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PubMed1999

Trends in educational placement and cost-benefit considerations in children with cochlear implants.

OBJECTIVES: To study the effect of cochlear implantation on the use of educational resources by profoundly hearing-impaired children and to determine trends in educational cost vs benefit. DESIGN: Retrospective study and cost-benefit analysis. SETTING: Outpatient pediatric cochlear implant program in an academic institution (The Listening Center at Johns Hopkins University School of Medicine, Baltimore, Md), in collaboration with public schools in Maryland and surrounding states. PATIENTS OR OTHER PARTICIPANTS: School-aged children with profound prelingual hearing impairment without other clearly defined disabilities. Thirty-five children with multiple-channel cochlear prostheses and a comparison group of 10 children without implants from 'total communication' programs in the Maryland public school system. INTERVENTIONS: Multiple-channel cochlear implantation and at least 1 year of a systematic auditory skill development program at the Listening Center, compared with standard educational management of children with conventional amplification. MAIN OUTCOME MEASURES: Classroom placement and number of hours of special educational support used. RESULTS: A correlation was observed between the length of cochlear implant experience and the rate of full-time placement in mainstream classrooms (r = 0.10; P= .04). There was also a negative correlation between the length of implant experience and the number of hours of special educational support used by fully mainstreamed children (Pearson product moment correlation = -0.10; P = .03). Children with greater than 2 years of implant experience were mainstreamed at twice the rate or more of age-matched children with profound hearing loss who did not have implants. They were also placed less frequently in self-contained classrooms and used fewer hours of special education support. A cost-benefit analysis based on conservative estimates of educational expenses from kindergarten to 12th grade shows a cost savings of cochlear implantation and appropriate auditory (re)habilitation that ranges from $30000 to $200000. CONCLUSIONS: Cochlear implantation accompanied by aural (re)habilitation increases access to acoustic information of spoken language, leading to higher rates of mainstream placement in schools and lower dependence on special education support services. The cost savings that results from a decrease in the use of support services indicates an educational cost benefit of cochlear implant (re)habilitation for many children.

Adolescent↗

PubMed2005

Ventilation tubes and cochlear implants: what do we do?

OBJECTIVE: To determine current practice management with respect to ventilation tubes and cochlear implants. STUDY DESIGN: Questionnaire. SETTING: All members of the American Neurotology Society were sent questionnaires. MAIN OUTCOME MEASURES: Members were asked a series of questions including how they deal with ventilation tubes before cochlear implantation, how they manage serous otitis media in patients undergoing cochlear implantation, and how they manage otitis prone children with cochlear implants. RESULTS: Two hundred and twenty members returned questionnaires. Surgeons who replied perform an average of 25 implants per year: 15 in adults and 10 in children. Analysis of the data revealed a wide practice variation between surgeons. Fifty-six percent of surgeons will place a cochlear implant in a patient with a clean, dry ventilation tube in place. More than half the surgeons will place a ventilation tube in a child with serous otitis media, let the ear settle down, and perform the cochlear implant at a second operation. Wide variation in the management of otitis prone children with cochlear implants exists with respect to placement of ventilation tubes. Only 5% of surgeons reported any complications with cochlear implants that they attributed to ventilation tubes. There were a number who suggested their practice had changed since the recent identification of issues involving meningitis in implantees. CONCLUSION: Wide practice variation exists with the management of ventilation tubes in cochlear implant patients. On the basis of the results of this survey, it is acceptable to place cochlear implants in patients with clean, dry ventilation tubes. It also acceptable to place ventilation tubes in otitis prone children with cochlear implants. Despite theoretic concerns, the reported incidence of complications is low.

Cochlear Implantation↗

PubMed2006

Auditory cortical responses in patients with cochlear implants.

