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PubMed2004

Cochlear implant fixation using polypropylene mesh and titanium screws.

HYPOTHESIS: Fixation of cochlear implants using prosthetic mesh is an improvement of the traditional fixation methods. STUDY DESIGN: A retrospective chart review was performed examining all adult and pediatric patients between 1998 and 2003 who underwent cochlear implantation using polypropylene mesh and titanium screws to fix the cochlear implant internal receiver. Patient age at implantation, postoperative infections, device failures, device migrations or extrusions, cerebrospinal fluid (CSF) leaks, flap complications, epidural hematoma data, and follow-up data were evaluated. RESULTS: Two hundred and eighty-five patients were identified who received cochlear implantation using the polypropylene mesh securing technique. There were five postoperative infections, two device failures, zero flap complications, zero device migrations or extrusions, zero cerebral spinal fluid leaks, and zero epidural hematomas. The two delayed device failures in this series were not related to fixation technique. CONCLUSIONS: We conclude that this technique is widely applicable, technically superior, and not associated with increased complications.

Adolescent↗

PubMed2003

Using SNAP Dragons to monitor narrative abilities in young deaf children following cochlear implantation.

OBJECTIVE: To assess the narrative abilities of young deaf children before cochlear implantation and 1 and 2 years following implantation, and to explore possible changes in the implanted children's preferred mode of communication in the narrative abilities task. STUDY DESIGN: Prospective longitudinal study assessing the narrative abilities of young deaf children before and after cochlear implantation. SETTING: Pediatric tertiary referral center for cochlear implantation. PATIENTS AND METHODS: The narrative abilities of 35 young profoundly deaf children were assessed before implantation and 1 and 2 years following implantation using the Stories/Narratives Assessment Procedure. Children with age at implantation less than 6 years were included in the study (mean age at implantation was 3.5 years; range 1.4-5.9 years). All children were filled with the Nucleus multichannel cochlear implant system. With respect to their communication modes, they came from a wide range of backgrounds and all children were encouraged to use their preferred mode of communication during the narrative task. RESULTS: The data showed that there was a statistically significant increase in narrative abilities across the three data points (P<0.001). Before receiving the implant, children were mostly in the pre-structural, receptive stages and could at most label or comment on the pictures (median narrative stage 2). By the 2-year interval, children were mostly using one or two categories or one complete episode with spontaneous retelling (median narrative stage 4). Although children were not pressured to use any particular communication mode, a shift to speech was found following implantation and this was statistically significant (P<0.001). CONCLUSION: Young implanted deaf children showed a significant progress in their narrative abilities through time and a significant shift in the predominant mode of communication towards more speech orientated communication modes following cochlear implantation.

Books↗

PubMed2002

Changes in quality of life and the cost-utility associated with cochlear implantation in patients with large vestibular aqueduct syndrome.

