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At least 253 records · Page 14Linked to original sources
PubMed1996

[Problems in cochlear implant surgery].

In cochlear implant surgery, major complications, requiring revision procedures, do not exceed 5% of cases reported. Less frequent are problems that call for specific technical solutions. In 44 multichannel implantations (out of 54 cases) adverse conditions occurred and were successfully resolved in 6 patients: 1) delayed wound breakdown (one case); 2) chronic otitis media (three cases); 3) cochlear obliteration (two cases). Problem 1 was managed with the excision of an ellipse of skin including the devitalized areas under local anesthesia. The electronic package was left untouched, and the freshly cutaneous edges were mobilized and layer-sutured. Problem 2 was solved through a two-stage procedure. The chronic ear was dealt with as usual (myringoplasty, tympanoplasty, revision of a radical mastoidectomy). In the second stage the cochleotomy and device implantation were carried out. Problem 3 is a major issue for the surgeon. Following the Lehnhardt technique we drilled along the basal cochlear turn using the sharp line between the yellowish otic bone and the white newly formed bone as a landmark, until a patent s.tympani was found at the ascending part of the 1st or at the beginning of the 2nd turn.

Cochlear Implants↗
PubMed1997

Predictive factors in cochlear implants.

Predictive factors in cochlear implants. The clinical records of 32 patients who received a multichannel cochlear implant between 1991 and 1994, were retrospectively reviewed. A Nucleus Mini 22 device was used in 27 cases, a Clarion device in 5 cases. The aim of this study was to identify the predictive role, and hence the influence on the final result of such factors as: the age of patients at implantation and at the onset of deafness, the duration of profound deafness, the aetiology of deafness, sudden or progressive hearing loss, the number of recordable sound frequencies, the promontory test outcome, the length of electrode insertion, the number of active electrodes, the map. A statistically significant negative correlation (p = 0.02) was found between the duration of deafness and patients' performance. The relationship between map and performance, due to the small number of patients, did not reach statistical significance although it was very close to the limit (p = 0.055). The other mentioned factors did not achieve any statistical significance.

Adolescent↗
PubMedDate not supplied

[Development of auditory handicap after a multi-electrode cochlear implantation].

The efficacy of cochlear implantation as an aid to communication for profoundly hearing impaired persons is now established. International data show that some comprehension without visual cues is possible in many cases. Up to now, the bulk of research has been focused on psychoacoustical and speech perception measures. Hearing handicap changes following an implantation were rarely explored. On a longitudinal study on the benefits of cochlear implantation for twelve adults with profound acquired deafness, we explored the evolution of the hearing loss handicap. Two questionnaires were completed by the participants before and after implantation. A descriptive analysis of the data shows a rather moderate diminution of the handicap. The importance of the diminution appears inversely correlated to the length of deafness.

Adolescent↗
PubMed1999

Programming features of the CLARION Multi-Strategy Cochlear Implant.

Because patient performance with multichannel cochlear implants varies widely, cochlear implant systems must address the diverse needs of patients during the postoperative fitting of the external equipment. This paper describes the processing strategies available with the CLARION Multi-Strategy Cochlear Implant and the different programming features available for optimization of these speech processing strategies. In addition, preliminary data are presented about the frequency of use of various fitting parameters with adult Simultaneous Analog Stimulation (SAS) and Continuous Interleaved Sampler (CIS) patients and pediatric CIS users. The data reveal that many of the programming features available to the clinician are useful with both the adult and pediatric populations and across strategies. The flexibility of both processing strategies and the programming options clearly contribute to the optimization of patient device fittings. Optimized device fittings, in turn, maximize patient performance.

Cochlear Implants↗
PubMed1996

An audit of the cochlear implant service in Manchester.

The adult cochlear implant programme in Manchester was established in 1988 and the evaluation of the cochlear implant service involved the first 58 implants users (mean age = 51.65 years, range 19-75 years). Questionnaires were sent to implant users and their partners to evaluate the service with regard to provision of information, clinical care during in-patient assessments, waiting times, operation for cochlear implant and post-operative rehabilitation. The results show that the majority of patients (78 per cent) felt that the implant gave them as much or more benefit than expected. Areas identified for improvements include provision of more written information about cochlear implants; reduction in waiting times for first appointments; more information about the surgical risks and more instruction about home auditory training exercises for family and friends. As a consequence of the audit results the clinical practice and service provision for cochlear implantation in Manchester has been modified.

