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PubMed2006

Cochlear implantation in the irradiated temporal bone.

OBJECTIVE: To demonstrate the feasibility and complexities of cochlear implantation in the setting of bilateral temporal bone osteoradionecrosis. STUDY DESIGN: Case report. SETTING: Tertiary care referral centre. CASE DESCRIPTION: A 66-year-old woman with bilateral temporal bone osteoradionecrosis and profound hearing loss, following treatment for tonsillar cancer, underwent cochlear implantation. Prior canal wall down mastoidectomy and subsequent temporal bone resection with free flap reconstruction had been performed on the implanted ear. The contralateral ear received a canal wall down mastoidectomy. A completely dehiscent mastoid segment of the facial nerve and extensive fibrosis were evident in the implanted ear. Only minimal fibrous reaction was found within the cochlea, allowing for full electrode insertion. At three months, speech recognition testing documented a consonant-nucleus-consonant (CNC) word score of 54 per cent. CONCLUSIONS: This report demonstrates the feasibility of cochlear implantation after temporal bone surgery and free flap reconstruction in the setting of diffuse osteoradionecrosis. The patient's excellent open-set speech understanding using the cochlear implant implies that radiation did not severely damage the central auditory pathways. Thus, some patients with radiation-induced hearing loss may be appropriate cochlear implant candidates. Special attention should be paid to surgical planning, as complications related to wound healing, electrode insertion and facial nerve injury may be more likely.

Aged↗

PubMed1990

A matched-pairs comparison of single and multichannel cochlear implants in children.

Auditory capabilities of Nucleus 22 multichannel cochlear implant users were compared to those of matched 3M/House single-channel users. Six children who received either the 3M/House or Nucleus 22 cochlear implants were separated into three matched pairs. Group 1 consisted of two postlinguistically deafened adolescents, group 2 consisted of two prelinguistically deafened school-age children, and group 3 consisted of two perilinguistically deafened preschoolers. Participants were evaluated using auditory comprehension and discrimination tasks as indicated by the 3M/House and Nucleus 22 protocols. However, only tasks common to both were included here. While the 3M/House single-channel device has been under an IDE for children under the age of 18 years since 1984, the Nucleus 22 multichannel implant only recently became available for this age group. Thus, short-term evaluations at 6 months and 1 year postimplantation have been used for comparison. Two of the three groups indicated that the multichannel users performed as early as the 6-month level; the children in the third group performed equally. These results indicate that multichannel cochlear implants show great promise in deaf children.

Adolescent↗

PubMed1999

The influence of ionizing radiation on the CLARION 1.2 cochlear implant during radiation therapy.

OBJECTIVE: This study aimed to determine the maximum dose of radiation the CLARION 1.2 cochlear implant can withstand safely. INTRODUCTION: Cochlear implants restore functional hearing to patients with sensorineural deafness. Because some patients may need radiation therapy, it is important to investigate the influence of ionizing radiation on cochlear implant function. METHODS: This study tested the function of four CLARION 1.2 implants (Advanced Bionics, Sylmar, CA, U.S.A.) after varying radiation treatments with gamma rays. The first implant received a cumulative dosage of 69 Gy over nine treatments (single doses between 0.1-30 Gy). The second was irradiated with a total of 90 Gy, receiving three treatments of 30 Gy each. The third and fourth received doses more typical of patient therapy (i.e., 2 Gy) approximately 30 times, for a cumulative dosage of approximately 60 Gy. Implant function was tested after every treatment; the CLARION implant incorporates a back-telemetry system, allowing impedance and current output testing. RESULTS: Despite the type of treatment, the results were quite consistent: difficulties in function occurred when the cumulative dosage inside the implant was approximately 60 Gy. The first implant recovered completely and the second recovered partially. DISCUSSION: The CLARION 1.2 cochlear implant seems to safely withstand approximately 60 Gy of radiation before experiencing functional difficulties. In a clinical situation, the implant would not likely be in the target volume irradiated, and thus the patient's therapeutic cumulative dosage might be higher.

Cochlear Implants↗

PubMed2003

[Cochlear implantation in patients with inner ear malformations, clinical analysis of 25 cases].

