Objectives: Recently, patients with certain legacy cochlear implants (CIs) have sought out reimplantation to enjoy the benefits offered by newer processor technology. This decision can be difficult, especially when the individual relies exclusively on the device for communication and scores at the ceiling of performance metrics. To date, most outcome data is derived from reimplantation of a non-functioning CI-a relatively easy decision. The aim of this study is to report hearing outcomes following reimplantation of legacy implants to guide surgeons and patients approaching this high-stakes clinical situation. Patients and intervention: Four patients implanted with Advanced Bionics Clarion C1 devices over 20 years ago underwent reimplantation. Results: Three reimplanted patients demonstrated a maintenance or improvement in their audiometric performance with one patient experiencing only a 5 % decrease in AzBioQ score. Each patient expressed satisfaction with the expansion of technological capabilities including improved battery life, and device connectivity. There were no failed reimplantations or other adverse effects. Conclusions: Reimplantation of a functioning legacy CI result in stability or improvement in auditory performance. All individuals in this series report that they enjoy the new connectivity and programming technologies. As the rate advancement in CI technology continues to increase and newer device architectures emerge, these data will help to inform the decision to reimplant functioning devices.

Objective The main objective of this clinical capsule was to outline the narrative of three teen cochlear implant (CI) users who experienced a sudden increase in their CI electrode impedance values, which coincided with decreased overall speech perception ability. In addition, the study explored the following questions: Are there any similarities between cases? What recommendations should be made for continuing treatment regarding these cases? Patients Three teenagers who reported sudden change in CI benefit were included in this study. Interventions Electrode impedance values and speech identification scores were obtained routinely during the CI mapping appointments. Specifically, word and sentence recognition scores were obtained using the Consonant-Nucleus-Consonant word list and the AZBio sentence test, respectively. Both patient 1 and patient 2 underwent CI reimplantation operations as a result of their perceived difficulties and decreased impedances. Patient 3 did not undergo reimplantation surgery. Main Outcomes All three patients' CI electrode impedances and speech perception scores eventually stabilized over time. No relationship could be drawn between revision surgery and stabilization of CI electrode impedances and speech perception scores. Conclusions Overall, we found no similarities between cases that could potentially explain the sudden electrode impedance value increase or the decrease in speech perception scores. Each case should be evaluated uniquely and carefully for CI revision operations by frequent monitoring, including mapping and speech perception testing. The most common factor contributing to each teen's eventual resolution of electrode impedance values and speech perception scores was time.

Objectives: To 1) describe changes in the electrical stapedial reflex threshold (eSRT), within and across patients over time and 2) to identify the clinical relationship between eSRT and an individual's upper limit of loudness. Study Design: Retrospective chart review and analysis using a multilevel modeling approach to describe changes in eSRT over time. Setting: Secondary care center. Patients: Two-hundred five cochlear implant recipients treated at the cochlear implant center during a 3-year time period. Intervention(s): Cochlear implantation, eSRT testing, and, electrical upper limits of loudness. Main Outcome Measure(s): The eSRT over multiple appointments and the cochlear implant recipients’ final upper limits of loudness. Results: Analysis of the eSRT testing indicated stability over time; no global trend was seen in trajectory across the population, b = –0.010, p = 0.899. The relationship between eSRT and user upper limits of loudness revealed a mean decrease of 19.47, units for manufacturer 1, 30.53 units for manufacturer 2, and 0.7 units for manufacturer 3. Conclusion: Electrical stapedial reflex thresholds remain consistent for individual subjects over time with implant experience being the only variable correlated with eSRT stability (increase in 5% of one standard deviation with each year of experience). In addition, a clinical relationship between eSRT and behaviorally set upper limits of loudness was identified for all three cochlear implant manufacturers available in the United States.

