Behavioral and Electrophysiological Assessment of Adults Who Underwent Cochlear Implantation After Hearing Aid Experience

THIEME 138 Original Research Behavioral and Electrophysiological Assessment of Adults Who Underwent Cochlear Implantation After Hearing Aid Experience
Victor Goiris Calderaro1 Maria Stella Arantes do Amaral2 Benedita Aparecida Borges da Luz2 Sarah Carolina Bernal1 Miguel Ângelo Hyppolito3 Ana Claudia Mirândola Barbosa Reis1 1 Department of Health Sciences, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil 2 Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil 3 Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil Address for correspondence Victor Goiris Calderaro, Master degree student, Department of Health Sciences, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo. Bandeirantes Avenue, 3900, Ribeirão Preto, SP, 14049-900, Brazil (e-mail: ). Int Arch Otorhinolaryngol 2020;24(2):e138–e145. Abstract Keywords ► event-related potentials ► P300 ► cochlear implantation ► adult ► hearing loss
Introduction Cochlear implantation has been considered a viable option to restore hearing perception in adults with severe to profound postlingual hearing loss. Objectives To analyze behavioral hearing responses and P300 latency and amplitude measurements in adults with bilateral sensorineural hearing loss at two phases, first when they were using hearing aids (HAs) and, then, after 12 months of cochlear implant (CI) use. The association between behavioral and electrophysiological evaluations was explored, as it is believed that the study of auditory processing with different hearing devices can contribute to future CI adjustments and fittings, especially for patients who cannot give subjective feedback (such as small children and individuals with multiple disabilities). Methods Prospective comparative study (Ethical approval 11489/2014). Twelve adults were assessed, 7 males and 5 females, in the 22 to 76 years old age range, who had undergone CI surgery after HA experience. Results The analyses showed an improvement of hearing thresholds when patients started using CIs. Comparing data from P300 latency measurements, there was an increase of the P300 wave post-CI at Cz and Fz. Regarding the amplitude, P300 mean values decreased at Cz, but increased at Fz. There was no significant correlation between behavioral and electrophysiological assessment and the variables age, gender, auditory deprivation, and electronic device used. Conclusion There was a significant improvement of hearing thresholds after twelve months of CI experience. The mean latency values of P300 after 12 months of CI use increased at Cz and Fz, while mean amplitude values decreased at Cz and increased at Fz. This paper was presented in: 31° Encontro Internacional de Audiologia - São Paulo, SP, Brasil. received February 17, 2019 accepted June 20, 2019 published online November 4, 2019 DOI https://doi.org/ 10.1055/s-0039-1695022. ISSN 1809-9777. Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil Behavioral and Electrophysiological Assessment of Adults Introduction Individuals with severe to profound hearing loss are known to receive little to no benefit with the use of hearing aids (HAs). In those cases, cochlear implants (CIs) are an efficient alternative, which can provide a high speech recognition rate.1 This device projects sound to be received by a microphone and be sent to a speech processor, which digitally codifies speech through different strategies that vary according to the device’s manufacturer. Signal is then sent by a transmitter to an internal stimulator, which converts signal into electrical impulses sent to electrodes inside of the cochlea. Thus, electrodes stimulate the cochlear nerve, and impulses can travel along the auditory system.2 Currently, there is a need to determine audiological parameters for CI indication and, especially, for patients’ follow-up. Behavioral assessment of CI patients, through speech perception tests and self-assessment questionnaires, has been a common procedure; however, there is a concern presented by audiologists regarding objective assessments, specifically electrophysiological tests, aiming to investigate the central auditory nervous system (CANS). Auditory evoked potentials, particularly cognitive ones, which are obtained by recording and measuring responses to sensorial stimuli captured on the cranial surface, have been under investigation, with the purpose of investigating possible changes in the CANS, such as neural plasticity, after CI stimulation. Among other cognitive auditory evoked potentials, P300 provides a neurophysiological assessment of cognitive function, since it is evoked by the conscious interaction between the hearing system and the somatosensory cortex, and it depends on the attention and participation of the subject to elaborate responses.3,4 The P300 data are collected through random presentations of a rare acoustic stimulus previously established among other frequent stimuli (“oddball” paradigm). The endogenous perception of rare stimuli will provide necessary data for the elicitation of waves. The analyzed waves can bring information on the treatment of hearing disorders and reflect on the electrophysiological activity involved during attention, discrimination, memory, integration and decision-making abilities.5 The P300 is included in the long latency auditory evoked potentials (LLAEPs), which can be observed approximately between 80 and 700 ms after an acoustic stimulus presentation.6 Studies show a wide variety of amplitude values for this potential, which can vary according to task and attention. The P300 has been tested with the CI population and is gradually being included in clinical practice. Studies have measured P300 waves in children and adults with HAs and CIs, showing that this kind of research is viable; however, more studies with P300 in adult CI users are needed to demonstrate its applicability.7–10 Hopefully, the results obtained in this study can contribute, along with behavioral tests, as sensitive indicators of the processing functions in these patients and therefore help us in the assessment of CI candidates. Thus, the aim of this study was to analyze the auditory behavioral and electrophysiological responses, latency and amplitude values of the P300 potential, in adults with Calderaro et al. bilateral profound sensorineural hearing loss, HA users submitted to cochlear implantation. Methods The present study is a transversal prospective comparative and correlational one, with emphasis on diagnostic research. The project was approved by the Institutional Review Board (IRB), ethical approval 11489/2014, CAE number 32404514.9.0000.5440 (Doc. 1.255.971). Participants Twelve adults participated in the present study, seven male and five female. To fulfill th (...truncated)