Periodic Reporting for period 2 - MOSAICS (Hearing Matters: European Industrial Doctorate to train experts in auditory implants for minimised outcome spread and maximized participation in society)
Reporting period: 2021-10-01 to 2023-09-30
According to the World Health Organization (WHO), over 5% of the world’s population requires rehabilitation to address their disabling hearing loss. It is estimated that by 2050 over 700 million people – or one in every ten people – will have a disabling hearing loss. Therefore, in 2021 the WHO issued the first WHO Report on Hearing calling for “Integrated people-centered ear and hearing care”. The MOSAICS H2020 MSCA EID project is supporting this call. For the higher degrees of bilateral hearing loss, hearing aids are no longer providing sufficient benefit, and cochlear implants (CI) are the only effective therapy. Cochlear implants are the most successful brain-machine interface devices so far, bridging the gap in the auditory pathways created by the loss of inner hair cells in the inner ear. They do this by direct electrical stimulation of the auditory nerve.
However, adoption by adults who would benefit from a CI is low, around 5%. There are many reasons for non-adoption, the variability of hearing outcomes being a major one. Although implants have been proven to be very effective at the group level, there is insufficient consistency of hearing outcomes at the individual level, raising concerns and doubts among patients and additional caution in counseling among clinicians. Hearing outcomes with a CI are the result of a multi-stage process, involving candidate selection, surgery, device fitting, and effective auditory training. At any stage, a variety of factors may limit performance. Patient-related factors include the degree of ear-level damage, cognition, and supportive environment. Surgical ones relate to the placement of the intracochlear electrode and the atraumaticity of the surgery. The audiologist fits the sound processor and the brain must adjust through training to maximize the use of the new electrical hearing modality – an effortful learning process helped by rehabilitation assisted by a speech and language therapist. In summary, hearing outcomes depend on both the patient’s personal capabilities and the expertise of several professionals. The current state of the art is that the root causes for the variability in performance among CI recipients are poorly understood, with only 25% explained by current clinical prediction factors. Clinicians tend to accept poorer outcomes, not knowing well enough what diagnostics or treatments to propose. MOSAICS has the ambitious goal to augment our understanding of the root causes, propose effective diagnostics, and explore personalized intervention in device fitting and rehabilitation, using a holistic and multidisciplinary approach.
However, adoption by adults who would benefit from a CI is low, around 5%. There are many reasons for non-adoption, the variability of hearing outcomes being a major one. Although implants have been proven to be very effective at the group level, there is insufficient consistency of hearing outcomes at the individual level, raising concerns and doubts among patients and additional caution in counseling among clinicians. Hearing outcomes with a CI are the result of a multi-stage process, involving candidate selection, surgery, device fitting, and effective auditory training. At any stage, a variety of factors may limit performance. Patient-related factors include the degree of ear-level damage, cognition, and supportive environment. Surgical ones relate to the placement of the intracochlear electrode and the atraumaticity of the surgery. The audiologist fits the sound processor and the brain must adjust through training to maximize the use of the new electrical hearing modality – an effortful learning process helped by rehabilitation assisted by a speech and language therapist. In summary, hearing outcomes depend on both the patient’s personal capabilities and the expertise of several professionals. The current state of the art is that the root causes for the variability in performance among CI recipients are poorly understood, with only 25% explained by current clinical prediction factors. Clinicians tend to accept poorer outcomes, not knowing well enough what diagnostics or treatments to propose. MOSAICS has the ambitious goal to augment our understanding of the root causes, propose effective diagnostics, and explore personalized intervention in device fitting and rehabilitation, using a holistic and multidisciplinary approach.
The MOSAICS project, despite facing challenges due to the COVID-19 pandemic, has made significant progress in line with its objectives. The Early-Stage Researchers (ESRs) began their research in February 2020, with their Ph.D. defence expected in 2024. The training program provided comprehensive education in Cochlear Implant (CI) research, tailored to each ESR, enhancing both academic and non-academic skillsets for optimal career mobility.
The project encompasses two work packages: WP1, "From cochlea to cortex," and WP2, "Brain, train, and sustain." In WP1, the focus is on understanding speech perception variability in CI recipients, considering factors like neural health and device fitting. ESR1 investigated the sensitivity of auditory neurons to electrical pulse characteristics, aiming to differentiate neural health states. ESR4's analysis of fitting data revealed a correlation between electrical dynamic range and speech recognition outcomes in CI users, suggesting implications for fitting strategies. ESR4 and ESR3 collaborated on the AuDiET project, exploring speech perception errors on a phoneme level. ESR1 unexpectedly contributed to the AuDiET study, examining auditive ripples in CI users.
WP1 successfully met its scientific and training objectives, enhancing knowledge of bottom-up mechanisms influencing CI performance. Objective measurements of these mechanisms are being validated in CI users. A ripple detection test and the TRAIT tool show promise for individualized diagnostics and potential AI-driven fitting strategies.