Background Many adults suffer from an array of consequences due to their hearing loss (e.g., self-efficacy, mastery, psychosocial challenges). Family involvement can help improve their outcomes. Purpose This study aimed to determine audiology adult patients hearing experiences and inquired about their perspectives on family involvement in appointments. Research Design A cross-sectional survey was completed. Descriptive statistics, item analyses, and quantitative analyses were used to examine patient's characteristics and perspectives. Study Sample Three hundred eighty-two adult audiology patients participated in the study. Data Collection and Analysis A 15-item survey was created with 4 sections, including patient demographic information, general hearing questions, hearing experiences, and family interactions and involvement. Descriptive statistics were used to examine patient's characteristics and perspectives on family involvement in audiology appointments. Chronbach's alpha was used to reveal good internal consistency of difficult feelings related to hearing and perceived negative family member reactions. Quantitative analyses were used to determine patient perspectives on family involvement. Results Though patients reported difficulties due to their hearing loss, more than half reported that they did not want family involvement or they were unsure of the benefit that the involvement would provide. Patients who were interested in having family involved reported benefits such as educational opportunities and support. Few barriers of family involvement were reported by patients. Conclusions Patients had a mixed desire about family involvement in their adult audiology appointments. Education of patients about the benefits of family involvement may need to happen for this shift in audiologic practice.

Title: Do you Know If Your Clients Are Having Challenges Coping? Karen Muñoz, Ed.D. Hannah McLeod, B.S. Cache Pitt, AuD Elizabeth Preston, AuD Tiffany Shelton, M.S. Michael P. Twohig, Ph.D. 1 Department of Communicative Disorders and Deaf Education, Utah State University, Logan, Utah; 2 National Center for Hearing Assessment and Management, Utah State University, Logan, Utah; 3 Department of Psychology, Utah State University, Logan, Utah

Background: Early identification of hearing loss has led to routine fitting of hearing aids in infants and young children. Amplification provides opportunities to optimize child development, although it also introduces challenges for parents to navigate. Audiologists have a central role in providing parents with support to achieve effective management strategies and habits.Purpose: The purpose of this study was to explore current practices of pediatric audiologists who work with children birth to 5 yr of age, regarding their support of parent learning in achieving effective hearing aid management, identify existing gaps in service delivery, and to determine if audiologists were receptive to receiving training related to effective approaches to provide counseling and support to parents.Research Design: A cross-sectional, population-based survey was used.Study Sample: Three hundred and forty-nine surveys were analyzed from pediatric audiologists who provided services to children birth to 5 yr of age. Responses were received from 22 states in the United States.Data Collection and Analysis: Responses were collected through the mail and online. Descriptive statistics were used to analyze the information.Results: More than half (61%) of the audiologists in the study had been providing pediatric hearing aid services to children birth to 5 yr of age for >10 yr. Of the audiologists who reported monitoring hours of hearing aid use, the majority reported that they used data logging (90%). More than half of the audiologists (57%) who shared data logging with parents reported that they encountered defensiveness from parents when addressing hearing aid use. Information and skills that were not routinely provided by one-third to one-half of the audiologists included the following: how to get access to loaner hearing aids (30%), available hearing aid options/accessories (33%), available financial assistance (36%), how to teach hearing aid management to other caregivers (38%), how to do hearing aid maintenance (44%), and how to do a Ling 6 sound check (52%). Many audiologists reported they did not frequently collaborate with speech-language pathologists (48%), early interventionists (47%), or physicians (68%). More than half of the audiologists indicated a desire for more training in counseling skills, for all 14 items queried, to support parents with hearing aid management (53-79%), regardless of their previous training experience.Conclusions: For young children with hearing loss to achieve optimal benefit from auditory experiences for speech and language development, they need evidence-based, comprehensive, and coordinated hearing aid management. Audiologists have an important role for teaching information and skills related to hearing aids, supporting parent learning, and collaborating with other providers. Pediatric audiologists in this study recognized and desired the need for further training in counseling skills that can better prepare them to meet the emotional needs of parents in the hearing aid management process.

Cochlear implants can provide benefit for many deaf and hard of hearing individuals. When candidacy for implantation is determined, recipients are often responsible for selecting the manufacturer of their own cochlear implant. Recipients may, however, encounter various challenges in the selection process, due to the complexity of information and lack of standardization for patient education. This study explored the experiences of cochlear implant recipients with the selection process, including influential factors in their selection, their commitment to the implant, and their post-implantation perceptions. Eighty recipients who had received their implant within the last 12 months completed an online survey. Results of the survey revealed that a wide range of factors influenced selection, that most recipients chose a device without direct recommendations from their audiologist, and that many would have preferred to receive advice from their cochlear implant center in the selection of the device manufacturer.

