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PubMed1999

Paediatric cochlear implantation and health-technology assessment.

Cochlear implants are provided to children on the basis of the hypothesis that short-term outcomes in auditory receptive skills will translate via a cascade of medium-term outcomes into greater social independence and quality of life. The medium-term outcomes include: (i) enhanced engagement and integration in primary education, leading to greater scholastic achievement; (ii) enhanced social versatility and robustness, permitting a successful transition to secondary education; and (iii) enhanced educational qualifications, allowing greater opportunities in further education and employment. A sufficient number of children have used implants for long enough for it to be feasible to establish whether the first two medium-term outcomes are being achieved and, if so, at what cost in the provision of health care and education. The first part of this paper discusses alternative research designs that could address these issues. Although a prospective randomised controlled trial would provide the most powerful evidence for or against the hypothesis, it is implausible that adequate compliance with randomisation to treatments could be sustained to give such a study sufficient power. The most powerful realisable design would be a large-scale cross-sectional comparison of implanted children and matched groups of their non-implanted peers. The second part of the paper describes the results of a speculative cost-benefit analysis that seeks to identify the cost to society of providing implants to children. The analysis is based on measured costs of health care, but on estimates of costs and cost-savings in other domains. It indicates that paediatric implantation could be cost-neutral in the UK, provided that implantation saved pound sterling 3000/year in the cost of education, pound sterling 1000/year in other domains, and permitted an increase in personal income of 25% of the national median household income. These savings might be realised if implantation permitted sufficient facility in spoken language to allow every implanted child to enter mainstream education.

Child↗
PubMed2002

Impact of cochlear implants on the functional health status of older adults.

OBJECTIVES: To assess the impact of cochlear implantation on quality of life changes in older adults aged 50 years and above. STUDY DESIGN: Retrospective study by questionnaire and chart review. METHODS: Forty-seven patients aged 50 to 80 years (mean age, 63.4 y [SD = 8.6 y]), who have multiple-channel cochlear implants received at The Listening Center at Johns Hopkins Hospital, completed the Ontario Health Utilities Index Mark 3 survey and a questionnaire on quality of life changes. Health utility scores before and after cochlear implantation were measured, and audiologic data before implantation and at 6 months and 1 year after implantation were analyzed. RESULTS: Cochlear implantation in older adults is associated with a mean gain in health utility(P <.0001) of 0.24 (SD = 0.33), which corresponds to a favorable cost-utility of $9530 per quality-adjusted life-year. Improvements in hearing and emotional health attributes were primarily responsible for this increase in health-related quality of life measure. There was a significant increase in speech perception scores at 6 months after surgery (P <.0001 for both CID sentence and monosyllabic word tests) and a strong correlation between the magnitude of health utility gains and the postoperative increase in speech perception scores (r = 0.45, P <.05). CONCLUSIONS: Cochlear implants have a significant impact on the quality of life of older deaf patients, and are a cost-effective intervention in this population. Improvements in speech perception are predictive of gains in health-related quality of life and associated emotional benefits after cochlear implantation.

Age Factors↗
PubMed2006

[The effect of cochlear implantation on voice development].

OBJECTIVES: The effect of cochlear implantation on voice development in prelingually deaf children was investigated. PATIENTS AND METHODS: The study included 60 prelingually deaf children (28 girls, 32 boys; mean age 68 months; range 37 to 128 months) who underwent cochlear implantation. Voice analyses were made between 6 to 21 months after the first fitting and six months after the baseline. The patients were divided into two groups (i) according to age (younger or older than 48 months) and (ii) to the duration of implant use (more or less than 18 months) to observe the changes in fundamental frequency (F(0)), and two formant frequencies (F(1) and F(2)). Forty-seven children (22 girls, 25 boys; mean age 62 months; range 38 to 118 months) with normal speech and language development comprised the control group. In all the cases, F(0), F(1), and F(2) values of the vowel /a/ were studied. RESULTS: In the patient group, F(0) and F(2) values significantly differed between the first and second voice analyses, whereas the change in F(1) values was insignificant. No significant differences were found in terms of F(0), F(1) and F(2) values between the patients younger than 48 months and age-matched controls; however, F(0) and F(1) values significantly differed in those older than 48 months while F(2) values remained insignificant. Albeit statistically insignificant, F(0), F(1), and F(2) values approximated normal levels in children in whom the duration of implant use exceeded 18 months. CONCLUSION: Our study confirms that early cochlear implantation and longer implant use result in improved development of voice, speech, and language.