OBJECTIVE: A group of 20 patients with large vestibular aqueduct syndrome was identified at the Indiana University School of Medicine. The major objective of this study was to explore the improvements in quality of life associated with cochlear implantation in patients with large vestibular aqueduct syndrome, as well as the cost-utility of cochlear implantation in this group. SETTING: A total of 70 patients were identified with large vestibular aqueduct syndrome through analysis of thin-section computed tomography of the temporal bone over the past 6 years at this medical center. Data collected from the medical records for each patient included demographic data, hearing-related statistics, implantation data, and audiometric data. Sixteen children and adults with large vestibular aqueduct syndrome had undergone cochlear implantation before the beginning of this study, and the remaining 54 children and adults were identified as undergoing treatment of progressive or fluctuant sensorineural hearing loss. Health utility indexes used in this analysis were taken through the use of the Ontario Health Utility Index, Mark III. The range of costs used for cost-utility analysis was derived from the costs of cochlear implantation at this medical center, as well as from costs associated with implantation published in the medical literature. METHODS: Participants were selected from the total population of patients with large vestibular aqueduct syndrome at this center who were postlingually deafened and who currently had severe hearing loss. Two groups were formed. These groups comprised either cochlear implant patients with large vestibular aqueduct syndrome or patients with large vestibular aqueduct syndrome currently using hearing aids. Ten of the 16 cochlear implant patients and 10 of the remaining 54 patients with large vestibular aqueduct syndrome met these criteria. Mark III health utility indexes were distributed to patients in each group and scored. Those health utility indexes not completed by the patients were scored by proxy, using the audiologist at this center who was the most familiar with the patient. Changes in quality of life associated with cochlear implantation were derived by comparison of the health utility index results of the two groups. Cost-utility measures were then made using discounted costs per quality-of-life years (QALYs) (5%), and a sensitivity analysis was performed that evaluated changes in scoring done by proxy. The cost-utility results were then compared with the cost-utilities derived from similar studies and associated with other disease states. RESULTS: Although both groups of patients had significant hearing loss, the hearing aid group had a better mean pure-tone average. The mean pure-tone average for the hearing aid group was 70.8 dB (SD 24.4), and the mean pure-tone average for the cochlear implant group was 107.0 dB (SD 21.7). Seven of the 20 health utility indexes were scored by proxy. Results from the base case indicate a 0.20 gain in health utility from cochlear implantation (hearing aid = 0.62, cochlear implant = 0.82, p = 0.037), resulting in a discounted cost per QALY of $12,774. Sensitivity analysis of the proxy scoring indicated that decreasing the hearing score one level on the health utility index resulted in a gain in health utility with cochlear implantation of 0.15, resulting in a discounted cost per QALY of $17,832. A decrease of the hearing score by two levels on the health utility survey resulted in no significant gain in quality of life with cochlear implantation. CONCLUSION: This study found an improvement in quality of life associated with cochlear implantation in postlingually deafened patients with large vestibular aqueduct syndrome. By weighing this improvement in quality of life against the significant difference noted between the pure-tone averages of each group, further strength can be given to this conclusion. This gain in quality of life, as well as the results derived for the cost-utility of cochlear implantation, was similar to that in previous published studies of cochlear implantation in all types of patients. These results also indicate a favorable cost-utility when compared with published data about other disease states. As patients with large vestibular aqueduct syndrome progress to profound levels of hearing loss, these results indicate that cochlear implantation can be offered as a beneficial, life-improving therapy.

Adolescent↗

PubMed2004

Communication abilities of children with aided residual hearing: comparison with cochlear implant users.

OBJECTIVE: To compare the communication outcomes between children with aided residual hearing and children with cochlear implants. DESIGN: Measures of speech recognition and language were administered to pediatric hearing aid users and cochlear implant users followed up longitudinally as part of an ongoing investigation on cochlear implant outcomes. The speech recognition measures included the Lexical Neighborhood Test, Phonetically Balanced-Kindergarten Word Lists, and the Hearing in Noise Test for Children presented in quiet and noise (+5 dB signal-to-noise ratio). Language measures included the Peabody Picture Vocabulary Test: Third Edition (PPVT-III), the Reynell Developmental Language Scales, and the Clinical Evaluation of Language Fundamentals-Revised. Subjects The experimental group was composed of 39 pediatric hearing aid users with a mean unaided pure-tone average threshold of 78.2 dB HL (hearing level). The comparison group was composed of 117 pediatric cochlear implant users with a mean unaided pure-tone average threshold of 110.2 dB HL. On average, both groups lost their hearing at younger than 1 year and were fitted with their respective sensory aids at 2 to 2.6 years of age. Not every child was administered every test for a variety of reasons. RESULTS: Between-group performance was equivalent on most speech recognition and language measures. The primary difference found between groups was on the PPVT-III, in which the hearing aid group had a significantly higher receptive vocabulary language quotient than the cochlear implant group. Notably, the cochlear implant group was substantially younger than the hearing aid group and had less experience with their sensory devices on this measure. CONCLUSION: Data obtained from children with aided residual hearing can be useful in determining cochlear implant candidacy.

Audiometry, Pure-Tone↗

PubMed2006

[Prediction and management about perilymph gusher in cochlear implantation].