In WP2, "Brain, train, and sustain," ESR2 and ESR3 focused on studies related to auditory perception, working memory, and inhibition. ESR2 conducted a pilot study in normal-hearing subjects and investigated auditory processing in CI recipients using electroencephalographic recordings. ESR3 initiated a prediction study on clinicians' accuracy in predicting speech perception outcomes post-implantation. ESR3 also played a key role in the AuDiET study, developing an app for individualized training based on phoneme error diagnostics.
The interdisciplinary collaboration among all four ESRs in both WP1 and WP2 led to impactful insights on individualized diagnostics and treatments. These findings are expected to significantly impact aftercare for adults with cochlear implants. Overall, the MOSAICS project has effectively covered the journey "from cochlea to cortex" and demonstrated promising avenues for enhancing CI outcomes through personalized approaches and innovative diagnostic tools.
The project encompasses two work packages: WP1, "From cochlea to cortex," and WP2, "Brain, train, and sustain." In WP1, the focus is on understanding speech perception variability in CI recipients, considering factors like neural health and device fitting. ESR1 investigated the sensitivity of auditory neurons to electrical pulse characteristics, aiming to differentiate neural health states. ESR4's analysis of fitting data revealed a correlation between electrical dynamic range and speech recognition outcomes in CI users, suggesting implications for fitting strategies. ESR4 and ESR3 collaborated on the AuDiET project, exploring speech perception errors on a phoneme level. ESR1 unexpectedly contributed to the AuDiET study, examining auditive ripples in CI users.
WP1 successfully met its scientific and training objectives, enhancing knowledge of bottom-up mechanisms influencing CI performance. Objective measurements of these mechanisms are being validated in CI users. A ripple detection test and the TRAIT tool show promise for individualized diagnostics and potential AI-driven fitting strategies.
In WP2, "Brain, train, and sustain," ESR2 and ESR3 focused on studies related to auditory perception, working memory, and inhibition. ESR2 conducted a pilot study in normal-hearing subjects and investigated auditory processing in CI recipients using electroencephalographic recordings. ESR3 initiated a prediction study on clinicians' accuracy in predicting speech perception outcomes post-implantation. ESR3 also played a key role in the AuDiET study, developing an app for individualized training based on phoneme error diagnostics.
The interdisciplinary collaboration among all four ESRs in both WP1 and WP2 led to impactful insights on individualized diagnostics and treatments. These findings are expected to significantly impact aftercare for adults with cochlear implants. Overall, the MOSAICS project has effectively covered the journey "from cochlea to cortex" and demonstrated promising avenues for enhancing CI outcomes through personalized approaches and innovative diagnostic tools.
The MOSAICS project aims to address the profound impact of deafness on the quality of life, emphasizing the global consensus linking hearing loss to depression, reduced cognition, and dementia. The project contributes to establishing hearing implants as the standard care solution for those affected by moderate-to-severe hearing loss and deafness. MOSAICS tackles hurdles at patient and professional levels through a holistic research program, benefiting counselors, ENT surgeons, audiologists, and therapists.
Four Early-Stage Researchers (ESRs) have been trained as junior scientists, enriching their multidisciplinary knowledge in an academic-industrial setting. Their integration into the cochlear implant community, network building, and collaborations highlight the project's impact. The scientific output of MOSAICS is of high quality, expected to be widely appreciated and referenced in the scientific, professional, and cochlear implant users’ community.
Effective communication with the broader professional community and stakeholders, including engaging with individuals with lived experience during EURO-CIU conferences, has provided valuable insights. Despite facing challenges, the consortium has made strides in understanding the root causes of poor performance with cochlear implants. The pandemic posed obstacles, limiting patient-related work, but the project has still achieved significant progress, influencing concepts for individualized rehabilitation and device fitting. The research findings of each ESR have led to novel insights, with some already impacting CI audiologists at the Radboud Medical Center, particularly in terms of fitting. While the road to clinical implementation varies for each aspect, both Cochlear and SRUMC clinical research departments are poised to build on the early-phase research conducted in the MOSAICS project.
Four Early-Stage Researchers (ESRs) have been trained as junior scientists, enriching their multidisciplinary knowledge in an academic-industrial setting. Their integration into the cochlear implant community, network building, and collaborations highlight the project's impact. The scientific output of MOSAICS is of high quality, expected to be widely appreciated and referenced in the scientific, professional, and cochlear implant users’ community.
Effective communication with the broader professional community and stakeholders, including engaging with individuals with lived experience during EURO-CIU conferences, has provided valuable insights. Despite facing challenges, the consortium has made strides in understanding the root causes of poor performance with cochlear implants. The pandemic posed obstacles, limiting patient-related work, but the project has still achieved significant progress, influencing concepts for individualized rehabilitation and device fitting. The research findings of each ESR have led to novel insights, with some already impacting CI audiologists at the Radboud Medical Center, particularly in terms of fitting. While the road to clinical implementation varies for each aspect, both Cochlear and SRUMC clinical research departments are poised to build on the early-phase research conducted in the MOSAICS project.