British Cochlear Implant Group Meeting Maximising Potential

Programme and Abstract Book

Thursday 28th and Friday 29th April 2016 London

Organising Committee Guys and St Thomas’ Hospital NHS Foundation Trust Hearing Implant Centre Royal National Throat, Nose and Ear Hospital Auditory Implant Programme

Invited Faculty Professor Marc Marshark National Technical Institute for the Deaf, Rochester Institute of Technology Professor Christine Petit Genetics and Physiology of Hearing Laboratory, Institut Pasteur, Paris Professor Astrid Van Wieringen Department of Neuroscience, University of Leuven Professor Christophe Vincent Centre Hospitalier, Régional Universitaire de Lille Welcome

Dear Colleagues,

It is our great pleasure to welcome you to Kings Place and to the 26th British Cochlear Implant Group Meeting. This year we will be focusing on the theme ‘Maximising Potential’ with an interactive conference comprising of a wide range of professionals working in the field of auditory implants.

It is with this interactivity in mind that we are hosting lively structured debates on current issues. Through the use of e-voting, we encourage audience participation in the hope of provoking thought and stimulating discussion.

We are very fortunate to have with us over the two days such a high quality, international faculty and are very much looking forward to their contributions.

Throughout the event e-Posters will be displayed in the exhibition area. Please visit this area and view them at your leisure. As well, please see the e-Poster programme for details of when authors will be presenting their work for 2 minutes at allocated times at e-Poster stations on Level -1.

We would also encourage you to visit all of the exhibitors on the mezzanine level, as without their continued support we would not be able to run this conference.

We are delighted to be hosting this year's conference dinner at the historic St Pancras Renaissance Hotel London. See opposite for details of the drinks reception and the networking conference dinner. Your name badge wallet should hold a dinner ticket which permits entry. Please do remember to bring this along to the dinner.

Finally, kindly complete and return your feedback forms to the onsite events team. Any feedback, whether positive or negative, is greatly appreciated as this will allow us to continue to provide education at a high standard.

If you have any queries or thoughts, please visit the onsite events team who will be happy to assist.

We hope that you find this conference both enjoyable and informative.

Welcome to London!

Organising Committee, London

Guys and St Thomas’ Hospital NHS Foundation Trust Hearing Implant Centre

Royal National Throat, Nose and Ear Hospital Auditory Implant Programme

1 Conference Dinner

Thursday 28th April 2016

St Pancras Renaissance Hotel Euston Road London NW1 2AR

The BCIG, Royal National Throat Nose and Ear Hospital Auditory Implant Programme and St Thomas’ Hearing Implant Centre would like to welcome you all to a London themed celebration at the St Pancras Renaissance Hotel.

Dress to impress! We hope you have an enjoyable evening and dance the night away!

19.00 - Drinks Reception, Ladies' Smoking Room 20.00 - Dinner Service, Hansom Hall 01.00 - Carriages

Starter Pea & Mint Panna Cotta, Asparagus & Broad Bean Salad

Main Roast Corn-Fed Chicken Breast, Confit Leg, Fondant Potato & Baby Spring Vegetables Tarragon Gnocchi, Smoked Tomato Confit, Peas, Herb & Pine Nut Crust (v)

Dessert Chocolate Duo, Dark Chocolate and Orange Ganache, White Chocolate Sorbet

2 Mark Slater, Naída CI recipient, using AB and Phonak technology to chat comfortably in the London Underground

BRING ON THE NOISE Sound has Never Been Smarter than with Naída CI Q Series Sound Processors from Advanced Bionics

It’s a noisy world. With AB and Phonak providing more ways to hear in noise than ever, your recipients can keep up with the conversation, no matter how loud it gets. Unique AB and Phonak innovations intelligently adapt to any situation for superior hearing in noise in any listening environment.

Focus on a single speaker in a noisy crowd with the advanced binaural StereoZoom beamformer

Automatially adapt to noisy environments with auto UltraZoom • 70% improved speech understanding in noise with UltraZoom and ClearVoice™ speech enhancement technology1

1. Buechner A. Utilization of advanced pre-processing strategies in cochlear implant systems: The new Naída CI Q70. Presented at the 11th European Symposium on Cochlear Implants in Children. Istanbul, Turkey, May 23-26, 2013.

For more information, contact your AB representative or visit AdvancedBionics.com

Professor Marc Marshark Marc Marschark, Ph.D., is a Professor at the National Technical Institute for the Deaf, a college of Rochester Institute of Technology (www.rit.edu/ntid/cerp), where he directs the Center for Education Research Partnerships. He also is Honorary Professor in the School of Psychology at the University of Aberdeen. His primary interest is in relations among language, learning, and cognition among deaf learners across the lifespan. His current research focuses on such relations among deaf adolescents and young adults. Marc founded the Journal of Deaf Studies and Deaf Education and co-edits the Perspectives on Deafness and Professional Perspectives on Deafness: Evidence and Applications series, all published by Oxford University Press. His more than 30 written and edited books include Raising and Educating a Deaf Child, Teaching Deaf Learners: Psychological and Developmental Foundations, and Bilingualism and Bilingual Deaf Education. He currently is engaged in a five-year project into language (signed, spoken, read), cognition (e.g., visual-spatial, memory), and psychosocial functioning among hearing students, deaf students with cochlear implants, and deaf students without cochlear implants.

Professor Christine Petit

Mark Slater, Naída CI recipient, using AB and Phonak technology Christine Petit graduated in medicine (M.D. from Pierre et Marie Curie University – Paris VI) and in basic biological sciences, genetics and to chat comfortably in the London Underground biochemistry, at Orsay University (Paris XI). She received her Ph.D at Institut Pasteur. During her research training, she studied microbial genetics with Gunnar Lindhal and François Jacob, cell genetics, human genetics with Jean Weissenbach and Pierre Tiollais, and immunology. In 2002, she was appointed Professor at College de France where she holds the chair of “Genetics and Cellular Physiology”. She is currently the head of the “Genetics and Physiology of Hearing laboratory” (Inserm Unit UMRS 1120) at Institut Pasteur. She is member of the French Academy of Sciences and member of the National Academy of Medicine (USA). Through her work on the structure of the human genome, Christine Petit elucidated the origin of sex inversion in humans, which results in XX males and XY females. She then focused on the sensory systems and attempted to understand the hereditary defects of BRING ON THE NOISE olfaction and subsequently hearing (and vision, to a lesser extent). After identifying the first gene responsible for a total absence of smell in humans (the X-linked gene responsible for Kallmann syndrome), she developed experimental conditions for the study of Sound has Never Been Smarter than with hereditary deafness. This approach led her to the identification of a large number of deafness-causing genes (>20 genes), most Naída CI Q Series Sound Processors from Advanced Bionics of which are implicated in early forms of deafness. She then elucidated the pathogenic mechanisms underlying these various deafness forms as well as the normal functions of the proteins encoded by these genes. As a result of the interdisciplinary approaches she developed, she enlightened in particular the molecular mechanisms underlying the development of the hair bundle and its processing of acoustic signals (including mechanoelectrical transduction, auditory distortions....) as well as the functioning of the synapse of the auditory It’s a noisy world. With AB and Phonak providing more ways to hear in noise than ever, your recipients can sensory cells. Recently, she uncovered a new mechanism protecting the auditory sensory system against sound-induced hearing loss. keep up with the conversation, no matter how loud it gets. Unique AB and Phonak innovations intelligently adapt to any situation for superior hearing in noise in any listening environment. Current Research Focus The overall aim of Christine Petit’s laboratory is: i) to understand the cellular and molecular mechanisms underlying sound Focus on a single speaker in a noisy crowd with the advanced processing in the auditory system; ii) to identify defects in these processes that lead to hearing impairment; and (iii) to prevent the occurrence of such defects and treat them. The hair bundle, which plays a central role in sound processing, is a main focus of her binaural StereoZoom beamformer research. In particular, she focuses on key aspects of the hair bundle, including understanding how it is built up, how it achieves its elementary functions of mechanotransduction, frequency tuning response and analysis, waveform distortion and suppressive masking, how it ensures the interplay between these activities and how these properties are coupled to the cytoarchitecture of its structure. Her Automatially adapt to noisy environments with auto UltraZoom interest in sound processing has since extended to the study of the central auditory system. The neurogenetic approaches established in • 70% improved speech understanding in noise with UltraZoom her laboratory are now being applied to identify genes associated with presbycusis. New insight gained from these advances will foster the development of novel therapeutic approaches. and ClearVoice™ speech enhancement technology1

For more information, contact your AB representative or visit AdvancedBionics.com 4

027-M633-02 ©2015 Advanced Bionics AG and affiliates. All rights reserved. q We make the device. You make the miracle. We make the device. You make the miracle. Cochlear™ Nucleus® 6 combines automation, advanced functionality and innovative design to deliver truly unique hearing performance.

Improving your patient’s hearing has never been Shaping the Future Together easier. Nucleus 6 includes SmartSound® iQ, integrated Hybrid Hearing capability and advanced data logging. At Cochlear, our innovations span a widePatients range of enjoypatient a needsseamless, and clinical automated preferences experience, built around the latest systems. Technologicalenhanced innovation with is key, their however natural it is hearing not the and only supported form of innovation at Cochlear. We make every effortby your to optimise clinical insights.our services, Choose processes Nucleus and operations6 and make to ensure efficiency of time and cost andsome to provide miracles. a positive experience every time.

For more information, please contact your Cochlear clinical business manager or visit www.cochlear.com/ukFor more information, please contact your Cochlear representative or visit www.cochlear.com Cochlear, Hear now. And always, Nucleus, SmartSound and the elliptical logo are either trademarks or registered trademarks of Cochlear Limited. ©Cochlear, Cochlear Hear Limited now. And 2016 always, C0185 Nucleus, MAR16 SmartSound, and the elliptical logo are either trademarks or registered trademarks of Cochlear Limited. N37070F ISS2 DEC14 Speaker Biographies

Professor Astrid Van Wieringen Astrid van Wieringen (PhD 1995 at the Univ. of Amsterdam) is full professor at Experimental ORL, Dept Neurosciences, KU Leuven (Belgium) where she combines research and teaching to Bachelor and Master students (5 full courses). Her current research interests include understanding neural processing in profoundly deaf persons with cochlear implants, disentangling peripheral and cortical processes in the aging auditory system and the development of binaural processes, spoken language, and cognitive development in children with different degrees and types of hearing impairment. She is coordinator of the European FP7 training network on improving Children’s auditory rehabilitation (iCARE, www.icareitn.eu, 2014-2017) and PI of the fundamental research project (OT, KULeuven) regarding neural temporal processing in the aging brain applying EEG and behavioral methods to the aging population. She is (co)-author of about 70 international peer-review publications, is frequently invited as a key speaker at conferences, and committee member of international conferences. She acts as a reviewer for several journals and funding bodies and is board member of the Belgian society of Audiology, the International Collegium for Rehabilitative Audiology and scientific board member of the Flemish League for Speech Therapists.

Professor Christophe Vincent Professor Vincent MD, PhD, is a Professor of Otolaryngology at the Faculty of Medicine of Lille and Head of the Otology and Neurotology Department. His PhD and MD studies were in Neuroscience from the University of Paris (Pasteur Institute, Pr C. Petit) and from the University of Lille. He has the honour of being the President-elect of the French Society of Audiology, General Secretary of the French Otologic and Neurotologic Association and a member of the INSERM U1008 Research team: Controlled Drug Delivery Systems and We make the device. You make the miracle. Biomaterials. His work as President of the Scientific Board for the French Cochlear Implant and Auditory Brainstem Implant Post-Market Registry is pioneering in the field of cochlear implants. He has a wealth of experience in establishing a National implant registry which is of great interest to the British cochlear implant field. We make the device. You make the miracle. Cochlear™ Nucleus® 6 combines automation, advanced functionality and innovative design to deliver truly unique hearing performance.

6 British Cochlear Implant Group Meeting 2016

Thursday 28th April 2016 10.00 Registration, refreshments and exhibition Kings Place Gallery 11.00 Welcome Katherine Wilson, Wanda Aleksy Chairs: Dan Jiang, Shakeel Saeed 11.10 Keynote Lecture Christine Petit Genetics as a help to predict the benefit of cochlear implantation Free Papers Session 12.00 Cochlear implant outcomes in cochlear nerve aplasia and hypoplasia Harry Powell Page 13 12.10 Developing the first clinical test of listening effort in cochlear implant users in order Helen Willis to maximise rehabilitation outcomes Page 14 12.20 Cochlear - Shaping our future together Helen Cullington 12.35 Lunch and exhibition Kings Place Gallery 12.50 e-Poster presentations Level - 1 Medical and audiological aspects Station A Adverse listening Station

Chairs: Terry Nunn, Jane Bradley 13.45 Keynote Lecture Astrid van Wieringen Single-sided deafness in children – Comparing outcomes with different interventions

Free Papers Session 14.35 The cost-effectiveness of restoring binaural hearing in unilaterally and bilaterally-deaf adults Pádraig Kitterick Page 13 14.45 Early outcomes in cochlear implantation for single sided deafness Douglas Sladen

Page 15 14.55 Development of localisation ability over time for sequential cochlear implants Tracey O’Neill Page 15 15.05 Perception of the pitch and naturalness of popular music by cochlear implant users Mary Grasmeder Page 16 15.15 Advanced Bionics - Dedicated fitting and signal processing techniques to maximise Josef Chalupper bimodal benefit 15.30 Refreshments and exhibition Kings Place Gallery

15.35 e-Poster presentations Level - 1 Wireless accessories Station A Rehabilitation aspects Station B 16.00 Graham Fraser Memorial Lecture Gerry O’Donoghue Auditory Implants in the UK - The end of the beginning? 17.00 Close of day one with take-away refreshments Kings Place Gallery

7 Programme

Friday 29th April 2016 08.30 Refreshments and exhibition Kings Place Gallery Chairs: Rosie Kentish, Sandra Driver 09.00 Keynote Lecture Marc Marshark Several things we thought we knew about deaf learners with cochlear implants Free Papers Session 09.50 Word learning in children with cochlear implants - Does age at implantation matter? Hannah Pimperton Page 16 10.00 Cortical activation to lip-reading is predictive of poor auditory speech perception Carly Lawler in adult CI users Page 17 10.10 Benefit of auditory-verbal therapy for adults after cochlear implantation David Schramm Page 17 10.20 Oticon Medical – Changing CI hearing care Søren Kamaric Riis 10.35 Refreshments and exhibition 10.40 e-Poster presentations Level - 1 Complex patients Station A Remote Medicine Station B

Chair: Alec Fitzgerald-O'Connor 11.15 Debates Motion: Congenitally deaf adults should be offered cochlear implants Speaking for the motion Louise Craddock Speaking against the motion Azhar Shaida Motion: There are not enough CI centres in the UK Speaking for the motion Simon Lloyd Speaking against the motion Ruth Thomsen 12.30 Lunch and exhibition 12.35 e-Poster presentations Level - 1 CI candidacy Station A Outcomes Station B 13.15 BCIG AGM Chairs: Jeremy Lavy, Gavin Morrison 14.00 Keynote Lecture Christophe Vincent The national cochlear implant database in France 14.50 International survey of cochlear implant candidacy John Graham Page 18 15.00 Issues in cochlear implant candidacy Debi Vickers Page 18 15.10 The impact on health provision for changing cochlear implant candidacy Adrian Davies 15.20 Discussion and consensus statement 15.45 Closing comments and poster prize Wanda Aleksy, Katherine Wilson 16.00 Conference close with take-away refreshments Kings Place Gallery 8 e-Poster schedule Thursday 28th April

e-Poster Session 1: 12.50-13.35

Station A Medical and Audiological Aspects: Chair – Irumee Pai Level - 1

Poster No. Title Presenter Page No 1 Outcomes for users of double array cochlear implants J. Bradley 19 2 Objective measurement of electrode discrimination with the acoustic change complex R. Mathew 19 3 Pre-operative assessment of cochlear implant candidates with auditory evoked cortical responses R. Mathew 20 4 To implant or not implant (intra operative testing of poor VIII nerve) Y. C. Tam 20 5 Comparing the HiFocus 1j and HiFocus mid scala electrodes in adults and children - Insertion depth and hearing preservation N. Vaid 21 6 Revision cochlear implant surgery in Ireland - Indications, outcomes and predictors J. Thapa 21 7 Advanced simulation of CI current spread to help predict the effect of electrode mapping changes J. Grange 22

8 Middle ear implants - The Oxford experience S. Kumar 22

e-Poster Session 2: 15.35 - 15.55

Station A Wireless Accessories: Chair – Jeanette Martin Level - 1

Poster No. Title Presenter Page No 16 The use of take home diaries on adult CI recipients to determine best practice for paediatric CI recipients S. Johnston 26 17 Review of cochlear's mini microphone in the educational setting C. Peake 27 18 Does wireless technology improve speech perception and discrimination? A. Small 27 19 Acceptance evaluation of the Cochlear™ wireless mini microphone in secondary school-aged cochlear implant recipients J. Bickley 28 20 Development of guidelines for clinics to advise patients being upgraded or fitted with Cochlear CP910 processors on which J. Humphries 28 cochlear wireless accessory may be most appropriate for them