OBJECTIVE: To discuss the clinical experience of prediction and management about perilymph gusher in cochlear implantation. METHOD: Among 327 cases of cochlear implant, eleven recipients were selected by the high resolution computed tomography (HRCT) findings of cochlear malformations and bony fistula on fundus of the internal auditory canal that caused an abnormal connection between subarachnoid and perilymphatic spaces. RESULT: Perilymph gusher was found in all of these 11 recipients during cochlear implantation and was controlled with muscle tissue seal. CONCLUSION: The reason of perilymph gushers in cochlear implantation is that abnormal connection between subarachnoid and internal auditory canal. HRCT can be used to assess the possibility of perilymph gusher in surgery. The safe and rapid surgical method of gusher controlling can avoid complication.

Cerebrospinal Fluid Otorrhea↗

PubMed2001

Should children who use cochlear implants wear hearing aids in the opposite ear?

OBJECTIVE: The aim of this study was to investigate 1) whether a hearing aid needs to be adjusted differently depending on whether a child wears a cochlear implant or another hearing aid in the contralateral ear; 2) whether the use of a hearing aid and a cochlear implant in opposite ears leads to binaural interference; and 3) whether the use of a hearing aid and a cochlear implant in opposite ears leads to binaural benefits in speech perception, localization, and communicative functioning in real life. DESIGN: Sixteen children participated in this study. All children used a Nucleus 22 or Nucleus 24 cochlear implant system programmed with the SPEAK strategy in one ear. The hearing aid amplification requirements in the nonimplanted ear of these children were determined using two procedures. A paired comparison technique was used to identify the frequency response that was best for speech intelligibility in quiet, and a loudness balancing technique was used to match the loudness of speech in the ear with a hearing aid to that with a cochlear implant. Eleven of the 16 children participated in the investigation of binaural effects. Performance in speech perception, localization, and communicative functioning was assessed under four aided conditions: cochlear implant with hearing aid as worn, cochlear implant alone, hearing aid alone, and cochlear implant with hearing aid adjusted according to individual requirements. RESULTS: Fifteen of the 16 children whose amplification requirements were determined preferred a hearing aid frequency response that was within +/-6 dB/octave of the NAL-RP prescription. On average, the children required 6 dB more gain than prescribed to balance the loudness of the implanted ear for a speech signal presented at 65 dB SPL. For all 11 children whose performance was evaluated for investigating binaural effects, there was no indication of significantly poorer performance under bilaterally aided conditions compared with unilaterally aided conditions. On average, there were significant benefits in speech perception, localization, and aural/oral function when the children used cochlear implants with adjusted hearing aids than when they used cochlear implants alone. All individuals showed benefits in at least one of the measures. CONCLUSIONS: Hearing aids for children who also use cochlear implants can be selected using the NAL-RP prescription. Adjustment of hearing aid gain to match loudness in the implanted ear can facilitate integration of signals from both ears, leading to better speech perception. Given that there are binaural advantages from using cochlear implants with hearing aids in opposite ears, clinicians should advise parents and other professionals about these potential advantages, and facilitate bilateral amplification by adjusting hearing aids after stable cochlear implant MAPs are established.

Adolescent↗

PubMed1989

[Cochlear implantation: clinical experience with 50 cases].

Fifty cochlear implantations with single-channel cochlear prosthesis were reported. The youngest patient was 12 and the eldest 50 years of age. Thirty patients were prelingually and twenty postlingually deaf. Surgical procedures consisted of a typical mastoidectomy and electrode placement via a posterior tympanotomy. The active electrode was introduced into the scala tympani through a hole on the promontory. Several problems regarding cochlear implantation which still have no unanimous opinion among otologists were discussed.

Adolescent↗

PubMed2006

Bacterial meningitis among children with cochlear implants beyond 24 months after implantation.

