Results of cochlear implant reinsertion.
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Child↗
Biomedical subjects
P M Chute
Publications and source records attributed to P M Chute.
The development of a Children's Implant Profile.
The decision to provide a child with a cochlear implant is quite complex, as it must include consideration not only of the implant itself but also of the habilitative services necessary following the surgical procedure. To provide a systematic means of selecting hearing-impaired children for cochlear implants, a team at Children's Hearing Institute, Manhattan Eye, Ear and Throat Hospital, developed the Children's Implant Profile (ChIP). There is no one profile of a successful implant user--at least 11 factors appear to contribute to successful implantation. In the ChIP, each factor is evaluated on a three-point scale: (1) no concern, (2) mild-to-moderate concern, and (3) great concern. A profile showing "no concern" on all 11 factors denotes clear acceptability of the child as an implant candidate. A profile including several ratings in the "mild-to-moderate concern" category suggests a need for further study to determine if improvements could be made in projected outcomes before initiating surgical procedures. Finally, ratings of "great concern," especially on more than one factor, indicate a very limited probability of successful implant outcomes, at least at the time of evaluation. A case study is presented to demonstrate the relationship between the evaluated factors and to show how the profile is used to address and remedy areas of concern.
Child↗
Pediatric cochlear implant candidacy issues.
Children with progressive sensorineural hearing impairment represent a special challenge to the audiologist and the otologist. These are patients with some residual auditory abilities that deteriorate with time as the hearing loss progresses. No doubt, the unnecessary implantation of an ear that significantly benefits from amplification needs to be avoided at all costs. By the same token however, there appears to be no advantage to waiting an inordinate amount of time after the loss of functional auditory abilities before recommending implantation. At times when a complete loss is predictable, implantation may be advantageous before the onset of complete auditory deprivation. Steps the clinicians should take to manage these patients effectively are briefly summarized below: Implementation of rigorous and frequent audiologic monitoring. If, for instance, a significant progressive loss of hearing has occurred over a 6-month period, resulting in a complete absence of open-set speech recognition abilities in the auditory-alone mode with appropriate hearing aids, it is probably counterproductive to wait to the point of a complete absence of aided speech detection. Implantation at a critical point in time will prevent complete auditory deprivation. Parental counseling concerning various management strategies, such as use of vibrotactile devices, changing communication skills, and issues involving cochlear implants need to be undertaken early. Parents need to be involved in every phase of the evaluation process because they are the ones who make the final decision concerning the implantation of their child. Relatively early implantation should be considered in light of what is known concerning the effects of disruption in a child's linguistic, cognitive, and emotional development resulting from complete auditory deprivation.(ABSTRACT TRUNCATED AT 250 WORDS)
Auditory Threshold↗
Cochlear implant flap complications.
In a series of 52 patients who received cochlear implants, 4 patients suffered flap complications (7.7%). The problems encountered involved the postauricular flap and were usually minor in nature. None required explantation as a direct result of these complications. Flap ischemia in a patient with Cogan's syndrome and vasculitis, two cases of suture extrusion with one having exposure of the implant, and a case of receiver unit magnet extrusion repaired with a vascularized pericranial flap based upon temporalis muscle are presented. Flap design in patients who have had postauricular incisions demands special consideration. Principles useful for avoiding complications as well as their management are discussed.
Adult↗
A matched-pairs comparison of single and multichannel cochlear implants in children.
Auditory capabilities of Nucleus 22 multichannel cochlear implant users were compared to those of matched 3M/House single-channel users. Six children who received either the 3M/House or Nucleus 22 cochlear implants were separated into three matched pairs. Group 1 consisted of two postlinguistically deafened adolescents, group 2 consisted of two prelinguistically deafened school-age children, and group 3 consisted of two perilinguistically deafened preschoolers. Participants were evaluated using auditory comprehension and discrimination tasks as indicated by the 3M/House and Nucleus 22 protocols. However, only tasks common to both were included here. While the 3M/House single-channel device has been under an IDE for children under the age of 18 years since 1984, the Nucleus 22 multichannel implant only recently became available for this age group. Thus, short-term evaluations at 6 months and 1 year postimplantation have been used for comparison. Two of the three groups indicated that the multichannel users performed as early as the 6-month level; the children in the third group performed equally. These results indicate that multichannel cochlear implants show great promise in deaf children.
Adolescent↗
The speech of a postlingually deafened teenager during the first year of use of a multichannel cochlear implant.
The speech of a profoundly postlingually deafened teenager was recorded before, immediately after, 3 months after, and 1 year after electrical stimulation with a Nucleus multichannel cochlear implant. Listener tests of target words revealed significant improvement in overall quality over the year. Spectrograms showed less aspiration and better definition of the lower formants. Acoustic measurements indicated immediate change in F0 and gradual changes in syllable duration and some aspects of voicing and manner of articulation. Vowel space shrank steadily over the year, with both first- and second-formant frequencies dropping. Prestimulation results are discussed relative to the literature on the speech of the congenitally hearing impaired. Effects of multichannel electrical stimulation on speech are compared with studies of single-electrode stimulation.
Adolescent↗
Surgical therapy of chronic mastoiditis with cholesteatoma.
One hundred fifty-seven ears treated surgically for chronic mastoiditis with cholesteatoma are reviewed. The selection of an operative procedure ("canal wall up" or "canal wall down") was dictated by the extent of pathologic indications in relation to the size of the patient's mastoid. The incidence of recurrent or residual cholesteatoma, the hearing results, and the frequency of visits required for mastoid cavity care are reported.
Adolescent↗