Currently, the most commonly used electrophysiological tests for cochlear implant evaluation are Averaged Electrical Voltages (AEV), Electrical Advisory Brainstem Responses (EABR) and Neural Response Telemetry (NRT). The present paper focuses on the study of acoustic auditory cortical responses, or slow vertex responses, which are not widely used due to the difficulty in recording, especially in young children. Aims of this study were validation of slow vertex responses and their possible applications in monitoring postimplant results, particularly restoration of hearing and auditory maturation. In practice, the use of tone-bursts, also through hearing aids or cochlear implants, as in slow vertex responses, allows many more frequencies to be investigated and louder intensities to be reached than with other tests based on a click as stimulus. Study design focused on latencies of N1 and P2 slow vertex response peaks in cochlear implants. The study population comprised 45 implant recipients (aged 2 to 70 years), divided into 5 different homogeneous groups according to chronological age, age at onset of deafness, and age at implantation. For each subject, slow vertex responses and free-field auditory responses (PTAS) were recorded for tone-bursts at 500 and 2000 Hz before cochlear implant surgery (using hearing aid amplification) and during scheduled sessions at 3rd and 12th month after implant activation. Results showed that N1 and P2 latencies decreased in all groups starting from 3rd through 12th month after activation. Subjects implanted before school age or at least before age 8 yrs showed the widest latency changes. All subjects showed a reduction in the gap between subjective thresholds (obtained with free field auditory responses) and objective thresholds (obtained with slow vertex responses), obtained in presurgery stage and after cochlear implant. In conclusion, a natural evolution of neurophysiological cortical activities of the auditory pathway, over time, was found especially in young children with prelingual deafness and implanted in preschool age. Cochlear implantation appears to provide hearing restoration, demonstrated by the sharp reduction of the gap between subjective free field auditory responses and slow vertex responses threshold obtained with hearing aids vs. cochlear implant.

Acoustic Stimulation↗

PubMed2005

Are cochlear implant patients suffering from perceptual dissonance?

Cochlear implants provide functional hearing to the majority of recipients and have gained widespread acceptance clinically, but the range of performance remains great and largely unexplained. Designs for implanted electrodes and electronics have converged, whereas novel speech processing strategies have proliferated. For each patient, the fitting audiologist must sort empirically through options that produce large but idiosyncratic differences in both objective performance and subjective preference. This review and analysis suggests that the place-pitch and rate-pitch theories on which cochlear implants have been designed are incomplete. The missing component may be related to the phase-locking of auditory nerve activity to both acoustic and electrical stimulation. This component is likely to be highly distorted by electrical stimulation but its importance as one of several different pitch encoding mechanisms may vary widely among patients. Systematic means to control these putative phase effects using modern, high-speed, and high-density cochlear implants may make it possible to identify more efficiently the best strategy for a given patient and to minimize the perceptual confusion that arises from conflicting cues.

Acoustic Stimulation↗

PubMed1986

Cochlear implantation in developing countries.

A cochlear implant program was started in Jeddah, Saudi Arabia, in September 1983. Three totally deaf adult patients have received implants so far, with encouraging results. The problems of cochlear implantation in developing countries are discussed with regard to the patient, team, and device. The rationale, stages, and future of the program are outlined.

Adult↗

PubMed2005

[Cochlear implantation with preservation of residual deep frequency hearing].

BACKGROUND: The aim of the present paper is to evaluate the clinical parameters in patients implanted for combined, ipsilateral electric-acoustic stimulation of the auditory system. METHODS: A total of 18 patients with residual deep frequency hearing were implanted with a Combi 40+cochlear implant (MED-EL, Austria). Insertion depths ranged from 18 to 22 mm (360 degrees ). A modified surgical technique should contribute to hearing preservation in low frequency regions of the cochlea. Pure-tone audiometric thresholds were measured pre- and postoperatively. A speech audiometric evaluation was performed on two subjects. RESULTS: Utilizing adapted surgical procedures, the preservation of low frequency hearing was accomplished in 16 of 18 subjects (88.9%). Seven (38.9%) patients had complete and nine (50.0%) partial preservation of residual hearing. The speech discrimination scores of two patients documented an increase in sentence intelligibility when compared with only the cochlear implant. CONCLUSIONS: Hearing preservation in cochlear implant surgery is possible. Insertions of 360 degrees provide a full functioning cochlear implant to stimulate sufficient neural structures for above average discrimination scores with the implant alone. A synergistic effect of the electric and the acoustic stimulation modes leads to high discrimination scores in background noise.

Adult↗

PubMed2001

Multichannel cochlear implantation in visually impaired patients.

