Theodore Richardson McRackan

Objective: To examine changes in datalogging statistics in adult cochlear implant (CI) users during their first post-CI year and evaluate their association with cochlear implant quality of life-35 (CIQOL-35) scores. Study design: Retrospective longitudinal cohort study. Setting: Tertiary medical center. Patients: 104 adult CI users with bilateral hearing loss. Main outcome measures: Hours of device use per day (h/d), percentage of use in various listening environments (quiet, noise, speech, music), and pre-/post-CI CIQOL-35 Profile scores were recorded at 1-, 3-, 6-, and 12-months postactivation. Data were assessed using linear mixed-effects models. Results: Daily hours of CI use increased significantly from 1-month ( 11.2±3.3 h/d) to 3-months ( 11.8±3.2 h/d) postactivation, then plateaued from 3-months to 12-months ( 11.8±3.6 h/d) postactivation. Between 1 and 12 months, the percentage of time spent in Quiet increased (42% vs. 46%, P P =0.007) and Noise (20% vs. 18%, P =0.025) declined. Device use (h/d) was positively associated with CIQOL-35 scores ( P P P <0.05). Conclusions: Patients increasingly use their CI during the first 3 months postactivation and spend less time listening to speech and noise over the first 12 months. Associations between listening environments and certain CIQOL domains demonstrate that listening patterns and functional abilities might influence each other. Determining causality in future studies may enable more individualized counseling on device use for an improved early CI experience.

Purpose: Construct validity of the Northwestern University Auditory Test No. 6 (NU-6) monosyllabic word lists or shortened versions have not been examined using the Rasch measurement theory. The study purposes were to test the fit of the Rasch measurement model to monosyllabic word lists and whether short forms and computerized adaptive testing can measure speech recognition. Method: A cross-sectional study design with 50 persons (average age = 71 years; 35 female, 15 male) with mild-to-moderate hearing loss was used to test the fit of NU-6 Word Lists 1 and 2 to the Rasch measurement model. Pearson's correlations quantified the accuracy of person measures from short forms or computer-adaptive testing simulations with measures from the full lists. Average standard error of person measures quantified measurement precision. Results: Word lists were unidimensional, had negligible misfit, and had high person reliability. Nineteen- and 11-word short forms were made per list. Person measures from 19-word short forms had a high linear association with person measures from the full word lists (List 1: r = .92, p < .0001, SE = 0.76; List 2: r = .91, p < .0001, SE = 0.74) compared to moderate association for the 11-word short form (List 1: r = .84, p < .0001, SE = 0.99; List 2: r = .81, p < .0001, SE = 0.97). Person measures from computerized adaptive testing simulation reached a correlation threshold, r > .90, after 15–20 words were administered for both lists. A precision-based stopping rule used an average of 18 (List 1) or 20 (List 2) words. Conclusion: Short forms with 19 words and computerized adaptive testing may accurately and precisely measure speech recognition.

Objectives: This scoping review examines the literature on the role of communication partners in pre-cochlear implant (CI) decision-making, with a focus on psychosocial influences, candidate motivations, expectations, and gaps in the current evidence base. Design: A systematic review of PubMed, CINAHL, Scopus, and Cochrane Library was conducted from inception through July 2025. Eligible studies included those examining the role of communication partners in pre-CI decision-making in adult CI candidates. Qualitative and quantitative designs were included. Results: From 4807 screened articles, 12 studies met the inclusion criteria, and 66% of the included studies were interviews or surveys. Across studies, both CI candidates and communication partners reported substantial psychosocial burden related to hearing loss, including loneliness, relationship strain, and safety concerns. Communication partners were frequently cited as motivators for pursuing implantation, with one study reporting 96% of candidates identifying partner support as a major influence. Candidates also drew on peer CI users and support networks for guidance. Expectations of improved communication and social engagement were consistently reported by candidates and partners. Conclusions: Communication partners play a critical but underexplored role in pre-CI decision-making. While evidence suggests they provide important support and shape expectations, existing literature is heterogeneous and largely qualitative. Future research should develop CI-specific measures for communication partners to systematically evaluate expectations and assess strategies for incorporating partners into pre-operative counseling to optimize outcomes.