9 e-Poster schedule Thursday 28th April

Station B Adverse Listening: Chair – Leah Meerton Level - 1

Poster No. Title Presenter Page No 9 Surviving in a noisy world - Use of assistive listening devices for students and young people C. Peake 23 10 Speech perception in noise outcomes after cochlear implantation A. Shaida 23 11 Can bimodal aiding improve outcomes from unilateral cochlear implantation? C. Fielden 24 12 Evaluation of StereoZoom in bilateral AB naida CI Q90 users B. Samra 24 13 Wearing a processor for swimming lessons C. Peake 25 14 Beamforming in bimodal cochlear implant users - Effect of (a)symmetric directivity E. Devocht 25 15 The use of SCAN and other smart-sound technologies in existing cochlear recipients S. Johnson 26

Station B Rehabilitation Aspects: Chair – Francesca Pinto Level - 1

Poster No. Title Presenter Page No 21 Outcomes for a new programme of auditory verbal therapy for six children in Belfast S. Hogan 29 22 Education of rehabilitation experts from emerging markets and International Rehabilitation Academy D. Herrmannova 29 23 Maximising the potential of the parent child partnership S. Hogan 30 24 Cochlear implants and social media E. Stapleton 30 25 Refinement and validation of a 'music-related quality of life' measure for adult cochlear implant users G. Dritsakis 31 26 The development of an on-line training course for carers of older CI recipients J. Brinton 31

10 e-Poster schedule Friday 29th April

e-Poster Session 3: 10.40–11.10

Station A Complex Patients: Chair – Julie Hare Level - 1

Poster No. Title Presenter Page No 27 Cochlear implantation in children with complex needs - The perceptions of professionals at cochlear implant centres S. Archbold 32 28 Parental experience of the cochlear implant assessment process - Children with multiple disabilities L. Edwards 32 29 Children with Autism and Cochlear Implants - An Audit F. Bathgate 33 30 CI children with severe complex needs and assessment and rehabilitation tools D. Herrmannova 33 31 Outcome of cochlear implantation in children with auditory neuropathy spectrum disorder C. Leal 34 and correlation with age at implantation - St. Thomas' experience 32 Cochlear implantation for hearing rehabilitation in patients with neurofibromatosis type 2 H. J. D. North 34

e-Poster Session 4: 12.35 – 13.15

Station A Candidacy: Chair – Kathryn Webb Level - 1

Poster No. Title Presenter Page No 40 Using the NICE criteria for selecting pre-lingually deafened adults for cochlear implantation is not good enough anymore E. Dyason 38 41 Challenges in cochlear implant assessment and candidacy for children with partial hearing K. Hanvey 39 42 Outcomes in implanted older children who do not meet the adult candidacy criteria F. Vickers 39 43 What difference has a cochlear implant made to born deaf congenitally deafened adults? T. L. Wright 40 44 Beyond SIR 3 - What do we listen for? C. Bartrop 40 45 Maximising the potential of longstanding SSD with a CI – A personal Perspective G. Mole 41 46 Staged bilateral versus simultaneous bilateral surgery for children with partial hearing - Parents' insights J. Maggs 42 47 Impact of a second cochlear implant on a group of primary school aged children - Outcomes and experiences E. Jeffers 42

11 e-Poster schedule Friday 29th April

Station B Remote Medicine: Chair - Wanda Aleksy Level - 1

Poster No. Title Presenter Page No 33 "A leap of faith"- Remote intra-operative testing - A Belfast prospective A. Speers 35 34 The use of telepractice in the assessment and management of patients with hearing implants - A pilot study S. Driver 35 35 Feasibility of telemedicine in paediatric rehabilitation after cochlear implantation T. Twomey 36 36 Remote programming of sound processors - The Scottish experience K. Munro 36 37 Surgery webcasts: LION v MED-EL Webgate Media - Quality of transmission, surgery and benefits of S. Backhouse 37 `communal' v `solo' viewing? 38 An audit into the clinical effectiveness of annual reviews in the adult CI population V. Soobrayen 37 39 Randomised control trial of remote care for adult cochlear implant users H. Cullington 38

Station B Outcomes: Chair – Louise Jenkinson Level - 1

Poster No. Title Presenter Page No 48 Pitch perception, production and links to language development in primary school children with cochlear implants L. Carroll 43 49 Measuring empowerment in adult cochlear implant users - The development of the CI-EMP questionnaire P. Kitterick 44 50 Educational outcomes in paediatric CI users in Ireland E. Walshe 44 51 Experiences of patients and audiologists about the impact of tinnitus on post-operative assessments in R. H. Pierzycki 45 cochlear implant clinics 52 eSRT versus behavioural maps - A comparison of outcomes in adult users of the MED-EL CONCERTO cochlear implant system W. Ellis 45 53 The personal and economic value of cochlear implantation - Adults' perspectives S. Archbold 46 54 Long term use/non-use of cochlear implants systems in an Indian setting N. Vaid 46 55 Comparative study of audiological outcomes and patient perceived benefit for three bone conducting hearing H. Ghulam 47 implant systems

12 British Cochlear Implant Group Meeting 2016

Please note the work published in this booklet has been submitted by the individual authors and therefore Aesculap Academia cannot take any responsibility for the content

Cochlear implant outcomes in cochlear nerve aplasia and hypoplasia H. R. F. Powell, C. S. Birman, W. P. R. Gibson, E. J. Elliott Discipline of Paediatrics and Child Health, Sydney Medical School and Sydney Cochlear Implant Centre. Bldg 39, Old Gladesville Hospital, Punt Road, Gladesville, NSW, AUSTRALIA 2111

Aim To assess cochlear implant (CI) outcomes, and factors affecting outcomes, for children with aplasia/hypoplasia of the cochlea nerve.

Method Retrospective case review at a tertiary referral hospital and cochlear implant programme. Children 0-16 years with a CI who had absent/ hypoplastic cochlea nerve on magnetic resonance imaging (MRI). Main Outcome Measures: MRI, trans-tympanic electrical auditory brainstem response (EABR), intra-operative EABR, NRT, Categories of Auditory Perception score, main mode of communication.

Result 50 CI recipients (26 male and 24 female) were identified, 21 had bilateral CIs, 27 had developmental delay. MRI showed cochlea nerve aplasia in 64 ears, hypoplasia in 25 ears, and a normal nerve in 11 ears. Main mode of communication was analysed for 41 children: 21(51%) used verbal language and 20 (49%) used sign language. 73% of children used some verbal language. CAP scores were available for 59 CI ears: 47% with CN aplasia and 89% with CN hypoplasia achieved CAP scores of 5-7 (some verbal understanding) (p= 0.003).

Conclusion Our results are encouraging and useful when counselling families regarding the likelihood of language outcomes and auditory understanding.

13 Oral Presentation Abstracts

Developing the first clinical test of listening effort in cochlear implant users in order to maximise rehabilitation outcomes H. Willis, S. Rosen, D. Vickers Speech, Hearing and Phonetic Sciences, University College London, Chandler House, 2 Wakefield Street, London WC1N 1PF

Aim To develop the first ever prototype of a clinical test able to quantify listening effort in the cochlear implant population (which can feasibly be used in both the clinical and home environment).

Method A novel dual task paradigm was developed to form the foundation of a prototype clinical test of listening effort. The dual paradigm comprised of a primary task of auditory recall that was to be simultaneously executed alongside a secondary task of visual recall, with the intention that secondary task performance will become the index of listening effort in the cochlear implant user. To validate the sensitivity and reliability of this listening effort index, a physiological process known to be intimately related to listening effort was measured: the pupil dilation response. In addition, a thorough assay of cognitive, executive, intellectual and hearing function was performed to separate out individual differences from listening effort.

Result A pilot study of the prototype revealed that, when five adult normal hearing controls listening to cochlear implant simulations and four adult cochlear implant users were tested, secondary task performance was worse, and pupil dilation response greater, in the cochlear implant group compared to the normal hearing group, despite no significant differences in cognitive, executive and intellectual function.

Conclusion There are indications that: 1) listening effort is being detected by this prototype; and 2) listening effort is increased in cochlear implant users (to their detriment). This is important because it is plausible for a cochlear implant user to exhibit exemplary speech recognition levels but at the cost of substantially increased levels of listening effort. If listening effort is excessive, too many cognitive resources are being used in speech recognition, leading to exhaustion and poor long term performance. Awareness of the level of listening effort will enable clinicians to adapt rehabilitation and processing strategies to optimise speech recognition without a punitive cognitive cost, thus maximising the cochlear implant user's potential.

The cost-effectiveness of restoring binaural hearing in unilaterally and bilaterally-deaf adults P. T. Kitterick, L. Lucas, C. Fielden, H. McKay, R. Hampton, S. Smith National Institute for Health Research Nottingham Hearing Biomedical Research Unit, University of Nottingham, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU

Aim The ability to listen through two ears helps with following conversations in noisy environments, focussing attention on different sources of sound, and determining the location of sounds. These abilities are significantly impaired in adults with bilateral or unilateral severe-to-profound deafness. The standard of care for both of these patient groups (unilateral implantation and CROS hearing aids, respectively) do not aim to restore binaural hearing despite the benefits that may be gained from doing so. This study assessed whether restoring binaural hearing in the bilaterally-deaf using a contralateral acoustic hearing aid (HA) and in the unilaterally-deaf through cochlear implantation (CI) could be a cost-effective use of NHS resources.

Method The impact of restoring binaural hearing was quantified in terms of a gain in health utility. Utility is a value between 0 and 1 that describes a patient’s health. The utility gain associated with HA use in unilateral CI users was estimated by administering the York Hearing-Related Quality of Life (YHRQL) questionnaire to patients implanted since 2009. The utility gain associated with CI in the unilaterally-deaf was estimated by describing their health when using either a CROS aid or a CI. Members of the public valued these descriptions using the time trade-off technique. Utility gains were converted to gains in Quality Adjusted Life Years (QALYs) using state transition models and the cost per QALY was calculated for each intervention.

Result A total of 319 valid responses to the YHRQL were received from unilateral CI users, of which 91 used a HA in their non-implanted ear. After controlling for the year in which they were implanted, the health utility of those who used a HA with their CI was found to be significantly greater than those who did not (mean gain 0.030). Compared to unilateral implantation, the incremental cost of HA use was £106 but HA use created an additional 0.18 QALYs (cost per QALY £589). Valuations of the unilaterally-deaf descriptions were obtained from 256 members of the public. While CI was associated with a significant gain in utility over CROS use (mean gain 0.043), it incurred an additional cost of £33,282 for 0.28 QALYs (cost per QALY £118,864).

Conclusion Based on the current data, the provision of a well-fit acoustic HA in the non-implanted ear of at least some unilaterally-implanted patients can improve quality of life, and doing so appears to be a cost-effective use of NHS resources compared to providing a unilateral CI alone. However, it remains unclear how best to identify those patients who may benefit from a contralateral HA and who will continue to use it in combination with their implant. The results also suggest that while the general public view the restoration of binaural hearing in the unilaterally deaf through cochlear implantation as having a significantly positive impact on health, it is unlikely that doing so would be cost-effective at current willingness-to-pay thresholds. 14 British Cochlear Implant Group Meeting 2016

Early outcomes in cochlear implantation for single sided deafness D. Sladen, M. Carlson, B. Neff, M. C. Beatty, M. DeJong, B. Dowling, A. Olund, A. Peterson, M. Schmitt, K. Teece, C. Driscoll. Otolaryngology, Mayo Clinic, 200 First St. SW, Rochester, MN USA 55057

Aim This study sought to determine if: 1) a CI will provide hearing restoration to an ear with UHL, 2) patients with SSD are able to achieve binaural benefit as measured using speech-in-noise testing and self-perceived benefit, and 3) a CI will reduce listening effort when the device is on compared to off in cases of SSD.

Method Participants. All participants had sudden onset unilateral sensorineural hearing loss (< 2 years and > 6 months of hearing loss), < 50% aided monosyllabic word recognition on affected side, and > 70% word recognition on the contralateral side. To date, 15 adults and 2 adolescents have been implanted. Materials. Test measures included: (1) speech recognition in quiet for the affected side using the Consonant-Nucleus-Consonant (CNC; Peterson & Lehiste, 1952) test and the AzBio sentence test (Spahr & Dorman, 2005), (2) speech recognition in noise in the bilateral condition using the Hearing in Noise Test (HINT; Nilsson et al., 1994) sentences in an R-SPACE 8-speaker array, (3) self-perceived benefit using the Speech Spatial and Qualities of Hearing Questionnaire and SF-36.

Result Results demonstrated significantly higher speech recognition performance for all test conditions. Results of the SSQ-C showed a preference for the device on versus off for each domain. Results of the listening effort task showed that reaction time was fastest in the baseline condition (button press only). Listening effort, as measured with reaction time, was not significantly different in the device on versus device off condition.

Conclusion The participants implanted thus far demonstrate significant improvement for speech understanding in quiet and noisy conditions in both the unilateral and bilateral listening conditions. Notably, the group average CNC word and AzBio sentence tests are lower than those reported for adults who are implanted following bilateral loss. Self-perceived benefit indicates that although the input from the implant is important for daily function, listening effort was not improved with the device on compared to the device off. Anecdotally, patients have reported that although they enjoy the implant and find it useful, they do have to exert energy to process sounds from that ear. These outcomes are preliminary and should be interpreted with caution when generalizing to the larger population.

Development of localisation ability over time for sequential cochlear implants T. O'Neill, C. Allan, M. Daft, J. Hatton, S. Johnson, P Kitterick K. Veekmans, Nottingham Auditory Implant Programme, Nottingham University Hospitals NHS Trust, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU

Aim To investigate how localisation ability develops over time following sequential cochlear implantation.

Method The data for localisation error collected at routine clinical appointments was investigated retrospectively for a group of sequentially implanted cochlear implant recipients. A model was created to explain the data.

Result Localisation error was seen to decrease over time and, in this group, was not related to age at 2nd implant or interval between implants. It was possible to create a model to fit the data, and to create prediction intervals to show where the results for individuals might be expected to fall at different points in time.

Conclusion The data shows how localisation ability develops over time, and the model generated can be used to show whether an individual's localisation ability is developing typically. This can be used to inform clinical practice, and expectations pre and post -implant.

15 Oral Presentation Abstracts

Perception of the pitch and naturalness of popular music by cochlear implant users M. L. Grasmeder, C. A. Verschuur University of Southampton Auditory Implant Service, University of Southampton, Building 19, University of Southampton, Southampton SO17 1BJ

Aim To assess the perceived pitch and naturalness of popular music by cochlear implant (CI) users.

Method Eleven experienced post-lingually deafened adult CI users rated the pitch, naturalness and clarity of a popular song with ten frequency allocation settings, including the default. The alternative settings all had logarithmic frequency spacing and frequency shifts of less than one octave compared to the default map. For maps which were perceived as having incorrect pitch, participants adjusted the pitch of the song in real time using a slider, in order to normalise it, and the amount of adjustment was recorded.

Result The default map was rated as having close to correct pitch. Naturalness rating was negatively correlated with basal shift from a baseline logarithmic map, which was the same as the default map for basal electrodes (R2=0.77). Ratings of the clarity of the lyrics were adversely affected by basal shift. The majority of participants were able to rate and adjust pitch appropriately. The frequency shift in the map was highly correlated with participants' adjustments of the pitch slider (R2=0.94) but the adjustments were less than expected for the majority of participants.

Conclusion The pitch ratings for the default allocation suggest that participants have acclimatised to their processors' frequency allocations. Adjustment of the pitch of the song was possible for the majority and suggested that all but one participant was experiencing frequency compression. Expansion of the frequency allocation might help to alleviate this.

Word learning in children with cochlear implants - Does age at implantation matter? H. Pimperton, E. Walker Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AZ

Aim The majority of research looking at language outcomes in children with cochlear implants (CIs) has used standardised language tests (e.g. vocabulary tests) which provide a static assessment of accumulated language knowledge. Dynamic word learning paradigms that assess children's ability to learn novel words offer the opportunity to examine the efficiency of their word learning processes. This study used a word learning paradigm to test whether deaf children who receive CIs before the age of three years show deficits in their ability to learn new words relative to their hearing peers and whether variation in age at implantation within the first three years of life relates to later word learning abilities.

Method Twenty one 6-10 year old children with CIs, 21 chronological age-matched hearing children (CA) and 21 younger vocabulary age-matched hearing children (VA) completed an auditory word learning task in which they were required to learn the names of eight rare animals. Their learning of these unfamiliar words was assessed using both recognition and production probes. The participants also completed standardised assessments of their vocabulary and non-verbal cognitive skills.

Result The children with CIs showed comparable performance to their age-matched hearing peers on the recognition component of the word learning task but showed significant deficits on the production component (t(40) = 2.70, p = .01, d = 0.83). The production performance of the CI group was in line with that of their younger vocabulary-matched hearing peers. After adjusting for age and non-verbal ability, there was no significant relationship between age at implantation and performance on the word learning task (r (17) = .20, p = .42, 95% CI = -.12 to .52). However, word learning task performance showed a significant positive correlation with existing vocabulary size (r (17) = .51, p = .03, 95% CI = .16 to .79).