OBJECTIVE: To explore the clinical experience of multi-channel cochlear implantation in patients with bilateral inner ear malformations. METHOD: Multi-channel cochlear implantation was conducted among 180 patients from 1997 to 2001. Twenty-five of them, being with inner ear malformations, were given hearing and speech rehabilitation including sound detection, word discrimination, auditory comprehension and spoken language skill development. A follow-up lasting 4 - 24 months was conducted after the operation. A retrospective analysis was performed among these 25 patients to observe the surgical outcomes and mapping characteristics after surgery. RESULTS: (1) All patients restored their auditory sensations after the operation. (2) Stapedial gusher was found in 13 cases with inner ear malformations, especially those with Mondini malformation, much more frequently than among the patients with other malformations. (3) Most of the action electrodes were inserted in the "cochleostomy" in full length, only 2 pairs of them remained outside of the "cochleostomy". (4) No serious complications occurred after implantation. (5) The impedance of the electrodes, T level and C level were higher in the 25 cases than in the normal cochlear implantation, however, with the hearing similar hearing threshold. (6) After training, the abilities of speech discrimination and spoken language were improved in comparison with those before operation. CONCLUSION: The cochlear implantation can be performed safely in patients with bilateral inner ear malformations. The primary outcome of cochlear implantation in hearing rehabilitation is similar for both the patients with inner ear malformations and those with normal cochlear structure.

Adolescent↗

PubMed1999

Residual speech recognition and cochlear implant performance: effects of implantation criteria.

OBJECTIVE: This study aimed to determine the effects of preoperative speech reception on postoperative speech recognition with a cochlear implant and to develop a statistical index allowing prediction of postoperative speech recognition before implantation. STUDY DESIGN: The study design was a retrospective case review with statistical modeling. SETTING: The study was conducted at a tertiary referral center with an associated Veteran's Administration hospital. PATIENTS: Postlingually deafened adults with and without residual speech reception participated. INTERVENTION: Cochlear implantation with Cochlear Corporation CI-22 and CI-24 devices was performed. MAIN OUTCOME MEASURES: Monosyllabic word recognition was measured. RESULTS: Duration of deafness and preoperative sentence recognition are both significant predictors of word recognition with a cochlear implant and can account for 80% of the variance in word recognition. CONCLUSIONS: Cochlear implant outcomes are variable but predictable within specific ranges.

Adult↗

PubMed2004

Parental decision-making in considering cochlear implant technology for a deaf child.

OBJECTIVES: Advances in cochlear implant (CI) technology have increased the complexity of treating childhood deafness. We compare parental decision-making, values, beliefs, and preferences between parents of eligible and ineligible children in considering cochlear implants. METHODS: Surveys were obtained from 83 hearing parents of deaf children. A subset of 50 parents also underwent semi-structured interviews. Nine hypothetical outcomes, ranging from mainstream success to poor mainstream outcome were created to measure parents' overall preferences and preference for specific outcomes for their child who is deaf. RESULTS: Among parents of eligible children (n = 50), approximately 2/3 considered implantation (n = 33). The other 1/3 did not consider implantation. Parents who were eligible but did not consider implantation placed significantly lower priority on mainstream success over bilingual success (P < 0.03), and on the child's ability to speak versus sign (P < 0.02). They also showed significantly higher concerns on the cost of services in general and on the availability of resources offered at the local school district (both P > 0.05). Parents of ineligible children (n = 30) rarely considered implantation, even if they showed similar aspirations in mainstream outcomes (P = 0.003). Semi-structured interview data supported these findings. CONCLUSIONS: The decision to consider cochlear implantation is strongly influenced by the eligibility and by professionals' recommendations. However, for some parents, the decision goes beyond eligibility and is determined by parental preferences, goals, values, and beliefs. This highlights the importance of careful audiologic evaluation and professionals' awareness of and sensitivity to parental goals, values, and beliefs in evaluating the child's candidacy.

Adolescent↗

PubMed2005

Cochlear implantation and management of chronic suppurative otitis media: single stage procedure?

