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Hearing Disorders: HELP
Articles by Joseph M. Chen
Based on 29 articles published since 2010
(Why 29 articles?)
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Between 2010 and 2020, Joseph Chen wrote the following 29 articles about Hearing Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Bilateral sequential adult cochlear implantation: who should receive priority in the context of a constrained health care system? 2013

Forzley, Brian / Chen, Joseph / Nedzelski, Julian / Lin, Vincent / Shipp, David / Godlovitch, Glenys / Hebert, Philip / Hochman, Jordan. ·Penticton Regional Hospital Renal Program Clinical Instructor, Department of Medicine, University of British Columbia Specialist Champion, British Columbia, Penticton, British Columbia. ·Laryngoscope · Pubmed #24115009.

ABSTRACT: Resource allocation decisions have become increasingly necessary as the cost of health care habitually increases. Bilateral (second side) adult cochlear implantation (CI) is an example of a novel technology with accruing evidence of benefit, yet expense has limited universal employ. Currently at our centers, bilateral implantation is only provided under research protocol. In this article, we discuss the need for a principled approach concerning the distribution of a second device, both during this period of investigation and if ultimately an insured service. Allocation strategies, while extensively addressed in some arenas, have yet to be developed for second-side sequential adult CI. We advocate that physicians must assume an explicit role when both caring for individual patients as well as administering health care programs. We review social justice theories that inform resource allocation macrodecisions, and include a defence of age-based considerations. Our approach to patient selection for adult second-side CI sequentially considers clinical criteria (directly addressed in the article), a willingness to participate in rigorous research, and a 65 year cut-off. Ultimately, we employ random blinded selection for allocating bilateral CI among the remaining similarly situated individuals. This approach functions impartially and in a manner that is transparent for both patient and physician.

2 Clinical Trial Musical Rehabilitation in Adult Cochlear Implant Recipients With a Self-administered Software. 2017

Smith, Leah / Bartel, Lee / Joglekar, Samidha / Chen, Joseph. ·*Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre †Department of Music ‡Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada. ·Otol Neurotol · Pubmed #28806336.

ABSTRACT: OBJECTIVE: The goal of this study was to determine if a self-administered computer-based rehabilitation program could improve music appreciation and speech understanding in adults who have a cochlear implant (CI). STUDY DESIGN: Prospective study. SETTING: Tertiary adult CI program. PATIENTS: Twenty-one postlingually deafened cochlear implant users between the ages of 27 and 79 years were recruited. INTERVENTIONS(S): A self-administered music rehabilitative software was designed to help improve the perception of musical patterns of increasing complexity, as well as pitch and timbre perception, premised on focused and divided attention. All participants completed a diagnostic music test before and after rehabilitative training, including tests of pitch and timbre perception and pattern identification with increasing levels of difficulty. Speech data in quiet and noise was also collected both pre- and post-training. Participants trained for a minimum of 3.5 hours a week, for 4 weeks. MAIN OUTCOME MEASURE(S): Mean changes in music perception and enjoyment as well as speech perception (IEEE sentence test in quiet and noise). RESULTS: Post-training diagnostic test scores, as compared with pretraining scores, indicated significant improvements in musical pattern perception. Tests of speech perception in quiet and in noise were significantly improved in a subset of this cohort. All of the training participants thought that the training helped to improve their recognition skills, and found the program to be beneficial. CONCLUSION: Despite the limitations of current CI technology, the results of this study suggest that auditory training can improve music perception skills, and possibly speech intelligibility, lending further support to rehabilitation being an integral part of the postimplantation paradigm.

3 Article Novel Statistical Analyses to Assess Hearing Outcomes After ABI Implantation in NF2 Patients: Systematic Review and Individualized Patient Data Analysis. 2019

Taslimi, Shervin / Zuccato, Jeffrey A / Mansouri, Alireza / Hachem, Laureen D / Badhiwala, Jetan / Kuchta, Johannes / Chen, Joseph / Pirouzmand, Farhad. ·Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. · Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: jeff.zuccato@mail.utoronto.ca. · Department of Neurosurgery, University of Cologne, Köln, Germany. · Department of Otolaryngology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada. · Division of Neurosurgery, Department of Surgery, Sunnybrook Health Science Centre, Toronto, Ontario, Canada. ·World Neurosurg · Pubmed #31059859.

ABSTRACT: BACKGROUND: Patients with neurofibromatosis type 2 develop bilateral vestibular schwannomas with progressive hearing loss. Auditory brainstem implants (ABIs) stimulate hearing in the cochlear nuclei and show promise in improving hearing. Here, we assess the impact of ABI on hearing over time by systematically reviewing the literature and re-analyzing available individual patient data. METHODS: A multidatabase search identified 3 studies with individual patient data of longitudinal hearing outcomes after ABI insertion in adults. Data were collected on hearing outcomes of different sound complexities from sound to speech using an ABI ± lip reading ability plus demographic data. Because of heterogeneity each study was analyzed separately using random effects multilevel mixed linear modeling. RESULTS: Across all 3 studies (n = 111 total) there were significant improvements in hearing over time from ABI placement (P < 0.000 in all). Improvements in comprehension of sounds, words, sentences, and speech occurred over time with ABI use + lip reading but lip reading ability did not improve over time. All categories of hearing complexity had over 50% comprehension after over 1 year of ABI use and some subsets had over 75% or near 100% comprehension. Vowel comprehension was greater than consonant, and word comprehension was greater than sentence comprehension (P < 0.0001 in both). Age and sex did not predict outcomes. CONCLUSIONS: ABIs improve hearing beyond lip reading alone, which represents baseline patient function prior to treatment, and the benefits continue to improve with time. These findings may be used to guide patient counseling regarding ABI insertion, rehabilitation course after insertion, and future studies.