Conclusion Children with CIs implanted before the age of three were able to approximate the performance of their age-matched hearing peers when learning to recognise novel words but showed deficits in their ability to retain the detailed phonological forms of those words to support accurate production. Variability in age at implantation within the first three years of life did not predict later word learning skill; earlier implantation was not associated with better word learning performance. However, existing vocabulary size did relate to word learning skill. This relationship is likely to be developmentally reciprocal: Early intervention for deaf children should focus on boosting initial vocabulary size to lay the foundations for later word learning.

16 British Cochlear Implant Group Meeting 2016

Cortical activation to lip-reading is predictive of poor auditory speech perception in adult CI users C. A. Lawler, I. M. Wiggins; P. T. Kitterick, D. E. H. Hartley NIHR Nottingham Hearing Biomedical Research Unit, University of Nottingham, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU

Aim Auditory speech perception abilities following cochlear implantation remain highly variable and largely unpredictable. Peripheral, surgical and device-related factors have been shown to influence the level of speech perception achieved. However, routinely available clinical data are not able to fully account for the variability observed in CI outcome. The aim of this research was to establish whether cortical plasticity within auditory brain regions, measured before implantation, could help to predict future CI outcome.

Method Adults with severe-to-profound deafness (n=17), who met NICE criteria for implantation, were tested at three time-points: (1) before implantation; (2) 1 month after CI activation; and (3) 6 months after CI activation. At each time point, functional near-infrared spectroscopy (fNIRS) was used to measure cortical responses to visual speech (lip-reading) in auditory brain regions. Behavioural measures of auditory speech perception and lip-reading ability were also obtained using the CUNY sentence test.

Result Substantial variability in CI outcome was observed within the present sample, with auditory speech perception abilities ranging from 1 - 100% correct after six months of CI use. Before implantation, greater response to visual speech within auditory brain regions was associated with greater lip-reading ability. However, stronger cortical activation to visual speech before implantation was significantly predictive of poorer auditory speech perception after six months of CI use (r=-.75, p<.01). Importantly, this cortical measure was able to provide unique predictive value above that of known clinical factors, such as age-at-onset and duration of deafness.

Conclusion During profound deafness, greater recruitment of the auditory brain regions for lip-reading may provide a behavioural advantage for spoken communication. However, this cortical adaptation to deafness may be detrimental to future auditory recovery with a CI. The results indicate that fNIRS holds promise as a clinical tool to support more accurate prognoses of CI outcome. This work has been supported by funding from the National Institute for Health Research and Cochlear Europe Limited.

Benefit of auditory-verbal therapy for adults after cochlear implantation D. Schramm, E. Fitzpatrick, C. Seguin, S. Armstrong, A. McAfee, T. Olmstead Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, 121-737 Parkdale Ave. Ottawa, Ontario Canada K1Y 1J8

Aim Some adults after cochlear implantation continue to have challenges with communication abilities. This project was designed to investigate whether individual auditory-based therapy would lead to measurable improvement in communication abilities for adults with cochlear implants. It was hypothesized that participants would demonstrate improvement in speech perception after a period of intervention. Using qualitative interviews, the study also examined participants' perceptions of the benefits they received from the intervention.

Method Participants received auditory-verbal therapy for up to 24 weeks. Objective measures were obtained pre- and post-intervention. Speech perception was measured using CNC Monosyllabic Words, HINT sentences in Noise and Quiet and the Early Speech Perception Test (ESP) for participants without open set ability. The Tait Telephone Profile and McGarr Sentences Speech Intelligibility assessment were administered. Participants completed the Nijmegen Cochlear Implant Questionnaire (NCIQ) pre- and post-intervention. As well, they completed a questionnaire about their progress on a monthly basis during intervention.

Result Fourteen adults have completed 24 weeks of therapy. The average age at implantation was 52.6 years. Two-thirds had post-linguistic deafness. One-third had pre-linguistic deafness. Implant use varied between 6 months and 11 years. Eleven participants had some open-set speech understanding pre-intervention. For these, CNC word scores showed a significant (p = .003) increase with median scores improving from 26.0% pre-intervention to 38% post-intervention. There was a significant (p=.004) increase in HINT sentences in noise scores with median scores improving from 28.4 to 53.8%. Both the participant questionnaire and telephone profile scores showed improvement in telephone use for 13 participants. The NCIQ increased on all sub-domain scores.

Conclusion Quantitatively, using standard speech perception tests and measures of telephone use ability, a 24-week block of individualized auditory based therapy conducted by a Certified Listening and Spoken Language Specialist therapist led to significantly improved performance of adult cochlear implant recipients. Qualitatively, using the NCIQ, patient questionnaires and feedback during focus groups, participants expressed significant improvement in their communication abilities.

17 Oral Presentation Abstracts

International survey of cochlear implant candidacy J. Graham, L. De Raeve, D. Vickers Cochlear Implant Team, Royal National Throat Nose and Ear Hospital, 332 Gray's Inn Road, London WC1X 8EE

Aim The goal of this work was to determine the differences in candidacy based on audiometric and speech perception measures, and to evaluate the information in light of the funding structure and access to implants within different countries.

Method An online questionnaire was circulated to professionals in 25 countries. There were 28 respondents, representing the candidacy practice in 17 countries.

Result Results showed differences between countries for funding model; typically a mixed model. Unilateral implants for both adults and children and bilateral implants for children, were covered by national funding in approximately 60% of countries, (30% used medical insurance, and 10% self-funding). Fewer countries provided bilateral implants routinely for adults; only 22% received national funding, (37% used medical insurance and 41% self-funding). Main evolving candidacy areas are asymmetric losses, auditory neuropathy disorders and electro-acoustic stimulation.

Conclusion For countries using speech-based adult candidacy assessments, the majority (40%) used word tests, 24% used sentence tests and 36% used a mixture of both. For countries using audiometry for candidacy (70-80% of countries), the majority used levels of 75-85 dB HL at frequencies above 1 kHz. The United Kingdom and Belgium had the most conservative audiometric criteria, and countries such as Australia, Germany and Italy were the most lenient. For countries with a purely self-funding model had greater flexibility in candidacy requirements.

Issues in cochlear implant candidacy D. Vickers, P. Kitterick, C. Verschuur, C. Leal, L. Jenkinson, F. Vickers, J. Graham British Cochlear Implant Group, Working Party on Candidacy

In a recent survey by the British Cochlear Implant Group (BCIG) council, members were asked what the priority working areas for the BCIG council should be. The topic of candidacy was the emphatic winner. This is because those working in the cochlear implant (CI) field in the UK believe that the guidelines for candidacy no longer reflect the entire population of patients that the BCIG and the UK implant field consider to be potential CI candidates. There is a clear need to review these guidelines in light of new evidence, some of is the evidence is collated in the supplement on “Issues in Cochlear Implant Candidacy”.

A score of less than 50% on the Bamford Kowal and Bench (BKB) sentences presented in quiet (at 70 dBSPL) is used as one of the candidacy criteria for assessing adult in the UK. Use of this measure alone to assess hearing function has become inappropriate. It is recommended that the pre-implant assessment battery is broadened to include the Arthur Boothroyd (AB) monosyllabic speech perception task (scored by both word and phoneme) together with CUNY (City University of New York) audio-visual sentence materials in quiet for poorer performing candidates. Additionally, it is recommended that speech-in-noise measures should be used for assessing individuals at the higher end of the performance range. A more complex combination of measures for determining candidacy will provide a better assessment of an individual’s access to speech. Other more qualitative measures to better understand an individual's everyday listening experience should also form part of the clinical evaluation assessment battery.

It has been recommended that the cut-off audiometric level should be reduced to 80 dB HL at 2 & 4 kHz in the UK for all implant candidates, compared to the current threshold of 90 dB HL. However, there are concerns that even this change would not sufficiently cover all of the unusual audiometric configurations that an appropriate candidate could have. It is also recognised that pure tone audiometry has important limitations and that possibly other measures, such as the speech intelligibility index could be added to the test battery as a way to support candidacy decisions in those cases regardless of where the threshold is set.

When contemplating changing candidacy for CIs for both adults and children it is not only the cost of the device and intervention that should be considered but also the cost of not providing implants to the appropriate individuals and the impact that this would have on their lives and on society more generally. Poorly managed hearing losses have a huge impact on a person’s life, for adults it could result for example in social isolation, reduced self-confidence and poor employability. For children it could impair their access to speech and in turn delay language acquisition, which has further implications on that child’s education and employment outcomes in later life.

18 British Cochlear Implant Group Meeting 2016

Outcomes for users of double array cochlear implants, e-Poster 1 J. Bradley Auditory Implant Department, Royal National Throat Nose and Ear Hospital, 330 Gray's Inn Road, London WC1X 8DA

Aim The use of double array cochlear implants is a management option for patients with obliterated or partly obliterated cochleae. This paper will review patients who have received double array devices and discuss the outcomes and complications which have been observed. Recommendations for counselling of potential recipients will be made.

Method A retrospective case note analysis was carried out for the 15 patients on the departmental case load who have received double array cochlear implants. Three of these patients received bilateral double array devices. Notes were examined to assess the reason for use of the double array, any complications experienced, and the outcomes achieved.

Result Double arrays were used to maximise the number of intracochlear electrodes, either at the original surgery or at subsequent reimplantation. Complications include device failure, infection, and extrusion of the electrode array, all requiring additional surgery. Users of double array devices frequently require high levels of electrical current, and have a high incidence of non-auditory stimulation. The outcomes observed range from moderate benefit through to those who are unable to use the device at all. All patients who originally had standard cochlear implants and who were re-implanted with double arrays, following device failure or infection, had poorer outcomes with their double arrays, some significantly so.

Conclusion Double array cochlear implants can, in some cases, offer users worthwhile benefit, but it is important to be aware of the possibility of limited or minimal benefit from the outset in order to counsel appropriately and set realistic expectations for the user.

Objective measurement of electrode discrimination with the acoustic change complex, e-Poster 2 R. Mathew, J. Undurraga, G. Li, P Boyle, D. Selvadurai, A. Shaida, D. Vickers The UCL Ear Institute, UCL, 332 Grays Inn Road, London WC1X 8EE

Aim The electrically evoked ACC (eACC) has been recorded in Nucleus users in response to a change in stimulating electrode. The aim of this study was to determine the feasibility of measuring the eACC in cochlear implant (CI) subjects with other CI systems and measure correlation with behavioural discrimination.

Method Two Medel and three Advanced Bionics (AB) adult implant users underwent testing. Stimulation level was at the most comfortable level and electrode pairs were loudness balanced. Stimuli for the eACC recording consisted of biphasic electrical pulses of 800ms duration. In the test condition there was a change in stimulating electrode at the stimulus midpoint. The first control condition consisted of stimulation at a subthreshold level and the second control consisted of stimulation with no change. Electrophysiological responses were recorded with a 66-channel active electrode system. CI artefact was removed with filtering and joint decorrelation. Behavioural discrimination was measured with a 3-interval 2-alternative forced choice task.

Result Despite the presence of CI artefact the eACC could be visualized in the test condition but was absent in the control conditions. The presence of the eACC was correlated with behavioural electrode discrimination.

Conclusion The eACC can be recorded in Medel and AB users to objectively assess electrode discrimination. A study to measure the development of these responses after surgery to assess brain plasticity is currently on-going.

19 e-Poster abstracts

Pre-operative assessment of cochlear implant candidates with auditory evoked cortical responses, e-Poster 3 R. Mathew, J. Undurraga, G. Li, L Meerton, D. Selvadurai, A. Shaida, D. Vickers The UCL Ear Institute, UCL, 332 Grays Inn Road, London WC1X 8EE

Aim There is significant variability in hearing outcome after cochlear implantation (CI). Auditory evoked cortical responses (ACR) allow objective assessment of the auditory pathway. The aim of this study was to determine the feasibility of recording ACRs in adults with long duration of deafness, prior to CI surgery.

Method Subject A had congenital hearing loss of 50 years duration and was a total communicator. Subject B had post-lingual deafness of 37 years duration and was an oral communicator. Unaided pure tone threshold at 0.5 and 1kHz was 90 and 110dB HL in subject A and 110 and 110dB HL in in subject B. Testing was conducted with a unilateral hearing aid at a comfortable level. Speech perception was tested with Bamford-Kowal-Bench sentences in quiet. Stimuli for ACR measurements were presented at an intensity of 65dBA and consisted of the spondee /ba/, with duration of 91ms and a 500Hz pure tone with 56ms duration. Three-hundred trials were presented at a rate of 0.66Hz. ACRs were measured with 64 scalp channels, 2 ocular channels and 2 mastoid channels.

Result BKB score in quiet was 0% in both individuals. Robust ACRs were measured in both individuals. The waveform was dominated by the N1 component and P1 was small or absent.

Conclusion Despite poor speech perception and long duration of deafness it was possible to record ACRs in in these subjects. ACRs may therefore be useful in the pre-operative assessment of CI candidates. We will also present longitudinal data on the development of these responses after surgery.

To Implant or not implant (intra operative testing of poor VIII nerve), e-Poster 4 Y.C. Tam, N.J. Hatton, N.P. Donnelly Emmeline Centre, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ

Aim Intraoperative testing to determine if cochlear implant was suitable for children with bilateral nerve aplasia. Where the MRI indicated there were no visible vestibulocochlear nerves. However, audiological testing showed a consistent response and a degree of cochlear nerve function.

Method The CI Team's decision was to use a standard cochlear implant approach and insert a single use test electrode and electrically stimulate the cochlear to determine if this electrical stimulation would elicit an auditory brainstem response.

The test electrode with three electrode contacts, manufactured by Medel, an ABI placement stimulator controlled by Maestro 4.1 and DIB II was used to provide the electrical stimulus. The eABR responses were measured with a Viasys Synergy 5 evoked potential system.

Result If an eABR response was present then a CI would be inserted otherwise the operation would be abandoned without the CI.

Conclusion The MRI suggested bilateral cochlear nerve aplasia, but behavioural audiological tests showed there was reliable and consistent responses in one ear. Use of a test electrode allows the decision to implant or not implant to be made at the time of surgery.

20 British Cochlear Implant Group Meeting 2016

Comparing the HiFocus 1j and HiFocus Mid Scala electrodes in adults and children - Insertion depth and hearing preservation, e-Poster 5 N. Vaid ENT, KEM Hospital and Research Centre, Jawaharlal Nehru Rd, Somwar Peth, Pune, India, Pune, India 411011

Aim The primary objectives of this study are to evaluate the average insertion depth and variation and to assess the potential for hearing preservation of the HiFocus 1j and Mid Scala electrodes in children and adults.

Method A group of postlingually deafened children and adults aged 1 year or older with regular anatomy who will receive the HiRes90K implant and either the HiFocus 1j or Mid Scala electrode will undergo a plain radiography (x-ray) investigation shortly after the surgery to determine the angular insertion depth. Audiometric thresholds determining the amount of residual hearing will be performed prior surgery and then monitored at device activation, one, three, six and twelve Months later.

Result Up to now 15 subjects are enrolled and data for ten (five per electrode group) are present at the time of submission. A mean insertion depth of 480° (SD=46°) is estimated for the 1j and 424° (SD=31°) for the Mid Scala group respectively. A complete preservation within 10dB HL was achieved for seven (four Mid Scala and 2 1j) and partial loss for the remaining two 1j subjects.

Conclusion Based on the present data both electrodes have a consistent insertion depth of slightly less than a turn and a quarter for the Mid Scala and slightly above for the 1j electrode. With both electrodes and in particular with the Mid Scala some non-functional residual hearing could be perserved. Study is ongoing and up to 18 subjects will be included until the end of the study. Data for additional subjects will be presented and discussed.

Revision cochlear implant surgery in Ireland - Indications, outcomes and predictors, e-Poster 6 C. Simoes-Franklin, F. Glynn, P. Walshe, L. Viani Cochlear Implant Department, Beaumont Hospital, Beaumont Road, Dublin, Ireland

Aim This study aims at categorise the indications for revision cochlear implant (RCI) surgery of the Irish Cochlear Implant Programme over a period of 20 years, and to analyse performance outcomes following re-implantation.

Method This study constitutes a retrospective review of the centralized database, the medical charts and surgical records, integrity tests and manufacturer's device analyses for all patients who underwent revision surgery in Ireland. Pre- and post- RCI speech and auditory performance indicators were analysed to assess the impact of RCI surgery on language outcomes.

Result Between 1995 and 2015, 508 children and 453 adults received a cochlear implant in Beaumont Hospital, the National Centre for Cochlear Implantation in Ireland. During this period, 36 children (7%) and 17 adults (3.7%) underwent RCI surgery. Two patients had two RCI surgeries resulting in a total of 55 RCI surgeries. The most common indication for RCI surgery was device failure (33/55), followed by infection (6/55) and device migration (6/55). Following explantation, patients were re-implanted in the same ear (37/55), the opposite ear (6/55) or bilaterally (10/55). Analysis of SIR and CAP scores in children and BKBs in adults revealed that revision surgery did not have a negative effect on speech and auditory performances.