In a series of 360 patients who underwent cochlear implantation at our center, four patients (five procedures) had cochlear implantation with obliteration of the mastoid cavity and management of cholesteatoma as a single-staged procedure. Three patients were bilaterally deaf secondary to CSOM and had bilateral mastoid cavities, and in one patient congenital cholesteatoma was identified during cochlear implantation. A mastoidectomy or revision mastoidectomy with obliteration of the mastoid cavity and cochlear implantation was performed as a single stage procedure. Cholesteatoma reoccurred in one patient 9 years after cochlear implantation. Surgical procedures, complications, follow-up and outcomes are discussed.

Adult↗

PubMed2005

Bacterial biofilm formation on a human cochlear implant.

OBJECTIVE: To report the characteristics of a bacterial biofilm from the surface of a cochlear implant. BACKGROUND: Bacterial biofilm formation on implanted devices causes intractable infections and device extrusions necessitating device removal, with loss of function. More information is needed about biofilm characteristics and interactions with the implant surface before better treatments can be designed. STUDY DESIGN: A retrospective case review was combined with a descriptive histological study of the surface of an otologic device. METHODS: The receiver/stimulator device removed from a cochlear implant patient because of intractable infection and partial device extrusion was fixed and processed for microscopic examination. Its surface and the material present on its surface were analyzed using light and electron microscopy, focusing on surface texture, cell types, and bacteria species and extracellular polymeric substances present within the biofilm. RESULTS: Stereomicroscopic examination revealed extracellular polymeric substances, pinkish yellow in color, with spheres of uniform size scattered throughout, indicative of a biofilm containing Staphylococcus aureus. Biofilm density was greatest in depressions on the surface of the implant. Cross-sectional analysis revealed bacteria interspersed with polymorphonuclear leukocytes. Scanning electron microscopic examination demonstrated an amorphous layer of extracellular polymeric substances containing small filaments, bacteria, and inflammatory cells. Only Staphylococcus aureus was detected. CONCLUSION: Cochlear implant material can provide a surface for bacterial biofilm formation. Impressions can provide an environment conducive to biofilm establishment and growth, ultimately necessitating device removal, with loss of implant function. Biofilm characterization should aid in design of cochlear implant devices less susceptible to biofilm formation.

Anti-Bacterial Agents↗

PubMed2004

Cochlear implant surgery at 12 months of age or younger.

OBJECTIVES: Early presentation of congenitally deaf children for cochlear implantation is leading to surgery in younger candidates. The safety of cochlear implantation in children aged 12 months and younger is reviewed with radiologic assessment of mastoid bone anatomy and surgical outcome data. STUDY DESIGN: Analysis of case records and temporal bone computed tomography (CT) scans with description of surgical technique in infants. METHODS: Chart analysis of children aged 12 months or younger at cochlear implantation. Mastoid bone anatomy was compared with older children (mean age 2 years) using CT scans. RESULTS: Twenty-five infants received implants at 7 to 12 months of age because of meningitis (n = 4) or early detection of deafness (n = 21). Mastoid marrow content on CT scan was significantly greater in this age group (P < .001 Mann-Whitney rank sum test), but pneumatization was always adequate for safe identification of surgical landmarks. The smaller size of the mastoid bone was not restrictive. An extended postauricular approach was used in the first 11 cases and a 2.5 cm hair-line incision in the remainder. Ligature tie-down of the device was completed in all cases. No complications occurred. All are full-time implant users, except one with other neurologic sequelae of preoperative meningitis. CONCLUSIONS: In our experience, cochlear implant surgery is safe in children aged 7 to 12 months with appropriate anesthetic and postoperative support. The small incision technique is particularly suited to this age group. Ligature fixation of the device is considered advisable because of the increased risk of displacement from frequent falls when learning to walk.

Age Factors↗

PubMedDate not supplied

Successful cochlear implantation in a patient with superficial siderosis.

OBJECTIVE: To define the presentation and outcome of cochlear implantation in a patient with profound sensorineural hearing loss due to superficial siderosis. STUDY DESIGN: Retrospective case review. RESULTS: Postimplantation speech reception threshold was 34 dB, and hearing in noise testing sentences were 71% demonstrating a successful outcome. These results have been maintained for 5 years after implantation. CONCLUSION: Cochlear implantation is a potentially successful rehabilitation option for certain patients with profound sensorineural hearing loss due to superficial siderosis.

Adult↗

PubMed2000

Self-reports about tinnitus and about cochlear implants.