Case-Control Studies↗
PubMed1996

Cochlear implantation in a case of Wegener's granulomatosis.

Cochlear implantation is now a routine clinical procedure for deaf patients in many countries (Gibson, 1987). It replaces the function of damaged cochlear hair cells and therefore, detects sound and by electrical stimulation produces an appropriate signal in the remaining cochlear nerve fibres (House and Berliner, 1991). Wegener's granulomatosis is an uncommon auto-immune disease. It has a peak incidence at the fifth decade with slight male predominance. Nasal problems are the predominant presentation with otological manifestations presenting rarely. We report a case of Wegener's granulomatosis presenting with total hearing loss and after right cochlear implantation a free field threshold of 40 dB and 20 per cent Bamford-Kowal-Bench (BKB) speech test. We conclude that Wegener's granulomatosis is not an absolute contraindication for cochlear implantation.

Aged↗
PubMed2003

Development of communication and speech skills after cochlear implant in a sign language child.

In selecting patients to undergo cochlear implant, a pre-existing use of sign language gives rise to two problems that have been widely debated in the literature. First, the caution shown toward the candidacy of patients using this mode of communication, since it is considered a possible element of interference in the acquisition of speech. Secondly, refusal of the cochlear implant procedure, on the part of the deaf community, on the grounds both of cultural identity and of it being more "natural" for a deaf person to use an unimpaired visual channel rather than an impaired hearing channel. In order to establish whether knowledge of sign language does, indeed, affect speech production negatively and evaluate which mode of communication, oral or gestual, is preferred, the present investigation was carried out on a preverbal deaf child who had undergone cochlear implant at about 7 years of age and has always used both languages. His verbal skills were evaluated in the precochlear implant stage, then at 6 and 12 months after, together with the changes in his use of sign language and in the relationship between the two modes. Results, besides observing the presence of linguistic evolution at each level examined and already evident at 6 months, also documented a progressive reduction in the spontaneous use of sign language. In conclusion, the present experience revealed no temporal or qualitative differences in post-cochlear implant evolution of speech skills, in comparison with that observed in patients with an exclusively aural-oral approach. Furthermore, the increased use of the hearing pathway, made possible by cochlear implant, determined a spontaneous choice of verbal language as the most natural and economic mode of communication.

Child↗
PubMedDate not supplied

Cochlear implants and the deaf child: a nursing perspective.

Cochlear implants are no longer considered new or experimental technology and are available for children with profound sensorineural hearing loss. Pediatric cochlear implantation requires a multidisciplinary team approach with contributions from surgeons, audiologists, speech-language pathologists, psychologists, nurses, special educators, and parents. The decision to perform cochlear implantation in children must be seriously considered. Some in the deaf community voice strong objections to the procedure. Additionally, it requires an enormous commitment on the part of the family and the health care system in both personal and financial terms. The surgery has some risks, and the rehabilitation period is lengthy. Outcomes are variable, and many factors play a role in a child's successful use of implants. Nonetheless, gradual, steady improvement in speech perception, speech production, and language typically occurs. The approach of Children's Hospital in Boston to the assessment, the surgical procedure, and follow-up is detailed here.

Adolescent↗
PubMed2005

Auditory training with spectrally shifted speech: implications for cochlear implant patient auditory rehabilitation.

After implantation, postlingually deafened cochlear implant (CI) patients must adapt to both spectrally reduced and spectrally shifted speech, due to the limited number of electrodes and the limited length of the electrode array. This adaptation generally occurs during the first three to six months of implant use and may continue for many years. To see whether moderate speech training can accelerate this learning process, 16 naïve, normal-hearing listeners were trained with spectrally shifted speech via an eight-channel acoustic simulation of CI speech processing. Baseline vowel and consonant recognition was measured for both spectrally shifted and unshifted speech. Short daily training sessions were conducted over five consecutive days, using four different protocols. For the test-only protocol, no improvement was seen over the five-day period. Similarly, sentence training provided little benefit for vowel recognition. However, after five days of targeted phoneme training, subjects' recognition of spectrally shifted vowels significantly improved in most subjects. This improvement did not generalize to the spectrally unshifted vowel and consonant tokens, suggesting that subjects adapted to the specific spectral shift, rather than to the eight-channel processing in general. Interestingly, significant improvement was also observed for the recognition of spectrally shifted consonants. The largest improvement was observed with targeted vowel contrast training, which did not include any explicit consonant training. These results suggest that targeted phoneme training can accelerate adaptation to spectrally shifted speech. Given these results with normal-hearing listeners, auditory rehabilitation tools that provide targeted phoneme training may be effective in improving the speech recognition performance of adult CI users.