Conclusion The revision surgery rate for the Irish Cochlear Implant Programme stands at 4.7% with a device failure rate of 2.8%. Revision surgery rates have been reported to range between 1.2% and 15.1% and device failure rates between 0.5% and 14.7% (Wang et al, Laryngoscope, 2014).

21 e-Poster abstracts

Advanced simulation of CI current spread to help predict the effect of electrode mapping changes, e-Poster 7 J. Grange, J. Culling School of Psychology, Cardiff University, 70 Park Place, Cardiff CF10 3AT

Aim To develop a vocoder that incorporates current spreadand matches existing CI-user speech-in-noise intelligibility data, for later simulation of sound coding strategies such as bilateral CI channel interleaving/zipping. To test Friesen et al.'s (2001) proposal that the plateauing of %-correct measures of speech-in-noise intelligibility beyond a knee point at ~8 'effective' electrodes is due to current spread. If it were, increasing current spread would shift the knee point to a lower number of activated electrodes.

Method A conventional vocoder makes use of the same number of analysis frequency bands and re-synthesis carrier bands/tones. Oxenham & Kreft (2014) proposed an exponential weighting function to incorporate current spread in a conventional tone vocoder. We propose an advanced vocoder that employs a fixed, large number of re-synthesis tones so as to better represent the spiral ganglia, regardless of the number or mapping of activated electrodes. We measured %-correct and SRTs with IEEE sentences and digit triplets with bth conventional and new vocoders. Simulated current spread and number of activated electrodes were both varied.

Result Where simulations with a conventional vocoder fail to exhibit a logical shift of the knee point to a lower number of activated electrodes with increasing current spread, our new vocoder succeeds. The knee point was not solely due to current spread, since one remained at 7 electrodes without current spread. Current spread was found to mostly elevate SRTs and beyond the knee point, SRTs kept improving, be it at a much slower rate. Our results also suggest that beyond a spread slope of 20-30 dB/Octave, reducing the current spread may not be the most effective way to improve speech intelligibility. CI data from Friesen et al. (2001) and Qin & Oxenham (2003) was well matched above the knee point. Perceptual learning may limit simulations.

Conclusion Current spread is not the main source of the plateauing of %-correct measures of speech-in-noise intelligibility. It however significantly elevates SRTs when spread slope is below 20-30 dB/Octave. The proposed advanced vocoder provides an improved means of simulating CI data with hearing listeners.

Middle ear implants - The Oxford experience, e-Poster 8 S. Kumar, V. Sivapathasingam, T. Mawby, J. Humphries, S. McKeith, J. Ramsden Oxford Cochlear Implant Centre, ENT, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU

Aim Implantable middle ear devices have a niche position in auditory rehabilitation in patients with moderate to severe hearing loss, not amenable to conventional hearing aids or bone anchored hearing aids. We are the first and currently the only implant center in the UK performing middle ear implants using the Cochlear Carina System, since Cochlear took over the manufacturing and trading of this design from Otologics (Previously known as Otologics MET CarinaTM). We describe our operative experiences, together with the surgical, audiological and patient satisfaction outcomes with this device.

Method All patients were selected following careful scrutiny of their audiologic parameters which included pure tone thresholds (air and masked bone), tympanometry and speech audiometry with headphones and free fields. All patients were English speaking adults, with bilateral moderate – severe mixed hearing loss, and many years of proven struggles with being conventionally aided. High resolution CT of the temporal bone was performed in all to show healthy middle ear.

Result We present our intra operative experience, including duration of surgery and experiences with the device implantation along with post -operative recovery and early complications. Post operatively, pure tone and speech audiometry were performed with device switched on and off, and compared with the unaided ear to show an overall improvement. There were no surgical complications. Some degree of feed back with head movement was reported, but not bad enough for patient to switch off the microphone.

Conclusion Overall, our early experience with the Carina –Cochlear middle ear device in this niche group of patients has been positive. We look to the future of more Carina middle ear implants, with longer follow up and comparative studies with other implantable devices that overcome the difficulties of conventional aids in this sub group of patients.

22 British Cochlear Implant Group Meeting 2016

Surviving in a noisy world - Use of assistive listening devices for students and young people, e-Poster 9 C. M. Peake Auditory Implant Service, University of Southampton, Building 19, Highfield campus, Southampton SO17 1BJ

Aim The aim of this project is to look at improving speech perception in background noise using Assistive Listening Devices (radio hearing aids).

Method Baseline measures were taken of speech in noise perception for a large number of children and young people. Their radio hearing aids were then adjusted electro -acoustically to produce a notional 10 dB advantage. The speech in noise tests were repeated using the radio system and the results compared with the first series of tests. An actual advantage of 10 DB was looked for.

Result The results for a large number of children showed significant improvement in speech in noise perception, justifying the 10 dB notional advantage used in setting up the radio system. These results are largely irrespective of both the processor type and the radio system used.

Conclusion High levels of background noise in many school and college learning areas create difficulties for the majority of cochlear implanted young people. The use of carefully adjusted radio hearing aids can make a tremendous difference to the learning experience of this particular cohort. Rehabilitation staff working in cochlear implant centres need to be foremost in getting this message out in order to improve the learning experience of implanted young people.

Speech perception in noise outcomes after cochlear implantation, e-Poster 10 A. Shaida Auditory Implant Department, The Royal National Throat Nose and Ear Hospital, 330 Grays Inn Road, London WC1X 8DA

Aim Cochlear implant patients often get excellent BKB scores, but complain of difficulty hearing in noise and real life situations. The aim of this study was to review speech perception outcomes in noise and quiet after cochlear implantation, identify factors predicting good outcomes and star users, and assess the utility of our current BKB in noise testing regime.

Method Consecutive patient case notes were reviewed. Speech perception outcomes in quiet and noise, use of telephone and enjoyment of music were considered as outcome measures. Factors such as aetiology, duration of hearing loss, non-traditional v. traditional candidates, device, use of hearing preservation technique and round window v. cochleostomy were assessed to see if they affected outcome.

Result Outcomes for all patients showed significant variability. However, if non-traditional patients were considered as a separate group, outcomes for traditional patients were much less variable, with a median score of 93, and lower quartile of 84. Interestingly, for BKB testing in noise (10dB, pink noise), the median score was 87 with a lower quartile of 77. The use of different devices, round window v. cochleostomy, and full hearing preservation techniques made little difference to outcomes. Regular use of the telephone or enjoying music was variable and did not correlate with BKB outcomes. For non-traditional candidates, BKB scores at 1 year were lower than for traditional candidates, but there was a correlation with speech SIR scores.

Conclusion Cochlear implant patients are often delighted with speech understanding in quiet, but complain of difficulties in group situations or in the presence of background noise. BKB testing in noise may simulate these situations, but is not routinely carried out. BKB testing in quiet is subject to a “ceiling effect” for many patients, but even BKB in noise (10dB, pink noise) is subject to a ceiling effect. It is recommended that some form of speech perception testing in noise is carried out more frequently to ascertain outcomes and help advise patients preoperatively, but the usual protocol may not be optimal for this, and other protocols may need to be considered.

23 e-Poster abstracts

Can bimodal aiding improve outcomes from unilateral cochlear implantation? e-Poster 11 C. Fielden, S. Smith, R. Hampton, R. Mehta, P. T. Kitterick NIHR Nottingham Hearing Biomedical Research Unit, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU

Aim Unilateral cochlear implantation is the current standard of care for severe-to-profoundly deaf adults in the UK. Since the publication of NICE guidance in 2009, adult candidates are permitted to have access to levels of residual hearing in their non-implanted ear that could potentially be aided usefully by a hearing aid. This `bimodal aiding' may therefore be an appropriate treatment option in at least some patients. This research assessed the views of clinicians and patients in the UK on whether bimodal aiding can increase, and potentially maximise, outcomes following implantation.

Method A survey was distributed to clinicians working with adult implant patients across all 20 centres in the UK. The survey included questions about aspects of current practice related to bimodal aiding along the current care pathway, from assessment to implantation and beyond. An additional survey was also distributed to 1027 adult unilateral implant users from two major UK centres to establish rates of contralateral HA usage among an existing population, and to characterise the reasons why some patients use a hearing aid and some stop using a hearing aid in the non-implanted ear following implantation.

Result The clinician survey suggested that hearing aid evaluation is only consistently undertaken during the assessment process, and rarely following implantation. Despite this, clinicians viewed bimodal aiding as beneficial and reported encouraging contralateral hearing aid use. The patient survey suggested that those implanted since NICE guidance were almost seven times more likely to use a contralateral hearing aid than those implanted prior to this, describing benefit in terms of better hearing in groups, music and ease of lipreading than with the implant alone. Of the individuals who had stopped wearing their hearing aid, the main cause was lack of perceived benefit, but factors such as audiologist advice and discomfort were also reported.

Conclusion Many clinicians and patients view bimodal aiding as improving the outcome that is achievable using a unilateral cochlear implant alone. However, current practice and clinical pathways are not designed to deliver or maximise bimodal aiding, and hence it is possible that bimodal listening outcomes are not being optimised in patients with aidable residual hearing. More research should identify ways to improve bimodal aiding and how to implement these in the clinic.

Evaluation of StereoZoom in bilateral AB naida CI Q90 users, e-Poster 12 B. Samra, H. Cullington, P. Boyle University of Southampton Auditory Implant Service, University of Southampton, Building 19, Highfield, Southampton SO17 1BJ

Aim To evaluate benefits of listening in noise with StereoZoom - a binaural beamformer algorithm - in adults and children using bilateral Naida CI Q90 sound processors.

Method Three different front-end processing algorithms were evaluated: omni-directional microphones (OM), independent beamformers on each sound processor (UltraZoom) and the binaural beamformer (StereoZoom). The primary outcome was the speech reception threshold (SRT) using the Coordinate Response Measure (CRM) test where listeners are required to attend to target phrases originating from one loudspeaker, placed directly in front of the subject, while competing voices are presented from loudspeakers arranged at angles of between ±30 and ±90 degrees azimuth and from behind the participant.

Result Results will be presented from 5 adult and child participants using bilateral AB Naida CI Q90 processors.

Conclusion The introduction of the AB Naida CI Q90 sound procesor offers the option of a binaural beamformer algorithm StereoZoom which is hoped to improve listening in complex real world noisy situations.

24 British Cochlear Implant Group Meeting 2016

Wearing a processor for swimming lessons, e-Poster 13 C. M. Peake Auditory Implant Service, University of Southampton, Building 19, Highfield campus, Southampton SO17 1BJ

Aim Study to assess the benefit of radio hearing aids in school swimming lessons using the aqua accessories from the cochlear corporation.

Method Eight children took part in the study and were users of Cochlear's CP810 or CP910 processor. Children were required to recognise the benefit of using a radio system in the classroom. In most cases swimming lessons were undertaken through the school and the children accompanied by a trained professional who understood the use of radio aid systems. Both the Aqua plus and the original aqua accessory were used.

Result All teachers reported benefit in the following areas: better engagement with classmates, greater participation in the lesson, greater independence, more confidence. All children enjoyed using the radio aid in the pool, and were able to discriminate speech under water.

Conclusion It is important for all children to participate in as many activities as possible, and in order to engage fully in those activities, being able to hear and communicate effectively is essential. Water proofing of hearing instruments is a major contribution to participation in a wider range of activities.

Beamforming in bimodal cochlear implant users - Effect of (a)symmetric directivity, e-Poster 14 E. Devocht, R. Stokroos, M. Brendel, J. Chalupper, E. George ENT/Audiology, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands

Aim Speech recognition in noise still remains one of the most challenging tasks of cochlear implant recipients. Both bimodal hearing and directional microphone systems are ways to improve performance in noise. They are considered to be complementary, but have not yet been evaluated conjointly. Therefore the goal of this study was to evaluate the effect of directional microphone systems on speech understanding in noise for users of a cochlear implant (CI) and a hearing aid (HA) in opposite ears.

Method Twelve adult bimodal CI users were fitted with an Advanced Bionics Naida Q speech processor and a state-of-the art Phonak Naida Q hearing aid. A within-subject repeated measures design evaluated different directional processing settings (standard omnidirectional, monaural beamforming or binaural beamforming) when activated in CI and/or HA. For each condition speech recognition thresholds (SRT) were assessed in a diffuse noise field using two types of noise: stationary speech-shaped noise versus a fluctuating masker.

Result Monaural beamforming provided a significant SRT improvement of 2.6dB SNR when activated in both CI and HA compared to 1.6 dB SNR when activated in only the CI. Since further improvement is expected, also binaural beamforming will be assessed. While similar directional benefits were observed, bimodal users performed overall about 7dB SNR worse in fluctuating compared to stationary noise.

Conclusion Beamforming provides a substantial benefit for speech recognition in noise for bimodal listeners. Most benefit was seen when beamforming was activated in both CI and HA. Even with beamforming a large difference remains between bimodal performance and a normal hearing reference, especially in the presence of a fluctuating masker.

25 e-Poster abstracts

The use of SCAN and other smart-sound technologies in existing cochlear recipients, e-Poster 15 K. Veekmans, S. Johnson, T. Twomey, L. DeBold Nottingham Auditory Implant Programme, Nottingham University Hospitals NHS Trust, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU

Aim The aim of this audit was to investigate the use of SCAN and other smart-sound technologies in long term Cochlear recipients by means of questionnaires and data logging.

Method Two groups of existing users were upgraded to the N6 processor: N24/(RE) & CI512 recipients (Group 1) and N22 recipients (Group 2). Both groups differed demographically and with regard to their technology. Group 1 included both uni- and bilateral users, as well as adult and paediatric users; group 2 consisted of mainly unilateral adult users. Both groups were given the option of different smart sound technologies. For group 1 questionnaire data was collected via Survey Monkey after 3 months of experience with the N6 as well as data logging. For group 2 questionnaire data was collected before and 3 months post upgrade, to fully compare their experience between their old and new processor together with the smart-sound options they are using.

Result Questionnaire data for group 1 showed 68% reported to be using SCAN, with a higher uptake in the younger children than the teenagers and adults. As these recipients attend for their annual appointment, data logging is also being analysed. Results appear to be similar, with currently 66% showing to be using SCAN to some extent. Data from group 2 is currently being analysed and will also be presented.

Conclusion Both groups are experienced and consistent users of their cochlear implant(s). For the majority of recipients, the change in technology has been generally positive and they are using SCAN to some extent. There are a number of recipients who have reported problems with the adaptation process, even without adding smart-sound options and they are being monitored. The results of this audit will be used to inform clinical practice further and aid in the counseling of other recipients going through the transition.

The use of take home diaries on adult CI recipients to determine best practice for paediatric CI recipients, e-Poster 16 S. Johnston, A. O'Malley, A. Allen Audiology, Scottish cochlear implant programme, Crosshouse Hospital, Kilmarnock KA2 OBE

Aim To gain subjective information through patient diaries from adult Nucleus® 6 recipients using the wireless accessories and applying those outcomes to our paediatric practice.

Method Thirty-four experienced adult Nucleus® 6 recipients were fitted with a Cochlear™ Wireless Accessory of their choice (5 TV streamers, 15 MiniMics, 14 phone clips). The recipients were issued with a diary/questionnaire and asked to complete it over a six week period. The recipients were instructed to use the wireless accessories in a range of listening environments and then record their experiences.

Result TV Streamer: 5 recipients - 4/5 recipients using the TV streamer felt it worked well. 2 patients self-reported they did not need subtitles with use of the TV streamer. MiniMic: 15 recipients asked to try the MiniMic in 11 environments. Prior to use of the MiniMic 84/131 responses indicated that subjects could not hear well normally in that environment. With use of the MiniMic 117/131 responses indicated that subjects could hear in specified environment with the MiniMic. Phone Clip: 14 recipients were asked to report three different uses with their phone. Prior to use of the Phone Clip 34/42 could not hear well normally in that situation. With use of the Phone Clip 38/42 could hear well in that same situation.

Conclusion The ability to try these new products on adults is a valuable tool to assess the usage of products on a paediatric population. This study allowed us to gain confidence in the use of the wireless accessories through feedback from the adults and provided us with the confidence to recommend them for our paediatric recipients.

26 British Cochlear Implant Group Meeting 2016

Review of Cochlear's mini microphone in the educational setting, e-Poster 17 C. M. Peake Auditory Implant Service, University of Southampton, Building 19, Highfield campus, Southampton SO17 1BJ

Aim To review the use of Cochlear's mini microphone in educational and other settings, and to consider the practicalities and implications of its use other than for personal benefit.

Method A significant number of young people are choosing the mini microphone as the free accessory when upgrading to the CP 910 processor. A review was undertaken of the practical uses to which this device was put, both within and outside of the context of school. Views of students and teachers of the deaf were considered.

Result There is considerable dubiety as to whether the mini microphone should be routinely used as a radio hearing aid despite its obvious advantages, as there are also shortcomings which could impact upon the education of younger children.

Conclusion The mini microphone is ideally suited as a personal accessory in many contexts, and in particular finds considerable acclaim when used in conjunction with the Aqua accessory for swimming lessons. However, its use in the classroom for very young children should not be encouraged, and local authorities should see this piece of equipment as a way to avoid purchasing more appropriate radio aid systems for the students .

