PubMed · 10541637
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A Limberger, H P Zenner. 1999. [Hearing disorders].. https://doi.org/10.1007/s001080050441
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A high prevalence of tinnitus in cochlear implant users has been demonstrated, but fortunately a large percentage of patients do report some degree of tinnitus suppression postoperatively. Improvements in the duration and intensity and the annoyance level and loudness of the perceived tinnitus postimplant have been demonstrated. The risk of worsening of the tinnitus percept after cochlear implantation is small.
We report on 113 multichannel intracochlear implantations. Although the surgical approach has evolved as a result of new implant designs, one essential step has remained, namely initial exploratory tympanotomy. This 15-min procedure allows direct anatomical assessment and work in the middle ear. After direct exposure, the lip of the niche is removed and the round window membrane is visualized. The basal turn of the cochlea is then assessed for patency, and the capability of inserting electrodes is verified. The surgical procedure is then performed in the knowledge that an adequate insertion will be possible. This approach allows insertion through the round window instead of a cochleostomy hole, thus avoiding potential damage to remaining neural structures and additional exposure of inner ear structures and electrodes to potential middle ear infections. It also requires a limited mastoidectomy (extended antrotomy) as the facial recess is visualized from the middle ear side (avoiding the need for extensive drilling), and the mastoid and facial recess openings are only used as conduits for the electrode array. In this study, 14/113 patients (12.4%) had either different degrees of ossification (n = 11) or Mondini deformity (n = 3). Direct work in the middle ear allowed handling and drilling as required in all cases. In two cases with severe ossification, a cochlea was sculpted around the modiolus. This included drilling of the anterior portion, which is inaccessible using the facial recess approach.
OBJECTIVE: To evaluate the time span over which there is greatest improvement in postlingually deaf adults undergoing cochlear implantation. Additionally, to quantify potential patient and device factors that may predict the postoperative results. MATERIAL AND METHODS: A longitudinal study was conducted. Numbers, monosyllables and sentence test results were collected for 66 cochlear implant subjects [Combi 40/40 +, n = 60; Clarion HF2, n = 2; Nucleus 24m/k, n = 4] at regular intervals for up to 6 years following cochlear implantation. RESULTS: All patients showed a steady improvement over time on all tests. Progress during the first 12 months was statistically significant, with further improvements being recorded after the 12-month testing period. The duration of deafness and the number of electrodes (8 for the Combi 40, 12 for the Combi 40 + ) appeared to be weakly correlated with postoperative performance. Re-implantation after device failure had no negative effect on speech reception. Subjects who were "upgraded" from an analogue to a digital cochlear implant improved their test results almost twofold. CONCLUSION: All the patients in our study gained substantial benefit from their cochlear implants. It is encouraging to note that the factors examined were not deemed to be relevant predictors of performance. Even long-term deaf subjects and re-implantees are able to achieve an excellent level of speech perception.