OBJECTIVE: To evaluate the outcome of cochlear implantation in patients with severe to profound hearing loss and visual impairment. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center with a large cochlear implant program. PATIENTS: Six adults and two children with severe or profound hearing loss and significant visual impairment underwent multichannel cochlear implantation. Follow-up period ranged from 6 months to 9 years. Case history, etiology of visual and hearing loss, and benefit from cochlear implant were evaluated. INTERVENTIONS: Cochlear implantation and subsequent rehabilitation. MAIN OUTCOME MEASURES: Speech perception measures were selected based on the patient age and cognitive abilities. Identical measures were used in each patient before and after implantation. RESULTS: As a group, patients did well after cochlear implantation. There was significant improvement in speech perception when compared with the score before implantation. CONCLUSIONS: Cochlear implants can play a significant rehabilitative role in patients with severe visual and auditory impairment. Additional skills are required by the implant team for rehabilitation of patients with multiple sensory deficits.

Adult↗

PubMed2005

Development of visual attention skills in prelingually deaf children who use cochlear implants.

OBJECTIVE: To determine the effects of length of cochlear implant use and other demographic factors on the development of sustained visual attention in prelingually deaf children and to examine the relations between performance on a test of sustained visual attention and audiological outcome measures in this population. DESIGN: A retrospective analysis of data collected before cochlear implantation and over several years after implantation. Two groups of prelingually deaf children, one >6 years old (N = 41) and one <6 years old (N = 47) at testing, were given an age-appropriate Continuous Performance Task (CPT). In both groups, children monitored visually presented numbers for several minutes and responded whenever a designated number appeared. Hit rate, false alarm rate, and signal detection parameters were dependent measures of sustained visual attention. We tested for effects of a number of patient variables on CPT performance. Multiple regression analyses were conducted to determine if CPT scores were related to performance on several audiological outcome measures. RESULTS: In both groups of children, mean CPT performance was low compared with published norms for normal-hearing children, and performance improved as a function of length of cochlear implant use and chronological age. The improvement in performance was manifested as an increase in hit rate and perceptual sensitivity over time. In the younger age group, a greater number of active electrodes predicted better CPT performance. Results from regression analyses indicated a relationship between CPT response criterion and receptive language in the younger age group. However, we failed to uncover any other relations between CPT performance and speech and language outcome measures. CONCLUSIONS: Our findings suggest that cochlear implantation in prelingually deaf children leads to improved performance on a test of sustained visual processing of numbers over 2 or more years of cochlear implant use. In preschool-age children who use cochlear implants, individuals who are more conservative responders on the CPT show higher receptive language scores than do individuals with more impulsive response patterns. Theoretical accounts of these findings are discussed, including cross-modal reorganization of visual attention and enhanced phonological encoding of visually presented numbers.

Age Factors↗

PubMedDate not supplied

Neurophysiological requirements for implanted cochlear prostheses.

Regarding the neurophysiological requirements for implanted cochlear prostheses, we have discussed (i) the complexity of speech sounds, (ii) problems of intensity, then (iii) the frequency problem, and (iv) finally the possibility of a frequency transposition to the genuine frequency range of a single fibre of any mechanoreceptor and its connecting nerve fibre (less than 1 kHz) for the construction of an intracochlear prosthesis. In general it would seem necessary to seek compromises based on the fact that speech, at least the vowels, contains redundancy and that the use of additional sensory channels might be helpful for cochlear implants. Certainly besides other preprocessing techniques for speech information, the multichannel stimulation set-up of special electrodes has to be used to convey a sufficient amount of speech information to restore the faculty of speech perception in completely deaf patients. Decompression of intensity range and compression of frequency range might be especially useful.

Acoustic Stimulation↗

PubMed2004

Navigation as a quality management tool in cochlear implant surgery.

This cadaver study assessed the value of navigation in cochlear implant surgery. Cochlear implantation was simulated on a cadaver using a Stryker-Leibinger navigation system and a Nucleus 24 Contour implant. A conventional surgical strategy consisting of mastoidectomy, posterior tympanotomy, and cochleostomy was performed. The navigated surgical procedure was evaluated for accuracy, reliability, reproducibility, and practicability. The technology of computer-assisted surgery is applicable in cochlear implantation and beneficial in as much as the navigation-controlled implantation constitutes a non-invasive instrument of quality management. Nevertheless, in order to keep the point accuracy below one millimeter, a referencing method using concealed bordering anatomical structures may be further needed to perform the cochleostomy reliably under the guidance of a navigation system. More reproducible reference systems are needed if navigated lateral skull base surgery is to be fully relied upon.

