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PubMed1999

Cochlear implants in the geriatric population: benefits outweigh risks.

Cochlear implantation has become widely accepted as an effective means of hearing rehabilitation in severely and profoundly deaf individuals. In the elderly, cochlear implantation involves a number of unique issues that can affect patient outcomes. These factors include age-related changes in the auditory system, prolonged durations of deafness, diminished communication abilities, and coexisting medical and psychosocial problems. In general, the results of cochlear implantation in the elderly have been comparable with those of younger adults. Perioperative attention to medical and surgical details allows for safe insertion and a minimum of postoperative complications. Patients older than 65 have obtained excellent results by both audiologic and quality-of-life measures.

Aged↗

PubMed2000

Long-term follow-up of cochlear implant users with ossified cochlea.

OBJECTIVE: Cochlear implantation surgery in ossified cochlea is a challenge, even for the experienced otologist. Short-term assessments of auditory perception show that implantation in partial or even extensive ossified cochlea could be achieved with varying success, but no long-term follow-up results have been published yet. DESIGN AND METHODS: This paper proposes a retrospective review of eight Nucleus cochlear implant users with ossified cochlea who have been followed on a 12- to 60-month period. MAIN OUTCOME MEASURE: Auditory performances of users are reported at each control on a scale of 100 units divided into 4 skill zones of 25 units based on Erber's proposition, that is, detection, discrimination, identification, and recognition. RESULTS: Three of the eight subjects showed some progression in their auditory performances during the follow-up. The five other subjects showed no long-term progress in their auditory performance. CONCLUSIONS: Open-set comprehension could be achieved with the insertion of 9 to 10 electrodes of the Nucleus device. Auditory performance in users with ossified cochlea seems to be influenced by the same factors as in users with patent cochlea.

Adult↗

PubMed2004

Perception and production of mandarin tones in prelingually deaf children with cochlear implants.

OBJECTIVE: Mandarin is a lexical tone language in which four tones are crucial for determining lexical meanings. Acquisition of such a tone system may be challenging to prelingually deaf children with cochlear implants because, as recent studies have shown, cochlear implant devices are ineffective in encoding voice pitch information required for tone recognition. This study aimed to investigate Mandarin tone production and perception skills of children with cochlear implants. DESIGN: Thirty prelingually deaf children with cochlear implants, ages 6;0 (yr;mo) to 12;6, participated. These children received their implants at an average age of 5;8, with a range from 2;3 to 10;3. The average length of their cochlear implant experience was 3;7, with a range from 1;7 to 6;5. Tasks of tone production and tone identification involved a pictorial protocol of 48 words containing the targeted tones in either monosyllabic or disyllabic forms. RESULTS: The average scores for tone production was 53.09% (SD = 15.42), and for tone identification was 72.88% (SD = 19.68; chance level = 50%). Significant differences were found in the percentages across the production or identification of tone types or tone pairs. The children with exceptional performance in tone production tended to also perform well in tone identification. The children's performance levels in tone identification and production were also discussed in relation to the factors of age at implantation and length of cochlear implant experience. CONCLUSIONS: The present results suggest that the majority of prelingually deaf children with cochlear implants did not master Mandarin tone production. However, a small group of participants demonstrated nearly perfect skills of Mandarin tone production in addition to tone perception. Thus, it is necessary to consider factors other than the device's limitations to explain these high levels of performance in the perception and production of Mandarin lexical tones.

Asian People↗

PubMedDate not supplied

Postnatal growth of the human temporal bone. Implications for cochlear implants in children.

Recent interest in cochlear implantation for children has made it important to understand how postnatal growth of the ear will affect such devices. In this study, the postnatal growth of the labyrinth, middle ear, and mastoid was measured in three dimensions using radiographic and temporal bone data. Measurements were made from histologic sections of 48 temporal bones from children and compared to adult temporal bones. Radiographic measurements were made from 253 sets of skull radiographs of children and compared to adult skull series. In the three dimensions measured, there was no postnatal growth of the labyrinth and little variation in size between individuals. Measurements of the middle ear showed greater variation between individuals than measurements of the inner ear, but growth only in the distance from stapes footplate to the tympanic membrane. The mastoid showed growth in all three dimensions: length, width, and depth. The pattern of growth for mastoid length and width appears to follow a double logistic model, with differences between males and females. The growth in mastoid depth is smaller and appears to follow a single exponential curve. The implications for cochlear implantation in children are discussed.

Child↗

PubMed1989

Telephone speech comprehension with use of the nucleus cochlear implant.