Does wireless technology improve speech perception and discrimination? e-Poster 18 A. Small, K. Munro, A. Allen Scottish Cochlear Implant Programme, University Crosshouse Hospital, Kilmarnock, Scotland KA2 0BE

Aim All four Cochlear Implant manufacturers have developed wireless technology with the aim of reducing the effect of distance and noise and allowing a cochlear implant user to better discriminate speech. This study aims to determine the extent of benefit from wireless technology, specifically from the Cochlear TV Streamer.

Method 20 patients were tested using standard BKB sentences. The sentences were randomly presented through speakers to the subject who listened through their processor microphones or presented through the Cochlear TV Streamer directly into the subjects processor. The sentences were scored and compared to determine any overall benefit from the technology.

Result Initial results from a small pilot study suggest that the wireless technology provides significant benefit in speech discrimination on BKB scores over those presented from the speaker.

Conclusion Using the wireless devices improves signal to noise ratio and reduces the effects of distance thus improving BKB scores. Anecdotally patients are very happy with the technology and using these devices allow them to achieve their potential, whether that is in an educational, a social or a work setting.

27 e-Poster abstracts

Acceptance evaluation of the Cochlear™ wireless mini microphone in secondary school-aged cochlear implant recipients, e-Poster 19 J. Bickley, C. Killan Yorkshire Auditory Implant Service, Bradford Teaching Hospitals NHS Foundation Trust, Listening for Life Centre, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ

Aim To evaluate the use of the Cochlear™ Wireless Mini Microphone in secondary school/college-aged cochlear implant users who were reluctant or non assistive listening device users.

Method Ten cochlear implant users in college or secondary school aged 12 to 18 took part. They were provided with a wireless Mini Microphone and asked to complete a diary as they used it in seven educational situations. The situations assessed were lesson or lecture, group work, meeting or tutorial, TV/screen, computer, break or lunchtime, and one other situation of their choice for example assembly. The local teacher of the deaf and school staff were also asked to comment on the student's use of the Mini Microphone. Students also rated the Mini Microphone in 6 general listening environments.

Result All ten participants returned the diary, and gave considerable written feedback about their experience. The Mini Microphone was found to be very helpful for TV/screen and computer use with 3 and 4 students respectively finding it better than their current provision, and no students rating it worse. In a group situation, 3 students found the Mini Microphone worse than their current provision and 5 the same. Students were generally reluctant to use the Mini Microphone at break and lunchtime as they found it embarrassing. School staff were generally impressed by the Mini Microphone and found it discreet and easy to use. Students also liked the design and wireless streaming.

Conclusion The Cochlear™ Wireless Mini Microphone provided benefits in some listening situations for college and secondary school students who were reluctant or non users of assistive devices. Seven of the ten students have continued to use the Mini Microphone in some educational situations. We would recommend a trial of a Mini Microphone for students who are reluctant, unable or refuse to use assistive listening devices.

Development of guidelines for clinics to advise patients being upgraded or fitted with cochlear CP910 processors, on which cochlear wireless accessory may be most appropriate for them, e-Poster 20 J. Humphries, H. Gilpin Oxford Auditory Implant Programme, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU

Aim The aim of this study is to ascertain what influences patient choice of device and to create guidelines on which wireless device is suitable for different types of people.

Method Since Cochlear have introduced the wireless accessories which are compatible with CP910 processors, Oxford have undergone a programme of offering all patients who already have their CP910 processors and are eligible to receive a free of charge device, a choice of all three devices. Uptake of the offer has been good and over 70 accessories have been fitted to this group of patients. We have sent patients a questionnaire asking for feedback about their device of choice, whether they feel they made the right choice, and specific lifestyle questions.

Result We will present the results of this qualitative study and draft guidelines for clinics to use.

28 British Cochlear Implant Group Meeting 2016

21. Outcomes for a new programme of auditory verbal therapy for six children in Belfast, e-Poster 21 L. Hönck, S. Hogan Auditory VerbalUK ,Bignell Park Barns, Chesteron, Oxon OX26 1TD

Aim To describe the outcomes of a one-year programme of auditory verbal (AV) therapy introduced in Belfast from May 2014 to June 2015.

Method A parent-support group raised the necessary funds to engage an LSLS Cert AV therapist for a year of 8 AV therapy sessions that allowed for up to 6 children and their families to participate in AV sessions. Families were visited by an AVT every 6 weeks for a face-to-face session in their homes. Skype sessions were offered to families in between the 6 weeks and 2 families took this opportunity. Each child's local therapy team was engaged with the process and involved in close liaison with the AV therapist.

Result Of the 6 families who embarked on the programme with their child, 5 participated for the entire year. Three of those children demonstrated accelerated language acquisition i.e. more than one year's language growth in the 12 months. One child increased their rate of language development to 0.83 over the year from 0.67 prior to the programme. The fifth child made slower progress having been implanted at 4 years of age without prior benefit of amplification. Since completion of the study, 3 other families from Belfast have enlisted in our AV programme. Two professionals working with these families have been supported financially to continue their professional development by training further in the AV approach. The learnings from this project have helped to shape a model of therapy delivery and training that is being rolled out to other areas of Europe.

Conclusion The one-year project funded by the efforts of a parent-support group has shown that effective habilitation can maximise the potential of individual children with hearing impairment and also maximise the potential of `parent-child' interactions. It has contributed to the continuing development of professionals working in the field of hearing impairment and has resulted in a financial investment of services for children with hearing-impairment.

22. Education of rehabilitation experts from emerging markets and international rehabilitation academy, e-Poster 22 D. Herrmannova Senior Education & Special Projects Manager, Emerging Markets and Disadvantaged Groups, MED-EL HQ; Innsbruck, Austria

Despite of overall difficult economic situation in developing countries there are still various ways to finance cochlear implants (private, charity, governmental programs). Especially third world countries have poor infrastructure of specialists, awareness about CI and rehabilitation availability. Everybody has the right to hear in spite the economic situation of the potential CI candidate. The lecture will explain the need to work on systematic building up the infrastructure and education of local experts to make it happen. MED-EL supports infrastructure for CI users, making sure they have good services, rehabilitation, education, trained experts . We designed for that reason International Rehab Academy to intensively support emerging markets and applying it in different regions for last 3 years. International Rehab Academy is an international education and rehab tool supporting experts working with hearing impaired of all age groups and needs. It is structured, continuous and systematic rehab education available in different regions for rehab experts, therapists, students, parents. Designed are 8 education modules & workshops. All modules follow holistic, natural rehab and education approach. Set of modules covers the most important rehab topics and goes through the theory to practice. Whole concept of the trainings and support will be explained during the presentation as well as the results / statistics from last 3 years from different developing countries and regions.

29 e-Poster abstracts

23. Maximising the potential of the parent child partnership, e-Poster 23 C. White, R. Quayle, L. Hönk, E. Tyszkiewicz†, S. Hogan Auditory VerbalUK and †Midlands Hearing Implant Programme, Bignell Park Barns, Chesteron, Oxon OX26 1TD

Aim For those parents embarking on a programme of Auditory Verbal (AV) therapy, to determine the common markers that separate the changing levels of confidence and competence that parents experience in supporting their child with hearing impairment to acquire listening and spoken language skills. The role of the therapist is to work in partnership with parents towards their chosen goal of listening and talking. This involves guiding and coaching them as they journey from not knowing what is possible for their child to reaching their long-term hopes of their child listening and talking alongside their hearing peers.

Method A retrospective analysis of inferred family attitudes to determine common markers of change during individual Auditory Verbal (AV) programmes.

Result The Stokes' Six-Step Parental Journey is a model depicting the distinct stages of parental engagement that are required in order to achieve full engagement and hence, optimise outcomes. This model serves as a diagnostic tool for therapists to use to evaluate the level of parental engagement and gives helpful strategies for the therapist to facilitate better parental engagement.

Conclusion Parental engagement is central to the success of AVT. The Stokes' model identifies six distinct stages of the journey that are required for full parental engagement. This model provides the therapist with a useful tool for monitoring the level of parental engagement and offers practical strategies for the therapist to help parents transition from one level to the next, thereby improving outcomes.

24. Cochlear implants and social media, e-Poster 24 E. Stapleton Scottish Cochlear Implant Centre, Crosshouse Hospital, Kilmarnock, KA2 0BE

Aim Social media usage is at an all-time high. The BCIG has its own Twitter account. Online information and interaction has always been particularly useful for people with hearing loss, and social media is a valuable tool for the dissemination of information by companies and research groups. The aim of this project was to analyse the use of Twitter in the discussion of cochlear implantation.

Method An advanced Twitter search was used to identify discussion of cochlear implantation on the social media website during 2015 in the English language, using both hashtags and plain text. Results were analysed according to the group or individual tweeting, and the nature of the information tweeted.

Result 12,392 cochlear implant themed posts were tweeted during 2015. The main groups tweeting were cochlear implant companies, deaf charities, and current implantees. Other prominent groups and individuals included potential implantees, individual clinicians, professional societies, private clinics, NHS trusts, research groups, support groups, and news providers. The main topics of discussion were news stories, research and technology, personal experience, and the promotion and discussion of events relating to cochlear implantation. Potential implantees largely post on Twitter in order to seek information about cochlear implantation, whereas current implantees (and parents of paediatric implantees) tend to post about their personal experiences.

Conclusion Twitter provides accessible information for patients and other interested parties, and is widely used by companies and research groups to disseminate relevant information. The use of the hashtag enables users to quickly identify information which is relevant to their needs and interests.

30 British Cochlear Implant Group Meeting 2016

Refinement and validation of a 'music-related quality of life' measure for adult cochlear implant users, e-Poster 25 G. Dritsakis, R. M. van Besouw, C. A. Verschuur University of Southampton, Faculty of Engineering and the Environment, Institute of Sound and Vibration Research, ISVR, University of Southampton, Highfiled, Southampton SO17 1BJ

Aim A prototype self-report questionnaire assessing aspects of the quality of life (QoL) of cochlear implant (CI) users that relate to music has been developed by the authors with adult CI users and professionals. The new instrument is intended to be used for the evaluation of music rehabilitation and as a music-specific clinical tool for routine assessments. The aim of the present study was to select the most useful items and assess the psychometric properties of the new instrument.

Method Classical test theory psychometric techniques were employed. The Music-related QoL (MRQoL) questionnaire was completed twice with a 2-week interval by 146 prelingually and postlingually deaf adult CI users. In addition, participants completed the Short-Form Health Survey (SF-12v2). The MRQoL questionnaire was also completed by 142 normal-hearing (NH) adults. CI users' responses to the MRQoL questionnaire are currently being analysed to determine redundant items and to assess test-retest reliability and internal consistency. Correlations between CI users' responses to the SF-12v2 and MRQoL are also being explored to assess construct validity. MRQoL responses of NH adults are being compared with those of CI users for construct validation.

Result In this presentation, the questionnaire's subscale structure and how items for the final version were selected will be presented. Reliability test results on the final item set, the extent to which CI users' MRQoL questionnaire scores and SF12v2 scores correlate, and the difference between the MRQoL questionnaire responses of CI users and NH adults will be shown. The ability of the measure to discriminate between individuals (of different age, duration of hearing loss, musical background) will also be seen.

Conclusion The presentation will conclude by considering the reliability, sensitivity and validity of the MRQoL questionnaire with a view to clinical utility. The advantages of the MRQoL questionnaire and practical issues with regard to using the questionnaire in clinic will also be discussed.

The development of an online training course for carers of older CI recipients, e-Poster 26 J. Brinton Julie Brinton Consulting, Romsey SO51 8JA

Aim All the forecasts indicate that by 2031 the number of people aged 60 or over is expected to pass 20 million (Later Life in the United Kingdom, June 2011, AgeUK). The report also reports that as of June 2014 “about 6.4 million people aged 65+ have some form of hearing loss; around 685,000 of these are severe/profound”and that the population of people over 65 will increase significantly over the next 20 years. Inevitably this will include those with cochlear implants (CI), both those implanted in early or middle adulthood or those implanted as older people. Some of these CI recipients will at some time require support within their homes or they will need to move to somewhere with more care.

Method An online training course with an integrated test has been designed for carers of older people who might be in their own home with support or those in residential care. This has been shown to a number of focus groups for feedback. Carers have indicated that they found the course of interest and written in a way which is comprehensible for their needs.

Result The information contained in the course covers in simple language: a basic introduction to hearing loss, the components of a cochlear implant processor, trouble shooting problems with the processor and tips for improved communication with a CI recipient.

Conclusion The course will be hosted on the Advanced Bionics web site and once the learner has finished the course they can complete the test online and receive a certificate of basic competence for their portfolio of learning when they have reached a satisfactory level of correct responses.

31 e-Poster abstracts

Cochlear implantation in children with complex needs - The perceptions of professionals at cochlear implant centres, e-Poster 27 S. Archbold, S. Athalye, I. Mulla, N. Wolters-Leermakers, J. Isarin, H. Knoors Research Programme, The Ear Foundation, 83 Sherwin Road, Nottingham NG7 2FB

Aim While the majority of profoundly deaf children now receive cochlear implants in developed countries, there has been caution about those with complex needs. Relatively little is known about the effects of implantation for children with complex needs, the decision making process prior to implantation, or experiences of parents and professionals.

Method In order to gain insight into the process of assessment and management of children with complex needs being considered for implantation, a survey of those professionals working at cochlear implant centres was undertaken. Responses were obtained from 7 centres in the Netherlands and from 8 centres in the UK.

Result Children with complex needs were more likely to be later referred than the norm, and more likely to take longer to assess. The most commonly seen additional disability was visual, followed by motor/physical challenges and autistic spectrum disorders. The most reported challenge was assessment, followed by parental expectations, and wearing the system: the least reported concern was educational management. Furthermore, there was little agreement about the assessments used prior to implantation, or in follow up. A huge diversity of assessments were used, making gathering of common long-term data impossible currently. All centres commented on the importance of parental observation, mentioning smiling and contentment observations.

Conclusion This study reveals little agreement about the management of children with complex needs or the measurement of appropriate outcomes. These children may be disadvantaged by later implantation than usual. There is a need for the development of a parent-driven outcome measure for these children. Sharing protocols and expertise in this low incidence group is vital to maximise benefits from implantation and may promote earlier referral; closer collaboration with educators, particularly those with other expertise, would facilitate long-term management. Objective measures of changes in auditory functioning would improve understanding of qualitative observations; data logging, now available, will help monitor wearing and use of system.

Parental experience of the cochlear implant assessment process - Children with multiple disabilities, e-Poster 28 L. Edwards, L. Rathborne, M. Mahon Cochlear Implant Programme, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH

Aim This study aims to gain insight into parent's perceptions of the cochlear implant assessment process for deaf children with multiple disabilities, in order to improve the process and experience for this group of children and their parents. The need for this information arises from the increasing number of children being assessed who have multiple disabilities, and the mixed feedback received informally by clinicians about parental experience of the assessment process, both negative and positive.

Method Semi-structured interviews comprising nine questions (with additional probes for use as required) were conducted with ten parents of seven children who had completed the cochlear implant process at GOSH. The interviews were transcribed verbatim, and Thematic Analysis used to analyse their content.

Result Two primary inter-related themes were identified: emotional responses to the cochlear implant assessment process, and level of information needed. Several sub-themes were also identified including difficulty adjusting to the information received, emotional support, logistic difficulties and leaving decision-making to the professionals.

Conclusion As expected there was a high degree of variability in parent's perceptions and experience of the assessment process. However a number of important themes emerged which paediatric cochlear implant teams should be aware of when assessing children with multiple disabilities in order to reduce the level of anxiety and stress experienced by parents during the process.

32 British Cochlear Implant Group Meeting 2016

Children with autism and cochlear implants - An audit, e-Poster 29 F. Bathgate, M. Prestidge, I. Dunn, R. Kentish, L. Partridge Cochlear Implant Team, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH

Aim To survey the children with Autism Spectrum Disorders (ASD) in paediatric cochlear implant centres.

Method Routine data collected by implant centres was collated for those children with a diagnosis of ASD. For example, aetiology of deafness, age at implant, age at ASD diagnosis, communication mode, speech intelligibility rating, etc.

Result TBA.

Conclusion In this survey, children with cochlear implants and ASD are as varied in the extent to which they develop language as children with ASD and normal hearing.