Cadaver↗

PubMed1991

Psychological change following 18 months of cochlear implant use.

Consecutive recipients of multichannel cochlear implants participated in preimplant as well as 9-month and 18-month psychological evaluations. Before receiving a cochlear implant, psychological tests indicated that the implant recipients were more depressed, suspicious, socially isolated, lonely, and socially anxious than was the general population. After 18 months of implant use, there was a significant reduction in depression, loneliness, social anxiety, social isolation, and suspiciousness. These changes in psychological state did not correlate with improved performance on audiological measures. The data suggest that although cochlear implants can have a positive effect on the emotional and behavioral status of persons with acquired postlingual profound deafness, the psychological outcome of implants is not simply a function of the audiological benefit assessed with standardized speech-based audiological tests.

Cochlear Implants↗

PubMed2003

Longitudinal changes in children's speech and voice physiology after cochlear implantation.

OBJECTIVES: The purposes of this investigation were 1) to describe speech/voice physiological characteristics of prelingually deafened children before and after cochlear implantation and determine whether they fall into a range that would be considered deviant, 2) to determine whether selected deviant articulatory and phonatory behaviors of children with cochlear implants persist despite long-term cochlear implant use and continued participation in aural rehabilitation services, and 3) to determine whether further development of deviant articulatory and phonatory behaviors occurs postimplantation. DESIGN: Seven prelingually deafened children who received cochlear implants after 5 yr of age were followed from shortly before implantation until 5 to 6 yr postimplantation. These children received their early education in a Total Communication environment and used the Nucleus 22-electrode cochlear implant. All of them initially used the MPEAK speech processing strategy, and five of them eventually upgraded to the SPEAK speech processing strategy. Speech/voice physiological measurements that were obtained periodically from the children included intraoral air pressure (P(o)), nasal and phonatory air flow, voice onset time (VOT), and fundamental frequency (F(o)). Data from the deaf children were compared with a database from 56 children with normal hearing to determine when the deaf children exhibited "deviant" speech/voice behaviors. Speech/voice behaviors were considered "deviant" if they never occurred for children with normal hearing or were associated with z-scores that were outside the range of +/-2.0. RESULTS: The deaf children showed a wide range of deviant speech and voice behaviors both pre- and post-cochlear implant. The most frequently occurring atypical behaviors were use of negative P(o), high P(o) for [b, m], long and short VOT for [p], and high F(o). Some deviant behaviors improved post-cochlear implant. However, deviant behaviors often persisted for several years post-cochlear implant. There was considerable evidence of further development of deviant behaviors post-cochlear implant. All of the deaf children demonstrated deviancy on at least two of our measures at the last data collection interval (5 to 6 yr post-cochlear implant). CONCLUSIONS: Children who received cochlear implants after 5 yr of age and who were educated in a Total Communication setting showed persistence and further development of deviant speech/voice behaviors for several years post-cochlear implant. Although our findings cannot be generalized to other populations of children with cochlear implants (i.e., those who were implanted earlier, those educated in auditory-oral programs), it seems wisest at the present time not to assume that children's deviant speech/voice behaviors will remit spontaneously with continued cochlear implant use. Our data provide an important comparative database for future investigations of pediatric cochlear implant users who have had shorter periods of auditory deprivation and who have received cochlear implants with more current technological features. Longitudinal Changes in Children's Speech and Voice Physiology after Cochlear Implantation

Child↗

PubMed2004

Histologic evaluation of the tissue seal and biologic response around cochlear implant electrodes in the human.