Purpose The purpose of this study was to investigate how cochlear implant audiologists manage the cochlear implant device selection process. Method This study used a cross-sectional survey design. ...

FigureHearing loss is a common condition. However, many adults who could benefit from amplification do not use their hearing aids even though it could help them overcome negative consequences, such as social withdrawal, loneliness, and depression. Equally concerning, hearing aid use is highly variable among young children (LSHSS. 2013;44[1]:73 http://bit.ly/2h7Kv6N;JAAA. 2014;25[4]:380 http://bit.ly/2h7MwQA), compromising speech and language development outcomes (Ear Hear. 2015;36:76S http://bit.ly/2h7JDiu).Figure: Karen Muñoz, EdDFigure: Hannah McLeod, BSHow clients are coping with emotional challenges may be a contributing factor to hearing aid usage; such challenges may go undetected by audiologists. Depression and anxiety are common mental health conditions (Int J Methods Psychiar Res. 2012;21[3]:169 http://bit.ly/2h7LEeK) and can interfere with effective health care management and treatment adherence; for example, when parents of children with hearing loss were experiencing symptoms of depression, their children wore hearing aids fewer hours per day than those with no depression (Ear Hear. 2016;37[6]:703 http://bit.ly/2h7LvYA). Stress can also impact the physical and emotional well-being of clients with hearing loss and caregivers, and may its impact be positively influenced by social support (J Health Soc Beh. 2010;51[1suppl]:S41 http://bit.ly/2gLdH2G).Figure: Cache Pitt, AuDFigure: Elizabeth Preston, AuDFor audiologists to understand client challenges, both internal (e.g., lack of confidence, fear) and external (e.g., need for information), they need to engage clients in communication aimed at identifying underlying issues that influence client behavior. Unfortunately, research shows that audiologists may not be sufficiently focused on understanding client challenges that are related to psychosocial factors; instead, they prefer to focus on challenges that are technical in nature (AJA. 2014;23[3]:337 http://www.ncbi.nlm.nih.gov/pubmed/25036799;Ear Hear. 2015;36[2]:191 http://bit.ly/2gYV0K2). Paying attention to communication with the purpose of developing an effective therapeutic relationship has been shown to have significant positive effects on client adherence to treatment recommendations (Med Care. 2010;47[8]:826 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728700/). Client involvement in their care through shared decision making, discussion about their concerns, and exploration of how to navigate challenges can decrease misunderstandings and help clients effectively integrate new habits into their routines for more successful outcomes.Figure: Tiffany Shelton, MSFigure: Michael P. Twohig, PhDAchieving an effective therapeutic alliance includes acknowledging and engaging pertinent emotions such as depression and anxiety. Including a screening instrument may be an effective way to determine when clients are struggling with depression, anxiety, and/or stress. Our study was conducted to find out how clients felt about completing a screening and how audiologists felt about performing the screening. SCREENING FOR DEPRESSION, ANXIETY, STRESSTable 1: Client Demographic Characteristics.From March to June 2015, clients and parents of children with hearing loss, in consecutive hearing aid and cochlear implant follow-up appointments, were invited to participate in the study. Adult clients (n=28) and parents of pediatric clients (n=24) completed a demographic form, the Depression, Anxiety and Stress Scale (DASS), and a feedback form (see Table 1 for client demographics). Ten clinicians (four clinical supervisors; six graduate student clinicians) trained in the use of the screening form and in making referrals for positive screens completed a feedback form at the end of the study. A counseling or medical referral was made when a score demonstrated mild or greater symptoms of depression, anxiety, or stress, particularly if the client perceived that the symptoms were persistent. Institutional Review Board approval from Utah State University was obtained, and participants signed informed consent. The word “clients” is used in the remainder of the article to refer to adult clients and parents of pediatric clients. STUDY FINDINGS AND SCREENING RESULTS We observed three main findings in this study: (1) some clients were experiencing clinical levels of depression, anxiety, and/or stress; (2) clients found the screening acceptable; and (3) clinicians had feelings of uncertainty related to managing the screening.Table 2: Screening Scores by Symptom Severity for Depression, Anxiety, and Stress Scale (DASS).The DASS screening questionnaire queried how clients felt during the week prior to their appointment for depression, anxiety, and stress. The majority scored within the normal range for each component, although some reported symptoms of depression, anxiety, and/or stress were outside the range of normal (Table 2). FEEDBACK ABOUT THE SCREENINGTable 3: Participant Feedback ScoresThe majority of clients who participated completed a feedback form (n=49; 92%; Table 3), and responded positively about the screening experience. They stated benefits of the screening in response to an open-ended question, and indicated that the screening tool could help individuals with depression, anxiety, or stress by increasing overall awareness. Two clients expressed concerns: “Some weeks are more challenging than others,” “Answers vary at different times based on child, treatment, etc.,” and “I don't really want to find out that I have depression–it sounds so hard to surmount.”Table 4: Clinician Feedback ScoresAll of the clinicians completed a feedback form at the completion of the study (Table 4). There was general agreement that the screening was easy to implement, not too time-consuming, and suitable for audiology practice; however, there was less agreement on the perception that including the screening was time well spent and whether the clinicians were comfortable managing the conversation with clients about the screening. Written feedback regarding benefits included helping clients who might not otherwise seek help, building stronger connections with clients, improving clinical skills, and providing more complete care. Concerns were related to client comfort, possible client reactions to the screening, clinician skills and ability, and time constraints to include the screening. CLINICAL IMPLICATIONS By screening for psychosocial conditions, audiologists can recognize when challenges such as depression may affect a client's daily management of hearing loss. Such challenges will be present—whether the audiologist acknowledges them or not—and have the potential of negatively influencing a client's regular use of hearing devices. It is useful to know if clinical levels of anxiety, depression, or stress are present because these will affect all aspects of life, including adherence to the treatment regime prescribed by audiologists. It was interesting to note that client responses to the screening were highly positive, which contrasted with the clinicians’ perception; clinicians feared that clients would have an aversive reaction to the screening. Client feedback revealed that 96 percent were pleased the clinician was checking on how they were feeling, while the primary concern of audiologists was that clients would not appreciate the screening or feel it was judgmental or invasive of their privacy. The clinicians also reported a lack of comfort in managing conversations about the screening with clients. Further research is needed to explore knowledge, skills, and attitudes of practicing audiologists related to counseling, and to evaluate how audiology graduate programs approach counseling training to support clinician self-efficacy. For providers to engage clients in discussions on hearing loss management, they first need to recognize the importance of addressing the clients’ emotional experiences. Comprehensive audiological care includes addressing client emotions as an intentional component in service delivery. A screening tool such as the DASS provides an opportunity to identify the presence of emotional challenges, and if needed, to refer clients for further specialized support.

