Schvartz‐Leyzac, Kara C.

AbstractTo review research on the effectiveness of computer-based auditory training (CBAT) in new adult cochlear implant (CI) recipients.Studies by the primary author on auditory training in new adult CI recipients were reviewed, focusing on a database of auditory training data in >100 patients followed over their first-year post-activation.CBAT, as used in a standard outpatient setting, affords benefits compared to other commonly employed exercises/programs. In new adult CI users, CBAT was associated with greater improvement in CNC words, AzBio sentences, and Cochlear Implant Quality of Life-35 (CIQOL-35) Profile scores at 3 months post-activation compared to CI recipients who did not train or used other resources. By 12 months, patients showed similar improvement in speech recognition scores, regardless of training modality; however, patients who used CBAT continued to show significantly greater improvement in CIQOL global and all domain scores compared to CBAT nonusers. This benefit was noted regardless of whether CBAT was started before or after 3 months post-activation. No demographic/lifestyle factors, audiological measures, or pre-CI CIQOL/CIQOL-Expectations scores were associated with CBAT use.CBAT during the first-year post-activation may contribute to early gains in CI speech recognition and to persistent improvements in functional abilities, as measured via the CIQOL-35 profile, in new implant recipients. Consideration of specific recommendations for the use of CBAT resources may be valuable, given the minimal risk, ease of access, and affordability of these programs.

Objective Computer-based auditory training (CBAT) has been shown to improve outcomes in adult cochlear implant (CI) users. This study evaluates in new CI users whether starting CBAT within 3 months of activation or later impacts CI outcomes. Study Design Prospective natural experiment. Setting Tertiary academic medical center. Patients Sixty-five new adult CI users. Interventions CBAT use over the first-year postactivation. Main Outcome Measures Speech recognition scores and CIQOL-35 Profile score improvements between CI recipients who started CBAT resources early (<3 mo) and late (3–12 mo) postactivation. Results A total of 43 CI recipients started using CBAT within 3 months postactivation (early) and 22 after 3 months (late). Patients who used CBAT within 3 months postactivation showed significantly greater improvement in consonant-nucleus-consonant words (CNCw) (48.3 ± 24.2% vs 27.8 ± 24.9%; d = 0.84), AzBio Sentences in quiet (55.1 ± 28.0% vs 35.7 ± 36.5%; d = 0.62), and CIQOL-35 listening domain scores (18.2 ± 16.3 vs 6.9 ± 12.9, d = 0.73 [0.023, 1.43]), at 3 months postactivation, compared to those who had not yet initiated CBAT. However, by 12 months postactivation, after which all CI recipients had started CBAT, there were no differences observed between patients who started CBAT early or late in speech recognition scores (CNCw: d = 0.26 [−0.35, 0.88]; AzBio: d = 0.37 [−0.23, 0.97]) or in any CIQOL global or domain score (d-range = 0.014–0.47). Conclusions Auditory training with self-directed computer software (CBAT) may yield speech recognition and quality-of-life benefits for new adult CI recipients. While early users showed greater improvement in outcomes at 3 months postactivation than users who started later, both groups achieved similar benefits by 12 months postactivation.

Objective: to review evidence on the efficacy of auditory training in adult cochlear implant recipients. Data Sources: PRISMA guidelines for a systematic review of the literature were followed. PubMed, Scopus, and CINAHL databases were queried on 29 June 2023 for terms involving cochlear implantation and auditory training. Studies were limited to the English language and adult patient populations. Study Selection: Three authors independently reviewed publications for inclusion in the review based on a priori inclusion and exclusion criteria. Inclusion criteria encompassed adult cochlear implant populations, an analysis of clinician- or patient-directed auditory training, and an analysis of one or more measures of speech recognition and/or patient-reported outcome. Exclusion criteria included studies with only pediatric implant populations, music or localization training in isolation, and single-sample case studies. Data Extraction: The data were collected regarding study design, patient population, auditory training modality, auditory training timing, speech outcomes, and data on the durability of outcomes. A quality assessment of the literature was performed using a quality metric adapted from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group guidelines. Data Synthesis and Meta-Analysis: Data were qualitatively summarized for 23 studies. All but four studies demonstrated significant improvement in at least one measured or patient-reported outcome measure with training. For 11 studies with sufficient data reporting, pre-intervention and post-intervention pooled means of different outcome measures were compared for 132 patients using meta-analysis. Patient-direct training was associated with significant improvement in vowel-phoneme recognition and speech recognition in noise (p < 0.05 and p < 0.001, respectively), and clinician-directed training showed significant improvement in sentence recognition in noise (p < 0.001). Conclusions: The literature on auditory training for adult cochlear implant recipients is limited and heterogeneous, including a small number of studies with limited levels of evidence and external validity. However, the current evidence suggests that auditory training can improve speech recognition in adult cochlear implant recipients.