Background. Cochlear implant (CI) provides excellent results for verbal perception, while listening to music is limited. Dedicated musical rehabilitation treatments have been developed, which to date are poorly applied in the clinical setting, also due to the lack of adequate indicators. Finally, some evidence suggested a cross-domain effects of music training, in particular about listening in noise and vocal production. Objectives. The present work encompassed two phases. The objective of the first phase is the evaluation of the epidemiological and clinical feature of the study group and the identification of the possible presence of rehabilitation needs in the sample. The second phase of the clinical trial will evaluate the effects of a self-administered rehabilitation intervention at home on the subjective perception of music, auditory perception in a noisy environment and speech production. Material and methods. Participants in the observational study underwent audiological and phoniatric examination, pure tone and speech audiometry, PCVRAR assessment and filled the I-NCIQ and MUSQUAV questionnaires. The patients involved in the clinical trial, enrolled among the participants of the observational study, underwent further evaluations, including MATRIX test, video laryngoscopy and voice spectroacoustic analysis. The latter patients were given access to Meludia, a web application that allows to learn the fundamentals of music, following an individual program. The surgery lasted one month, at the end of which the patients underwent a second evaluation to compare the results. Pearson's statistical tests, ANOVA and ANCOVA were used and p-values <0.05 were considered significant. Results. 79 patients took part in the first observational phase. Average PTA2 hearing threshold at pure tone audiometry was 29.7 ± 5.7 dB and average SRT was 40.0 ± 9.3 dB. The I-NCIQ showed an average score of 64.6 ± 13.1. The rehabilitation need (Rehab Factor) was present in 50 patients (63.3%). There was a significant negative correlation with Pearson's test between age and MUSQUAV frequency (r = 0.385, p-value <.001), there were no significant differences for hearing loss onset (ANCOVA test p =0.089). Music training was completed by 12 out of 15 patients, with an individual improvement trend more evident in half of the sample. The ANOVA test did not report statistically significant differences before and after treatment. Conclusion. The observational study retrieved adequate audiological outcomes. Although there was a marked inter-individual variability, the quality of life was satisfactory and the data were in line with what was reported in the literature. It was found that increasing age is associated with a reduction in musical perceptual skills, while the time of onset of hearing loss does not have a significant impact. A new tool has been proposed for the assessment of rehabilitation needs, the Rehab factor, according to which a musical auditory rehabilitation course is indicated for 63% of the patients. The self-conducted remote music training (App Meludia) has been confirmed as a valid rehabilitation possibility, with an individual improvement in musical Perception or Engagement in 50% of patients after just one month of treatment. There was no significant evidence of cross-domain effects, neither for verbal perception in noise nor for speech production. The enrollment of further patients as well as multicenter randomized clinical trials would be necessary to confirm the preliminary results of this thesis work.
Background. L’impianto cocleare (IC) fornisce degli ottimi risultati per la percezione verbale, mentre l’ascolto della musica è limitato. Sono stati sviluppati trattamenti riabilitativi musicali dedicati, che ad oggi risultano scarsamente applicati in ambito clinico, anche per la mancanza di indicatori adeguati. Infine, non vi è chiarezza sugli effetti cross-dominio del training musicale, in particolare per quanto riguarda l’ascolto nel rumore e la produzione vocale. Scopo della tesi. La presente tesi è composta da due fasi sperimentali. L’obiettivo della prima fase è la valutazione delle caratteristiche epidemiologiche, cliniche e l’identificazione dell’eventuale presenza di esigenze riabilitative nel campione. La seconda fase del trial clinico valuterà gli effetti di un intervento riabilitativo autosomministrato a domicilio sulla percezione soggettiva della musica, la percezione uditiva in ambiente rumoroso e la produzione vocale. Materiali e metodi. I partecipanti allo studio osservazionale sono stati sottoposti a visita audiologica e foniatrica, audiometria tonale e vocale, valutazione PCVRAR e hanno compilato i questionari I-NCIQ e MUSQUAV. I pazienti coinvolti nel trial clinico, arruolati tra i partecipanti dello studio osservazionale, sono stati sottoposti a valutazioni ulteriori, comprendenti MATRIX test, videolaringoscopia e analisi spettroacustica vocale. A questi ultimi è stato fornito l’accesso a Meludia, un’applicazione web che permette di apprendere i fondamenti della musica, secondo un programma individuale. L’intervento ha avuto una durata di un mese, alla fine del quale i pazienti sono stati sottoposti ad una seconda valutazione per il raffronto dei risultati. Sono stati utilizzati i test statistici di Pearson, ANOVA e ANCOVA e valori p<0,05 sono stati considerati significativi. Risultati. Nei 79 pazienti che hanno preso parte alla prima fase osservazionale, la soglia uditiva media PTA2 all’audiometria tonale è 29,7 ±5,7 dB e la SRT media risulta di 