The reported telephone usage by cochlear implant recipients has become a major issue of controversy. Although patients and clinicians report good communication skills via the telephone, no standardized tests have been used and no quantifiable results have been reported. In an effort to determine the extent to which our better-performing patients can use the telephone, we established a clinical protocol to assess their ability to recognize speech, taking into consideration the problems inherent in telephone testing. Eight cochlear implant recipients were administered the NU-6 Monosyllabic Word Test and the City University of New York Topic Related Sentences under the following listening conditions: soundfield in a soundproof suite and via telephone within the hospital, locally, and long-distance. Twenty-three percent of the patients implanted at New York University Medical Center demonstrated a significant degree of telephone communication ability.

Cochlear Implants↗

PubMed2004

Willingness-to-pay for pediatric cochlear implantation.

OBJECTIVE: This paper presents the results of the first willingness-to-pay (WTP) study to be undertaken on cochlear implantation. It aims to measure the values parents place on the UK having a pediatric cochlear implantation (PCI) programme. METHODS: Face-to-face semi-structured interviews were conducted with parents of children from the Nottingham Pediatric Cochlear Implant programme, whom had been implanted for a period ranging from 1 month to 13 years. Parents willingness-to-pay for the UK to have a pediatric cochlear implantation programme were elicited using a bidding process question format and via a discrete choice question. To see if income was a significant determinant of willingness-to-pay an analysis of variance (ANOVA) was undertaken in the statistical package SPSS version 10. RESULTS: Two hundred and sixteen parents were interviewed over the period July 2001-August 2002, representing over 130h of interviewing. The mean and median willingness-to-pay values elicited were UK pound 127 and 50 per month, respectively (UK pound 2001/2002). Willingness-to-pay was positively related to income (P<0.020). When the income constraint was removed, 99% of parents choose the implant over having the money the implant would cost to spend in some other way to benefit their child. CONCLUSIONS: Parents of implanted children were willing to pay substantial monthly amounts for pediatric cochlear implantation. Most parents saw no alternative to pediatric cochlear implantation that could improve their child's quality of life to the same extent. Willingness-to-pay was sensitive to income as expected suggesting that the values elicited are both valid and influenced by a respondent's budget constraint.

Adult↗

PubMed2002

Cochlear implantation with large vestibular aqueduct syndrome.

OBJECTIVES: In this investigation, we report the outcomes of 14 adults (age >18 y) and 9 children (age <18 y) with radiographically proven large vestibular aqueduct syndrome (LVAS) who received cochlear implants at Indiana University School of Medicine. STUDY DESIGN: This is a retrospective case-control study detailing the outcomes of 23 patients with LVAS and 46 control patients implanted with Nucleus (Cochlear Corp., Englewood, CO), Clarion (Advanced Bionics Corp., Sylmar, CA), or Med-El (MED-EL Corp., Innsbruck, Austria) cochlear implants. METHODS: Performance data on pure-tone averages, speech detection thresholds, and a variety of auditory and speech recognition tasks from these patients with LVAS were compared with performance data obtained from a matched group of 46 cochlear implant users who did not have LVAS. Specific patient characteristics used in matching included the age of the patient, the age at implant of the patient, and whether the patient was pre- or postlingually deafened. Data for the adult group was analyzed using the Student t test, and data for the pediatric patient group was compared using a chi2 test. RESULTS: The results indicated positive outcomes for both pediatric and adult groups. With both adult and pediatric groups, auditory and speech recognition performance did not differ significantly between those patients with LVAS and control subjects. CONCLUSIONS: This study adds further support for the use of cochlear implantation in patients with LVAS. Cochlear implantation is beneficial and can be offered as an eventual treatment of LVAS if hearing loss progresses to profound levels in these patients.

Audiometry↗

PubMed1991

Cochlear implants in children: a study of parental stress and adjustment.

A contextual model of stress was employed to examine the impact of cochlear implantation on parents' levels of stress and psychological adjustment. This model provided a framework for identifying stressors tied directly to the situation, and pointed to important life roles that may be altered. Twenty-four mothers of children implanted with cochlear implants completed a series of questionnaires assessing stressors related to daily parenting tasks, time demands, and childhood deafness. Standardized measures of depression, anxiety, and somatic complaints were also administered. The results provided preliminary evidence that parents of children receiving cochlear implants experience higher levels of stress and poorer psychological adjustment than parents of normally hearing children. Greater parenting stress and emotional distress were reported by parents of children using multichannel as opposed to single-channel devices, with little evidence that this was related strongly to length of time using the devices. Finally, in analyses controlling for type of device and length of use, parenting stress as measured in the current study, accounted for substantial proportions of the variance in psychological distress. The implications of these findings, as well as directions for future research, are discussed.