4 Article The Role of Preoperative Steroids for Hearing Preservation Cochlear Implantation: Results of a Randomized Controlled Trial. 2017

Kuthubutheen, Jafri / Joglekar, Samidha / Smith, Leah / Friesen, Lendra / Smilsky, Kari / Millman, Tara / Ng, Amy / Shipp, David / Coates, Harvey / Arnoldner, Christoph / Nedzelski, Julian / Chen, Joseph / Lin, Vincent. ·Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. ·Audiol Neurootol · Pubmed #29332068.

ABSTRACT: OBJECTIVES: To determine whether preoperative steroids can improve hearing outcomes in cochlear implantation (CI). METHODS: This is a randomized controlled trial involving 30 postlingual deaf CI patients. Subjects had preoperative thresholds of better than or equal to 80 dB at 125 and 250 Hz, and better than or equal to 90 dB at 500 and 1,000 Hz. The subjects were randomized to a control group, an oral steroid group (receiving 1 mg/kg/day of prednisolone for 6 days prior to surgery), or a transtympanic steroid group (receiving a single dose of 0.5 mL of 10 mg/mL dexamethasone at 24 h prior to surgery). RESULTS: The subjects receiving transtympanic steroids had a significant decrease in the pure tone average over 3 months compared to the control and oral steroid group, which persisted over 12 months (p < 0.05). CONCLUSION: A single dose of preoperative transtympanic steroids prior to CI appears to have a beneficial effect, at least in the short term, with minimal effects seen in the longer term.

5 Article Isolated Second Implant Adaptation Period in Sequential Cochlear Implantation in Adults. 2017

Smilsky, Kari / Dixon, Peter R / Smith, Leah / Shipp, David / Ng, Amy / Millman, Tara / Stewart, Suzanne / Nedzelski, Julian M / Lin, Vincent Y / Chen, Joseph M. ·*Department of Otolaryngology-Head and Neck Surgery, University of Toronto †Sunnybrook Cochlear Implant Program, Sunnybrook Health Sciences Centre ‡Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre Toronto, Canada. ·Otol Neurotol · Pubmed #28806338.

ABSTRACT: OBJECTIVE: To determine if depriving the use of the first cochlear implant (CI1) impacts adaptation to a sequential implant (CI2). STUDY DESIGN: Prospective cohort. SETTING: Academic center. PATIENTS: Sixteen unilateral cochlear implant recipients undergoing contralateral implantation (sequential bilateral) were matched according to age, etiology, duration of deafness, device age, and delay between implants. INTERVENTION: During a 4-week adaptation period after CI2 activation, patients underwent deprivation of CI1 or were permitted continued use of it. MAIN OUTCOME MEASURES: Speech perception scores and subjective quality of life outcomes before CI2 and at 1, 3, 6, and 12-months following activation. RESULTS: Maximal CI2 speech perception scores in quiet were achieved by 1-month postactivation for the "deprivation" group (71.3% for hearing in noise test [HINT], p = 0.767 for change beyond 1-mo) compared with 6-months for the "continued use" group (67.9% for HINT, p = 0.064 for change beyond 6-mo). The "deprivation" group experienced a temporary drop in CI1 scores (67.9% for HINT in quiet at 1-mo versus 78.4% pre-CI2, p = 0.009) recovering to 77.3% by 3-months; unchanged from baseline levels (p = 1.0). A binaural advantage over the better hearing ear was present for HINT sentences with noise (72.4% versus 58.8% for "deprivation", p = 0.001; 71.5% versus 52.7% for "continued use," p = 0.01). Missing data precluded a meaningful analysis of subjective quality of life outcome scales. CONCLUSION: Bilateral cochlear implantation improves speech perception compared with one implant. A period of deprivation from CI1 shortens time to maximum speech perception by CI2 without long-term consequences on the performance of CI1.

6 Article Development of cognitive screening test for the severely hearing impaired: Hearing-impaired MoCA. 2017

Lin, Vincent Y W / Chung, Janet / Callahan, Brandy L / Smith, Leah / Gritters, Nils / Chen, Joseph M / Black, Sandra E / Masellis, Mario. ·Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. · Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. ·Laryngoscope · Pubmed #28409842.

ABSTRACT: OBJECTIVES: To develop a version of the Montreal Cognitive Assessment (MoCA) to be administered to the severely hearing impaired (HI-MoCA), and to assess its performance in two groups of cognitively intact adults over the age of 60. STUDY TYPE: Test development followed by prospective subject recruitment. METHODS: The MoCA was converted into a timed PowerPoint (Microsoft Corp., Redmond, WA) presentation, and verbal instructions were converted into visual instructions. Two groups of subjects over the age of 60 were recruited. All subjects passed screening questionnaires to eliminate those with undiagnosed mild cognitive impairment. The first group had normal hearing (group 1). The second group was severely hearing impaired (group 2). Group 1 received either the MoCA or HI-MoCA test (T1). Six months later (T2), subjects were administered the test (MoCA or HI-MoCA) they had not received previously to determine equivalency. Group 2 received the HI-MoCA at T1 and again at T2 to determine test-retest reliability. RESULTS: One hundred and three subjects were recruited into group 1, with a score of 26.66 (HI-MoCA) versus 27.14 (MoCA). This was significant (P < 0.05), but scoring uses whole numerals and the 0.48 difference was found not clinically significant using post hoc sensitivity analyses. Forty-nine subjects were recruited into group 2. They scored 26.18 and 26.49 (HI-MoCA at T1 and T2). No significance was noted (P > 0.05), with a test-retest coefficient of 0.66. CONCLUSION: The HI-MoCA is easy to administer and reliable for screening cognitive impairment in the severely hearing impaired. No conversion factor is required in our prospectively tested cohort of cognitively intact subjects. LEVEL OF EVIDENCE: 1b. Laryngoscope, 127:S4-S11, 2017.