BACKGROUND: More than 11000 children in the United States with severe-to-profound hearing loss have cochlear implants. A 2002 investigation involving pediatric cochlear implant recipients identified meningitis episodes from January 1, 1997, through September 15, 2002. The incidence of pneumococcal meningitis in the cohort was 138.2 cases per 100000 person-years, >30 times higher than that for children in the general US population. Children with implants with positioners were at higher risk than children with other implant models. This higher risk of bacterial meningitis continued for up to 24 months after implantation. OBJECTIVE: To evaluate additional reported cases to determine whether the increased rate of bacterial meningitis among children with cochlear implants extended beyond 24 months after implantation. METHODS: Our study population consisted of the cohort of children identified through the 2002 investigation; it included 4265 children who received cochlear implants in the United States between January 1, 1997, and August 6, 2002, and who were <6 years of age at the time of implantation. We calculated updated incidence rates and incidence according to time since implantation. RESULTS: We identified 12 new episodes of meningitis for 12 children. Eleven of the children had implants with positioners; 2 children died. Six episodes occurred >24 months after implantation. When cases identified in the 2002 and 2004 investigations were combined, the incidence rate of > or =24-months postimplantation bacterial meningitis among children with positioners was 450 cases per 100000 person-years, compared with no cases among children without positioners. CONCLUSIONS: Our updated findings support continued monitoring and prompt treatment of bacterial infections by health care providers and parents of children with cochlear implants. This vigilance remains important beyond 2 years after implantation, particularly among children with positioners. The vaccination recommendations for all children with implants, with and without positioners, and all potential recipients of implants continue to apply.

Child↗

PubMed2004

[Speech understanding in post-lingual adults with cochlear implants].

It is well recognised that multi-channel cochlear implants are highly effective in gaining or regaining auditory perceptual skills of severe to profound hearing-impaired people. Research shows that adults rapidly improve in speech understanding after cochlear implantation. This study reports on speech understanding from two Spanish Clinics. 32 post-lingually deafened adults were fitted with either a MED-EL COMBI 40 or COMBI 40+ cochlear implant at the Hospital Universitario San Cecilio, at the Granada or Hospital Universitario La Fe, Valencia Clinic, Spain. Subjects were assessed at 1, 3, 6 and 12 months post-fitting on a number of speech perception tests. Results showed a highly significant improvement on all speech perception tests over the time. These ratify other studies in saying that cochlear implantation is a viable and successful treatment in post-lingually deafened adults.

Adult↗

PubMed2004

Prelinguistic communication and subsequent language acquisition in children with cochlear implants.

OBJECTIVE: To investigate the relationship between prelinguistic communication behaviors and subsequent language development after cochlear implantation in deaf children. Evaluative tools with predictive validity for language potential in very young deaf children remain elusive. SETTING: A tertiary care cochlear implant center and a preschool setting of spoken language immersion in which oral language development is emphasized through auditory and oral motor subskill practice. SUBJECTS: Eighteen prelingually deaf children who underwent unilateral implantation at an average age of 15 months also underwent testing with the Communication and Symbolic Behavior Scales (CSBS) before device activation and with the Reynell Developmental Language Scales (RDLS) at an average of 20 months after cochlear implantation. METHODS: A prospective study correlated preoperative communication behavior assessments of 18 children who were candidates for cochlear implantation. We examined the value of prelinguistic behavioral testing with the CSBS in predicting later language level after cochlear implantation as reflected in RDLS scores. RESULTS: We found positive, though weak, correlations between prelinguistic communication skills (CSBS scores) and language learning after cochlear implantation (RDLS scores). Linear correlation between test results failed to reach statistical significance (receptive comparisons, P =.17; expressive comparisons, P =.13). CONCLUSIONS: Evaluating the quality of prelinguistic communication behaviors potentially adds important predictive information to profiles of children who are candidates for cochlear implantation. Correlative analysis suggests that early CSBS testing may provide useful clinical information. Poor CSBS scores may serve as a precaution: if children lack an appropriate prelinguistic behavioral repertoire, the emergence of age-appropriate formal language may be at risk. Observations suggest that symbolic prelinguistic behaviors are necessary, but not sufficient, for the development of strong linguistic skills. The variability of behavioral measures in very young deaf children poses challenges in designing objective measures with predictive value for later language level.

Adolescent↗

PubMed1995

Cost effectiveness of the multichannel cochlear implant.

Although most third-party payors presently fund cochlear implantation, some do not, and many cite the current lack of cost-effectiveness data as a major concern. Cost-utility analysis is a widely used method of medical technology assessment that permits cost-effectiveness comparisons between medical interventions by determining the cost per quality-adjusted life-year (QALY) they provide. The cost per QALY for the cochlear implant was determined using clinical cost data and a health-utility outcome model based on the established communication gains attained with the device. Cochlear implantation costs approximately $15,600 per QALY provided. Sensitivity analysis, a technique that systematically varies the assumptions underlying the calculations, favorably with other medical interventions, such as coronary artery bypass grafting ($10,431) for three-vessel disease, $64,033 for single-vessel disease), the implantable defibrillator ($29,200), and cardiac transplantation ($38,970). This analysis indicates that the cochlear implant lies well within the cost-effectiveness range currently accepted by the American medical system.