Objective: To describe the imaging findings and clinical outcomes of children with apparent cochlear nerve aplasia undergoing cochlear implantation. Study Design: Retrospective case review. Setting: Tertiary care center. Patients: Three patients with imaging findings consistent with absent cochlear nerve canal on diagnostic imaging and questionable audiometric responses on testing who underwent promontory stimulation and subsequent cochlear implantation. Intervention(s): Magnetic resonance imaging and computed tomography, audiologic assessment, and cochlear implantation. Main Outcome Measure(s): Audiologic performance after cochlear implantation. Results: Three patients were identified to have hearing loss on newborn hearing screening and underwent auditory brainstem response testing revealing absent brainstem responses. ASSR testing was inconclusive when performed. Imaging in all cases identified 1 ear with a small internal auditory canal with 2 nerves present, one of which seems to enter the vestibule in each case and the other is assumed to be the functioning facial nerve. There was a bony plate present over the entrance to the cochlea in 2 of the 3 patients. Over time, 2 of the families reported responses to auditory stimuli with amplification. Promontory stimulation testing showed reproducible responses to electrical stimuli in the ears in question. After cochlear implantation, all 3 patients have shown responses to auditory stimuli. Conclusion: The absence of a visible cochlear nerve or cochlear nerve canal on radiologic imaging does not preclude auditory innervation of the cochlea. Cochlear implantation can be a viable option for patients with apparent cochlear nerve aplasia who have undergone appropriate testing. Electronically evoked auditory brainstem response is critical in the evaluation of this patient group.