7 Article Provincial Variation of Cochlear Implantation Surgical Volumes and Cost in Canada. 2017

Crowson, Matthew G / Chen, Joseph M / Tucci, Debara. ·1 Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA. · 2 Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Canada. ·Otolaryngol Head Neck Surg · Pubmed #27650806.

ABSTRACT: Objectives To investigate provincial cochlear implantation (CI) annual volume and cost trends. Study Design Database analysis. Setting National surgical volume and cost database. Subjects and Methods Aggregate-level provincial CI volumes and cost data for adult and pediatric CI surgery from 2005 to 2014 were obtained from the Canadian Institute for Health Information. Population-level aging forecast estimates were obtained from the Ontario Ministry of Finance and Statistics Canada. Linear fit, analysis of variance, and Tukey's analyses were utilized to compare variances and means. Results The national volume of annual CI procedures is forecasted to increase by <30 per year ( R

8 Article Depth of Cochlear Implant Array Within the Cochlea and Performance Outcome. 2016

Hilly, Ohad / Smith, Leah / Hwang, Euna / Shipp, David / Symons, Sean / Nedzelski, Julian M / Chen, Joseph M / Lin, Vincent Y W. ·Department of Otolaryngology and Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto. ON, Canada Department of Otolaryngology and Head and Neck Surgery, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel ohadhilly@yahoo.com. · Department of Otolaryngology and Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto. ON, Canada. · Department of Otolaryngology and Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto. ON, Canada Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto. ON, Canada. ·Ann Otol Rhinol Laryngol · Pubmed #27443343.

ABSTRACT: OBJECTIVE: To evaluate whether the depth of cochlear implant array within the cochlea affects performance outcomes 1 year following cochlear implantation. METHODS: A retrospective case review of 120 patients who were implanted with the Advanced Bionics HiFocus 1J. Post-implantation plain-radiographs were retrospectively reviewed, and the depth of insertion was measured in degrees from the round window to the electrode tip. Correlation between the depth of insertion and 1-year post-activation Hearing in Noise Test (HINT) scores was analyzed. Intrascala position was not assessed. RESULTS: Depth of electrode insertion ranged from 180° to 720°, and HINT scores ranged from 0% to 100%. A Mann-Whitney U test demonstrated significantly improved 1-year post-activation HINT scores in patients with an insertion depth of 360° or more in comparison with patients with insertion depth of less than 360° (81% vs 61%, P = .048). Patients with 13 to 15 contacts within cochlear turns performed as well as patients with full insertion of all 16 contacts, while patients with only 12 contacts performed poorly. CONCLUSIONS: Insertion depth of the AB HiFocus 1J electrode of less than 360° is associated with reduced 1-year post-activation HINT scores when compared with deeper insertions. Partial insertion of 13 active contacts or more led to similar results as full insertion.

9 Article Assessment of the psychosocial impacts of cochlear implants on adult recipients and their partners. 2016

Chen, Stephen / Karamy, Babak / Shipp, David / Nedzelski, Julian / Chen, Joseph / Lin, Vincent. ·a Department of Otolaryngology - Head & Neck Surgery , Sunnybrook Cochlear Implant Program, Sunnybrook Health Sciences Centre, FRCSC - University of Toronto , Canada. ·Cochlear Implants Int · Pubmed #26839952.

ABSTRACT: OBJECTIVES: In the present study we sought to evaluate the psychosocial and quality of life (QOL) impacts of cochlear implant (CI) treatment on both CI recipients and their partners in a Canadian population. METHODS: A qualitative cross-sectional contemporary cohort evaluation was conducted by distributing specifically designed questionnaires to both CI recipients and their partners at their follow-up appointments over a month at Sunnybrook Health Sciences Centre. RESULTS: It was found that both CI recipients and their partners demonstrated substantial benefit and improvement in multiple psychosocial domains. DISCUSSION: Musical listening was found to show variable improvements between recipients. Further analysis found a simple correlation where the group of recipients who all had a hearing disability for a longer duration had demonstrated a higher proportion of improvement in musical listening. CI recipients endorsed having improved QOL which was in agreement with proxy observation by partners. CONCLUSION: Overall, CI use has been shown to have significant benefit to psychosocial well-being of CI recipients. This benefit is also conferred to their caregivers/partners; which in our society concerned about caregiver burden is quite important to recognize.

10 Article The role of extended preoperative steroids in hearing preservation cochlear implantation. 2015

Kuthubutheen, Jafri / Coates, Harvey / Rowsell, Corwyn / Nedzelski, Julian / Chen, Joseph M / Lin, Vincent. ·Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada; School of Surgery, University of Western Australia, Perth, Western Australia, Australia. Electronic address: jafri.kuth@gmail.com. · School of Surgery, University of Western Australia, Perth, Western Australia, Australia. · Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. · Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. ·Hear Res · Pubmed #26117408.

