The study will include 9 key informant interviews discussing how patients developed their impression of the benefit of an implant and how patients prefer expectation data be relayed. No video recordings will be performed during interviews. Interview notes or audio recordings will be taken and uploaded into a password protected network server. The results of interviews will mainly be descriptive. To test the plasticity of preoperative patient expectations and the impact of the CI evaluation the CIQOL expectations form will be administered prior to CI evaluation, directly after the CI evaluation, and prior to surgery for all patients who are undergoing cochlear implantation and meet inclusion/exclusion criteria and agree to participate. The decisional conflict scale will also be administered directly after the CI evaluation and prior to surgery for the above patient group. The 9 patients who undergo key informant interviews will also be part of the larger study group of 200 patients and have the same surveys administered and be subject to the same inclusion/exclusion criteria. The group of patients will also be asked about how they prefer expectation and QOL data to be relayed. All survey data will be collected in a secure RedCap database. Patients expectations at the three preoperative timepoints will be compared using paired T-tests. Data regarding how patients develop expectations and how they prefer expectation data to be presented to them will be mainly qualitative and discussed in terms of the most common themes from patient surveys and interviews. When exploring how patients prefer expectations and QOL data to be relayed we intend to include numbered clinical vignettes relaying differing levels of hearing capability. We will compare relaying information through vignettes to more conventional outcome measures such as speech recognition and QOL scores to determine which is the more effective means of communication.

Patient-reported outcome measures (PROMs) are crucial for understanding the impact of cochlear implants (CIs) on real-world functional abilities and quality of life (QOL) and for monitoring changes over time. However, CI clinical outcome measures traditionally focus solely on CI users' speech recognition ability to evaluate treatment success, which limits our understanding of CI's effects on patients' social isolation, emotional impact, and mental and listening effort related to severe hearing loss. Moreover, patient's speech recognition scores demonstrate low correlations with CI users' real-world communication experiences and QOL. Therefore, there is a critical gap in the measures commonly used to quantify patient outcomes after CI activation. To address this gap, we developed the Cochlear Implant Quality of Life (CIQOL)-35 Profile instrument, which provides a comprehensive, patient-centered assessment of CI-related functional abilities and QOL. However, difficultly in interpreting an individual patient's PROM score is a major barrier for PROM implementation and applications to clinical care. Therefore, additional work is critical for clinicians to appropriately interpret CIQOL-35 Profile scores for individual patients and apply those results to inform intervention decisions and monitor patient progress. In the current study we will longitudinally assess CI users CIQOL scores to help identify CI users with lower functional abilities who may benefit from increased support and allow clinicians to better track functional improvement after implantation for individual patients. This work will inform patient discussions regarding expected outcomes and timeframe for improvement.

Meniere's disease is a common cause of vertigo that becomes more common with age. Unfortunately, Meniere's disease and vestibular migraine have significant overlap and are sometimes difficult to diagnose. This is due to a lack of understanding of the true cause of Meniere's disease. Due to the lack of a biomarker (an objective test), the diagnosis of Meniere's disease has been based on clinical history and hearing loss. We are exploring ways to differentiate Meniere's disease and vestibular migraine, potentially through a lab test. In addition, identifying biomarkers may help early diagnosis and direct more personalized treatment strategies, especially early on before hearing loss occurs.

Older adults typically have trouble identifying the speech they hear, especially in noisy environments. Fortunately, compared to younger adults, older adults are better able to compensate for difficulties identifying the speech they hear by recruiting the visual system. However, the extent to which older adults can benefit from visual input, and how this influence relates to age-related changes in brain structure and function, have not been thoroughly investigated. The general purpose of this study is to determine how age-related changes in brain structure and function affect how well people hear and see. This study seeks participants with normal hearing to mild hearing loss, who also have normal or corrected-to-normal vision.