Adult↗
PubMed2000

Surgical outcome after paediatric cochlear implantation: diminution of complications with the evolution of new surgical techniques.

OBJECTIVE: Cochlear implantation is a commonly performed surgical procedure with specific aspects in the paediatric population. The surgical outcome associated with this procedure in a paediatric population is analyzed. METHOD: A retrospective study was performed of all children receiving a cochlear implant at The Hospital for Sick Children from 1990 to 1998. During this period, 104 patients received a cochlear implant. RESULTS: The complications encountered were classified as major (4%), minor (3%), and device failure (2%). The surgical techniques developed to decrease complications are discussed. CONCLUSION: Paediatric cochlear implantation is a safe procedure with a low incidence of complications. Nevertheless, the surgeon is now facing new challenges with cochlear implantation performed in patients with an abnormal cochlea, who carry a higher rate of complications, and cochlear reimplantation in case of device failure.

Adolescent↗
PubMed1996

Self-report of cochlear implant use and satisfaction by prelingually deafened adults.

OBJECTIVE: Prelingually deafened adults tend to demonstrate smaller improvements in speech recognition after cochlear implantation than do postlingually deafened adults, which has led some professionals to believe that prelingually deafened adults receive only minimal benefit from a cochlear implant. The primary objective of this study was to evaluate cochlear implant use and satisfaction by prelingually deafened adults. DESIGN: A questionnaire was administered to 12 prelingually deafened adult cochlear implant patients to evaluate cochlear implant efficacy and satisfaction. Questionnaire results were contrasted with performance on speech recognition tasks. RESULTS: Although these patients demonstrated little or no improvements in speech recognition 12 mo postoperatively, most patients reported that they used their device regularly, that they were satisfied with their device, and that using the cochlear implant improved both their expressive and receptive communication skills. CONCLUSIONS: Procedures other than traditional speech recognition measures should be used to evaluate cochlear implant benefit, particularly with prelingually deafened adults.

Adult↗
PubMed2004

[Cochlear implantation in patients with inner ear malformations].

OBJECTIVE: To describe clinical experiences with multi-channel cochlear implantation in patients with bilateral inner ear malformations. METHODS: Among 410 patients who received multi-channel cochlear implantations from 1996 to 2004 in Beijing Tongren Hospital, 82 patients were diagnosed with inner ear malformations and implanted. A retrospective analysis was performed about the surgical characteristics and mapping characteristics after implantation. RESULTS: (1) All patients had auditory sensations. (2) Gusher was more common than the normal cochlear implantation. (3) The electrodes were inserted in the "cochleostomy" in full length of 80 Patients, but 2 pairs of electrodes remained outside of "cochleostomy" in 2 patients. (4) No serious complications occurred after implantation. (5) The impedance of the electrodes, the T level and C level were similar with the normal cochlear implantation. The results had no significant difference in compare with normal cochlear group (P > 0. 05). (6) The abilities of speech discrimination and spoken language were improved through rehabilitation. CONCLUSIONS: The cochlear implantation can be performed safely in inner ear malformations. The outcome of hearing rehabilitation for patients with inner ear malformations are similar to those children with normal cochlear structure followed the multi-channel cochlear implantation.

Adolescent↗
PubMed1987

Speech perception with multi-channel cochlear implant of short duration pulse strategy.

A multi-channel cochlear implant (Nucleus type) was implanted in a 40-year-old female Japanese patient who became totally deaf after meningitis. The formant-based speech processing strategy was used, but a narrow pulse width of 22-42 microseconds was required because of intermittent difficulty in controlling the pulse amplitude. The patient was tested with a speech tracking test and could recognize 24 bunsetsues (the minimum meaningful unit of the Japanese sentence) per minute using the cochlear implant plus lipreading and 14.3 bunsetsues for the lipreading alone after 3.5 months' training. The patient was also able to understand usual conversational sentences spoken a little slowly. Scores of vowel and consonant tests reached 70% and 54% respectively for the cochlear implant alone, and 100% and 73% for the cochlear implant plus lipreading. This study has also shown that cochlear stimulation with very narrow pulse widths can be used, and restore speech comprehension ability for the Japanese.