ABSTRACT: INTRODUCTION: Steroids have been shown to reduce the hearing threshold shifts associated with cochlear implantation. Previous studies have examined only the administration of steroids just prior to surgery. The aim of this study is to examine the role of extended preoperative systemic steroids in hearing preservation cochlear implantation. METHODS: An animal model of cochlear implantation was used. 24 Hartley strain guinea pigs with a mean weight of 768 g and normal hearing were randomised into a control group, a second group receiving a single dose of systemic dexamethasone one day prior to surgery, and a third group receiving a daily dose of systemic dexamethasone for 5 days prior to surgery. A specially designed cochlear implant electrode by Med-EL (Innsbruck) was inserted through a dorsolateral approach to an insertion depth of 5 mm and left in-situ. Auditory brain stem responses at 8 kHz, 16 kHz and 32 kHz were measured preoperatively, and 1 week, 1 month and 2 months postoperatively. Cochlear histopathology was examined at the conclusion of the study. RESULTS: At 1-week post operative, both groups receiving dexamethasone prior to implantation had smaller threshold shifts across all frequencies and which was significant at 32 kHz (p < 0.05). There were no differences among the three groups in the area of electrode related fibrosis. Spiral ganglion neuron (SGN) density was significantly higher in the group receiving steroids for 5 days, but only in the basal cochlear turn. DISCUSSION: This is study demonstrates the benefits of extended preoperative systemic steroids on hearing outcomes and SGN density in an animal model of cochlear implantation surgery.

11 Article The role of a new contralateral routing of signal microphone in established unilateral cochlear implant recipients. 2015

Grewal, Amandeep S / Kuthubutheen, Jafri / Smilsky, Kari / Nedzelski, Julian M / Chen, Joseph M / Friesen, Lendra / Lin, Vincent Y W. ·Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sunnybrook Cochlear Implant Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. ·Laryngoscope · Pubmed #25224587.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To investigate whether a contralateral routing of signal (CROS) microphone combined with a unilateral cochlear implant (CI) results in hearing improvement after a prolonged trial period. STUDY DESIGN: A prospective experimental trial was undertaken on a group of 10 postlingually deafened adults who are experienced CI users. METHODS: Participants completed audiometric testing and validated questionnaires with their unilateral CI alone, followed by addition of a CROS microphone (CI-CROS). This was worn daily for the 2-week trial, after which hearing performance was reevaluated using the same measures. Objective tests included AzBio sentences in quiet and noise and consonant-vowel nucleus-consonant (CNC) words. Subjective measures included the Abbreviated Profile of Hearing Aid Benefit (APHAB); Speech, Spatial, Qualities of Hearing Index (SSQ); Hearing Implant Sound Quality Index; an institutional questionnaire; and a daily log sheet. RESULTS: There is statistically significant enhanced speech discrimination with the CI-CROS when speech is presented on the CROS side. However, scores are markedly diminished when background noise is introduced, particularly to the CROS side. Subjective results indicate lower satisfaction scores for the global and ease of communication subdomains of the APHAB with the CI-CROS, but increased scores on the spatial hearing subdomain of the SSQ (P < 0.05). CONCLUSION: The CI-CROS provides significant benefit in certain situations, particularly speech recognition in quiet. CI-CROS performance with background noise is poor, leading to low satisfaction scores. Further refinement of the device may yield a useful tool for unilateral CI users in the future.

12 Article The effect of different utility measures on the cost-effectiveness of bilateral cochlear implantation. 2015

Kuthubutheen, Jafri / Mittmann, Nicole / Amoodi, Hosam / Qian, Wei / Chen, Joseph M. ·Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; School of Surgery, University of Western Australia, Perth, Western Australia, Australia. ·Laryngoscope · Pubmed #25169819.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine if the choice of health utility measure affects the incremental cost-utility ratio (ICUR) when assessing the cost-effectiveness of bilateral cochlear implantation (CI). STUDY DESIGN: A scenario-based estimate with three scenarios: 1) a patient with severe to profound sensorineural hearing loss with no intervention, 2) the same patient with a unilateral CI with average or better performance, and 3) the same patient with bilateral CIs with average or better performance. METHODS: One hundred and forty-two subjects comprising preimplantees (n = 30), unilateral cochlear implantees (n = 30), bilateral implantees (n = 30), and healthcare professionals (n = 52). The four health utility instruments applied were the Health Utility Index Mark 3 (HUI3), European Quality of Life Questionnaire in 5 Domains (EQ5D), visual analog scale (VAS), and time trade-off (TTO). Cost for each implant was based on a 25-year time horizon, 50% discount for the second implant, and a 15% failure rate. RESULTS: Using the HUI3, the utility gain from unilateral to bilateral implantation was 0.035 or 11.5% of the total utility gain. This ratio was higher using the other instruments: EQ5D (22.2%), VAS (35.0%), and TTO (41.4%). For the scenario of bilateral CI compared to no intervention, HUI3 ICUR estimates were the lowest, and for bilateral CI compared to unilateral CI, HUI3 ICUR estimates were the highest. CONCLUSIONS: The choice of utility instrument in cost-utility analysis of bilateral CI heavily influences whether the second implant is deemed cost-effective. The HUI3 is the utility of choice in CI studies and is the most conservative. LEVEL OF EVIDENCE: 4.

13 Article Cochlear implantation in patients with chronic suppurative otitis media. 2014

Wong, Matthew C / Shipp, David B / Nedzelski, Julian M / Chen, Joseph M / Lin, Vincent Y W. ·Department of Otolaryngology-Head and Neck Surgery, University of Toronto; and Cochlear Implant Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. ·Otol Neurotol · Pubmed #24569796.