Adult↗
PubMed2005

Speech perception in elderly patients following cochlear implantation.

CONCLUSIONS: Elderly patients benefit from cochlear implantation in terms of speech perception and quality of life. Age alone should be no contraindication for implantation. OBJECTIVE: There have been concerns whether elderly patients may perform poorly after cochlear implantation due to degenerative processes in the central and peripheral auditory systems. The purpose of this study was to analyze the benefits of cochlear implantation in elderly patients in comparison to younger recipients. MATERIAL AND METHODS: We examined 26 postlingually deafened adults aged > 65 years who received a cochlear implant at our center regarding preoperative findings, comorbidities, postoperative complications and quality of life. Speech perception was assessed by means of multi- and monosyllabic word recognition and compared to the results obtained by younger patients. RESULTS: The surgical procedure was well tolerated by all patients without notable perioperative complications. In terms of speech perception, no significant differences between the elderly patients and younger recipients were noted. All patients found that cochlear implantation had a positive impact on their quality of life.

Age Factors↗
PubMed2005

Is word recognition correlated with the number of surviving spiral ganglion cells and electrode insertion depth in human subjects with cochlear implants?

OBJECTIVES/HYPOTHESIS: Speech perception scores using cochlear implants have ranged widely in all published series. The underlying determinants of success in word recognition are incompletely defined. Although it has been assumed that residual spiral ganglion cell population in the deaf ear may play a critical role, published data from temporal bone specimens from patients have not supported this hypothesis. The depth of insertion of a multichannel cochlear implant has also been suggested as a clinical variable that may be correlated with word recognition. In the current study these correlations were evaluated in 15 human subjects. STUDY DESIGN: Retrospective review of temporal bone histopathology. METHODS: Temporal bones were fixed and prepared for histological study by standard techniques. Specimens were then serially sectioned and reconstructed by two-dimensional methods. The spiral ganglion cells were counted, and the depth of insertion of the cochlear implant as measured from the round window was determined. Correlation analyses were then performed between the NU6 word scores and spiral ganglion cell counts and the depth of insertion. RESULTS: The segmental and total spiral ganglion cell counts were not significantly correlated (P > .50) with NU6 word scores for the 15 subjects. Statistically significant correlations were not achieved by separate analysis of implant types. Similarly, no significant correlation between the depth of insertion of the electrode array and postoperative NU6 word score was identified for the group. CONCLUSION: Although it is unlikely that the number of residual spiral ganglion cell counts is irrelevant to the determination of word recognition following cochlear implantation, there are, clearly, other clinical variables not yet identified that play an important role in determining success with cochlear implantation.

Aged↗
PubMed1987

[Cochlear implantation in the child?].

Cochlear implants in early childhood may be recommended at this age which is critical for speech and language development. Implantation cannot yet be accepted in this group because of diagnostic difficulties, special rehabilitation problems and the frequency of middle ear infections with the possible risk of bacterial invasion of the cochlea. As children grow older, insufficient motivation may reduce the effects of rehabilitation procedures. A good cooperation with educators must be guaranteed. A further problem of cochlea implantation in children is posed by pre-operative counselling complicated by ethical and legal considerations. Cochlear implantation in children requires improved diagnostic tools to establish the etiology, objective testing of residual hearing and quantifications of nerve survival in addition to special rehabilitation programs.

Auditory Threshold↗
PubMed1999

Prolonged deafness limits auditory system developmental plasticity: evidence from an evoked potentials study in children with cochlear implants.

The use of cochlear implants to restore hearing in profoundly deaf children is increasing, with a trend toward earlier implantation. However, little is known about how auditory deprivation and subsequent implant use affects the maturing central auditory system. Previously reported results indicate that stimulation of the auditory system by a cochlear implant is sufficient to restore at least some aspects of central auditory pathway maturation, as reflected by age-related changes in the auditory evoked potentials. We review animal and human studies on sensory deprivation and report new results based on longitudinal evoked potentials data recorded from two individuals. Analyses show that age-related changes in the EPs may asymptote at levels very different from those found in the adult normal-hearing population. These results suggest that maturation of at least some aspects of central auditory system activity is limited by the onset and duration of the period of deafness prior to implantation.

