LM204 - Revision of the Adult Cochlear Implant Minimum Speech Test Battery

Abstract:
In 1996/2011, separate committees identified sets of materials to assess candidacy and the performance of adults with cochlear implants. Due to recent changes in candidacy criteria, a new committee formed consisting of co-chairs and selected content experts, to develop test batteries for pre-operative adult candidacy determination and postoperative assessment for groups of diverse candidates.

Content experts performed rigorous literature reviews to develop protocol recommendations for traditional, single/asymmetrical deafness, electro-acoustic stimulation, and bimodal candidates. Consensus through Likert statements via e-survey was conducted for recommendations including test materials, listening conditions, presentation level, and calibration. The outcomes of this process are described.

Summary:
In 1996, and in the revision of 2011, separate committees identified sets of materials, herein called Minimum Speech Test Battery-1(MSTB-1) and MSTB-2, to be used clinically and in research studies to assess candidacy and the performance of adults with cochlear implants (CI). A decade later, and following changes in test materials and candidacy criteria, a new committee formed to revise the MSTB-2 to reduce uncertainty and variability in CI candidacy evaluation and outcomes for a diverse group of candidates, herein called MSTB-3. A test battery was developed with a breadth and scope of content for clinics as they evaluate not only traditional unilateral and bilateral candidates, but also candidates with Single Sided Deafness (SSD), Asymmetrical Hearing Loss (AHL) and candidates with the potential to benefit from Bimodal hearing and Electric Acoustic Stimulation (EAS). The battery includes pre- and post-operative speech test batteries in addition to interpretive definitions (e.g., best aided), functional questionnaires, cognitive screening recommendations, documentation templates, and calibration instructions.

The project was overseen by two co-chairs and 12 content experts to develop streamlined test batteries for adult CI patient populations that would be widely and consistently used among CI audiologists for pre-operative determination of candidacy and postoperative assessment of adult CI users.

Content experts performed a rigorous of the literature and evidence related to their assigned content area to develop evidence- and experience-based protocols and test recommendations. As part of the two-round consensus process, Likert statements regarding testing protocols were developed by content experts. These included test materials, listening conditions, presentation level, and calibration. A rigorous iterative process to protect against bias and undue influence was implemented through an anonymized e-survey of Likert statements. Consensus on round one Likert statements was established for the purpose of further deliberation if: 1) mean score of each statement was 7 or higher; and 2) there were fewer than two outlying ratings ( < 2 points below the mean). Following round one, written comments and a web-based conference discussion was utilized to establish agreements, reduce eventual disagreements, and allow content experts to refine their Likert statements at their discretion. Final consensus was determined by a Round 2 anonymized e-survey of Likert statements.

Final protocols and test materials will be discussed and described. The MSTB-3 incorporates current best-practice metrics for a standardized minimum battery of tests used for CI candidacy and recommended follow-up.