ABSTRACT: OBJECTIVE: To determine the safety, efficacy, and outcomes of cochlear implantation in patients with chronic suppurative otitis media (CSOM). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center with large cochlear implant program. PATIENTS: Nineteen patients with CSOM who underwent cochlear implantation were identified. Case history, timing of surgical procedures, complications, infections, and postimplant audiometric scores (Hearing in Noise Test [HINT], City University of New York Sentences [CUNY], and Central Institute for the Deaf Sentences [CID]) were evaluated. MAIN OUTCOME MEASURES: Rates of postoperative infections and complications as well as postimplant auditory performance. RESULTS: Twelve patients underwent a staged procedure involving canal wall down mastoidectomy or radical revision mastoidectomy with middle ear and mastoid obliteration and closure of the external auditory canal followed by cochlear implantation approximately 5 months later. Seven patients were implanted in a single procedure. There were no infections or medical complications after implantation. On average, patients had excellent audiometric scores at 1 year postimplantation (mean sentence test, 79%; SD, 14), and these scores were comparable to our general population (mean sentence test, 71%; SD, 32). CONCLUSION: Cochlear implant patients with CSOM have no increased risk of postoperative infections or complications. These patients have excellent outcomes with audiometric scores comparable to the general cochlear implant population. Cochlear implantation is a safe and effective treatment for patients with profound hearing loss secondary to CSOM.

14 Article Quality of life in cochlear implantees: comparing utility values obtained through the Medical Outcome Study Short-Form Survey-6D and the Health Utility Index Mark 3. 2014

Arnoldner, Christoph / Lin, Vincent Y / Bresler, Richard / Kaider, Alexandra / Kuthubutheen, Jafri / Shipp, David / Chen, Joseph M. ·Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. ·Laryngoscope · Pubmed #24536018.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To evaluate the changes in health-related quality of life in unilateral adult cochlear implant patients using the Medical Outcome Study Short-Form Survey-36 (SF-36) and the Health Utility Index Mark 3 (HUI-3). To do so, a health utility index was obtained by converting the SF-36 to the Medical Outcome Study Short-Form Survey-6D (SF-6D) to permit comparison with HUI-3 scores in the context of health preference as measured by quality-adjusted life years. STUDY DESIGN: Prospective cohort study. METHODS: Eighty-one postlingually deaf adult patients undergoing cochlear implantation completed the SF-36 and HUI-3 preoperatively and at a median of 1.4 years (range, 11 months-5 years) after cochlear implantation. RESULTS: The SF-36 improvement was statistically significant in two domains. The SF-36 data were converted to SF-6D. Preoperatively, the mean SF-6D utility score was 0.575 ± 0.056. One year postoperatively this score increased to 0.590 ± 0.064. The improvement of 0.015 ± 0.082 was not statistically significant (P = .1118). Of the HUI-3 attributes, two showed improvement between preoperative and postoperative evaluations. The overall HUI-3 score increased from 0.464 ± 0.207 preoperatively to 0.611 ± 0.190 postoperatively. The gain of 0.146 ± 0.19 was statistically significant (P < .0001). The intraclass correlation coefficient between the SF-6D and HUI-3 showed a very small correlation, both pre- and postoperatively. CONCLUSIONS: Against the backdrop of diminishing resources for healthcare, cost-effective analysis is fast becoming an important tool. There remains a strong need for health-related quality-of-life instruments that can truly reflect the benefit of cochlear implantation, in which utility estimates are fundamentally important. The SF-36 scores, when converted to SF-6D, do not correlate well with HUI-3 scores in a cohort of adult cochlear implant recipients. The HUI-3 remains the most appropriate tool for this patient group. LEVEL OF EVIDENCE: 4

15 Article Cost-utility analysis of bilateral cochlear implantation in adults: a health economic assessment from the perspective of a publicly funded program. 2014

Chen, Joseph M / Amoodi, Hossam / Mittmann, Nicole. ·Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. ·Laryngoscope · Pubmed #24431194.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine the cost-effectiveness of bilateral cochlear implantation (CI) in deaf adults. STUDY DESIGN: Cost-utility analysis. METHODS: Ninety patients and 52 health professionals served as proxies to estimate the benefit of bilateral cochlear implantation, utilizing the Health Utility Index. Three scenarios were created to reflect 1) deafness without intervention, 2) unilateral CI, and 3) bilateral CI. Cost evaluation reflected the burden on a publicly funded healthcare system. The base case included 25 years of service provision, processor upgrades every 5 years, 50% price reduction for second side, and 15% failure rate. Discounting and sensitivity analyses were applied. RESULTS: Costs were $63,632 (unilateral CI), $111,764 (bilateral CI), and $48,132 (incremental cost of second CI). The health preference gained from no intervention to unilateral CI, and to bilateral CI were 0.270 and 0.305. Incremental utility gained by the second implant was 11.5% of total. The incremental cost-utility ratio (ICUR) was $14,658/quality-adjusted life year (QALY) for bilateral CI compared to no intervention. It was stable regardless of discounting or sensitivity analyses. ICUR was $55,020/QALY from unilateral to bilateral CI with higher uncertainties. It improved with differential discounting, further second-side price reduction, and reduced frequency of processor upgrades. ICUR worsened with reduced length of use and higher failure rates. CONCLUSIONS: Sequential bilateral CI was cost-effective when compared to no intervention, although gains were made mostly by the first implant. Cost-effectiveness compared to unilateral implantation was borderline but improved through base case variations to reflect long-term gains or cost-saving measures. LEVEL OF EVIDENCE: 2C.

