lingually deaf adults and children with SSD can achieve a speech perception outcome comparable with CI in conventional candidates. Improvements in spatial hearing were also observed. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.

Correlation of psychosocial support concerns and depression in Deaf adults at Nairobi and Kajiado Counties, Kenya

The Deaf are considered persons with disabilities owing to societal stigma resulting in inequality and discrimination. The sequential mixed methodology utilized a cross-sectional approach, with interviews translated and administered in Kenyan Sign Language. The MMSE screened for mental status, while PHQ-9 assessed for depression and WSAS for Psychosocial Support Concerns (PSS) concerns. Researcher-designed in-depth interviews explored qualitative themes. In addition, Focus Group Discussions, ethnographic observation checklist, and mental health providers’ key informant interviews corroborated data. Deaf adults (N=100, 83% response rate) reported inadequate counseling access (62%) while 55% reported no depression. However, 45% depicted clinically significant depression levels, with a notable 28% of Deaf adults also indicating suicidality. Content analyses revealed family, socioeconomic welfare and stigma as the topmost PSS concerns. The study found a significant positive correlation between depression and overall PSS concerns at 0.225 (p=0.024), and home management PSS concern with depression at 0.253 (p=0.011). ANOVA analyses revealed statistically significant differences between the depression categories’ effects on PSS concerns, F = 3.22, p =.026. T-tests analyses indicated that means for None and Mild Depression (M=8.93, SD=8.80) were significantly lower than for Severe depression, t (13) = -3.16, p = .007, 95% CI [-15.15, -2.85]; and Moderately Severe (M=12.64, SD=7.40) were significantly lower than for Severe depression, t (13) -2.67, p = .019, 95% CI [-9.57, -1.00]. The study implications are to design Deaf-friendly assessments. The study recommends Deaf-centric interventions and for further study, national census on Deaf mental health and development of instruments normed for Kenyan Deaf populations.

Methodological considerations of clinical research with Deaf adults in Kenya

Clinical research with adults who are Deaf in Kenya is nascent and with a loose array of methodological considerations detailed by various authors (Kakiri, 2019). Indeed, Deaf clinical research considerations are necessary for viable outcomes. A desk review of Deaf studies found that there are certain global sets of principles on ethical research and clinical practice considerations with Deaf populations. The document analysis method was used in this literature review, revealing the need for modifications to the standard protocol including the use of a visual-spatial language (Kenyan Sign Language) rather than a spoken language (English), as well as coding and procedural variations from the standardized protocol to fully accommodate Deaf culture. The use of Deaf research assistants or/and the researcher’s reflexivity as a Hearing signing researcher are certain key component of field research considerations. Since the Deaf are a marginalized sub-set of the population, paradigmatic as well as methodological considerations are recommended for effective clinical research in Kenya.

Restoration of High Frequency Auditory Perception After Robot-Assisted or Manual Cochlear Implantation in Profoundly Deaf Adults Improves Speech Recognition

Background and Purpose: Robot-assisted cochlear implantation has recently been implemented in clinical practice; however, its effect on hearing outcomes is unknown. The aim of this preliminary study was to evaluate hearing performance 1 year post-implantation whether the electrode array was inserted manually or assisted by a robot.Methods: Forty-two profoundly deaf adults were implanted either manually (n = 21) or assisted by a robot (RobOtol®, Collin, Bagneux, France) with three different electrode array types. Participants were paired by age, and electrode array type. The scalar position of the electrode array in the cochlea was assessed by 3D reconstruction from the pre- and post-implantation computed tomography. Pure-tone audiometry and speech perception in silence (percentage of disyllabic words at 60 dB) were tested on the implanted ear 1 year post-implantation in free-field conditions. The pure-tone average was calculated at 250–500–750 Hz, 500–1,000–2,000–3,000 Hz, and 3,000–4,000–8,000 Hz for low, mid, and high frequencies, respectively.Results: One year after cochlear implantation, restoration of the high-frequency thresholds was associated with better speech perception in silence, but not with low or mid frequencies (p < 0.0001; Adjusted R2 = 0.64, polynomial non-linear regression). Although array translocation was similar using either technique, the number of translocated electrodes was lower when the electrode arrays had been inserted with the assistance of the robot compared with manual insertion (p = 0.018; Fisher's exact test).Conclusion: The restoration of high-frequency thresholds (3,000–4,000–8,000 Hz) by cochlear implantation was associated with good speech perception in silence. The numbers of translocated electrodes were reduced after a robot-assisted insertion.