Adolescent↗

PubMed2004

Binaural benefits for adults who use hearing aids and cochlear implants in opposite ears.

OBJECTIVE: This study aimed to investigate 1) how a hearing aid needs to be adjusted for an adult who uses a cochlear implant in the contralateral ear; 2) whether the use of a hearing aid with a cochlear implant leads to interference; and 3) whether adults derive binaural benefits from using a hearing aid with a cochlear implant for speech perception, localization, and functional performance in everyday life. DESIGN: Twenty-one adults (11 female and 10 male) who used either a Nucleus CI-22 (N = 3) or a Nucleus CI-24 (N = 18) cochlear implant system in one ear participated in this study. Twelve of the adults were experienced hearing aid and implant users, whereas nine did not use a hearing aid after implantation. The hearing aids were fitted using the NAL-NL1 prescription, and fine-tuned for each individual by using a paired-comparisons test to identify the frequency response that was best for understanding speech, and a loudness balancing test to find the hearing aid gain that gave the same overall loudness as that perceived in the ear with a cochlear implant. Effects from using a hearing aid with a cochlear implant (bimodal hearing) were assessed by three measures. These included speech perception in noise in diotic and dichotic listening conditions, horizontal localization, and functional performance in everyday life. Performance with cochlear implant and hearing aid (CIHA) was compared with that with cochlear implant alone (CI) and hearing aid alone (HA). RESULTS: The NAL-NL1 prescribed appropriate frequency response slope on average, and the mean gain needed for binaural loudness balance was 4 dB lower than the prescribed gain. Individual variations in preferences suggest that it is desirable to fine-tune the hearing aid response slope and gain according to individual needs. The speech test results indicated that the CIHA scores were significantly better than the CI or the HA scores. Localization test results showed that the adults made significantly less error when locating a sound source using CIHA compared with CI or HA. Functional performance questionnaire scores for CIHA were significantly higher than CI scores or HA scores. All adults showed binaural benefits in at least one performance measure. On average, those who derived greater speech benefits also made less localization error and functioned more effectively in real life. CONCLUSIONS: The results clearly indicate that binaural advantages can be obtained from using a hearing aid with a cochlear implant in opposite ears. It is recommended that bimodal stimulation be standard practice for rehabilitation of adults who wear unilateral cochlear implants. A hearing aid should be fitted to the nonimplanted ear using the NAL-NL1 prescription as a starting point, and the frequency response slope and gain could be fine-tuned to suit individual needs.

Adult↗

PubMed1986

[Phoniatric aspects in the rehabilitation of patients with cochlear implants].

The method employed in conventional rehabilitation programmes after cochlear implantation is described in detail. A cochlear implant is expected to provide a better acoustic speech discrimination by recognition of prosodic speech elements, such as rhythm, stress, intonation and rudimentary discrimination of phonemes. Furthermore we need to know about the influence of the new auditory control on speech and voice of the deaf. These changes are regularly documented by logopaedic examinations and phonetically adjusted tests. The indication of cochlear implantation in prelingually deaf and in children is discussed.

Cochlear Implants↗

PubMedDate not supplied

Multichannel cochlear implant in a deaf-blind patient.

In this work, a case study of the first deaf-blind patient implanted with the Combi-40 cochlear implant is analyzed. The patient is a 69-year-old man who has been blind since the age of 25 and deaf since the age of 51. Before surgery, his wife used Braille and finger-spelling on his hand to communicate with him. In this study, we intend to show how the rehabilitation program was applied to his particular characteristics and to describe the problems we faced throughout the process. Significant improvements in the dynamic ranges of perception and comprehension of segmental features of speech were observed within two weeks after the setting up. Within four weeks, the patient was able to maintain a simple conversation through the cochlear implant alone, and he abandoned the use of tactile communication. Nowadays, he is able to speak over the phone. A battery of tests was performed 2, 4 and 6 months after the switch-on. The results obtained for this patient, whose scores are among the best in our experience, suggest that deaf-blind individuals may benefit from a multichannel cochlear implant as an auditory substitute.