16 Article Cochlear implantation in patients with advanced Ménière's disease. 2014

Mick, Paul / Amoodi, Hosam / Arnoldner, Christoph / Shipp, David / Friesen, Lendra / Lin, Vincent / Nedzelski, Julian / Chen, Joseph. ·*Harvard School of Public Health, Boston, Massachusetts, U.S.A.; and †Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. ·Otol Neurotol · Pubmed #24366468.

ABSTRACT: BACKGROUND/OBJECTIVES: Ménière's disease (MD) that results in bilateral severe to profound sensorineural hearing loss is a rare indication for cochlear implantation; only a few studies exist documenting performance in these patients. The primary objective was to compare the difference in preoperative to 12-month postoperative speech perception scores among subjects with MD and controls. Groupwise comparisons of secondary postoperative outcomes (Tinnitus Handicap Inventory [THI] scores, 36-Item Short Form [SF-36] scores, and postoperative dizziness) were also performed. METHODS: A retrospective cohort study was conducted. Subjects with MD and controls matched by age, device manufacturer and model, preoperative sentence score, and sentence test used for preimplantation and postimplantation performance assessments were identified from 1,130 patients in the prospectively maintained cochlear implant database at our center. Speech perception, THI, and SF-36 scores and demographic variables were obtained from the database. Vestibular outcomes were obtained by retrospective chart review. Statistical comparisons were performed to compare preoperative to postoperative change between groups. RESULTS: Twenty patients with MD were identified. At 1 year after CI, improvements in sentence and word understanding did not differ in magnitude from the controls. Tinnitus was reduced significantly in patients with MD, whereas there was a trend for improvement in the controls. Quality of life as measured by the SF-36 improved in both groups. Patients with MD had significant improvements in 1 domain compared with 5 domains for the controls. Subjects with MD had significantly more chronic dizziness in the postoperative period than did controls. CONCLUSIONS: Patients with MD who have bilateral severe to profound sensorineural hearing loss benefit significantly from CI. Ongoing dizziness in some patients with MD may result in quality of life improvements that are slightly less than seen for the average adult patient with CI. Larger studies are needed to corroborate the results.

17 Article The addition of a contralateral routing of signals microphone to a unilateral cochlear implant system--a prospective study in speech outcomes. 2013

Arora, Roochi / Amoodi, Hosam / Stewart, Suzanne / Friesen, Lendra / Lin, Vincent / Nedzelski, Julian / Chen, Joseph. ·Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. ·Laryngoscope · Pubmed #23404529.

ABSTRACT: OBJECTIVES/HYPOTHESIS: The purpose of the study was to investigate the potential clinical advantages of incorporating a contralateral routing of signals (CROS) microphone in unilateral cochlear implant (CI) users. STUDY DESIGN: A prospective study was undertaken on a group of 21 postlingually deafened adults who were all implanted with the same multichannel CI system. METHODS: Performance with a unilateral CI was compared with performance using both a unilateral implant and a CROS microphone system worn on the opposite site (CI-CROS). Speech understanding using the AzBio sentence was evaluated in quiet, with speech presented at 0° and 270° azimuth in the horizontal plane. Speech understanding in noise was performed with speech at 0°, and noise at 0°, 90°, and 270°. RESULTS: A significant gain in speech understanding using CI-CROS compared to the unilateral CI alone was found in quiet when speech was presented at 270° (average improvement of 8.8%, P < .01). Participants also demonstrated statistically significant improvement using CI-CROS compared with the unilateral CI alone when noise was presented at 90° and speech at 0° (average improvement of 6.7%, P < .01). CONCLUSIONS: Adding a contralateral microphone to a unilateral CI resulted in a significant improvement in speech understanding in different conditions. This method could provide a greater cost/benefit ratio than bilateral CIs and be a potential improvement for those who are not candidates for bilateral CIs.

18 Article Cochlear implantation: a personal and societal economic perspective examining the effects of cochlear implantation on personal income. 2012

Monteiro, Eric / Shipp, David / Chen, Joseph / Nedzelski, Julian / Lin, Vincent. ·Department of Otolaryngology/Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON. ·J Otolaryngol Head Neck Surg · Pubmed #22569049.

ABSTRACT: OBJECTIVE: Although cochlear implantation has been shown to improve quality of life, the socioeconomic benefit to the individual and society has not been thoroughly investigated. Our objective was to determine the economic impact of profound deafness and subsequent effects of unilateral cochlear implantation. DESIGN: Retrospective analysis of a prospectively collected cochlear implantation database. SETTING: An academic, tertiary care hospital. METHODS: A prospectively collected cochlear implantation database of 702 patients was reviewed. Known Canadian economic surrogates were used to estimate the personal economic impact of both deafness and unilateral cochlear implantation. MAIN OUTCOME MEASURES: The main outcome measures included employment rates and personal income prior to and following cochlear implantation. RESULTS: A total of 637 patients had sufficient occupational data for inclusion in the study; 36.7% suffered a negative economic impact as a result of their deafness. Cochlear implantation was associated with a significant increase in median yearly income compared to preimplantation ($42 672 vs $30 432; p = .007). CONCLUSIONS: Cochlear implantation not only improves quality of life but also translates into significant economic benefits for patients and the Canadian economy. These benefits appear to exceed the overall costs of cochlear implantation.

19 Article Results with cochlear implantation in adults with speech recognition scores exceeding current criteria. 2012

Amoodi, Hosam A / Mick, Paul T / Shipp, David B / Friesen, Lendra M / Nedzelski, Julian M / Chen, Joseph M / Lin, Vincent Y W. ·Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. hosamamodi@hotmail.com ·Otol Neurotol · Pubmed #22090001.