To evaluate the perceived utility, challenges, and opportunities for improving a regional telehealth model for cochlear implant (CI) care. This qualitative study involved a focus group with five CI audiologists at a tertiary care center. Participants discussed their experiences with a regional telehealth program that used seven satellite sites as part of an ongoing non-inferiority trial. The transcript was analyzed using inductive thematic analysis. Audiologists identified regional telehealth as beneficial for routine follow-ups, troubleshooting, and reducing travel burden. Visits were shorter and more convenient for patients and providers. Challenges included difficulty communicating with patients who had cognitive or auditory limitations, limited capacity for remote troubleshooting and device handling, and lack of audiometric testing. Site variability in equipment and room acoustics also affected care quality. Participants recommended improving audiovisual infrastructure, standardizing site setups, integrating interpreter and captioning services, and expanding reimbursement. While certain populations posed greater challenges, regional telehealth was viewed as beneficial for mitigating geographic access barriers without the technological requisites for home-based telehealth. Audiologists perceived regional telehealth as a valuable adjunct to traditional CI care for improving access in underserved areas. Addressing infrastructure and workflow limitations may enhance effectiveness and support broader adoption.

Hearing-related quality of life is a crucial outcome for adults with cochlear implants. The Cochlear Implant Quality of Life (CIQOL)-35 Profile is a patient-reported outcome measure originally developed in English. In a previous study, this instrument was cross-culturally adapted into German to address the need for standardized assessment tools in German-speaking regions. To ensure the adapted instrument meets psychometric criteria, validation is required. The German adaptation of the CIQOL-35 Profile was validated through an online survey including questions on demographics, the German CIQOL-35 Profile, and the German Nijmegen Cochlear Implant Questionnaire (NCIQ). The collected data were analyzed for reliability and validity. A total of 204 adults (aged 19–87 years) with bilateral hearing loss completed the online survey. Cronbach's α between 0.84 and 0.91 demonstrates good internal consistency for all subscales of the CIQOL-35 Profile and the global outcome. Moderate to strong correlations ( r _s = 0.55–0.85) between the CIQOL and NCIQ indicate good convergent validity. Confirmatory factor analysis established construct validity for the German CIQOL instruments. These findings confirm that the adapted German version of the CIQOL instruments is a reliable and valid measure for assessing hearing-related quality of life in adults with cochlear implants and demonstrates higher validity than the NCIQ. The availability of the CIQOL in multiple languages facilitates international comparability of research results and increases clinical application. Implementing quality of life instruments in clinical practice enables a more comprehensive evaluation of patient outcomes and may help identify patient needs that may be addressed in therapy and rehabilitation.

Objective: To identify patient characteristics associated with improvements in speech recognition scores (SRS) and Cochlear Implant Quality of Life (CIQOL-35) scores following cochlear implantation. Study design: Multi-institutional prospective cohort. Setting: Tertiary medical centers. Patients: Two hundred thirty-five adult CI users with bilateral hearing loss. Main outcome measures: Pre-CI and 12-month post-CI CIQOL-35, CNC word (CNC), and AzBio quiet (AzBio) scores were obtained. On the basis of improvement beyond established minimally detectable change values for each CIQOL domain and 95% CIs of pre-CI SRS as compared with post-CI, the cohort was divided into 4 groups for each CIQOL domain/SRS pair: (A) CIQOL and SRS improvement, (B) CIQOL improvement only, (C) SRS improvement only, and (D) no CIQOL or SRS improvement. Results: Correlations between CIQOL and SRS improvements were weak ( r =0.02–0.17). Grouped by CIQOL-Global/AzBio after 12 months post-CI, 51% of patients were classified as Group A, 4% as Group B, 39% as Group C, and 7% as Group D; percentages were similar for CIQOL-Global/CNC outcomes. Patients without CIQOL improvement had higher pre-CI CIQOL scores than patients who improved ( d =0.58–2.19), and patients without SRS improvement had higher pre-CI SRS scores than patients who improved (CNC: d =1.35–2.89, AzBio: d =1.09–2.78). Patients in Group D for the Entertainment domain were older than patients in Group A. Other patient factors were not significantly associated with the odds of improvement. Conclusions: Patients with higher baseline scores for a given outcome measure are less likely to improve following cochlear implantation. SRS and CIQOL score improvements were weakly correlated. The vast majority of patients (93%) improved in one or both outcome measures.

Objective: To determine what factors are associated with patients’ preoperative expectations of their postimplantation experience with their cochlear implant devices. Study Design: A retrospective review of data from a prospectively maintained cochlear implant database was conducted. Setting: Tertiary, academic hospital. Patients: Adult patients who underwent a cochlear implant candidacy evaluation and completed the CIQOL-Expectations validated instrument were included. Results: Age was found to have a weak association with increased expectations in some domains of the CIQOL-Expectations. There were some very weak associations identified between a patient’s baseline functional ability and their expectations in the corresponding domain. However, no modifiable variable included in the current analysis was found to have an association with patient expectations. Conclusion: Understanding patient expectations is a critical part of the success of medical interventions such as cochlear implantation. However, they are complex and likely multifactorial, and future studies are needed to look at other potential variables that may contribute to their formation.

To 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.