Adaptation, Psychological↗

PubMed2003

Cochlear implantation in prelingually deaf children with ossified cochleae.

OBJECTIVE: To evaluate the effects that degree of cochlear ossification has on performance of prelingually deafened children who receive cochlear implants. STUDY DESIGN: A matched-pairs analysis comparing speech perception results obtained 6 and 24 months after implant by children with ossified and nonossified cochleae. Additionally, long-term performance was evaluated in patients with follow-up periods longer than 24 months. Comparisons were also performed within the ossified cochleae group to determine if degree of cochlear ossification and surgical technique affected outcome with the cochlear implant. SETTING Large cochlear implant program in an academic tertiary care medical center. PATIENTS: Twenty-one pairs of prelingually deaf children with and without cochlear ossification. Meningitis was the etiology of hearing loss in children with ossified cochleae. The control group had nonmeningitic etiology for the hearing loss. INTERVENTIONS: Multichannel cochlear implantation and routine postoperative auditory rehabilitation and performance evaluation. MAIN OUTCOME MEASURES: Speech perception category ratings based on scores obtained on a battery of closed- and open-set speech recognition tests 6 and 24 months after implant. Longer follow-up period is also reported. RESULTS: As a group, children with cochlear ossification showed significant improvement in their speech perception abilities 6 and 24 months after implant. Children with cochlear ossification performed at a significantly lower speech perception category than a group of matched controls with nonossified cochleae at both the 6- and 24-month postimplant intervals. With longer implant use, open-set speech recognition was possible in some children with ossification. Within-group analysis of the children with ossified cochleae revealed that degree of ossification and surgical procedure used for implantation did not significantly affect outcome. CONCLUSIONS: Prelingually deafened children with postmeningitic hearing loss and ossified cochleae receive significant benefit from cochlear implants. Their performance is frequently poorer, however, than children with nonossified cochleae.

Case-Control Studies↗

PubMed2006

Speech perception for adults who use hearing aids in conjunction with cochlear implants in opposite ears.

This study aimed to (a) investigate the effect of using a hearing aid in conjunction with a cochlear implant in opposite ears on speech perception in quiet and in noise, (b) identify the speech information obtained from a hearing aid that is additive to the information obtained from a cochlear implant, and (c) explore the relationship between aided thresholds in the nonimplanted ear and speech perception benefit from wearing a hearing aid in conjunction with a cochlear implant in opposite ears. Fourteen adults who used the Nucleus 24 cochlear implant system in 1 ear participated in the study. All participants had either used a hearing aid in the nonimplanted ear for at least 75% of waking hours after cochlear implantation, and/or, hearing loss less than 90 dB HL in the low frequencies in the nonimplanted ear. Speech perception was evaluated in 3 conditions: cochlear implant alone (CI), hearing aid alone (HA), and cochlear implant in conjunction with hearing aid in opposite ears (CIHA). Three speech perception tests were used: consonant-vowel nucleus-consonant (CNC) words in quiet, City University of New York style (CUNY) sentences in coincident signal and noise, and spondees in coincidental and spatially separated signal and noise. Information transmission analyses were performed on the CNC responses. Of the 14 participants tested, 6 showed significant bimodal benefit on open-set speech perception measures and 5 showed benefit on close-set spondees. However, 2 participants showed poorer speech perception with CIHA than CI in at least 1 of the speech perception tests. Results of information transmission analyses showed that bimodal benefit (performance with CIHA minus that with CI) in quiet arises from improved perception of the low frequency components in speech. Results showed that participants with poorer aided thresholds in the mid-to-high frequencies demonstrated greater bimodal benefit. It is possible that the mid-to-high frequency information provided by the hearing aids may be conflicting with the cochlear implants.

Adult↗

PubMedDate not supplied

Effects of the acoustical dynamic range on speech recognition with cochlear implants.

The amplitude compression function in a speech processor for cochlear implants maps the wide acoustical dynamic range of sounds into the smaller electrical dynamic range available on the implanted electrodes. In this study, we examined the effects of systematic variations of the acoustical dynamic range of the compression function on speech recognition with cochlear implants. Statistical measures of the amplitude distribution of speech sounds were made in each channel of a research speech processor providing more than 50 dB of input signal-to-noise ratio. Several systematic variations of the dynamic range of the compression function were implemented on this basis, and speech recognition was determined using vowel and consonant identification tests in three experienced cochlear implant users. Results demonstrated that the acoustical dynamic range of the compression function does have a significant effect on speech recognition with cochlear implants. They suggest that a dynamic range of about 45 dB is necessary for optimal speech recognition.