Adult↗
PubMed2002

[Binaural cochlear implantation: general concept, surgical technique and electrophysiology].

Cochlear implant have been proven to be safe and cost-effective in deafened adults. Generally, a single cochlear implants is proposed providing monaural audition. Some teams have published interesting results in patients wearing two cochlear implants. The cost of the surgical procedure is greatly increased for bilateral implantation. In an attempt to provide patients with binaural hearing and a better chance to improve their capacity for frequency discrimination without an excessive increase in cost, we developed an new concept and design for binaural cochlear implants. The aim of the present study was to establish the surgical technique for binaural cochlear implantation with a single internal receptor-stimulator. We report descriptive data on surgical procedures performed in two cadavers and in two deafened adults. The special implant is composed of a single receptor-stimulator and two electrode arrays: a short one implanted into the ipsilateral ear and a long one in the contralateral ear. A specially designed tool for endoscopic facial lifting was used to create subcutaneous tunnels from the ipsilateral to the contralateral ear. Insertion into cochleas was unremarkable. Additional time for surgery (compared with mean operative time for routine adult surgery in our unit), and surgical details are discussed. Binaural cochlear implantation is feasible, easy and not very time consuming. Studies are in progress to determine patient benefit. Obtaining auditory brainstem evoked potentials electrically in patients with binaural cochlear implants is possible and provides an interesting mode for in vivo analysis of the long-term effect of profound/total deafness on neural transmission. In our patients, results have demonstrated that neural response properties in auditory pathways are negatively related to duration of deafness.

Adult↗
PubMed2003

Aetiology of hearing loss and other related factors versus language outcome after cochlear implantation in children.

OBJECTIVE: Cochlear implantation outcome in prelingually deafened children is highly variable. The objective of this study was to examine the relationship between the yearly improvements in speech and language scores after cochlear implantation in children, with the aetiology of the hearing loss and other related factors. METHODS: We reviewed the case notes of children with early onset (0-2 years) of hearing loss, who were implanted in their first decade of life between 1992 and 2000 in Great Ormond Street Children Hospital. We assessed the relationship between the improvement of the receptive language and speech scores, on each year after implantation, with the aetiology of hearing loss and with the presence of additional medical problems. RESULTS: Children with a syndromic diagnosis had lower speech and language improvement scores at years 4 and 5 after implantation than children with a hereditary-non syndromic or unknown diagnosis. Vision and vestibular problems were significant negative predictors for speech and language improvement scores. The disability score, i.e. an overall index of additional to the hearing loss problems, had a negative correlation with the speech and language improvement scores. CONCLUSIONS: The presence of a syndromic diagnosis, vision or vestibular problems, and the overall level of additional to the hearing loss problems, may be negative prognostic indicators for speech and language improvement after implantation.

Child, Preschool↗
PubMed2002

[Bioethical issues in pediatric cochlear implants].

The use of cochlear implants can modify significantly the way in which deaf children relate with the outside world through psychological, linguistic and cognitive changes. The main question about this subject is the ethical controversy with regards to who has the right to make such a decision for a young child. We present the children evaluated at our hospital in order to assess the cochlear implant option. That population was of 37 implanted children, 10 children waiting for surgery and 21 rejected children. We describe and analyze from the bioethical bases and methodology the problems found: decision of no implant in children of hearing parents, the deaf culture point of view, the mature minor doctrine, teenagers, social and cultural problems, multihandicapped children and responsibility of the implants team.

Bioethics↗
PubMed1986

Cochlear implant electronics made simple.

Electronics used in cochlear implants are relatively straightforward. While all cochlear implants process signals by amplifying, compressing, filtering, and encoding them for transmission to and use by the receiver, there are significant electronic variations amongst cochlear implant systems. The evolving nature of cochlear implant research and development makes it difficult, at the least, to predict the optimum electronic configuration. Since the biologic system which this prosthesis replaces is subject to so many forms and degrees of pathology, there is likely no one best answer. Since their first use in 1957, cochlear implants have steadily evolved to their current state. Much is still unknown about the biologic system on which they operate. It is exciting to contemplate that this biologic system, even though damaged, may be made more understandable by the same device which restores some hearing function.