40,0 ±9,3 dB. L’I-NCIQ mostra un punteggio medio di 64,6 ±13,1. L’esigenza riabilitativa (Fattore Rehab) è presente in 50 pazienti (63,3%). Si osserva una correlazione negativa significativa con test di Pearson tra età e Frequenza MUSQUAV (r=0,385, p-value<.001), non ci sono differenze significative per l’epoca di esordio (test ANCOVA p=0,089). Il training musicale è stato portato a termine da 12 su 15 pazienti, con un trend di miglioramento individuale più evidente in metà del campione. Il test ANOVA non ha segnalato differenze statisticamente significative prima e dopo il trattamento. Conclusioni. Lo studio osservazionale ha mostrato la presenza di buoni outcome audiologici. Sebbene si evidenzi una spiccata variabilità interindividuale, la qualità di vita è soddisfacente e i dati sono in linea con quanto riportato in letteratura. È stato rilevato che l’aumento dell’età è associato ad una riduzione delle competenze percettive musicali, mentre l’epoca di esordio dell’ipoacusia non incide in maniera significativa. Si è proposto un nuovo strumento per la valutazione delle esigenze riabilitative, il Fattore Rehab, secondo il quale un percorso di riabilitazione uditiva musicale è indicato per il 63% dei soggetti considerati. Il training musicale da remoto autocondotto (App Meludia) si è confermata come una valida possibilità riabilitativa, con un miglioramento individuale in Percezione o Coinvolgimento musicale nel 50% dei pazienti dopo un solo mese di trattamento. Non vi sono evidenze significative di effetti cross-dominio, né per la percezione verbale, né per la produzione vocale. L’ampliamento del campione e ulteriori studi clinici randomizzati multicentrici saranno necessari per confermare i risultati preliminari della presente tesi.
La percezione e la riabilitazione musicale nei portatori di impianto cocleare: risultati di uno studio osservazionale seguito da un trial clinico
BADIN, GIULIO
2021/2022
Abstract
Background. Cochlear implant (CI) provides excellent results for verbal perception, while listening to music is limited. Dedicated musical rehabilitation treatments have been developed, which to date are poorly applied in the clinical setting, also due to the lack of adequate indicators. Finally, some evidence suggested a cross-domain effects of music training, in particular about listening in noise and vocal production. Objectives. The present work encompassed two phases. The objective of the first phase is the evaluation of the epidemiological and clinical feature of the study group and the identification of the possible presence of rehabilitation needs in the sample. The second phase of the clinical trial will evaluate the effects of a self-administered rehabilitation intervention at home on the subjective perception of music, auditory perception in a noisy environment and speech production. Material and methods. Participants in the observational study underwent audiological and phoniatric examination, pure tone and speech audiometry, PCVRAR assessment and filled the I-NCIQ and MUSQUAV questionnaires. The patients involved in the clinical trial, enrolled among the participants of the observational study, underwent further evaluations, including MATRIX test, video laryngoscopy and voice spectroacoustic analysis. The latter patients were given access to Meludia, a web application that allows to learn the fundamentals of music, following an individual program. The surgery lasted one month, at the end of which the patients underwent a second evaluation to compare the results. Pearson's statistical tests, ANOVA and ANCOVA were used and p-values <0.05 were considered significant. Results. 79 patients took part in the first observational phase. Average PTA2 hearing threshold at pure tone audiometry was 29.7 ± 5.7 dB and average SRT was 40.0 ± 9.3 dB. The I-NCIQ showed an average score of 64.6 ± 13.1. The rehabilitation need (Rehab Factor) was present in 50 patients (63.3%). There was a significant negative correlation with Pearson's test between age and MUSQUAV frequency (r = 0.385, p-value <.001), there were no significant differences for hearing loss onset (ANCOVA test p =0.089). Music training was completed by 12 out of 15 patients, with an individual improvement trend more evident in half of the sample. The ANOVA test did not report statistically significant differences before and after treatment. Conclusion. The observational study retrieved adequate audiological outcomes. Although there was a marked inter-individual variability, the quality of life was satisfactory and the data were in line with what was reported in the literature. It was found that increasing age is associated with a reduction in musical perceptual skills, while the time of onset of hearing loss does not have a significant impact. A new tool has been proposed for the assessment of rehabilitation needs, the Rehab factor, according to which a musical auditory rehabilitation course is indicated for 63% of the patients. The self-conducted remote music training (App Meludia) has been confirmed as a valid rehabilitation possibility, with an individual improvement in musical Perception or Engagement in 50% of patients after just one month of treatment. There was no significant evidence of cross-domain effects, neither for verbal perception in noise nor for speech production. The enrollment of further patients as well as multicenter randomized clinical trials would be necessary to confirm the preliminary results of this thesis work.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/30522