Acoustics↗

PubMed1995

NIH consensus conference. Cochlear implants in adults and children.

OBJECTIVE: To provide clinicians and other health care providers with a current consensus on the benefits, limitations, and technical and safety issues that need to be considered in the use of cochlear implants. PARTICIPANTS: A nonfederal, nonadvocate, 14-member consensus panel representing the fields of otolaryngology, audiology, speech-language pathology, pediatrics, psychology, and education, and including a public representative. In addition, 24 experts in auditory anatomy and physiology, otolaryngology, audiology, aural rehabilitation, education, speech-language pathology, and bioengineering presented data to the consensus panel and a conference audience of 650. EVIDENCE: The literature was searched through MEDLINE and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS: The panel, answering predefined consensus questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. CONSENSUS STATEMENT: The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: Cochlear implantation improves communication ability in most adults with severe-to-profound deafness and frequently leads to positive psychological and social benefits as well. Currently, children at least 2 years old and adults with profound deafness are candidates for implantation. Cochlear implant candidacy should be extended to adults with severe hearing impairment and open-set sentence discrimination that is less than or equal to 30% in the best-aided condition. Access to optimal education and (re)habilitation services is important for adults and is critical for children to maximize the benefits available from cochlear implantation.

Adult↗

PubMedDate not supplied

Cochlear implants in adults and children.

OBJECTIVE: To provide clinicians and other health care providers with a current consensus on the benefits, limitations, and technical and safety issues that need to be considered in the use of cochlear implants. PARTICIPANTS: A non-Federal, nonadvocate, 14-member consensus panel representing the fields of otolaryngology, audiology, speech-language pathology, pediatrics, psychology, and education and including a public representative. In addition, 24 experts in auditory anatomy and physiology, otolaryngology, audiology, aural rehabilitation, education, speech-language pathology, and bioengineering presented data to the consensus panel and a conference audience of 650. EVIDENCE: The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS: The panel, answering predefined consensus questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. CONSENSUS STATEMENT: The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: Cochlear implantation improves communication ability in most adults with severe to profound deafness and frequently leads to positive psychological and social benefits as well. Currently, children at least 2 years old and adults with profound deafness are candidates for implantation. Cochlear implant candidacy should be extended to adults with severe hearing impairment and open-set sentence discrimination that is less than or equal to 30 percent in the best aided condition. Access to optimal education and (re)habilitation services is important for adults and is critical for children to maximize the benefits available from cochlear implantation.

Adult↗

PubMed1999

Cost-utility of the cochlear implant in adults: a meta-analysis.

OBJECTIVE: To conduct a meta-analysis of the cost-utility of the cochlear implant in adults. DATA SOURCES: MEDLINE literature search, review of article bibliographies, and consultation with experts. STUDY SELECTION: Studies that reported (1) data on adults (age > or = 18 years) with bilateral, postlingual, profound deafness; (2) a health-utility gain from cochlear implantation on a scale from 0.00 (death) to 1.00 (perfect health); (3) a cost-utility ratio in terms of dollars per quality-adjusted life-year (QALY); and (4) at least 1 conventional statistical parameter (ie, SD, 95% confidence interval [CI], or P value). DATA EXTRACTION: From each study, we extracted the number of subjects, study design, health-utility instrument used, health-utility associated with profound deafness, health-utility gain from cochlear implantation, cost-utility of cochlear implantation, and reported statistical parameters. DATA SYNTHESIS: Weighted averages were calculated using a statistical weight of 1 per variance. Pooling 9 reports (n = 619), the health-utility of profoundly deaf adults without cochlear implants was 0.54 (95% CI, 0.52-0.56). Pooling 7 studies (n = 511), the health-utility of profoundly deaf adults after cochlear implantation was 0.80 (95% CI, 0.78-0.82). This improvement of 0.26 in health-utility resulted in a cost-utility ratio of $12,787 per QALY. CONCLUSIONS: Profound deafness in adults results in a substantial health-utility loss. Over half of that loss is restored after cochlear implantation, yielding a cost-utility ratio of $12,787 per QALY. This figure compares favorably with medical and surgical interventions that are commonly covered by third-party payers in the United States today.

Adult↗

PubMed2004

An investigation of telephone use among cochlear implant recipients.