Can contactless volunteer activities be an alternative during the COVID-19 pandemic?

The purpose of this study is to provide a viable alternative for volunteer services which became inactive due to the COVID-19 pandemic. Accordingly, cases of contactless volunteer work involving children using the M Social Welfare Center located in the city of Paju in Gyeonggi-do Province were studied using reputational case selection. The aforementioned children are children whose parents have hearing disabilities (CODAs: child of deaf adults). In all of the examined cases, six sessions of online volunteer work have been carried out with these children. In-depth interviews were conducted with four participants, two non-participants, two of the twelve youth volunteers, and one social worker. The results of the study were as follows: firstly, there are several advantages to online volunteer work such as providing an alternative to the conventional volunteering method during the COVID-19 pandemic, no restrictions of location or place, recipients having their own private space, and the volunteers and recipients being able to open up to each other and being able to grow together through this process. Secondly, issues to be noted during the process are the characteristics of the recipients, the role of social workers, the education of volunteers and the attitude of the volunteers. Finally, aspects that need to be improved are the recognition of online volunteer hours and paralleling online volunteer work with other volunteer methods when the COVID-19 situation improves in the future. Through these findings, this study suggested practical and policy implications.

Analysis of Neural Interface When Using Modiolar Electrode Stimulation. Radiological Evaluation, Trans-Impedance Matrix Analysis and Effect on Listening Effort in Cochlear Implantation

Background: The proximity of the electrode to the modiolar wall may be of interest to investigate the effect of pitch discrimination. This research establishes the relation between these factors and whether perimodiolar positions may provide benefits regarding improved electrode discrimination. Methods: A prospective randomized study including 24 post-lingual deaf adults was performed. A psychoacoustic study was done by using a psychoacoustic research platform. Radiological study, and a cone-beam computed tomography was used to assess post cochlear implantation electrodes’ position. Trans-impedance matrix (TIM) analysis was performed after cochlear implant insertion in all cases, and pupillometry test was also performed. Results: 12 patients received a slim perimodiolar electrode array, and 12 patients received a straight electrode array. Although all the patients showed similar speech test results after 12 months follow-up, those implanted with a perimodiolar electrode obtained better scores in electrode discrimination test and pupillometry test, and showed more homogenous TIM patterns. Conclusions: The better positioning of the electrode array seams to provide a better hearing resolution and less listening effort trans-impedance matrix seems to be a useful tool to analyze positioning of the perimodiolar array.

Crianças ouvintes filhos de pais surdos: adversidades no diálogo familiar - Relato de experiência

Introdução: Estudos envolvendo aquisição de linguagem em “Children of Deaf Adults” (CODA), filhos de pais surdos, ainda são recentes no Brasil, embora seja o país que possui uma linguagem específica (LIBRAS) para pessoas não ouvintes (SOUZA, 2014). O CODA, geralmente, cresce em meio a duas culturas, bilíngue, e nessa perspectiva, a aquisição da linguagem das crianças torna-se um processo complexo e intrigante. Objetivo: Compreender a dinâmica familiar e a aquisição da Língua Brasileira de Sinais (Libras) concomitante à língua portuguesa falada em crianças sem deficiência auditiva filhos de pais surdos. Considerações: O CODA apresenta risco de comprometimento no rendimento escolar além de desenvolver uma maturidade precoce. Ressalta-se a importância da Atenção primária em saúde e da família na estimulação das potencialidades e monitoramento do desenvolvimento dessas crianças. São necessários novos estudos sobre esse grupo e ações específicas na área da saúde.