Acoustic Stimulation↗
PubMed2001

[Cochlear implantation through the middle fossa approach].

The inner part of cochlear implant is inserted into inner ear during surgery through mastoid and middle ear. It is a classical method, used in the majority cochlear centers in the world. This is not a suitable method in case of chronic otitis media and middle ear malformation. In these cases Colletti proposed the middle fossa approach and cochlear implant insertion omitting middle ear structures. In patient with bilateral chronic otitis media underwent a few ears operations without obtaining dry postoperative cavity. Cochlear implantation through the middle fossa approach was performed in this patient. The bone fenster was cut, temporal lobe was bent and petrosus pyramid upper surface was exposed. When the superficial petrosal greater nerve, facial nerve and arcuate eminence were localised, the cochlear was open in the basal turn and electrode were inserted. The patient achieves good results in the postoperative speech rehabilitation. It confirmed Colletti tesis that deeper electrode insertion in the cochlear implantation through the middle fossa approach enable use of low and middle frequencies, which are very important in speech understanding.

Adult↗
PubMed2006

Conservation of residual acoustic hearing after cochlear implantation.

OBJECTIVE: This study was designed to test the hypothesis that partial hearing conservation is attainable after cochlear implantation with a long perimodiolar electrode. Surgical strategies for hearing conservation during cochlear implantation are described. STUDY DESIGN: Prospective, single-subject, repeated-measures design. SETTING: Academic tertiary care center. PATIENTS: Twenty-eight severely to profoundly hearing-impaired adult cochlear implant recipients who had some measurable hearing preoperatively. INTERVENTION: Cochlear implantation using Nucleus Freedom Contour Advance electrode. MAIN OUTCOME MEASURES: Preimplant and postimplant pure-tone thresholds and speech recognition scores were obtained to determine the incidence and degree of conserved hearing at a mean interval of 9 (+/-3.9) months. RESULTS: Thirty-two percent of subjects experienced complete conservation of hearing (0- to 10-dB loss), and 57% experienced partial conservation of hearing (>11 dB) after implantation. However, open-set speech recognition was partially conserved in only one subject. Cochlear implant performance was not better in patients with conservation of residual hearing. CONCLUSION: Conservation of pure-tone hearing was possible in 89% of implanted patients; however, residual speech perception was not conserved with this long perimodiolar electrode. A ceiling effect tends to inflate the prevalence of hearing conservation in implantation studies of severely to profoundly hearing-impaired patients.

Adult↗
PubMed2000

[Prediction of verbal and numerical comprehension in patients with cochlear implants].

BACKGROUND: Cognitive abilities determine the outcome of cochlear implantation. Neuropsychological tests of intellectual, memory, attentional and emotional functions were applied pre-operatively in 33 deaf patients receiving a cochlear implant. The outcome of verbal and numerical comprehension was measured in a subgroup of 14 patients post-operatively and correlated with pre-operative neuropsychological performance. METHODS: Neuropsychological performance was recorded using standardized tests for intellectual abilities (abbreviated Wechsler Adult Intelligence Scale [WAIS], crystallized intelligence scale), memory performance (Benton Visual Retention Test), attentional functions (d2 letter-cancellation-test), reaction time (Vienna Reaction Test) and emotional state (personality inventories). Verbal and numerical comprehension was measured post-operatively following adaptation of the speech processor. Performance and comprehension data were correlated. RESULTS: Cognitive performance parameters did not differ significantly from those of a healthy group. There was a correlation of r = +0.65 between numerical comprehension and the "mosaic-test", a subtest of the WAIS and of r = +0.78 between numerical comprehension and the crystallized intelligence scale. CONCLUSIONS: Pre-operative cognitive parameters may predict the outcome of cochlear implants.

Adolescent↗
PubMed2003

Cochlear implantation in patients with bilateral Ménière's syndrome.