ABSTRACT: OBJECTIVES: The primary purpose of this study was to evaluate a group of postlingually deafened adults, whose aided speech recognition exceeded commonly accepted candidacy criteria for implantation. The study aimed to define performance and qualitative outcomes of cochlear implants in these individuals compared with their optimally fitted hearing aid(s). STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: All postlingually deafened subjects (N = 27), who were unsuccessful hearing aid users implanted between 2000 and 2010 with a preimplantation Hearing in Noise Test (HINT) score of 60% or more were included. INTERVENTION: We compared patients' preoperative performance (HINT score) with hearing aids to postoperative performance with the cochlear implant after 12 months of device use. In addition, the Hearing Handicap Inventory questionnaire was used to quantify the hearing-related handicap change perceived after the implantation. RESULTS: The study group demonstrated significant postoperative improvement on all outcome measures; most notably, the mean HINT score improved from 68.4% (standard deviation, 8.3) to 91.9% (standard deviation, 9.7). Additionally, there was a significant improvement in hearing-related handicap perceived by all patients. CONCLUSION: The envelope of implantation candidacy criteria continues to expand as shown by this study's cohort. Patient satisfaction and speech recognition results are very encouraging in support of treating those who currently perform at a level above the conventional candidacy threshold but struggle with optimally fitted hearing aids.

20 Article Improved hearing with cochlear implantation in Fabry's disease. 2011

Clinkard, David J / Amoodi, Hosam / Lin, Vincent Y W / Chen, Joseph M / Nedzelski, Julian M. ·Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. David.Clinkard@sunnybrook.ca ·Cochlear Implants Int · Pubmed #22251813.

ABSTRACT: OBJECTIVE: To describe our center's experience with cochlear implantation in patients suffering from Fabry's disease, an inherited mutation resulting in an alpha-galactosidase A enzyme deficiency. CLINICAL PRESENTATION: Case report of two patients aged 49 and 59 at implant, with genetically confirmed Fabry's disease and progressive hearing loss. INTERVENTION: Surgical implantation of Clarion (Advanced Bionics) and Nucleus Freedom (Cochlear) cochlear implants. CONCLUSION: Cochlear implantation improves hearing discrimination by 60 points on the HINT scale. This suggests that cochlear implantation is a safe and effective intervention that improves hearing discrimination in patients suffering from Fabry's disease.

21 Article When do we choose the 'better balance' ear for cochlear implants? 2011

Hugh, Sarah C / Shipp, David B / Chen, Joseph M / Nedzelski, Julian M / Lin, Vincent Y W. ·University of Toronto, Toronto, Ontario, Canada. ·Cochlear Implants Int · Pubmed #22251805.

ABSTRACT: OBJECTIVES: In cochlear implant planning, the ear with poorer vestibular function, as determined through electronystagmography (ENG), is often selected as the site for implantation since surgery carries a low risk of iatrogenic labyrinthine injury. We sought to determine reasons for placing a cochlear implant in the 'better balance' ear. METHODS: A retrospective cohort study of patients implanted with a cochlear implant at a tertiary care center from 1984 to June 2009 was performed. Based on ENG results, patients with asymmetric caloric reduction were identified. Of these patients, those who were implanted in the 'better balance' ear were selected for chart review. The charts were reviewed to determine rationale for ear selection. RESULTS: Of the 724 cochlear implant patients implanted from 1984 to June 2009, ENG tests demonstrated that 130 (18%) had asymmetric abnormal responses. Thirty five (27%) of the patients with asymmetric abnormal responses were implanted in the 'better balance' ear. Review of these 35 patient charts revealed that reasons for selection of the 'better balance' ear fell into four categories: anatomical contraindications, attempting to attain binaural hearing, avoiding implantation of an ear with marked auditory deprivation, and patient preference. DISCUSSION: Based on our current practice, we have identified four situations in which patients were implanted in the 'better balance' ear, and subsequently developed an algorithm to aid surgeons in side selection for cochlear implantation. Further study and validation of this algorithm is recommended.

22 Article Postlingually deaf adults of all ages derive equal benefits from unilateral multichannel cochlear implant. 2011

Park, Edward / Shipp, David B / Chen, Joseph M / Nedzelski, Julian M / Lin, Vincent Y W. ·Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada. ·J Am Acad Audiol · Pubmed #22212763.

ABSTRACT: BACKGROUND: Controversy still exists regarding the impact of age on speech recognition following cochlear implant in postlingually deaf adults. In some studies elderly recipients did not perform as well as younger patients on standard speech recognition tests. Furthermore, previous studies have shown that cochlear implantation improves quality of life, as measured by self-administered questionnaires, but the sample sizes of these studies have been relatively small, thus making age stratification a challenge. PURPOSE: The primary objective was to assess whether the age at which a patient receives a unilateral cochlear implant affects improvements in speech recognition scores and perceived quality of life. A secondary objective was to determine whether preoperative use of hearing aids correlates with improvement in speech recognition and perceived quality of life after cochlear implantation. RESEARCH DESIGN: A retrospective study in a tertiary referral center. PATIENTS: A total of 161 postlingually deaf adults, who were divided based on age (<50, 50-65, >65) and on prior hearing aid(s) use. INTERVENTION: All patients received a unilateral multichannel cochlear implant. DATA COLLECTION AND ANALYSIS: Speech recognition was quantified by percent correct scores on the Hearing in Noise Test sentences delivered in a quiet setting only (HINT%), and quality of life was quantified by the Hearing Handicap Inventory (HHI) before and 1 yr after cochlear implantation. RESULTS: Speech recognition, as measured by HINT%, improved significantly and to similar extents in all three age groups following cochlear implantation. Similarly, quality of life as quantified by HHI improved markedly and to similar extents in all age groups. Whether hearing aids were used pre-implant, or whether the cochlear implant (CI) was implanted on the same side or contralateral to the hearing aid side, had no substantial effect on the patients' performances on either speech recognition or quality of life. Moreover, there were no statistically significant correlations between pre-implant speech recognition scores and pre-implant quality of life scores or between postimplant speech recognition scores and postimplant quality of life scores. CONCLUSION: The findings of the present study demonstrate that cochlear implantation improves HINT% and HHI scores to similar extents across all age groups. This finding suggests that elderly patients may derive speech recognition and quality of life benefits similar to those of younger patients and that age should not be an essential factor in the determination of CI candidacy. Furthermore, prior use of a hearing aid, and its location in relation to the cochlear implant, does not influence the extent of improvement in speech recognition or quality of life measurements following cochlear implantation.

