Biomedical subjects

Jennifer D Yeagle

Publications and source records attributed to Jennifer D Yeagle.

4 recordsLinked to original sources

PubMed2005

Predictive models for cochlear implantation in elderly candidates.

OBJECTIVE: An aging American population carries a high prevalence of profound sensorineural hearing loss. We examined the performance of multichannel cochlear implant recipients in a large database of adult subjects. DESIGN: Nonconcurrent prospective study of a national cohort with multivariate regression analysis of preoperative and postoperative performance variables in multichannel cochlear implant recipients. We applied models of prediction established in previous studies to the observed results. SETTING: Referral centers with active cochlear implant programs. PATIENTS: Adolescents and adults with profound hearing loss (N = 749; age range, 14-91 years). MAIN OUTCOME MEASURE: Postoperative monosyllabic word recognition. RESULTS: The population 65 years and older demonstrated a clinically insignificant 4.6%-smaller postoperative word score compared with the population younger than 65 years. When duration of deafness exceeded 25 years, elderly recipients demonstrated higher word scores than their younger counterparts. A more significant factor affecting outcomes is the ratio of duration of deafness to age at implantation. CONCLUSIONS: Age at implantation carried relatively little predictive value for postoperative performance in subjects 65 years and older. Although a small decrement in mean speech recognition scores was evident, the clinical significance of this difference is questionable when all of the results observed in elderly patients are considered. A shorter percentage of life spent in severe-to-profound sensorineural hearing loss suggests a foundation of acoustic/auditory processing in the elderly cohort that may mitigate potential physiological effects associated with advanced age. This study confirms and extends previous observations that duration of profound deafness and residual speech recognition carry higher predictive value than the age at which an individual receives an implant.

Adolescent↗

PubMed2005

Cochlear implant outcome is not influenced by the choice of ear.

OBJECTIVES: This study tested the hypothesis that patients with residual hearing in the nonimplanted ear had the same cochlear implant benefit whether the implanted ear had profound or severe hearing loss. DESIGN: A retrospective chart review of adult cochlear implant recipients with postlingual hearing loss. Patients were categorized according to the pure-tone average of the implanted and contralateral ears as (a) bilateral profound, (b) severe-profound, and (c) bilateral severe. The results of a test battery of spoken language measures were compared among patients belonging to these hearing categories at 6, 12, and 24 months after surgery, using a t-test and multivariate regression analyses. RESULTS: The presence of residual hearing in one or both ears was associated with significantly higher postoperative speech perception scores compared with participants with bilateral profound hearing loss. Among participants with similar amounts of residual hearing in the nonimplanted ear, however, there was no difference in speech recognition scores between those with profound and those with severe hearing loss in the implanted ear. CONCLUSIONS: Among participants with asymmetric hearing loss, there is no additional benefit to implanting the better-hearing ear that can be preserved for use with a hearing aid for better speech understanding in noise and sound localization. These results suggest that the additional benefit received by patients with residual hearing is mediated by trophic effects on crossed pathways in the central nervous system and is independent of the preoperative functional status of the implanted ear.

Adult↗

PubMed2004

Effects of central nervous system residua on cochlear implant results in children deafened by meningitis.

BACKGROUND: This study explored factors associated with speech recognition outcomes in postmeningitic deafness (PMD). The results of cochlear implantation may vary in children with PMD because of sequelae that extend beyond the auditory periphery. OBJECTIVE: To determine which factors might be most determinative of outcome of cochlear implantation in children with PMD. DESIGN: Retrospective chart review. SETTING: A referral center for pediatric cochlear implantation and rehabilitation. SUBJECTS: Thirty children with cochlear implants who were deafened by meningitis were matched with subjects who were deafened by other causes based on the age at diagnosis, age at cochlear implantation, age at which hearing aids were first used, and method of communication used at home or in the classroom. MAIN OUTCOME MEASURE: Speech perception performance within the first 2 years after cochlear implantation and its relationship with presurgical cognitive measures and medical history. RESULTS: There was no difference in the overall cognitive or postoperative speech perception performance between the children with PMD and those deafened by other causes. The presence of postmeningitic hydrocephalus, however, posed greater challenges to the rehabilitation process, as indicated by significantly smaller gains in speech perception and a predilection for behavioral problems. By comparison, cochlear scarring and incomplete electrode insertion had no impact on speech perception results. CONCLUSIONS: Although the results demonstrated no significant delay in cognitive or speech perception performance in the PMD group, central nervous system residua, when present, can impede the acquisition of speech perception with a cochlear implant. Central effects associated with PMD may thus impact language learning potential; cognitive and behavioral therapy should be considered in rehabilitative planning and in establishing expectations of outcome.

Child↗

PubMed2004

Central effects of residual hearing: implications for choice of ear for cochlear implantation.

OBJECTIVES/HYPOTHESIS: The study tested the hypothesis that among patients with similar levels of residual hearing in the nonimplanted ear, speech perception outcome is the same whether or not the implanted ear has profound or severe levels of hearing loss. STUDY DESIGN: Retrospective. METHODS: Levels of hearing loss in postlingually deafened adults who had cochlear implantation at Johns Hopkins University (Baltimore, MD) between 1991 and 2002 were classified according to pure-tone averages as bilateral severe (n = 20), severe-profound (severe in one ear and profound in the other) (n = 23), and bilateral profound (n = 43). There was no significant difference in the age at onset and duration of deafness among the three patient groups. Individuals in the bilateral severe and severe-profound groups had comparable levels of severe hearing loss in their nonimplanted ears, whereas those in severe-profound and bilateral profound groups had comparable levels of profound hearing loss in their implanted ears. Speech perception performance was evaluated using words from the Consonant Nucleus Consonant word list, Hearing in Noise Test sentences in quiet, and Central Institute for the Deaf sentences through recorded presentation at 70 dB sound pressure level (SPL). RESULTS: Despite the profound hearing loss of the implanted ear in the asymmetrical group, there was no significant difference in mean speech perception scores compared with the bilateral severe group within the first year after implant surgery. By comparison, the bilateral profound group had lower speech perception results compared with patients with residual hearing in one or both ears. CONCLUSION: The study results suggest that implantation of the profoundly deafened ear does not diminish the functional advantage conferred by residual hearing in a patient with asymmetrical hearing loss. Therefore, the central auditory pathway may be the site at which persistent auditory function has its most beneficial effects.

Adult↗