Cochlear Implants↗
PubMed1992

Auditory perception changes after reimplantation in a child cochlear implant user.

The ability to remove cochlear implants from children and subsequently reimplant a more complex device in the same ear was the concern of this single case study. A postlinguistically deafened child, J.L., received a single-channel cochlear implant 1 yr after contracting meningitis and suffering a profound bilateral sensorineural hearing loss. After 3 yr of successful implant use, J.L. suffered an internal coil failure. She was then explanted and reimplanted with a multichannel cochlear implant in the same ear. This case report details her speech perception skills with her single-channel cochlear implant, a vibrotactile aid, and a multichannel cochlear implant. Results from auditory perceptual measures suggest that the explantation/reimplantation process was technically feasible with no adverse effects on J.L.'s ability to utilize a more sophisticated device and to exceed her previous performance levels.

Acoustic Stimulation↗
PubMed2005

Long-term results of cochlear implantation in children.

OBJECTIVES: Since the first implantation of a multichannel cochlear implant over 15 years ago there have been improvements in implant devices, surgical techniques, speech coding strategies and rehabilitation matters. There also have been concerns, whether the first implanted systems are stable and the benefit for the patients is constant over a long time. This study analyzes long-term results of prelingually deaf children who were implanted at Aachen University Hospital. STUDY DESIGN AND SETTING: We examined 16 prelingually deaf children, who underwent cochlear implantation at our department between 1990 and 1993 over a time period of 10 to 13 years. The indication, perioperative complications, technical parameters, speech test results as well as the psychosocial development of the children were analyzed. A questionnaire containing questions about the daily use, expectations and the personal evaluation of the procedure was sent to all patients. RESULTS: The mean age of all patients was 9 years at time of implantation. In two cases we saw postoperative complications which needed an intervention. The speech test results remained stable after reaching a plateau after 5 years. Eighty-eight percent of all patients would undergo the procedure again and 94% would recommend cochlear implantation to others. CONCLUSION: Cochlear implantation in cases of prelingual deafness is feasible without severe complications and leads to an increasing quality of life demonstrated by long-term observation.

Child↗
PubMed1998

Design for an inexpensive but effective cochlear implant.

Widespread application of cochlear implants is limited by cost, especially in developing countries. In this article we present a design for a low-cost but effective cochlear implant system. The system includes a speech processor, four pairs of transmitting and receiving coils, and an electrode array with four monopolar electrodes. All implanted components are passive, reducing to a minimum the complexity of manufacture and allowing high reliability. A four-channel continuous interleaved sampling strategy is used for the speech processor. The processor and transmission link have been evaluated in tests with a subject previously implanted with the Ineraid electrode array and percutaneous connector. A prototype of the link, consisting of four pairs of transmitting and external receiving coils, was used, with the outputs of the receiving coils directed to four intracochlear electrodes through the percutaneous connector. The subject achieved speech reception scores with the prototype system that were equivalent to those achieved with a standard laboratory implementation of a continuous interleaved sampling processor with current-controlled stimuli.

Cochlear Implantation↗
PubMed1992

[Psychological aspects of cochlear implantation].

Psychological aspects of cochlear implantation were studied in 20 adults and children. Patients were interviewed before admission and were given tests and questionnaires to answer with regard to overall wellbeing, intellectual functioning, hopes and beliefs, expectations with regard to the implant and the support they were getting (last 2 also for a family member). Those who passed the screening were referred for surgery, and those who didn't were referred for therapy. 6 months after implantation the patient and the family member were again interviewed and answered questionnaires with regard to adjustment to the implant and the patient's satisfaction with it. In those who benefitted from the implant there were no psychopathological features, there was good cognitive functioning, a moderate level of concentration and attention span and a great degree of flexibility in personality traits. Crucial to better adjustment was quality of family support. Following cochlear implantation there was considerable improvement in life style.

Adaptation, Psychological↗