Patient perspectives on the need for improved hearing rehabilitation: A qualitative survey study of German cochlear implant users

Abstract

Background: The electrical cochlear implant (eCI) partially restores hearing in individuals affected by profound hearing impairment (HI) or deafness. However, the limited resolution of sound frequency coding with eCIs limits hearing in daily situations such as group conversations. Current research promises future improvements in hearing restoration which may involve gene therapy and optical stimulation of the auditory nerve, using optogenetics. Prior to the potential clinical translation of these technologies, it is critical that patients are engaged in order to align future research agendas and technological advancements with their needs.

Methods: Here, we performed a survey study with hearing impaired, using an eCI as a means of hearing rehabilitation. We distributed a questionnaire to 180 adult patients from the University Medical Center Göttingen's Department of Otolaryngology who were actively using an eCI for 6 months or more during the time of the survey period. Questions revolved around patients needs, and willingness to accept hypothetical risks or drawbacks associated with an optical CI (oCI).

Results: Eighty-one participants responded to the questionnaire; 68% were greater than 60 years of age and 26% had bilateral eCIs. Participants expressed a need for improving the performance beyond that experienced with their current eCI. Primarily, they desired improved speech comprehension in background noise, greater ability to appreciate music, and more natural sound impression. They expressed a willingness for engaging with new technologies for improved hearing restoration. Notably, participants were least concerned about hypothetically receiving a gene therapy necessary for the oCI implant; but expressed greater reluctance to hypothetically receiving an implant that had yet to be evaluated in a human clinical trial.

Conclusion: This work provides a preliminary step in engaging patients in the development of a new technology that has the potential to address the limitations of electrical hearing rehabilitation.

Keywords: cochlear implant; gene therapy; hearing rehabilitation; optogenetics; survey study; translational research.

FIGURE 1

Participants’ rating of importance for five hypothetical improvements in a new cochlear implant (CI). Percent out of N = 80 completed responses (1 non-respondent). Gray quadrant indicates the percent of participants that rated the improvement from 0 to 2; light green indicates the percent that rated 3–5; light blue indicates that percent that rated 6–8; and dark blue indicated the percent that rated 9–10.

FIGURE 2

Participants’ acceptance of hypothetical risks and drawback associated with a new cochlear implant (CI). Percent values are out of the total number of participants who completed each question (N = 76–81). Participants were asked “If you were to be hypothetically implanted with a new CI that was expected to improve the limitations mentioned in Section I of the questionnaire (Supplementary material 2), which of the following risks and disadvantages would you accept in this new CI?” Dark blue indicates an response of “yes,” and light blue indicated a response of “no.”