Reflections on a Single Institution Cochlear Implant Experience

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dc.contributor.advisorHunter, Jacob B.en
dc.contributor.committeeMemberKutz, J. Walteren
dc.contributor.committeeMemberIsaacson, Brandonen
dc.creatorSchauwecker, Natalie Marie-Roseen
dc.creator.orcid0000-0001-7493-9844
dc.date.accessioned2022-06-24T20:59:09Z
dc.date.available2022-06-24T20:59:09Z
dc.date.created2020-05
dc.date.issued2020-05-01T05:00:00.000Z
dc.date.submittedMay 2020
dc.date.updated2022-06-24T20:59:10Z
dc.descriptionThe general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.en
dc.description.abstractOBJECTIVE: To utilize cochlear implant (CI) outcomes to further explore health disparities, hearing preservation (HP) surgery, and standardization of pre- and post-operative CI assessment, with the goal of predicting and improving CI outcomes, including quality of life. STUDY DESIGN: Retrospective chart review of adult patients who underwent CI evaluation and surgery at a single institution between 2009 and 2018. MAIN OUTCOME MEASURES: Improvement in open sentence testing postoperatively, according to patient marital status, race, and gender, as well as HP status. RESULTS: Post-operative performance: Of the 402 total patients who underwent CI during the study period, 372 were followed and programmed at the institution. A total of 87% of these patients achieved "good performance" with their CI, based upon an improvement in post-operative open sentence testing ≥10%. Patient demographics, including gender, age, marital status, and race did not significantly affect whether a patient achieved higher post-operative performance levels. Unmarried patients saw poorer outcomes, but this did not reach significance (37.5% vs 24.3%, p = 0.2123). HEARING PRESERVATION: HP surgery evolved during the study period, with modern "soft surgery" technique defined by perioperative steroids, round window cochleostomy, and atraumatic CI insertion. A slight majority of HP surgical patients maintained low frequency hearing postoperatively (54.2%). However, documentation of preserved hearing was limited, with only 53.7% of patients with recorded unaided audiograms. Analyzing speech perception outcomes, HP candidates, and patients who underwent "soft surgery," did not demonstrate significantly larger improvements with their post-operative open sentence testing when compared to patients who underwent standard CI, and were concurrently not HP candidates, during the study period (overall improvement: 41% vs 53% respectively, p = 0.10). Additionally, non-white hearing preservation candidates were less likely to retain low frequency hearing post-operatively, but this did not reach significance in the study population (22.2% vs 8.5%, p=0.0992). However, HP surgery, and overall CI surgery outcomes assessment was limited by lack of standardized documentation. CONCLUSIONS: Unmarried patients and non-white patients continue to warrant special attention post-operatively to ensure equability in CI. HP surgery has evolved over the past decade. All, patients, should also have their quality of life evaluated, with standard assessment through open sentence testing failing to demonstrate the added benefit of HP, and likely the overall benefit of any CI. There continues to be a need for standardization in CI evaluation, documentation, and follow-up to allow for larger outcomes based research. IRB: STU 032018-085 PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED: The field of CI is in need of large outcome based studies to better predict which patient factors, including demographics and HP status, may predict CI success. DESIRED RESULT: Systematic review of a decade of cochlear implantation outcomes in order to identify areas in which improvement will result in increased ability to assess outcomes, and augmented cochlear implant success leading to improved CI patient quality of life.en
dc.format.mimetypeapplication/pdfen
dc.identifier.oclc1333220416
dc.identifier.urihttps://hdl.handle.net/2152.5/9884
dc.language.isoenen
dc.subjectCochlear Implantationen
dc.subjectHealthcare Disparitiesen
dc.subjectHearing Loss, Sensorineuralen
dc.subjectOutcome Assessment, Health Careen
dc.subjectRetrospective Studiesen
dc.titleReflections on a Single Institution Cochlear Implant Experienceen
dc.typeThesisen
dc.type.materialtexten
thesis.degree.departmentUT Southwestern Medical Schoolen
thesis.degree.disciplineResearchen
thesis.degree.grantorUT Southwestern Medical Centeren
thesis.degree.levelDoctoralen
thesis.degree.nameM.D. with Distinctionen

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