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Cochlear Implant Outcomes: A Comparison between Irradiated and Non-irradiated Ears.

Soh JM, D'Souza VD, Sarepaka GK, Ng WN, Ong CS, Low WK - Clin Exp Otorhinolaryngol (2012)

Bottom Line: Global and category scores in both groups were averaged and statistically compared via non-inferiority (NI) testing.From the results, lower 95% confidence interval limits of global APHAB, SDS, ease of communication, and background noise scores of the irradiated group were within the defined -ΔNI boundary and hence are not inferior to the control.The overall hearing outcomes after cochlear implantation for post-irradiated patients were not worse than patients who have had no prior irradiation to ear structures.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Singapore General Hospital, Singapore.

ABSTRACT

Objectives: Radiotherapy for head and neck tumors is known to potentially induce sensorineural hearing loss, which is possibly due to damage to the cochlear and/or auditory pathways. Since the success of cochlear implantation depends on a functional auditory nerve, this paper aims to study the hearing outcomes of cochlear implantation in irradiated ears.

Methods: A retrospective study of cochlear implant recipients from our institution who had previously received radiotherapy for head and neck cancers was performed. A control group with cochlear implants who did not receive radiotherapy was recruited. A review of case records, speech discrimination scores (SDS), and a validated subjective questionnaire in the form of the Abbreviated Profile of Hearing Aid Benefit (APHAB) was administered to the study group who fulfilled the inclusion criteria. Global and category scores in both groups were averaged and statistically compared via non-inferiority (NI) testing.

Results: With the control group (n=8) as the reference, the -ΔNI was defined, and a one-tailed lower 95% confidence interval was used for the irradiated group (n=8). The APHAB degree of improvement (%) results were as follows: global, 28.9% (19.32%, -ΔNI=16.3%); ease of communication, 67.0% (58.36%, -ΔNI=37.5%); background noise, 53.2% (44.14%, -ΔNI=26.8%); reverberation, 41.7% (28.85%, -ΔNI=32.7%); and aversiveness, -46.2% (-67.80%, -ΔNI=-56.9%). The SDS was 66.9% (56.02%, -ΔNI=51.0%). From the results, lower 95% confidence interval limits of global APHAB, SDS, ease of communication, and background noise scores of the irradiated group were within the defined -ΔNI boundary and hence are not inferior to the control. The categories of reverberation and aversiveness could not be proven, however.

Conclusion: This study demonstrated marked improvements in hearing measured both objectively and subjectively. The overall hearing outcomes after cochlear implantation for post-irradiated patients were not worse than patients who have had no prior irradiation to ear structures.

No MeSH data available.


Related in: MedlinePlus

Non-inferiority diagram depicting the mean differences for speech discrimination score (SDS) subcategory between the irradiated and control groups.
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Figure 5: Non-inferiority diagram depicting the mean differences for speech discrimination score (SDS) subcategory between the irradiated and control groups.

Mentions: A further test of NI was undertaken to further prove that those who suffer from hearing loss due to previously received irradiation have been able to attain a mean degree of hearing benefit that is not worse when compared to the controls. A one-tailed 95% confidence interval was established for all subcategories and compared in Figs. 4 and 5. The subcategories of EC, BN, global, and SDS scores have a mean difference and a lower confidence interval that was within the -ΔNI boundary of -16.6% (-20.0% for SDS). Whereas for the subcategories of RV and AV, despite having a mean difference as compared to controls of -7.29% and -5.55%, respectively, which was well within the -ΔNI boundary, the lower 95% confidence limits of -23.0% (RV) and -31.9% (AV) exceeded the lower limit of -ΔNI. This indicates that for the subcategories of EC, BN, global, and SDS, the irradiated group under study was not worse off compared to controls, but that is not the case for the subcategories of RV and AV. In addition, the T-testing done on the mean differences for all subcategories revealed a P>0.05, indicating no significant differences between the groups.


