The Ineraid cochlear implant in children: surgical implications and tolerance.
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Adolescent↗
Biomedical subjects
P Montandon
Publications and source records attributed to P Montandon.
Electrically evoked auditory brainstem responses in cochlear implant patients.
Electrically evoked auditory brainstem responses (EABR) were recorded in completely deaf patients implanted with Ineraid multichannel cochlear implants. Clear and reproducible EABR were obtained from all patients. Parametric differences with auditory brainstem responses (ABR) were demonstrated and can be explained by the different natures of both types of stimulations (electric versus acoustic). Evidence is given that other well-known properties of auditory evoked responses, like 'binaural interaction' or suppression of responses in a forward masking paradigm, can be observed in EABR of implanted patients.
Acoustic Stimulation↗
Exploratory cochleotomy. Assessment of auditory nerve excitability and anatomical conditions in cochlear implant candidates.
The exploratory cochleotomy is a new diagnostic procedure for the selection of cochlear implant candidates. We use this procedure to assess the excitability of the auditory nerve, the patency of the cochlea and to detect undesirable side effects of electrical stimulation, such as facial nerve activation. The exploratory cochleotomy is a limited surgical procedure performed under local anesthesia in adults and light sedation in children. It is combined with the recording of electrically evoked brainstem responses elicited by an intracochlear probe electrode.
Adult↗
Geneva experience with the Ineraid multichannel cochlear implant.
Ineraid is a multichannel intracochlear implant of recent design that can provide high levels of speech recognition to totally deaf patients. We chose this device when it became available in 1985 because of our clinical and research interests. We had no commercial ties and could therefore critically assess the value of this implant in an array of patients, including congenital deafness, ossified cochleas and perilingual children.
Adolescent↗
A case study of a 4-year-old perilingual deaf child implanted with an Ineraid multichannel cochlear implant.
In August 1989, we implanted the first young (age 2-4) perilingual deaf child with the Ineraid multichannel cochlear implant. The child experienced sudden deafness at the age of 3 years 9 months. The time lapse between the onset of deafness and the implantation of the electrode array was only 4 months, but during that time the child completely stopped talking. Electrically evoked auditory brainstem responses were used for diagnosis and follow-up.
Child, Preschool↗
Restoration of hearing with type V tympanoplasty.
Type V tympanoplasty with fenestration of the oval window and protection of the round window in a residual hypotympanic cavity can be considered as the last-chance procedure for rehabilitation of hearing in ears with 'canal wall down' or other conditions. The review of 64 cases suggests that restoration of hearing can be adequate in the majority of cases.
Adipose Tissue↗
Intracochlear potential distribution with intracochlear and extracochlear electrical stimulation in humans.
Intracochlear potential distributions were measured from subjects implanted with the Ineraid multichannel cochlear implant. The electrode array provided direct accessibility for obtaining measurements. Different modes of stimulation were used. The findings with intracochlear monopolar stimulation seem to confirm that significant low-resistance pathways, in which currents can flow into or out of the cochlea, are located in the basal turn. The results with extracochlear stimulation only show small intracochlear potential gradients. This finding suggests that no substantial currents flow along the auditory nerve fibers when extracochlear stimulation is used. These results concur with the electrically evoked auditory brain stem responses, in that intracochlear stimulation consistently elicited auditory brain stem responses, whereas responses elicited at or near the round window by extracochlear stimulation were weak or absent.
Cochlea↗
Indication of a relation between speech perception and temporal resolution for cochlear implantees.
In order to better understand the reasons for success or failure of a cochlear implant system for various patients, it appears necessary to analyze the patients' basic psychophysical capacities in relation to speech perception. Five patients with intracochlear multichannel Ineraid implants were studied in terms of their performance on temporal analysis in relation to their perception of consonants. For temporal analysis we measured the detection of a silent gap in noise and of an interval between two clicks. For consonant perception we established a confusion matrix based on 12 consonants presented in a vowel-consonant-vowel context using the vowel /a/. The results showed a correlation between temporal resolution for two successive clicks at the most basal cochlear electrode used, and the perception of place of articulation of consonants. This finding indicates that delivering fine temporal coding can be crucial for the success of an implant and that for a given subject, optimal capacity for temporal resolution may serve as a criterion for choosing a basal electrode.
Cochlear Implants↗
Bilateral electrical stimulation of a congenitally-deaf ear and of an acquired-deaf ear.
Two identical multichannel intracochlear prostheses were implanted in the same patient. The first prosthesis, implanted in the congenitally-deaf right ear, elicited clear sound perception but no speech recognition. After 2 years, a second prosthesis, implanted in the acquired-deaf left ear, enabled the patient to understand speech without lip-reading. Brainstem and middle-latency evoked potentials were similar with electrical stimulation of both ears and resembled those evoked by acoustic stimuli in subjects with normal hearing. Cortical electric and magnetic responses differed for right- and left-sided electrical stimulation suggesting that stimulation of the congenitally-deaf ear elicited an abnormal activation of the auditory cortex. These results suggest that only cortical responses were affected by the different histories of deafness of the ears.
Cochlear Implants↗
[The "Ineraid" multichannel cochlear implant].
In Geneva from 1985 to November 1990, we have implanted 21 Ineraid TM multichannel-cochlear implants in 18 totally deaf patients. On the basis of our experience we have divided the patients in 2 categories: optimal cases and difficult cases. Optimal cases had post lingual deafness and adequate anatomical conditions for implantation. They all recovered understanding of free running speech without lip-reading. Difficult cases had ossified cochlea or pre-and-perilingual deafness: results are variable and less predictable. The cochlear implant is both an artificial sense organ and a prosthetic device. With the aid of the prothesis the patient can hear. When the processor stops functionning the patient is again totally deaf. Implanted deaf patients require life-long technical and medical support.