Specific ways to work and support of CI children with severe complex needs and assessment and rehabilitation tools, e-Poster 30 D. Herrmannova Senior Education & Special Projects Manager, Emerging Markets and Disadvantaged Groups, MED-EL HQ; Innsbruck, Austria

Many studies confirm that during the last two decades the population of children with complex needs has grown. In particular, a greatly increased number of very premature babies are now surviving through advanced medical care where this is available. However, up to 40% of very early born babies have significant and permanent disabilities. These frequently include difficulties in the areas of hearing, vision, kidney function and respiration. Society can now offer much to premature babies. Multiple disabilities can cause fatigue and frustration in dealing with everyday situations, especially: communication, learning, orientation and mobility, social relationships (isolation, lack of confidence and self-esteem), independence in daily living skills, access to information, access to education, access to employment, access to aids and equipment (because of cost), access to interpreters. Significant changes have taken place, and continue to take place, in the tools and technology to support them. One example is the Cochlear Implant (CI): this can benefit children who are profoundly deaf, including those with complex additional needs. Cochlear implants can bring benefits across a range of areas, including listening, the development of communication, psychosocial skills, and pre-academic and academic function. However, there are differences in the type of benefits cochlear implantation will bring to children who are deaf with complex additional needs and to those whose primary need is caused by deafness alone. By using standard tests, it is sometimes difficult to measure different benefits from CI for complex needs children. Also the rehabilitation strategies to develop different listening skills, communication and social skills are different than strategies usually used with hearing impaired children without additional disabilities. MED-EL has useful materials supporting children with severe complex needs: Rehab tool: WE CAN! designed to support the specialists working with children cochlear implant users with severe complex needs to help them to develop effectively their communication, listening skills and also music skills . This rehabilitation package WE CAN! contains 2 textbooks, DVD with the videos, sounds, poems and songs and there are also rehabilitation tools included to the package. Assessment tool: MED-EL Quality of Life Improvement of Hearing Impaired Children with Complex Needs and Their Families Related to Cochlear Implant Use ‘QLICI . « QLICI’ is to highlight different but significant benefits for children with severe complex needs which they can get from CI and impact of this device for quality of life for this population of children and their families. Both of the materials will be introduced during the lecture.

33 e-Poster abstracts

Outcome of cochlear implantation in children with auditory neuropathy spectrum disorder and correlation with age at implantation - St. Thomas' experience, e-Poster 31 C. Leal, A. Montgomery, I. Pai Hearing Implant Centre (Paediatric), GSTT, 2nd Floor, Lambeth Wing, Westminster Bridge Road, St Thomas' Hospital, London SE1 7EH

Aim Recent research has shown efficacy of cochlear implants (CI) in Auditory Neuropathy Spectrum Disorder (ANSD). CI provides supraphysiologic electrical stimulation of the auditory nerve and may improve the synchronicity of neural activity. However, in our experience very few children with ANSD are referred for CI assessment and most are referred too late for optimal speech and language development. In this study we present the CI outcomes in children with ANSD from St Thomas' Hearing Implant Centre and discuss the correlation between outcomes and age at implantation.

Method This was a retrospective case series study of children with ANSD who underwent cochlear implantation at our centre. Only children with normal imaging were included. Outcome measures included Meaningful Auditory Integration Scale (MAIS), Category of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR).

Result Five children were bilaterally implanted, with a mean age at implantation of 51.8 months (range 11 - 104). One child implanted at 69 months of age is an inconsistent user. All other children showed improvement in their MAIS, CAP and SIR scores, and are good users. Greatest benefit was observed in the youngest implantee (11 months).

Conclusion Although the outcomes for CI in children with ANSD may vary due to the heterogeneous nature of the condition, our experience suggests that early CI intervention benefits the development of speech and language. We recommend an early referral for these children to an implant centre, where their progress can be closely monitored in a multi-disciplinary environment and prompt intervention implemented if necessary.

Cochlear implantation for hearing rehabilitation in patients with neurofibromatosis type 2, e-Poster 32 H. J. D. North, D. Mawman, M. O'Driscoll, S. R. Freeman, S. A. Rutherford, A. T. King, C. Hammerbeck-Ward, D. G. Evans, S. K. Lloyd Richard Ramsden Auditory Implant Programme and Manchester Skull Base Centre, Central Manchester Foundation Trust and Salford Royal Foundation Trust, ENT Department, Stott Lane, Manchester M6 8HD

Aim Hearing rehabilitation in NF2 is complex. Bilateral cerebellopontine angle (CPA) disease, usually bilateral vestibular schwannomas, results in progressive bilateral hearing loss. Similarly, treatment of CPA pathology often results in profound hearing loss. For untreated or radiotherapy treated tumours, cochlear implantation was traditionally not used in patients with vestibular schwannoma due to concern that retrocochlear disease would render the implant ineffective. There has, however, been some recent evidence that this assumption is incorrect and furthermore cochlear nerve preserving surgery is possible. This paper discusses cochlear implantation in patients with NF2 at the Richard Ramsden Auditory Implant Programme.

Method A retrospective analysis of audiological outcomes in all patients with NF2 under the care of the Manchester NF2 service who were offered cochlear implants was undertaken. Outcome measures included CUNY (City University of New York) and BKB (Bamford-Kowal-Bench) word recognition scores. There were two main groups within the cohort. Group 1 included those patients undergoing surgery for tumours less that 10mm in the CPA who had their cochlear nerves preserved. This included patients having a translabyrinthine approach together with those who had failed retrosigmoid hearing preservation surgery. Group 2 included patients with stable tumours but deteriorating hearing.

Result Thirteen patients with NF2 were implanted from 2004 to 2015. There were seven patients in group 1 and six patients in group 2. Ten patients were active users. Two patients were implanted as sleepers and are not currently using bimodal hearing. Only one patient did not receive benefit from the cochlear implant and proceeded to have an auditory brainstem implant. Of the users, the median CUNY score with lip reading was 98, the BKB in quiet was 90 and the BKB in noise was 68. Detailed audiological outcomes will be presented. None of the patients suitable for cochlear implantation had prior treatment with radiotherapy on their ipsilateral side of implantation and no patients were treated with Bevacizumab.

Conclusion Although the extended indications for cochlear implantation are possible only in a small group of NF2 patients, when possible they result in hearing outcomes that easily surpass the audiological outcomes of the alternative auditory brainstem implants. 34 British Cochlear Implant Group Meeting 2016

'A leap of faith' - Remote intra-operative testing - A Belfast prospective, e-Poster 33 A. Speers, J. G. Toner, A. Keenan, J. Mailey Auditory Implant Centre Belfast, Belfast Health & Social Care Trust, Level 2. Beech Hall Well Being & Treatment Centre, 21 Andersonstown Road, Belfast BT11 9AF

Aim In January 2013 the Auditory Implant Centre relocated its premises. This posed unique working challenges for the service as ENT wards and operating theatres were hospital based approximately a round trip of 4 miles away. This also coincided with staffing issues as only 1 scientist was available to perform intra operative testing. Time for some “Lean” thinking ….. The aim of the poster is to evaluate the usage of the Cochlear ™ Nucleus ® CR220 remote intra operative system to establish its feasibility and clinical effectiveness in the modern day implant centre.

Method A retrospective comparison was made of 20 patients tested with the conventional intra operative system and 20 subjects using the Cochlear ™Nucleus ® CR220 intra operative system. Average mean length of test time and changes in the quality of test measures, namely impedance telemetry and auto neural response telemetry were analysed.

Result In total 20 surgeries were completed using the remote system from a possible total 29 surgeries between March 2015 - January 2016. There was a significant difference in the average length of test time between the two systems. There was no significant difference between impedance telemetry and auto neural response telemetry measurements of conventional and remote intra operative testing.

Conclusion Remote intra operative testing appears to be an accurate and trustworthy solution to conventional testing. This has resulted in the significant reduction of staffing requirements and has financially benefitted the Centre. It is time saving and cost efficient in the day to day running of our Centre.

The use of telepractice in the assessment and management of patients with hearing implants - A pilot study, e-Poster 34 A. Montgomery, S. Driver, C. Bartrop, H. Walters, K. Webb St Thomas' Hearing Implant Centre, Guys and St Thomas’ NHS Foundation Trust, 2nd Floor Lambeth Wing, Westminster Bridge Road, London SE1 7EH

Aim Internationally, there is a growing evidence base supporting the use of telepractice in clinical settings (Constantinescu, G et al. (2014), Rangarathnam B, et al. (2015), Valentine, D.T. (2014)). Our location in central London means that we receive referrals from greater London, and the South East and South West of England. We also provide services to the population of cochlear implant users on the island of Jersey. As a team we are constantly searching for new ways of improving patient care and maximising our clinical time and space. Telepractice is a tool we are trialing. We wanted to investigate and evaluate the role that telepractice can have on the assessment and ongoing management of children and adults with hearing implants.

Method We consulted the trust policy relating to the use of technology/ telepractice and met with our enterprise architect and Information Governance (IG) teams. After this consultation we initiated a pilot study, introducing telepractice to patients in both our paediatric and adult populations. We considered the location, acoustics, lighting, and backdrop for our telepractice sessions to ensure we had created the best environment. We polled patients using a structured questionnaire and then conducted test calls, evaluating the technology and environment with the patient. We connected with patients and families using a computer-based system (Skype and FaceTime). We evaluated the clinical content and technology after each telepractice session.

Result We have introduced telepractice sessions at different points in our care pathway, for both paediatric and adult populations. We have created a “blended service” offering both clinic and telepractice sessions throughout our care pathway for a small group of patients. We have completed assessment and therapy sessions using telepractice and evaluated both the technology and clinical content at the end of each session. Feedback from patients and professionals is positive.

Conclusion Our results to date illustrate that telepractice can enhance patient care and that it can be used as part of a “blended service” delivery model.

35 e-Poster abstracts

Feasibility of telemedicine in paediatric rehabilitation after cochlear implantation, e-Poster 35 T. Twomey, J. R. Inscoe Nottingham University Hospitals NHS Trust (ENT), Nottingham Auditory Implant Programme, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU

Aim Although delivery of cochlear implant support via the internet is becoming increasingly popular, the introduction of safe and effective patient appointments by this method requires careful evaluation of the technical and clinical viability, together with the clinical and cost-effectiveness. Our goal is to evaluate which components of our paediatric outreach support (rehabilitation) pathway can be undertaken through tele-consultation, with a view to improving both the patient experience and the cost-effectiveness of our service, whilst maintaining the clinical effectiveness and adhering to stringent NHS information governance (IG) requirements. Our first step is to evaluate the interest and willingness of families to receive support by this.

Method To evaluate the interest and willingness of families to receive support by this means, together with the technical feasibility of undertaking appointments using their own current technology, we surveyed parents of children who had been implanted in the last 3 years. Questions included their interest in taking part, what technology they had available and how confident they were at using Skype/Facetime media. Clinicians also identified local professionals who would be interested in trialling WebEx meetings in clinics and schools. NUH IT department provided WebEx training to staff, advice on equipment and IG issues and assistance setting up conference cameras with existing NAIP laptops.

Result This information was evaluated by NAIP and the IT department to determine the technical feasibility, service-user acceptance and clinical and cost-effectiveness of this approach. Learning outcomes will be shared.

Conclusion The technical feasibility, service-user acceptance and clinical and cost-effectiveness of this approach will be discussed together with the implications for increased choice of service delivery methods and patient care.

Remote programming of sound processors - The Scottish experience, e-Poster 36 K. Munro, A. O'Malley, A. Allen Scottish Cochlear Implant Programme, Crosshouse Hospital, Kilmarnock KA2 0BE

Aim As cochlear implants (CIs) have become more sophisticated over time with more options to customise map parameters the need for custom programming is more important now than ever to ensure we maximise each patient's hearing potential. Whilst this is delivered by specialised CI services, the NHS is being encouraged to deliver localised services.

Method To facilitate this we have developed our remote programming system to allow us to deliver high quality care with the expertise of the national cochlear implant programme at a local level.

Result This has been successful. We will present the technical requirements including solutions to problems encountered. We will also describe how we have made this more accessible to a wider group of patients and share their feedback.

Conclusion This new technology is allowing us to maximise the patients hearing potential whilst delivering remote programming on their doorstep without reducing quality of care.

36 British Cochlear Implant Group Meeting 2016

Surgery webcasts - LION v MED-EL Webgate Media - Quality of transmission, surgery and benefits of `communal' v `solo' viewing? e-Poster 37 S. Backhouse, V. Jaiswal, A. Davies, R. Murphy, R. Miah, D. Owens Department of ENT, Bridgend Cochlear Implant Programme, Princess of Wales Hospital, Coity Road, Coity Road CF31 1RQ

Aim Theoretically internet webcasts provide a cost effective, environmentally friendly way for otologists to access CPD. The Live International Otolaryngology Network (LION) aims to promote quality continuous surgical education programmes for otologists worldwide, using distant learning videoconferencing technology over the last 10 years. More recently, in 2015, MED-EL launched their online Surgical Video Library Webgate. We organised a `communal' viewing in Wales of the 10th LION Otology Annual Broadcast 2015 to assess by questionnaires the broadcast quality & educational experience of attendees to give validity for CPD accreditation by RCSEdinburgh & ENTUK. The senior author then compared the `live LION' vs 'pre-recorded MEDEL' surgeries.

Method A free viewing on Tuesday 12th May 2015 for otolaryngology & allied professionals in Wales of the 10th LION Otology/Neurotology Broadcast event at the Princess of Wales Hospital, Bridgend. 2 feedback questionnaires assessed this communal viewing event for broadcast quality, content, educational benefit and CPD accreditation. The senior author subsequently viewed comparable but pre-recorded CI surgeries on the MED-EL Surgical Video Library Webgate.

Result 15 delegates (5 ENT consultants of which 3 were CI surgeons, 6 ENT trainees, 1 ENT SAS, 2 audiologists & 1 audiology student) attended and completed questionnaires. 71% had watched a LION broadcast previously & all felt that the communal broadcast was better than viewing alone. All delegates agreed: that they would re-attend a communal LION broadcast; they would recommend colleagues attend; the local Welsh expert Faculty added benefit and educational value; perceived broadcast transmission quality, surgical technique and discussion were generally good across both channels; the venue for the screening had good facilities & location; the CPD certification accreditation was valued highly. 93% recognised value from allied professions presence.

Conclusion Communal viewing of the LION Global Otology Surgical Internet Broadcasts adds value and educational benefits for the delegates in attendance. Recommendations were made to improve future LION communal broadcast viewings. Comparatively, the senior author felt that overall, although lacking interactivity the broadcast quality was better on the pre-recorded MED-EL Surgical Video Library Webgate. Surgery webcasts are an invaluable tool for widespread education and dissemination of surgical proce- dures. The excitement and benefit of seeing `real-time problem solving' with live surgery must be weighed against the measured and pre-determined high quality cases of surgery and image that can be obtained by viewing pre-recorded optimal surgeries.

An audit into the clinical effectiveness of annual reviews in the adult CI population, e-Poster 38 V. Soobrayen, J. Bradley, A. van Rooyen Cochlear Implant Department, RNTNE Hospital, 330 Grays Inn Road, London WC1X 8DA

Aim An audit of annual reviews in the Adult Population of Cochlear Implant (CI) users at the RNTNE Hospital was initiated to look at how practical Annual review appointments were in light of increasing workloads and patients. The Audit also aimed to look for any key indicators in identifying subsets of patients that would need to be reviewed on a more regular basis.

Method An audit of Adult annual reviews were looked at from January 2014 to April 2015. The annual reviews ranged from 2 years to 22 years post surgery. Patients were arranged into groups pending on how long they had been implanted. For each patient, various criteria were looked at to see if any significant changes had taken place. The factors considered were as follows: Telemetry, BKBs, Soundfield thresholds, map parameters and external equipment changes. It was also noted whether the patient reported any concerns and whether any onward referral was made. The data was analysed to appraise the outcome.

Result From preliminary results, over two thirds of patients required a change in map, half of the subjects reported concerns with their Implant, a third needed intervention as determined by a Clinician and a fifth have been referred onward to other health practitioners or for integrity tests of CI function.

Conclusion The Audit determines the need for regular Annual reviews to ensure that patients continue to derive maximum benefit from the Cochlear Implant as-well as to identify areas of concern so they can be dealt with effectively. Looking at certain indicators such as duration of Implant usage may allow Clinicians to identify which patients need to be reviewed on a regular basis when clinic resources are limited. 37 e-Poster abstracts

Randomised control trial of remote care for adult cochlear implant users, e-Poster 39 H. Cullington, P. Kitterick, L. DeBold, M. Weal, N. Clarke, E. Newberry, L. Aubert University of Southampton Auditory Implant Service, University of Southampton, Building 19, Highfield, Southampton SO17 1BJ

Aim Many resources are required to provide post-operative care to cochlear implant recipients. The implant service commits to lifetime follow-up. The patient commits to regular adjustment and rehabilitation appointments in the first year and approximately annual follow-up appointments thereafter. Offering remote follow-up may result in more stable hearing; reduced patient travel expense, time and disruption; more empowered patients; greater equality in service delivery and more freedom to optimise the allocation of clinic resources.

Method This is a two-arm feasibility Randomised Control Trial (RCT) involving 60 adult cochlear implant users with at least 6 months device experience in a 6 month clinical trial of remote care. A person-centred long-term follow-up pathway has been designed and implemented offering a triple approach of remote and self-monitoring, self-adjustment of device and a personalised online support tool for home hearing testing, information, self-rehabilitation, advice, equipment training and troubleshooting.

Result Sixty adult cochlear implant users from around the UK are enrolled. The main outcome measure is patient activation. Secondary outcomes are stability and quality of hearing, stability of quality of life, clinic resources, patient and clinician experience, and any adverse events associated with remote care. We will examine the acceptability of remote care to service users and clinicians, the willingness of participants to be randomised, and attrition rates. The trial ends summer 2016; interim results will be available.

Conclusion This is the first RCT of a triple approach to remote care for cochlear implant users. The study results will inform further work on a larger scale roll out of cochlear implant remote care in the UK.