Cochlear Implant Outcomes: A Comparison between Irradiated and Non-irradiated Ears.

Soh JM, D'Souza VD, Sarepaka GK, Ng WN, Ong CS, Low WK - Clin Exp Otorhinolaryngol (2012)

Non-inferiority diagram depicting the mean differences for speech discrimination score (SDS) subcategory between the irradiated and control groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369992&req=5

Figure 5: Non-inferiority diagram depicting the mean differences for speech discrimination score (SDS) subcategory between the irradiated and control groups.
Mentions: A further test of NI was undertaken to further prove that those who suffer from hearing loss due to previously received irradiation have been able to attain a mean degree of hearing benefit that is not worse when compared to the controls. A one-tailed 95% confidence interval was established for all subcategories and compared in Figs. 4 and 5. The subcategories of EC, BN, global, and SDS scores have a mean difference and a lower confidence interval that was within the -ΔNI boundary of -16.6% (-20.0% for SDS). Whereas for the subcategories of RV and AV, despite having a mean difference as compared to controls of -7.29% and -5.55%, respectively, which was well within the -ΔNI boundary, the lower 95% confidence limits of -23.0% (RV) and -31.9% (AV) exceeded the lower limit of -ΔNI. This indicates that for the subcategories of EC, BN, global, and SDS, the irradiated group under study was not worse off compared to controls, but that is not the case for the subcategories of RV and AV. In addition, the T-testing done on the mean differences for all subcategories revealed a P>0.05, indicating no significant differences between the groups.

Bottom Line: Global and category scores in both groups were averaged and statistically compared via non-inferiority (NI) testing.From the results, lower 95% confidence interval limits of global APHAB, SDS, ease of communication, and background noise scores of the irradiated group were within the defined -ΔNI boundary and hence are not inferior to the control.The overall hearing outcomes after cochlear implantation for post-irradiated patients were not worse than patients who have had no prior irradiation to ear structures.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Singapore General Hospital, Singapore.

ABSTRACT

Objectives: Radiotherapy for head and neck tumors is known to potentially induce sensorineural hearing loss, which is possibly due to damage to the cochlear and/or auditory pathways. Since the success of cochlear implantation depends on a functional auditory nerve, this paper aims to study the hearing outcomes of cochlear implantation in irradiated ears.

Methods: A retrospective study of cochlear implant recipients from our institution who had previously received radiotherapy for head and neck cancers was performed. A control group with cochlear implants who did not receive radiotherapy was recruited. A review of case records, speech discrimination scores (SDS), and a validated subjective questionnaire in the form of the Abbreviated Profile of Hearing Aid Benefit (APHAB) was administered to the study group who fulfilled the inclusion criteria. Global and category scores in both groups were averaged and statistically compared via non-inferiority (NI) testing.

Results: With the control group (n=8) as the reference, the -ΔNI was defined, and a one-tailed lower 95% confidence interval was used for the irradiated group (n=8). The APHAB degree of improvement (%) results were as follows: global, 28.9% (19.32%, -ΔNI=16.3%); ease of communication, 67.0% (58.36%, -ΔNI=37.5%); background noise, 53.2% (44.14%, -ΔNI=26.8%); reverberation, 41.7% (28.85%, -ΔNI=32.7%); and aversiveness, -46.2% (-67.80%, -ΔNI=-56.9%). The SDS was 66.9% (56.02%, -ΔNI=51.0%). From the results, lower 95% confidence interval limits of global APHAB, SDS, ease of communication, and background noise scores of the irradiated group were within the defined -ΔNI boundary and hence are not inferior to the control. The categories of reverberation and aversiveness could not be proven, however.

Conclusion: This study demonstrated marked improvements in hearing measured both objectively and subjectively. The overall hearing outcomes after cochlear implantation for post-irradiated patients were not worse than patients who have had no prior irradiation to ear structures.

No MeSH data available.


Related in: MedlinePlus