HYPOTHESIS: Histopathologic study of the tissue seal and biologic response around cochlear implant electrodes in patients who had received a cochlear implant during life could provide clues concerning the pathogenesis of meningitis after cochlear implantation. BACKGROUND: Bacterial meningitis has been reported as an infrequent complication of cochlear implantation using a variety of electrode designs. The cause of meningitis in cochlear implant recipients has not been firmly established. In an analogous surgical situation, namely stapedectomy, delayed meningitis could occur as a complication of ipsilateral acute suppurative otitis media in which there was open communication between the middle ear and perilymph. METHODS: Twenty-one temporal bones from 20 individuals who had undergone cochlear implantation during life were studied by light microscopy. All sections passing through the cochleostomy site and electrode track were examined to evaluate the tissue seal at the cochleostomy, the presence or absence of an extracochlear electrode sheath, and finally, to seek evidence of a cellular inflammatory response near the electrode. These data were compared with clinical data, including electrode system used, the number of years between implantation and death, type of tissue used at surgery, and the age and sex of the patients. RESULTS: The 21 specimens included cases implanted with the Symbion Ineraid, Cochlear Corporation Nucleus 22-channel, Cochlear Corporation Nucleus 24-channel, a Cochlear Corporation Nucleus single channel, and Advanced Bionics Clarion C1 devices. At the cochleostomy site, and just within the cochlea, there was a robust fibrous and bony tissue response in all 21 ears and in most cases, there was a fibrous sheath surrounding the electrode in the middle ear. No recognizable open communication or potential communication between the middle ear and the inner ear was seen in any of the 21 ears. An inflammatory cellular response, including mononuclear leukocytes, histiocytes, and foreign body giant cells, were present in 12 of the 21 temporal bones (57%) and was most intense at the cochleostomy site. No statistically significant relationship was found between the presence or absence of inflammatory cells and the type of tissue graft used at surgery. CONCLUSIONS: The histologic evidence presented in this study does not support open communication between the middle and the inner ear as part of the pathogenesis of bacterial meningitis as a late complication after cochlear implantation. Rather, the finding of a cellular inflammatory response in 12 of 21 temporal bones suggests that late hematogenous contamination and colonization of the implant is a much more likely pathogenic mechanism. This putative mechanism has implications for possible strategies to prevent meningitis after cochlear implantation.

Aged↗

PubMed1994

Pitch perception in patients with a multi-channel cochlear implant using various pulses width.

Cochlear implants have been designed to partially restore hearing to those people who are totally deaf. Multi-channel cochlear implants offer the opportunity to evoke acoustic perceptions like loudness and pitch, elicited by a controllable pattern of electric stimulation by means of electrodes placed in different places along the cochlear length. In this study, two psychophysical experiments were conducted with 4 patients, 1 prelingually and 3 postlingually-deafened, implanted with the multi-channel cochlear prosthesis Nucleus 22. Experiments were carried out to study the effect of varying the width of the electric biphasic pulsatile stimuli on the discriminative abilities of the pitch perception. The tests involved place pitch ranking and pulse rate discrimination. Place pitch ranking was studied by determining the just noticeable difference in pitch pairs (jnd-pp), defined as the pair of nearest electrodes which elicit different pitch perception. Pulse rate discrimination was studied by determining the just noticeable difference in pulse rate (jnd-pr) defined as the minimal difference in stimulus repetition rate over a given electrode, which elicits different pitch perceptions. Both experiments were conducted using pulses of 400, 200, 100 and 50 microseconds/phase. The results indicated that in spite of the differences in pathologies and personal histories, both jnd-pp and jnd-pr decrease by diminishing the pulse width. Speech perceptual data, measured for various pulse widths, validates the usefulness of decreased pulse width which yields favorable results in the psychophysical tests.

Acoustic Stimulation↗

PubMed2002

The potential risk of carotid injury in cochlear implant surgery.

BACKGROUND: The advent of cochlear implantation has revolutionized the options afforded to the deaf population. With the increase in the prevalence of this procedure have come larger experiences in the associated technical challenges and complications. RESULTS: We present the evaluation and management of a patient with an unusual complication of improper placement of the implant electrode into the carotid canal and its management. We discuss the anatomy of the carotid artery and its proximity to the cochlea to emphasize the potential risk to this large vessel. CONCLUSIONS: Damage to the carotid canal and the carotid artery is a potential risk of cochlear implant surgery. When available, we recommend intraoperative electrical testing of the cochlear implant be performed. If there is doubt as to the placement of the electrode, a radiograph should be obtained before the patient is taken out of the operating room to avoid this complication.

Audiometry↗

PubMed2005

Spoken word recognition development in children with residual hearing using cochlear implants and hearing AIDS in opposite ears.