Using the NICE criteria for selecting pre-lingually deafened adults for cochlear implantation is not good enough anymore, e-Poster 40 E. Dyason, F. Pinto Auditory Implant Department (Adult programme), Royal National Throat Nose and Ear Hospital, 330 Grays Inn Road, London WC1X 8DA

Aim To ensure that pre-lingually or early deafened adult patients are selected appropriately for a cochlear implant to avoid this group of patients becoming non-users. Also to formalize a protocol for assessment and management of this cohort to ensure a successful outcome which is more robust than just utilizing the NICE selection criteria.

Method A retrospective medical notes review was performed on 16 pre-lingually deafened adults from our CI department. We looked at the duration of deafness, aided history, total number of appointments pre and post implantation, additional appointments required, open set speech perception results at pre-implant, three months and one year post implantation, this includes BKB sentence tests and CUNY sentence testing. Datalogging was also analysed. We also looked at the main mode of communication pre-op and looked at their rated speech intelligibility (SIR).

Result The average duration of deafness at implantation was 41.8 years. All patients have been wearing hearing aids consistently since childhood on the ear that was implanted. Out of the 18 subjects, 50% required at least two additional appointments after the activation period following the 3 month review. Data logging from 9 patients at their three month review appointment revealed that they used their processor for twelve or more hours a day. The speech perception scores indicated an improvement with and without lipreading with sound. Half of the patients used oral language alone, whereas just under half of the patients were oral and BSL users. Only one patient was predominately a BSL user.

Conclusion The results indicate that with careful selection by a multi-disciplinary team, we can implant pre-lingually deafened adults with a successful outcome which minimizes the possibility of these adults becoming non-users or having periods of consecutive non-use (eg. for months). We have reached this conclusion through adapting our selection criteria and have formalized a protocol in managing them for the first year post implantation.

38 British Cochlear Implant Group Meeting 2016

Challenges in cochlear implant assessment and candidacy for children with partial hearing, e-Poster 41 K. Hanvey1, K. Wilson2, M. Ambler1, M. Jenkins2, D. Jiang2, J. Maggs1, K. Tzifa1 1. Children's Service, The Midlands Hearing Implant Programme, Optegra Building, Birmingham, B4 7ET 2. Audiology Department, St Thomas' Hospital Hearing Implant Centre, 2nd Floor Lambeth Wing, London, SE1 7EH

Aim In recent years hearing preservation surgical techniques have allowed children with partial hearing to be considered for cochlear implantation. In the UK, such children are likely to have profound high frequency hearing loss within current NICE guidance, and much better hearing in the low frequencies. Pre-referral, these children are often reported to be “doing well” with their hearing aids, however audiological, speech and language testing and academic progress may indicate otherwise. Early intervention is an established principle of cochlear implantation for congenitally deaf children. Yet there can be concerns around offering cochlear implants to young children with partial hearing. These concerns, along with trying to ascertain `sufficient' benefit from hearing aids can make early referral, assessment and counselling more challenging for this client group than for more routine paediatric cochlear implant cases. This paper will review the additional challenges faced during assessment along with the multi-disciplinary team approach we use when considering cochlear implants for children with partial hearing. Surgical considerations and challenges around post-operative support and measurement of benefit will also be discussed, including the importance of timely intervention in this client group.

Method We undertook a retrospective review of 28 children with partial hearing who were implanted at our two centres between 2008 and 2015.

Result Functional improvements are seen in listening and speech intelligibility for most children by comparison with pre-implant performance. Challenges related to non-use and limited improvements in speech intelligibility are seen with older children.

Conclusion Early implantation is equally important for children with partial hearing as with more `traditional' candidates. In our clinical opinion, children with partial hearing make better progress with cochlear implants than they do with their hearing aids, irrespective of the amount of hearing that is preserved. More professional education is required for timely referral and skilled multi-disciplinary assessment is essential for cochlear implant teams to have the confidence to implant children with partial hearing in a timely manner.

Outcomes in implanted older children who do not meet the adult candidacy criteria, e-Poster 42 F. Vickers The Royal National Throat Nose and Ear Hospital, University College London Hospitals, 330 Grays Inn Road, London WC1X 8DA

Aim Severe to profoundly deaf adults who score 50% or over on the Bamford-Kowal-Bench (BKB) sentence test currently cannot obtain NHS funding for a cochlear implant according to the NICE guidelines (NICE Technical Appraisal Guidance (TAG166), 2009). There is no cut off restriction from the BKB score for children. This study challenges this restrictive criteria for adults, by presenting the outcomes of cochlear implantation in older children who scored over 50% on BKB sentence testing pre-implantation and therefore would not have been implanted under the adult NICE guidelines.

Method Subjects were presented with the Speech, Spatial and Qualities of Hearing Scale Version C (SSQ-C) (developed by Noble and Gatehouse, 2004) between the 7 and 18 month interval post-implantation. They were asked to assess their hearing ability in the present condition with their cochlear implant/(s) compared to their previous hearing aids, across a large number of listening situations using a scale from -5 to +5. A score of +5 meant they thought their hearing was much better with cochlear implants than hearing aids, whereas -5 meant they felt the hearing aids were significantly better.

Result The outcomes across all the different listening domains from the SSQ-C questionnaire are presented across the 17 subjects. The results show subjects reported their cochlear implants to be better than their previous hearing aids in the vast majority of listening situations.

Conclusion The findings of the SSQ-C in this study provides evidence that the subjects hearing improved substantially following implantation, and therefore were deemed as very successful candidates. A review of the NICE criteria for adults is recommended.

39 e-Poster abstracts

What difference has a cochlear implant made to born deaf congenitally deafened adults? e-Poster 43 T. L. Wright, C. A. Fielden, S. Jervis, H. R. Cooper Midlands Hearing Implant Programme (Adult Service), University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital Audiology Centre, Nuffield House, Birmingham B15 2TH

Aim Recently there has been an increase in the numbers of congenitally deafened adults seeking a referral for cochlear implantation. These 'non-traditional' candidates fall within National Institute for Health and Care Excellence (NICE criteria for unilateral implantation in adults in the UK. However, many of them are unable to complete the outcome measures typically used in cochlear implant recipients due to limited respective speech and language. The key question of the focus group was to determine the differences having a cochlear implant has made to their lives.

Method We ran a series of focus groups with born deaf and prelingually deafened adult cochlear implant recipients asking about the actual benefits they receive to determine aspects of cochlear implantation that are important to this group. An adaptive focus group approach was adopted using British Sign Language (BSL), BSL interpreters were used to assist in the identification of themes and the groups were videoed. The focus group looked at three key aspects.

Result Systematic analyses were conducted to establish the key differences a cochlear implant has made to these prelingual cochlear implant users in terms of outcomes, quality of life, with both positive and negative factors.

Conclusion These focus groups demonstrated that prelingually deafened adults gained benefit from a cochlear implant, however it became apparent that their assessment and rehab requirements are different from post long term deaf adults. It is then therefore recommended that a rehabilitation programme specific to this group becomes a routine part of clinical practice.

Beyond SIR 3 - What do we listen for? e-Poster 44 C. Bartrop, H. Walters, S. Driver Hearing Implant Centre, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH

Aim To provide adequate objective information about adults who have been deaf from early childhood speech and language skills to assist the multi-disciplinary team (MDT) in deciding who will benefit from cochlear implantation.

Method The rehab team undertook a literature review to identify key factors that may predict positive outcomes for adults who have been deaf from early childhood from cochlear implantation. The key themes established from the research will be outlined.

An assessment was developed that is objective, quick to administer and score and provides objective measures of speech ability adapted from Dijkhuizen et al (2011). This is being used with candidates who have been deaf from early childhood and whose speech is judged at screening to be within the SIR 3 category. The implementation of this assessment will be summarised.

Result The first candidates who were implanted following the use of this assessment have been implanted or discharged recently. The objective information about a candidate's speech and language skills gathered from these assessments has been used to contribute to the MDT discussion and decision making on whether to offer a cochlear implant.

Conclusion The results obtained from the assessment have been beneficial in providing objective information about a candidate's speech and language skills. The MDT find it beneficial to have information about a candidate's speech and language skills, that is more refined than the SIR category. The assessment can continue to be used to evaluate whether it a useful tool in predicting positive benefit from implantation for candidates who have been deaf since childhood.

40 British Cochlear Implant Group Meeting 2016

Maximising the potential of longstanding SSD with a Cl - A personal perspective, e-Poster 45 G. Mole Midlands Adult Hearing Implant Programme Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham 815 2TH

Aim To go through how a Cl has reduced the difficulties experienced due to SSD. Looking at my approach to rehabilitation, what works, what doesn't.

Method I was lucky enough to get a Cl in June 2014 and put myself through intensive rehabilitation, searching for appropriate listening materials and ways of stimulating only my Cl ear.

Result Improved social interaction in groups and background noise. Improved localisation. I am a more productive member of staff. A happier family.

Conclusion Having a Cl in my longstanding dead ear (46+ yrs)has certainly maximised my potential at home, work and socially. It has also had an impact on how I work with patients.

MRI? No Worries.

Give your patients peace of mind for years to come. Our hearing implants* enable MRI without magnet removal or risk of magnet dislocation, even without a head bandage. For your patients, this means no additional surgery, no discomfort, and no hearing downtime.

*Recipients with a SYNCHRONY Cochlear Implant may be safely MRI scanned without magnet removal at 0.2, 1.0, 1.5, and 3.0 Tesla following the conditions detailed in the instructions for use. Recipients of the SOUNDBRIDGE VORP 503 Middle Ear Implant may be safely MRI scanned without magnet removal at 1.5 Tesla following the conditions detailed in the instructions for use. Recipients of the BONEBRIDGE Bone Conduction Implant may be safely MRI scanned without magnet removal at up to 1.5 Tesla following the conditions detailed in the instructions for use.

25946 r1.0 medel.com

41 e-Poster abstracts

Staged bilateral versus simultaneous bilateral surgery for children with partial hearing - Parents' insights, e-Poster 46 J. Maggs, M. Ambler, K. Hanvey, R. Irving, R. Mason, A. Pretorius, A. Sandhu, E. Tyszkiewicz, K. Tzifa, J. Whitehouse, J. Williams, S. Zoolfqar. The Midlands Hearing Implant Programme - Children's Service, Optegra Building, Aston University Campus, Coleshill Street, Birmingham B4 7ET

Aim Improvements in both hearing preservation surgical techniques and atraumatic electrode design have allowed children with partial hearing (PH) to be considered for cochlear implantation. There is emerging evidence that CIs provide better results compared with hearing aids in children with PH, even if hearing is not preserved (Gratacap 2015). Pre-referral, these children are often reported to be “doing well” with their hearing aids. As a result, quite often the focus of having a cochlear implant is what they might have to lose rather than what they might have to gain from implantation. Hence, this cohort of children are often reluctant to have simultaneous bilateral cochlear implants and opt instead for either unilateral or staged bilateral surgeries. The aim of this questionnaire is to explore the experiences and parental feedback of children with PH who have either had unilateral, staged bilateral or simultaneous bilateral surgeries. With the benefit of hindsight, knowing how their child has accepted and learned to listen with the first cochlear implant, would these children and their families have accepted simultaneous bilateral surgery instead of unilateral or staged bilateral CIs.

Method A questionnaire was devised and administered to 8 parents of children with PH. 3 had unilateral surgery and are awaiting surgery for the second side, 3 children had staged bilateral surgeries and 2 children had simultaneous bilateral surgery. The questionnaire probes how long and how willing their child is to wears the implant(s), how readily the CI was accepted and how long it took for them to adjust to the sound precept from the CI. It also probes if the families would choose the same treatment pathway or something different.

Result The results of the 8 children and families questioned will be presented in the poster.

Conclusion Patient experience and feedback is vital for improving service delivery for other children with PH.

Impact of a second cochlear implant on a group of primary school aged children - Outcomes and experiences, e-Poster 47 E. Jeffers, A. McIlroy, A. Speers, A. George, J. Clarke-Lyttle, V. McCreedy Auditory Implant Centre, Belfast Trust, Beech Hall Health and Wellbeing Centre, Andersonstown Road, Belfast BT11 9AF

Aim This poster looks at the progress of a small group of primary aged deaf children over the first 2 years following sequential implantation. It considers outcomes for listening skills and quality of life and how the levels achieved with the 2nd implant may affect this progress. It also assess the impact on future decision making.

MRI? No Worries. Method The children were assessed before and after receiving their second implant at regular intervals. Automated tests looked at speech discrimination in quiet and noise and ability Give your patients peace of mind for years to come. Our hearing implants* enable MRI without to locate sound. Live voice testing assessed discrimination skills of the 2nd implant by itself over time. Additional information was gathered through parental questionnaires. magnet removal or risk of magnet dislocation, even without a head bandage. For your patients, Result this means no additional surgery, no discomfort, and no hearing downtime. Most of the children made rapid progress with their sequential implant and this continued over the 2 years. Overall, speech discrimination skills and ability to locate sound showed good progress. Parents gave positive feedback and perceived an improvement on quality of life measures. A few became non users of the 2nd implant by the end of *Recipients with a SYNCHRONY Cochlear Implant may be safely MRI scanned without magnet removal at 0.2, 1.0, 1.5, and 3.0 Tesla following the conditions detailed in the instructions for use. Recipients of the SOUNDBRIDGE VORP 503 Middle Ear Implant may be safely MRI scanned the first year. These children were at the upper end of the age range and had discontinued use of their hearing aid after receiving their first implant. without magnet removal at 1.5 Tesla following the conditions detailed in the instructions for use. Recipients of the BONEBRIDGE Bone Conduction Implant may be safely MRI scanned without magnet removal at up to 1.5 Tesla following the conditions detailed in the instructions for use. Conclusion Sequential implantation is a successful intervention in primary aged deaf children. Targeted specialist support to encourage listening with the 2nd implant is important to help maintain motivation and maximise benefit. How we measure outcomes for this

25946 r1.0 medel.com group and the limitations of different methods of assessment need to be considered. The positive impact of continued hearing aid use following initial implantation should not be underestimated.

42 British Cochlear Implant Group Meeting 2016

Pitch perception, production and links to language development in primary school children with cochlear implants, e-Poster 48 L. Carroll, A. Faulkner, D. Vickers Speech Hearing and Phonetic Science, University College London (UCL), Chandler House, Chandler House, London WC1N 1PF

Aim Pitch perception is a crucial aspect of language development. In child-directed speech, the use of pitch is universal [Jusczyk, Houston, & Newsome, 1999]. However, children with a cochlear implant may be unable to hear changes in the pitch due to device limitations, and to the auditory response to the electrical stimulation [Green, Faulkner & Rosen, 2002]. There is wide variation in outcomes for children with cochlear implants - both in their auditory skills and their speech and language. This research aims to establish the range of pitch processing abilities of implanted children and ask how this is linked to pitch use in speech production and to language skills.

Method Cochlear implanted children between 5 and 11 took part along with normal hearing children in the same age range. The ability to perceive the acoustic correlates of stress and intonation was assessed using both harmonic complex tones and speech-like sounds. Just noticeable differences were established for changes in pitch, intensity and duration. Perception of prosody from speech was also investigated using both natural and manipulated utterances and input components of the PEPS-C task [Peppé & McCann, 2003]. Receptive language, speech perception, non-verbal skills and the production of pitch and prosody were also assessed.

Result Results showed great variability in the pitch perception ability of children with cochlear implants. For complex tones, these children showed much poorer performance than controls and some were unable to hear pitch changes typical of speech. In the implanted group, discrimination of pitch and duration were both correlated with the ability to hear stress patterns in speech. In turn, the ability to hear stress patterns in speech was linked to auditory digit span, to the processing of grammar in heard speech, and to a non-verbal measure of intelligence (Block Matrices). Pitch production was atypical in some of the implanted children.

Conclusion This work adds to other recent studies {e.g., Torppa et al, 2014] in more clearly establishing links between auditory pitch processing and speech and language development in implanted children. The primary implication is that it seems to be of major importance to support the development of good pitch processing skills in implanted children. This may be achievable by appropriate training (for example with musical activities or other targeted training tasks). Further, current cochlear implant devices seem unable to provide good cues for pitch for many children and it remains a challenge for auditory science to overcome this shortcoming.

43 e-Poster abstracts

Measuring empowerment in adult cochlear implant users - The development of the CI-EMP questionnaire, e-Poster 49 P. T. Kitterick, H. Cullington National Institute for Health Research Nottingham Hearing Biomedical Research Unit, University of Nottingham, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU

Aim Research demonstrates that patients with long-term conditions who are activated and involve in their care tend to have better health outcomes. A well-validated generic measure of patient activation already exists, the Patient Activation Measure®, and has been used extensively. However, its items do not appear to cover many factors that may be relevant when assessing the engagement of cochlear implant (CI) users in their care. This project aimed to design and validate a new engagement measure for adult CI users that (a) recognises the beliefs, knowledge, and skills required to cope with the long-term condition of deafness and manage a CI; and (b) is sensitive to interventions that seek to empower CI users to engage in their own care.