OBJECTIVE: To evaluate the indications and clinical outcomes (audiologic and vestibular) in patients with Ménière's syndrome who have undergone cochlear implantation. STUDY DESIGN: This is a retrospective review of patients at a large tertiary academic medical center. PATIENTS: Nine patients were included in the study with AAO-HNS criteria for diagnosis of Ménière's syndrome as well as bilateral severe to profound sensorineural hearing loss as an indication for undergoing cochlear implantation. Audiologic criteria for implantation were considered in the context of speech recognition performance with well-fit, powerful hearing aids noting large fluctuations in performance levels in some patients. In all cases, the poorer hearing ear was implanted. Seven subjects had bilateral disease and had progressed to profound sensorineural hearing loss. The average age of the patients was 61 years. Six patients had undergone previous surgery to control vertigo, including endolymphatic shunt surgery and vestibular nerve section. No patient had received previous treatment with intra-tympanic gentamicin. Symptoms of Ménière's syndrome had been present in all patients for at least 10 years before implantation. INTERVENTION: Cochlear Implantation. MAIN OUTCOME MEASURES: Pre- and Postoperative audiometric scores (monosyllable words/phonemes, Central Institute for the Deaf (CID) sentences, Hearing in Noise Test (HINT) in quite/noise (+10 db)), pre- and postoperative vestibular symptoms (number of vestibular attacks, aural fullness, tinnitus). RESULTS: Follow-up after implantation ranged from 1 to 5 years. Average 6 month postimplantation scores were: monosyllable words/phonemes = 52%/65%, CID sentences = 82%, HINT in quiet/noise = 70%/50%. Average 1-year postimplant scores were: monosyllable words/phonemes = 60%/76%, CID sentences = 97%, HINT in quiet/noise = 89%/78%. Postoperative speech recognition scores were, on average, substantially greater than preoperative scores. While there were few complications associated with implantation, some patients experienced alterations in their implant performance in association with fluctuations in vestibular symptoms. CONCLUSIONS: Patients with advanced binaural involvement with Ménière's Disease may present a challenge to conventional criteria for cochlear implant candidacy because of fluctuating symptoms. We observed significant benefit over baseline in a consecutive series of patients with Ménière's syndrome who progressed to bilateral, severe-to-profound sensorineural hearing loss and underwent cochlear implantation. Further, previous vestibular surgery, including labyrinthectomy, does not contraindicate cochlear implantation.

Adult↗
PubMed2004

[Pre-operation evaluation and intra-operation management of cochlear implantation].

OBJECTIVE: To summarize pre-operation evaluation experiences in cochlear implantation. METHODS: Performing auditory evaluation and image analysis seriously in 158 severe hearing loss or total deaf cases before cochlear implantation, comparing their performance with the findings during and post operation. RESULTS: Among the total 158 cases, 116 cases with normal structure, 42 cases with the abnormal findings of the inner or middle ear. Stapedial gusher happened in 6 cases, 1 case was not predicted before operation. Except 1 case with serious malformation, the findings of other 157 cases in operation were consistent with the pre-operation evaluation. We helped all patients reconstruct auditory conduction with cochlear implantation, and the average hearing level up to 37.6 dB SPL. CONCLUSIONS: Performing image analysis seriously before operation and planning for operation according to HRCT can do great help to cochlear implantation. The operation under the HRCT instruction has less complications.

Adolescent↗
PubMedDate not supplied

Relationships among types of speech intelligibility in pediatric users of cochlear implants.

UNLABELLED: Twenty pediatric users of cochlear implants were administered three tests of speech intelligibility: (1) a test of contrast perception intelligibility, (2) a test of contrast production intelligibility, and (3) a test of production sentence intelligibility. Sixty adults with normal hearing served as listener judges for the two speech production tasks, and percent correct scores were generated for each of the three tasks. Correlational analyses showed significant correlations among overall scores for the three tasks. However, scores for individual feature classes from the contrast perception task were not correlated with their corresponding contrast production feature class scores, and only some of the feature class scores were correlated significantly with sentence intelligibility. We conclude that although these three types of intelligibility are related at a gross level, relationships are more tenuous at finer levels of analysis, suggesting that the separate skills may need to be addressed separately in remediation. EDUCATIONAL OBJECTIVES: As a result of this activity, the participant will be able to differentiate various methods for assessing speech intelligibility and describe the relationships among different types of speech intelligibility in pediatric users of cochlear implants.

Child↗