Blindness↗

PubMed2001

Reliability of a rating scale for measuring speech intelligibility after pediatric cochlear implantation.

OBJECTIVE: To evaluate the reliability of the Speech Intelligibility Rating scale to monitor the speech intelligibility of deaf children who have received cochlear implants. STUDY DESIGN: A prospective study assessing the speech intelligibility of deaf children with cochlear implants by local and cochlear implant program speech and language therapists. SETTING: Pediatric tertiary referral center for cochlear implantation. PATIENTS AND METHODS: Fifty-four children were each rated by two speech and language therapists, one working with the child locally and the other working with the child at the cochlear implant program. All children were between 1.2 and 10.9 years of age at the time of implantation (median, 4.0 years). The follow-up intervals ranged from before implantation to 9 years after implantation. MAIN OUTCOME MEASURE: Correlation coefficient, intraclass correlation coefficient, and kappa statistics were used to assess the interobserver reliability of the Speech Intelligibility Rating scale. RESULTS: Spearman rank correlation coefficient and intraclass correlation coefficient were 0.82 with high statistical significance (p < 0.00001). Kappa statistical analysis revealed a moderate to substantial agreement between the ratings. This agreement also reached a high statistical significance (overall kappa = 0.53, p < 0.000001). The Speech Intelligibility Rating scale was found to be able to discriminate speech intelligibility among subjects, and the ratings covaried with high consistency. CONCLUSION: The study found a high rate of agreement between observers when they used the Speech Intelligibility Rating scale to assess the speech intelligibility of deaf children after cochlear implantation. Because the scale presents information in a format that is understood by parents, local professionals, and health care purchasers, it will be useful to provide them with accessible information on speech intelligibility outcomes of deaf children who have received cochlear implants.

Child↗

PubMed2002

[Initial information on adjustment of speech processor of the cochlear implant].

Adjustment of a speech processor of the cochlear implant is the first procedure in rehabilitation of patients after cochlear implantation. Influence of setting understated and overstated threshold levels of current perception on processing of a speech signal was studied. The results of the study show that only precise estimation of current perception threshold and comfortable loudness allow transmitting maximal acoustic information for each patient.

Cochlear Implantation↗

PubMed1997

Malformations in cochlear implant patients.

OBJECTIVE: To report on cochlear implantation in children with bony inner ear malformations. PATIENTS: 30 children with bony inner ear malformations who have received cochlear implants. INTERVENTIONS: High-resolution spiral computed tomography is used to identify malformations. Magnetic resonance imaging is used to detect the presence of an acoustic nerve and determine the integrity of the auditory pathway and central nervous system structures. Both imaging techniques may be used intraoperatively, as well as facial nerve monitoring and electrical auditory brainstem response monitoring. Three-dimensional reconstructions are helpful in preoperative planning. Large vestibular aqueducts and vestibular malformations can be successfully managed. RESULTS: Postoperative results have been encouraging, although children with malformations tend to occupy the lower third of rehabilitation results of all children with implants.

Child↗

PubMed1995

Criteria for selecting the side for cochlear implantation.

Choice of the side for cochlear implantation should take into account peripheral (extracortical) factors and central (cerebral dominance) factors. From 111 patients implanted with a Nucleus device, the authors found that significant peripheral factors were the degree of cochlear ossification, the duration of deafness before cochlear implantation, and the preoperative promontory test dynamic range (degree of response on the promontory test in decibels); cause of deafness and residual hearing were not correlated with speech discrimination. Cerebral dominance was indirectly determined by handedness. Handedness laterality was determined by a questionnaire. There was no significant difference in results between patients implanted on their dominant side and patients implanted on their nondominant side. When ears are different according to their peripheral factors, the authors suggest implanting the better ear, provided there is no significant hearing in that ear. When both ears are identical, the side of implantation should be the side of handedness laterality to facilitate device manipulation (a practical reason).

Adolescent↗