Cochlear Implants↗
[Surgical treatment of Ménière's disease by sacculotomy, cochleo-sacculotomy and transtympanic aerators].
Sixty-two patients suffering from severe Ménière's disease with invalidating vertigo attacks were treated between 1976 and 1987 by three minoir surgical procedures: sacculotomy (19), cochleo-sacculotomy (15) or a transtympanic ventilation tube (28). The results were assessed after the second post-operative year according to the criteria of the American Academy of Otolaryngology (1985). The overall success rate for vertigo control was 79% with sacculotomy, 80 with cochleo-sacculotomy and 82% with transtympanic ventilation tubes. Severe permanent hearing-losses occurred in 20% after sacculotomy and cochleo-sacculotomy. Drop-attacks were not improved. These three surgical procedures give similar results with respect to vertigo control without any vital risk. The precise mechanisme of action in these procedures is not yet well understood.
Evaluation Studies as Topic↗
[The treatment of deafness].
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Cochlear Implants↗
Binaural interaction in a cochlear implant patient.
Binaural interaction was demonstrated in electrically evoked brainstem responses (EBRs) of a bilaterally implanted patient. A clear binaural difference waveform (BD), consisting of a negative peak near 3.6 ms followed by a positive peak near 4.4 ms, was found by subtracting the recordings with diotic stimulation from the sum of the recordings with monotic stimulation. These results are consistent with those reported for normal subjects and suggest that neural processing in this patient might resemble those ordinarily used in binaural hearing. They strengthen the argument that EBRs in cochlear implant patients do result from activity in auditory brainstem neurons and suggest a method for aligning the positions of the intracochlear electrodes.
Brain Stem↗
Wegener's granulomatosis with otological disorders as primary symptoms.
Otological symptoms as initial manifestations of Wegener's granulomatosis have been observed in 3 patients. In one of them, symptoms consisted of a bilateral sensorineural hearing loss, improved by corticoid therapy. No other organ system was involved and laboratory tests remained within normal limits for 2 years after the onset of otological signs. In the other 2 patients, Wegener's granulomatosis manifested mainly as serous otitis media. Otologic involvement underscores the role of the otolaryngologist in the early diagnosis and treatment of this disease.
Adult↗
Multi-channel cochlear implant patients with different open speech understanding show some similar basic psychophysical results.
A series of tests was recently undertaken on three multi-channel cochlear implant patients showing different degrees of open speech understanding in order to try to determine underlying differences in inner ear excitation. First we wanted to determine whether these patients showed notable differences in basic psychophysical tasks. This article reports a series of measures including absolute and differential thresholds, simultaneous and forward masking, and some polarity and phase perception. Absolute and differential sensitivities were found to be similar. In forward or simultaneous masking, the patients often showed no masking at all and in cases of masking, no frequency selectivity. In forward masking, their time constants were found to be longer than those in normal hearing. Multi-harmonic signals differing only in phase relations to produce large differences in peak amplitude did not seem to elicit different perceptions. In stimulating with very low-frequency square waves, only negative going fronts were perceived. The similarity of results for the 3 patients in this study suggest that individual differences lie in more complex stimulus processing and perhaps in qualitative aspects of perception.
Adult↗
Electrically evoked responses in Cochlear implant patients.
Highly reproducible recordings of evoked responses elicited by electrical stimulation of the auditory nerve were obtained in a group of 4 totally deaf patients implanted with a multichannel intracochlear prosthesis. They were compared to auditory evoked responses obtained in a normal-hearing subject tested with the same equipment. The most striking observation drawn from these data is certainly the close resemblance, at all latencies, between evoked responses elicited by electrical stimulation and those elicited by acoustic stimulation. The remarkable correspondence of waveform morphology, waveform amplitude and interpeak latencies provides indirect evidence that the same sequence of events is triggered in the central auditory system in both cases. Those aspects of the responses which differ significantly are easily interpreted by the physical and physiological properties of the different types of stimulation.
Auditory Perception↗
Noninvasive extratympanic electrical stimulation of the auditory nerve.
We have developed a noninvasive technique for extratympanic stimulation of the auditory nerve. 119 ears of 76 subjects with either normal, residual or no hearing were tested. 73% of the subjects with experience of hearing reported definite auditory sensations. Subjects with no certain experience of hearing could not describe accurately the nature of their sensations. Electrical stimulation of normal ears failed to elicit auditory sensations. These results compare well with those of promontory stimulation in cochlear implant candidates.
Adolescent↗
Prevention of vertigo in Ménière's syndrome by means of transtympanic ventilation tubes.
The insertion of a transtympanic ventilation tube prevented the occurrence of vertiginous attacks in 82% of a series of 28 patients suffering typical Ménière's syndrome with incapacitating vertigo resistant to medical treatment. The follow-up time exceeds 2 years for all cases. It ranges from 2 to 4 years with an average of 2.5 years. This treatment had no effect on drop attacks. Also, hearing loss does not seem to be influenced. The presence of a transtympanic ventilation tube has not caused any major complications in these patients. Obstruction or loss of the tube was in some cases followed by the reappearance of vertigo. It is therefore important to check the patency of the tube before concluding that treatment has failed. The apparent benefit of ventilation tubes in reducing the occurrence of vertiginous attacks suggests that patients with endolymphatic hydrops are particularly sensitive to middle ear pressure.
Adolescent↗