The purpose of this study was to examine telephone use among cochlear implant recipients. A questionnaire was constructed and mailed to 803 adults who received a Clarion cochlear implant system manufactured by Advanced Bionics Corporation. Questionnaire recipients were implanted at least 12 months prior to receiving the questionnaire (i.e., they were implanted in 1998 or 1999). Approximately 60% (n = 478) responded, of whom 70% (n = 336) were considered "telephone users" (i.e., they answered the telephone and/or initiated calls). Telephone users were significantly younger and had significantly more daily hours of cochlear implant use than nonusers. Not surprisingly, there were differences between groups with respect to method of communication (i.e., more users employed oral communication, while more nonusers employed both oral and manual communication) and ability to understand words without lipreading (i.e., more users were able to understand). Thirty-seven percent of the telephone users were male, and 63% were female. The average age was 51.8 years (SD = 15.5). Ninety-five percent of users initiated calls to family and friends, 65% made appointments by phone, and approximately 50% asked for information about a product or service and conducted business over the phone. Over 95% of users could identify a dial tone, a busy signal, and voices. The average telephone use per week was 5.4 hr. Approximately 85% indicated that they were able to interact with strangers on the telephone within 5 months of receiving the sound processor. Approximately 30% communicated via a cellular phone for personal use. The findings of this survey suggest an increase in cochlear implant users' telephone use relative to a decade earlier. Advances in cochlear implant and telephone technologies are 2 of several factors that may contribute to the changes observed.

Adult↗

PubMed1999

Neural response telemetry with the nucleus CI24M cochlear implant.

OBJECTIVES: To review our intraoperative and postoperative testing protocol for cochlear implant patients. This study describes the methodologies and applications of a new technique called neural response telemetry (NRT) for the Nucleus CI24M cochlear implant system. NRT uses radiofrequency telemetry technology to measure the action potentials of the auditory nerve. STUDY DESIGN: We have developed a specific protocol for intraoperative testing of the implant device before, during, and after implantation. This includes device integrity tests, visual detection of electrical stapedius muscle reflexes (VESR), and NRT. METHODS: Our methodologies use the commercial software (Windows-based Diagnostic and Programming System [WIN-DPS] and NRT) for the Nucleus CI24M. We describe the details of our protocol used on all of the patients (14 adults and 14 children) who received CI24M implants at Mayo Clinic (Rochester, MN). Our protocol correlates the NRT threshold with the behavioral responses for each patient on at least four electrodes. RESULTS: From August 1, 1998, to December 31,1998, we completed electrode integrity tests, NRT, and VESR testing intraoperatively on 12 patients with the Nucleus CI24M. We have measured normal implant function on all 28 of our CI24M patients with one exception. One of our children had a device failure after approximately 4 months as a result of head trauma. We have also obtained NRT results from an additional 10 patients postoperatively. CONCLUSIONS: The measurement of device and electrode array function is quite simple with the CI24M software. These measurements can be obtained intraoperatively as well as postoperatively. We conclude that VESR and NRT measurements can be very helpful in programming for patients with cochlear implants, especially children, because they provides us with target settings for the speech processor.

Action Potentials↗

PubMed2005

Music recognition by Japanese children with cochlear implants.

Congenitally deaf Japanese children with cochlear implants were tested on their recognition of theme songs from television programs that they watched regularly. The children, who were 4-9 years of age, attempted to identify each song from a closed set of alternatives. Their song identification ability was examined in the context of the original commercial recordings (vocal plus instrumental), the original versions without the words (i.e., karaoke versions), and flute versions of the melody. The children succeeded in identifying the music only from the original versions, and their performance was related to their music listening habits. Children gave favorable appraisals of the music even when they were unable to recognize it. Further research is needed to find means of enhancing cochlear implants users' perception and appreciation of music.

Auditory Perception↗

PubMed1994

Multichannel cochlear implantation in obliterated cochleas using the Gantz procedure.

Gantz, et al, reported two patients with extensive cochlear ossification in which cochlear implantation was done with a Nucleus 22-Channel Cochlear Implant after extensive cochlear drill-out. One of the patients did well with 20 functioning electrode pairs. We report an additional three patients with extensive cochlear ossification who received Nucleus 22-Channel Cochlear Implants. All three patients had extensive cochlear drill-out as described by Gantz, et al. All three patients have use of all 21 electrode pairs with amperages typical of conventional implantation in two of the three and slightly increased levels in the third. Extensive bilateral cochlear ossification does not seem to be an absolute contraindication for multi-channel cochlear implantation.

Adult↗