23 Article Telephone use and the factors influencing it among cochlear implant patients. 2011

Clinkard, David / Shipp, David / Friesen, Lendra M / Stewart, Suzanne / Ostroff, Jodi / Chen, Joseph M / Nedzelski, Julian M / Lin, Vincent Y W. ·Sunnybrook Cochlear Implant Program, Canada. david.clinkard@sunnybrook.ca ·Cochlear Implants Int · Pubmed #21917201.

ABSTRACT: OBJECTIVE: To investigate telephone use in cochlear implant patients and to determine factors most likely to influence telephone use. METHODS: Surveys were mailed to 504 cochlear implant patients treated at Sunnybrook Health Sciences Hospital. RESULTS: Two hundred four patients returned surveys (49%), 87% were classified as telephone users. No differences were found in age, pre-implant hearing characteristics, and the majority of post-implant behaviors. Education and post-implant sound perception scores were found to be significantly different (P < 0.05) between telephone users and non-users. DISCUSSION: Telephone use among cochlear implant patients shows a positive increase compared to previous studies. In addition, we find that higher attained education and post-implant hearing scores to be independently correlated to telephone use.

24 Article Qualitative case studies of five cochlear implant recipients' experience with music. 2011

Bartel, Lee R / Greenberg, Simon / Friesen, Lendra M / Ostroff, Jodi / Bodmer, Daniel / Shipp, David / Chen, Joseph M. ·University of Toronto, Ontario, Canada. lbartel@chass.utoronto.ca ·Cochlear Implants Int · Pubmed #21756456.

ABSTRACT: Cochlear implantation has revolutionized the management of those who suffer from severe-to-profound hearing loss because many patients now achieve excellent speech understanding with objective testing. Nevertheless, speech understanding in noisy conditions and music appreciation remain significant challenges to cochlear implant (CI) users. Music appreciation is an extremely complex experience that is difficult to quantify through a conventional outcome study. This paper aims at documenting the experience of five CI patients with regard to music appreciation using qualitative techniques. This information was obtained through a semi-structured interview process. The interviews were then transcribed and analysed using a constant comparative method of qualitative description. The results together with medical case records were used to identify emerging themes. The common themes that evolved were: musical background, the experience of receiving the implant, current experience with music, attention, musical prediction ability, internal hearing, hedonic vs. critical listening, determination, and timbre perception. By documenting their experiences in this manner, novel insights into the patient perspective are provided that are unique to the literature. These descriptions will aid clinicians and researchers who work in the area of cochlear implantation to better understand the needs of their patients.

25 Article The effects of unilateral cochlear implantation on the tinnitus handicap inventory and the influence on quality of life. 2011

Amoodi, Hosam A / Mick, Paul T / Shipp, David B / Friesen, Lendra M / Nedzelski, Julian M / Chen, Joseph M / Lin, Vincent Y W. ·Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. hosamamodi@hotmail.com ·Laryngoscope · Pubmed #21647911.

ABSTRACT: OBJECTIVES/HYPOTHESIS: Cochlear implantation is now the standard of care in patients with significant sensorineural hearing loss. It is well known that patients with severe hearing loss also experience disabling tinnitus. The purpose of this study was to assess the effects of cochlear implants on the perception of tinnitus using the Tinnitus Handicap Inventory (THI). STUDY DESIGN: Prospective, longitudinal study of 142 cochlear implant patients. METHODS: The THI was administered to 142 patients pre- and postimplantation. Outcome measures were obtained 12 months after the implantation. Secondary analyses to examine the correlation between changes in THI scores and outcome measures such as Hearing Handicap Inventory, Hearing in Noise Test (HINT), and short-form 36 (SF-36) quality-of-life scores were performed. RESULTS: Patients demonstrated statistically significant reduction of the THI scores including its subscales (P < .001). Prior to implantation, 37% of patients described their tinnitus as moderate to severe. Postoperatively, this percentage decreased to 10%. Cochlear implantation resulted in complete tinnitus suppression in 37% and tinnitus reduction in another 29% of patients. THI scores significantly correlated with three domains of the SF-36 quality-of-life questionnaire, namely social, emotional, and general health domains. CONCLUSIONS: Cochlear implants have a significant suppressive effect on tinnitus in 66% of implant users. Although the reduction in the subjectively perceived tinnitus was statistically significant, it did not correlate with HINT; however, it did correlate with three quality-of-life domains, more significantly for those whose pretreatment conditions were moderate or worse.

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