Method An existing conceptualisation of engagement in one’s own healthcare was used as the basis for the new measure. A pool of 76 items was generated initially by the authors based on existing literature and clinical experience. A survey of cochlear implant clinicians and a focus group of adult implant users were used to generate additional items and refine existing items. The resulting pool of 108 items was sent to 70 adult cochlear implant users for initial validation. Rasch analysis was used to assess the unidimensionality of the construct being measured and to identify unrelated and poor-performing items.

Result The item generation and refinement process identified a range of beliefs, skills, and knowledge considered to be related to patient empowerment by both CI users and clinicians. The focus group with patients highlighted beliefs that their own role in maximising outcomes with their implant is important and identified skills that are required to self-manage and prevent declines in hearing abilities over time. The Rasch analysis suggested that many of the initial items tapped into knowledge and skills associated with levels of empowerment that most patients would exceed without any further intervention, and were therefore removed. The analysis also identified the need for additional items that are associated with higher levels of empowerment.

Conclusion The initial development work on the CI-EMP created a 50-item instrument that shows promise as a tool for measuring the uni-dimensional construct of empowerment. Further development and validation of the instrument is now being conducted, including the administration of the CI-EMP to 60 adults enrolled in a randomised controlled trial at the University of Southampton assessing a remote care intervention to improve empowerment. Additional research with a broader population of CI users will assess the criterion and construct validity. A well-validated measure of empowerment could both support the assessment of the effectiveness of such interventions and identify those for whom a remote care pathway may be appropriate.

Educational outcomes in paediatric CI users in Ireland, e-Poster 50 E. Walshe, R.O'. Halpin, C. Simoes-Franklin, F. Glynn, P. Walshe, L. Viani Cochlear Implant Programme, Beaumont Hospital, P.O Box 1297, Beaumont Road, Dublin 9

Aim The aim of this study is to demonstrate how children with cochlear implants are performing in the Irish educational system. State examination results will be presented for children who were implanted under 18 years.

Method Questionnaires were designed to collect data from 166 Cochlear Implant users who were born between January 1986 and December 2001 and were implanted as children in the National Cochlear Implant Programme.

Result This is an ongoing study and to date, we have received approximately 70 responses to our questionnaire. Approximately 78% of the respondents attended mainstream primary school and 74% attended mainstream secondary school. 40% of the respondents over 18 years old are attending further education while 49% are currently employed.

Conclusion The findings will be analysed and the implications of the results will be discussed.

44 British Cochlear Implant Group Meeting 2016

Experiences of patients and audiologists about the impact of tinnitus on post-operative assessments in cochlear implant clinics, e-Poster 51 R. H. Pierzycki, C. Corner, P. T. Kitterick Nottingham Hearing Biomedical Research Unit, National Institute for Health Research, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU

Aim This study explored whether tinnitus has an effect on cochlear implant (CI) programming appointments. In particular, the study aimed to: (1) identify what difficulties may arise during programming appointments due to tinnitus according to audiologists and patients; (2) determine what specific strategies are considered by audiologists to be most effective in dealing with these difficulties; (3) characterise the views of audiologists on the need for specific guidelines in management of CI patients with tinnitus.

Method Semi-structured interviews were used to discuss the research questions with six audiologists involved in managing the care of adult CI users. A postal survey was used to gather the views of adult CI patients. The interviews and relevant free-text sections of the survey were analysed thematically using an inductive approach. Other survey questions were analysed using descriptive statistics. Data from the clinical notes of patients were also analysed deductively for evidence of any tinnitus effects and strategies used during routine appointments identified through the interviews.

Result Tinnitus mostly affects T level estimation according to a majority of audiologists and patients - a finding supported by the analysis of clinic notes. Strategies to redirect patient's attention (e.g. counting stimuli or alternating different assessments) are most often used to counteract effects of tinnitus, but estimated Ts may still be unreliable. Audiologists agreed unanimously that patients with tinnitus would gain more from extended hearing therapy than from longer or additional programming appointments. Patients preferred to receive tinnitus advice from audiologists rather than be referred to a specialist tinnitus clinic. Audiologists welcomed guidance on programming but flexibility and clinical experience were considered essential.

Conclusion Tinnitus can have a disruptive effect on CI programming in some patients and in particular on the estimation of T levels. The reliability of Ts may be compromised even though audiologists have developed strategies to overcome tinnitus-related difficulties during programming. Ongoing research aims to assess whether the effect of tinnitus on Ts affects patient's speech outcomes. A manual for CI programming with tinnitus, developed with CI clinicians, might be a useful resource of 'good practice' methods and instructions based on clinical experience, but should be adaptable to permit flexibility to manage individual patient needs.

eSRT versus behavioural maps - A comparison of outcomes in adult users of the MED-EL CONCERTO cochlear implant system, e-Poster 52 W. Ellis Auditory Implants Department, Royal National Throat, Nose & Ear Hospital, 330 Gray's Inn Road, London WC1X 8DA

Aim To compare speech perception and qualitative outcomes in patients using progams based on electrically evoked stapedial reflex thresholds (eSRT) versus programs based on behavioural loudness scaling measures.

Method MCL levels were set using loudness scaling measures and eSRTs in a cohort of patients with the MED-EL CONCERTO cochlear implant system. Speech perception ability was assessed on each program using BKB sentences in quiet and noise, and AB words. Patient preference for each program was also recorded.

Result Several patients had significantly better on speech perception, and preferred, programs based on eSRTs compared with behavioural measures.

Conclusion For some patients, programs created using eSRTs yielded better speech recognition and subjective sound quality than programs using conventional behavioural loudness scaling measures.

45 e-Poster abstracts

The personal and economic value of cochlear implantation - Adults' perspectives, e-Poster 53 Z.Y. Ng, S. Archbold, B. Lamb, S. Harrigan, S. Athalye, S. Allen Research Programme, The Ear Foundation, 83 Sherwin Road, Nottingham NG7 2FB

Aim This presentation will report on a survey and interviews carried out with adults who have gone through the cochlear implantation pathway. It explores their experiences of current services and the assessment process for implantation, and discusses the impact on their daily lives, including views and experiences communication, independence and confidence. It also explores, in today's financially challenging climate, their awareness of current funding issues and the value of their implant to them.

Method An online questionnaire containing both open and closed questions and semi-structured qualitative interviews were used to gather data on the participants' views and experiences with cochlear implant(s). Questionnaire responses were received from 149 adults with cochlear implants, and eight interviews were carried out to explore issues further.

Result The cochlear implant users described profound changes to their lives, including greater ability to communicate, less reliance on others for communication support, gaining and retaining employment, the ability to continue to care for others and increased independence for themselves. They reported increased wellbeing and reduction in stress, anxiety and reduced isolation which also leads to less reliance on health and social care services. They put a very high economic value on the benefit of their cochlear implant but most would not be able to afford this privately and value it is available on the NHS. Patients felt that the information, the time they had to wait to gain a cochlear implant and lengths of assessments were unreasonable.

Conclusion Respondents were overwhelmingly positive about the impact of their implant on increasing their independence and wellbeing. They highlighted they were able to communicate more independently, relied less on communication support, functioned better on the telephone, had more confidence in the workplace, and with family and friends, and were able to take up more sports activities. Cochlear implants were highly valued, not only economically but also personally. Furthermore, they did ask for better communication and access to information and services from professionals throughout the CI pathway.

Long term use/nonuse of cochlear implants systems in an Indian setting, e-Poster 54 N. Vaid, S. Deshpande, K. Salve, A. Wadhwa Big Ears, K.E.M. Hospital, Sardar Moodliar road, Rasta Peth, Pune 411011

Aim To evaluate the incidence of non users and limited users of cochlear implants and identify reasons for the same.

Method 225 patients who underwent implantation from 2006 - 2013 were contacted telephonically and verbally regarding the extent of use of the implant system and reasons for the same if they were not using their implant systems. They were divided into non users ie not wearing the device at all, Limited users ie using the device for less than 6 hours and good users ie using it throughout the day expect during bath times.

Result Out of the 225 patients, we were unable to contact 32 patients. The results revealed that 187 patients were using their implants full time. Six patients were nonusers (3.10%). Two of these had limited benefit and therefore stopped using the implant. One of these was implanted after 12 years of auditory deprivation and the other had an absent cochlear nerve on imaging. Both these candidates had intermittent usage of the implant prior to stopping using it completely. Data evaluation also revealed that these 2 implantees and their families repeatedly visited the clinic regarding the limited benefits to the implantees. One of the patients has associated challenges of autism and ADHD due to which he has become a nonuser. Three patients are unable to financially sustain their implants.

Conclusion Financial considerations and social issues such as family and educational support are important to ensure long term usage of cochlear implants. In countries like India where either the implants are self funded or provided by various government schemes for the below poverty line families this is an important aspect to be considered.

46 British Cochlear Implant Group Meeting 2016

Comparative study of audiological outcomes and patient perceived benefit for three bone conducting hearing implant systems, e-Poster 55 H. Ghulam, H. R. F. Powell, T. Nunn, I. Pai, D. Jiang St Thomas' Auditory Implant Centre, Guy's and St Thomas' Hospitals NHS Foundation Trust, 2nd floor, Lambeth wing, Westminster bridge road, London SE1 7EH

Aim In an evolving era of bone conducting hearing implant systems (BCHIS) with different technologies available we compared outcomes for transcutaneous (skin drive and active implant) and percutaneous BCHIS; the Cochlear Baha Attract, MED-EL Bonebridge and the Oticon Medical Ponto.

Method Tertiary referral auditory implant centre. Prospective collection of audiological and subjective quality of hearing data in consecutive patients offered BCHIS after trial of Baha Intenso on softband. Adult patients with either unilateral profound sensorineural hearing loss or conductive/mixed hearing loss not suitable for conventional aiding were eligible for inclusion in the study. Pre and post–operative testing included: • Unaided/aided soundfield audiometry • Adaptive speech perception in noise test • APHAB questionnaire

Result 38 patients were eligible for the study and had complete data sets (18/10/10). Comparing all three BCHIS with their pre-operative Baha Intenso on softband results; there was no significant difference for Baha Attract, but a marked audiological benefit with Bonebridge and Ponto. We will present APHAB results (pre and post implantation) for all patients (data collected but not yet analysed).

Conclusion This is the first study to compare three different BCHIS. Skin attenuation with transcutaneous conduction (Attract) leads to poor amplification in the higher frequencies and a resultant lack of speech appreciation in noise, particularly in patients with single sided deafness. Commissioning for Bonebridge remains a challenge in the NHS but our results show that audiologically this is the best non-abutment BCHI solution, however patient anatomy must be favourable for safe and effective positioning. The outcome of this clinical study helps to further understand BCHIS choice and candidacy criteria for patients with unilateral sensorineural hearing loss or conductive/mixed hearing loss.

Detection of non-organic hearing loss during cochlear implant assessment - The Yorkshire Auditory Implant Service experience, e-Poster 56 S. G. Mistry, S. Carr, B. Meredith, L. Tapper, D. R. Strachan, C. H. Raine Otolaryngology, Yorkshire Auditory Implant Service, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford BD69RJ

Aim The diagnosis of Non-organic hearing loss (NOHL) is a difficult but important issue during the assessment process for cochlear implantation. Inability to identify such patients may lead to inappropriate surgery on patients who would otherwise be outside implantation criteria. We aim to identify the key factors in identifying patients with NOHL during cochlear implant assessment and present our local strategy and screening protocol for NOHL.

Method A retrospective review of all patients referred to the Yorkshire Auditory Implant Service who were subsequently diagnosed with NOHL during the assessment. Patient demographic data, audiological and functional assessments (e.g. speech testing) were assessed. Several factors common to this patient cohort were identified.

Result Fifteen patients were included in the study. Mean age was 37 years (range 14-66 years). Male to female ratio was 1:2. Indicators of possible NOHL included a sudden deterioration in hearing (n=9; 60 per cent), recent telephone use (n=9; 60 per cent), stapedial reflexes below reported audiological thresholds (n=7; 47 per cent) and mismatch in functional hearing (n=7; 47 per cent). Patients with suspected NOHL from the initial multidisciplinary assessment underwent objective testing (Cortical Evoked Response Audiometry (CERA)). All fifteen patients who underwent CERA had better hearing levels compared to reported hearing thresholds thus placing them outside of implant criteria. Four candidates were found to have normal hearing levels.

Conclusion NOHL is a complex condition with several underlying causes. Patients with NOHL do present to implant teams and we highlight several key indicators that may help identify such patients. We describe a change in our local assessment process for patients referred for possible implantation which is specifically aimed at screening for NOHL.

47 e-Poster abstracts

Seeking connectedness - A constructivist grounded theory of subjective listening effort in cochlear implantation, e-Poster 57 S. Hughes, H. Hutchings, F. Rapport, C. Llewellyn South Wales Cochlear Implant Programme, Bridgend, UK, School of Medicine, Centre for Healthcare Resilience and Implementation Science (CHRIS), Macquarie University, Bridgend, Swansea, Syndney Sydney, Australia

Aim This paper presents key findings from the first qualitative study of subjective listening effort (LE) in cochlear implant recipients. High LE is a remaining challenge in cochlear implantation (CI) and its clinical meaning is not yet clear (1). This research explores the meaning of listening effort and examines the perceptions and experiences of listening effort in individuals with acquired sensory-neural hearing loss (SNHL) before and after CI.

Method Three focus groups were held in June 2015. The data, collected from a purposive sample of deafened adults using hearing aids (HA), CI-only, or CI+HA and their significant others (n=17), were analysed using constructivist Grounded Theory methodology (2). Verbatim transcripts were conceptually coded line-by-line using gerunds. Focussed coding clustered initial codes into categories. Category properties and dimensions were examined, relationships between categories explored for process, and the extant literature integrated into the model. Memowriting and diagramming continued throughout data analysis. A follow-up questionnaire ensured theoretical saturation and confirmed credibility of the emergent theory.

Result Listening effort (LE) is a complex, multi-dimensional construct of significance to deafened individuals. A typology of effort including attentional, cognitive and compensatory domains emerged from participant accounts. After CI, listening effort remained high but differed qualitatively from pre-implant experiences. Participants linked listening effort to their sense of belonging. Increased social distance pre-implantation was countered through investment of listening effort. Unrewarded listening effort contributed to isolation, leading to anxiety and lack of confidence. Receiving a CI restored social connectedness, reconciling high LE as acceptable.

Conclusion Subjective listening effort is linked to the basic human need for social connectedness. The substantive theory offers a rich description of listening effort based on patient experience and proposes an explanation for reported discrepancies between objective and subjective measures. The model will underpin the development of a patient reported outcome measure (PROM) allowing listening effort to be measured more appropriately in the clinic. Implications for practice and further research are discussed. References 1. McGarrigle R, Munro K, Dawes, Stewart, Moore, Barry, et al. Listening effort and fatigue: What exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group “white paper.” Int J Audiol. 2014;Early onli:1–13. 2. Charmaz K. Constructing Grounded Theory. 2nd Editio. London: SAGE Publications Ltd;

2014.

48 COCHLEAR IMPLANT SYSTEM People Make Audiology Neuro - The ﬁrst cochlear implant system from Oticon Medical

NEW

Neuro Zti implant

Neuro One sound processor British Academy

A hearing partner Designed for a future of sounds As part of one of the world’s leading hearing health care The Neuro cochlear implant system is the result of our latest of Audiology companies, Oticon Medical combines more than 100 years advancements in hearing research and technologies. of hearing expertise with decades of experience in cochlear implant technologies. The ultra-compact Neuro Zti implant provides a powerful and future-ready technology platform. 13th Annual Conference We use all of this combined expertise and resources to open up the world of sound to as many people as possible. The Neuro One sound processor uses Oticon’s advanced Inium 10TH - 11TH NOVEMBER 2016 We do so, because we know that when it comes to quality chip technology. This enables automatic coordination of a full of life, sound matters. package of advanced sound processing features. The Neuro system is designed to enable the optimal hearing experience – now and in the future. www.oticonmedical.co.uk/neuro Contact your local Oticon Medical representative to learn more or email: [email protected]. SECC,Glasgow Alternatively call: 01698 208234 More information will become available on www.baaudiology.org COCHLEAR IMPLANT SYSTEM People Make Audiology Neuro - The ﬁrst cochlear implant system from Oticon Medical

NEW

Neuro Zti implant

Neuro One sound processor British Academy

A hearing partner Designed for a future of sounds As part of one of the world’s leading hearing health care The Neuro cochlear implant system is the result of our latest of Audiology companies, Oticon Medical combines more than 100 years advancements in hearing research and technologi es. of hearing expertise with decades of experience in cochlear implant technologies. The ultra-compact Neuro Zti implant provides a powerful and future-ready technology platform. 13th Annual Conference We use all of this combined expertise and resources to open up the world of sound to as many people as possible. The Neuro One sound processor uses Oticon’s advanced Inium 10TH - 11TH NOVEMBER 2016 We do so, because we know that when it comes to quality chip technology. This enables automatic coordination of a full of life, sound matters. package of advanced sound processing features. The Neuro system is designed to enable the optimal hearing experience – now and in the future. www.oticonmedical.co.uk/neuro Contact your local Oticon Medical representative to learn more or email: [email protected]. SECC,Glasgow Alternatively call: 01698 208234 More information will become available on www.baaudiology.org Event Organisers

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