http://pubs.jamanetwork.com/ en-us Fri, 01 Mar 2013 00:00:00 GMT Thu, 21 Mar 2013 21:44:45 GMT Silverchair editor@pubs.jamanetwork.com webmaster@pubs.jamanetwork.com http://pubs.jamanetwork.com/article.aspx?articleID=1655350 Fri, 01 Mar 2013 00:00:00 GMT Gaylor JM, Raman G, Chung M, et al. <span class="paragraphSection"><div class="boxTitle">Importance</div>Sensorineural hearing loss is the third leading cause of years lived with disability worldwide. Cochlear implants may provide a viable alternative to hearing aids for this type of hearing loss. The Coverage and Analysis Group at the Centers for Medicare & Medicaid Services was interested in an evaluation of recently published literature on this topic. In addition, this meta-analysis is to our knowledge the first to evaluate quality-of-life (QOL) outcomes in adults with cochlear implants.<div class="boxTitle">Objective</div>To evaluate the communication-related outcomes and health-related QOL outcomes after unilateral or bilateral cochlear implantation in adults with sensorineural hearing loss.<div class="boxTitle">Data Sources</div>MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and previous reports from January 1, 2004, through May 31, 2012.<div class="boxTitle">Study Selection</div>Published studies of adult patients undergoing unilateral or bilateral procedures with multichannel cochlear implants and assessments using open-set sentence tests, multisyllable word tests, or QOL measures.<div class="boxTitle">Data Extraction</div>Five researchers extracted information on population characteristics, outcomes of interest, and study design and assessed the studies for risk of bias. Discrepancies were resolved by consensus.<div class="boxTitle">Results</div>A total of 42 studies met the inclusion criteria. Most unilateral implant studies showed a statistically significant improvement in mean speech scores as measured by open-set sentence or multisyllable word tests; meta-analysis revealed a significant improvement in QOL after unilateral implantation. Results from studies assessing bilateral implantation showed improvement in communication-related outcomes compared with unilateral implantation and additional improvements in sound localization compared with unilateral device use or implantation only. Based on a few studies, the QOL outcomes varied across tests after bilateral implantation.<div class="boxTitle">Conclusions and Relevance</div>Unilateral cochlear implants provide improved hearing and significantly improve QOL, and improvements in sound localization are noted for bilateral implantation. Future studies of longer duration, higher-quality reporting, and large databases or registries of patients with long-term follow-up data are needed to yield stronger evidence.</span> 139 3 265 272 10.1001/jamaoto.2013.1744 http://pubs.jamanetwork.com/article.aspx?articleID=1655350 http://pubs.jamanetwork.com/article.aspx?articleID=1671204 Fri, 01 Mar 2013 00:00:00 GMT Dillon MT, Buss E, Adunka MC, et al. <span class="paragraphSection"><div class="boxTitle">Importance</div>A review of a test battery presented in both quiet and noise may clarify what the progression of speech perception abilities is in older adult cochlear implant users and whether the performance declines with advancing age.<div class="boxTitle">Objective</div>To examine whether older adults (≥65 years) with cochlear implants maintain stable speech perception performance after at least 10 years of listening experience with an external speech processor.<div class="boxTitle">Design and Setting</div>Retrospective analysis performed in an academic tertiary care center.<div class="boxTitle">Participants</div>Fourteen older adult cochlear implant recipients with at least 10 years of listening experience.<div class="boxTitle">Main Outcome Measures</div>Speech perception outcomes as measured with Consonant-Nucleus-Consonant words in quiet and Hearing in Noise Test sentences in quiet and steady-state noise were analyzed retrospectively at the 6-month and 1-, 5-, and 10-year postoperative follow-up intervals.<div class="boxTitle">Results</div>Consonant-Nucleus-Consonant word scores remained stable between 6 months and 1 year of listening experience, improved significantly (P < .001) between 1 year and 5 years, and remained stable between 5 years and 10 years. Hearing in Noise Test sentence scores in quiet and noise showed a similar pattern, with stability in performance between the 6-month to 1-year and 5-year to 10-year follow-up intervals, and significantly improved performance (P = .04) between the 1-year and 5-year follow-up intervals.<div class="boxTitle">Conclusions and Relevance</div>On average, patients who undergo cochlear implantation at age 65 years or older do not experience a decline in speech perception performance with extended listening experience and may potentially continue to see improvements beyond the 1-year follow-up interval.</span> 139 3 279 283 10.1001/jamaoto.2013.1814 http://pubs.jamanetwork.com/article.aspx?articleID=1671204