OBJECTIVE: With broadening candidacy criteria for cochlear implantation, a greater number of pediatric candidates have usable residual hearing in their nonimplanted ears. This population potentially stands to benefit from continued use of conventional amplification in their nonimplanted ears. The purposes of this investigation were to evaluate whether children with residual hearing in their nonimplanted ears benefit from bilateral use of cochlear implants and hearing aids and to investigate the time course of adaptation to combined use of the devices together. DESIGN: Pediatric cochlear implant recipients with severe sensorineural hearing loss in their nonimplanted ears served as participants. Ten children continued to use hearing aids in their nonimplanted ears after cochlear implantation; 12 children used their cochlear implants exclusively. Participants were tested longitudinally on spoken word recognition measures at 6-month intervals. The children who continued wearing hearing aids were tested in three sensory aid conditions: cochlear implants alone, hearing aids alone, and cochlear implants in conjunction with hearing aids. The children who did not continue hearing aid use were tested after surgery in their only aided condition, cochlear implant alone. RESULTS: The results suggest that children with severe hearing loss who continued using hearing aids in their nonimplanted ears benefited from combining the acoustic input received from a hearing aid with the input received from a cochlear implant, particularly in background noise. However, this benefit emerged with experience. CONCLUSIONS: Our findings suggest that it is appropriate to encourage pediatric cochlear implant recipients with severe hearing loss to continue wearing an appropriately fitted hearing aid in the nonimplanted ear to maximally benefit from bilateral stimulation.

Adaptation, Physiological↗

PubMed2003

[Temporal bone CT and MRI in cochlear implant candidates].

PURPOSE: Hearing can be restored by cochlear implantation in patients with sensorineural hearing loss, who have a normal seventh cranial nerve. The aim of imaging in cochlear implant candidates is to determine the etiology of the hearing loss, congenital malformations and variations that may cause difficulty during the operation, patency of the cochlea and the presence of the seventh, cranial nerve. The aim of this study is to review the literature and to discuss the imaging findings that may affect the type and success of the operation. MATERIALS AND METHODS: 33 cochlear implant candidates, who underwent high resolution computed tomography, were included in the study. High resolution fast spin echo T2 weighted and constructive interference in steady state sequences were performed in 23 patients with a 1.5 Tesla magnetic resonance unit. RESULTS: Computed tomography and magnetic resonance imaging were normal in 16 patients. Unilateral or bilateral labyrinthine ossification was detected in 4 patients. Variations of the temporal bone, congenital malformations, sequelae of chronic otitis and trauma were detected in 13 patients. Cochlear implantation was performed in 5 patients. Operative difficulty, complications and postoperative outcome were noted in these 5 patients. CONCLUSION: High resolution computed tomography and magnetic resonance images obtained by high resolution T2 weighted fast spin echo sequence and constructive interference in steady state sequence help the surgeon in planning the operation and predict potential complications in cochlear implant candidates.

Adolescent↗

PubMed2005

Disequilibrium after cochlear implantation caused by a perilymph fistula.

OBJECTIVES: Cochlear implantation has become a safe and effective method for the auditory rehabilitation of the profoundly hearing impaired. Incidence of disequilibrium and vertigo after cochlear implantation ranges from 13% to 74% in the literature. Most patients report resolution of these symptoms with medical therapy and vestibular rehabilitation. We present a case of persistent disequilibrium after cochlear implantation. Further workup of this patient revealed radiographic findings suggestive of a perilymphatic fistula, with immediate and complete resolution of symptoms after exploratory tympanotomy and packing around the cochleostomy. STUDY DESIGN: Case report. METHODS: A retrospective chart review of a patient with postoperative disequilibrium unresponsive to maximal medical and vestibular rehabilitation therapy. RESULTS: Diagnostic workup of the patient included a temporal bone computed tomography (CT) scan, which revealed air in the vestibule and the ampulla of the superior and lateral semicircular canals. After failure of 5 months of conservative therapy, the patient was taken to the operating room for middle ear exploration and repacking of the cochleostomy site. The patient reported immediate and complete resolution of vertigo postoperatively. CONCLUSION: We present a case of disequilibrium as a result of an apparent perilymphatic fistula after cochlear implantation that was refractory to standard therapy. In such cases, appropriate workup should include a temporal bone CT scan to look for air in the vestibule or other abnormalities that may indicate potential etiology. Surprisingly, this patient had immediate and complete resolution of symptoms after surgery. If conservative therapy fails, middle ear exploration by way of an exploratory tympanotomy and packing of the cochleostomy with periosteum and muscle is a viable option and may lead to resolution of symptoms.

Adult↗