OBJECTIVE: Analyze literature on self-report outcomes in two areas of audiological rehabilitation: 1) tinnitus and 2) cochlear implant hearing aids. DESIGN: 1) Tinnitus: survey of features in the development of self-report approaches and of formal scales used in assessment of tinnitus disability and handicaps. 2) Cochlear implants: summary of the literature using self-report approaches to cochlear implant experience that indicates points of theoretical significance. RESULTS: 1) Major features of tinnitus are: a) disabilities such as interference with and distortion of normal auditory perception; b) handicaps such as emotional distress, interference with sleep, and with personal and social life. Nonauditory factors-chronic depression, high self-focused attention-mediate the degree of experienced tinnitus handicap. 2) People with prelingual loss of hearing report that a cochlear implant primarily enables improved detection and discrimination of environmental sound; those with postlingual loss find that an implant in addition provides improved speech recognition. CONCLUSIONS: 1) Coping with tinnitus is influenced by the personal resources that can be brought to bear on the experience, highlighting a general point that any rehabilitation outcome is not only a matter of acoustical solutions. By the same token, tinnitus can be easier to cope with if its "psychoacoustic presence" can be diminished by some form of masking. 2) Cochlear implants fitted in childhood that do not provide meaningful input signals in real-world settings may be rejected in adolescence. 3) "Hearing," as a capacity, does not have a fixed worth. Different circumstances mean it will be taken as desirable or as delivering torment (extreme tinnitus, e.g.). Its value will also vary depending on the extent of a person's access to spoken language (aiding in very early childhood, e.g.).

Adaptation, Psychological↗

PubMedDate not supplied

Radiographic imaging for the cochlear implant.

Imaging plays an essential role in evaluating the cochlear implant candidate and the results of implantation. Eighteen candidates for cochlear implantation were reviewed for this study. Fourteen received implants; all but one, intracochlear devices. Based on the trial use of multiple techniques, a protocol has been established for the use of radiography in implant studies. The protocol suggests preoperative high resolution semiaxial computed tomographic scanning, intraoperative anteroposterior transorbital plain films if there is doubt concerning the electrode placement, and postoperative plain films in cases of unexpected poor device performance. In cases with complications, postoperative CT scanning may be required.

Adult↗

PubMed2001

Assessment of vocabulary development in children after cochlear implantation.

OBJECTIVES: To assess vocabulary development in children following cochlear implantation and to evaluate the effect of age at implantation on performance. DESIGN: Retrospective study (mean follow-up, 3(1/2) years). SETTING: Tertiary center. PATIENTS: Children with prelingual deafness provided with a cochlear implant between 1988 and 1999, who serially performed the Peabody Picture Vocabulary Test-Revised (60 patients) and the Expressive One-Word Picture Vocabulary Test-Revised (52 patients). The children were subgrouped into those receiving implants at younger than 5 years and at 5 years or older. OUTCOME MEASURES: Age-equivalent vocabulary test score and gap index (chronological age minus the age-equivalent score, divided by the chronological age at the time of testing) were calculated. For each test, the following were performed: calculation of rate of change for age-equivalent score; comparison of earliest and latest gap indices means (the cohort and intergroup and intragroup comparison); and multiple regression analysis demonstrating the effect of age at implantation, sex, communication mode, etiology of deafness, and residual hearing on the rate of vocabulary development. RESULTS: Expressive and receptive vocabulary development rates were 0.93 and 0.71 (age-equivalent scores per year), respectively. Subgrouped by age at implantation, the children's rates (for both vocabularies) were not statistically different (Peabody Picture Vocabulary Test-Revised, P =.90; Expressive One-Word Picture Vocabulary Test-Revised, P =.23). The global latest gap indices were significantly less than the earliest (Peabody Picture Vocabulary Test-Revised, P =.048; Expressive One-Word Picture Vocabulary Test-Revised, P<.001), indicating an improvement in age-appropriate vocabulary development over time. The age subgroups demonstrated similar results, except for the younger group's receptive gap index. On multiple regression analysis, the significant predictive variables were residual hearing (Expressive One-Word Picture Vocabulary Test-Revised) and male sex and oral communication mode (Peabody Picture Vocabulary Test-Revised). CONCLUSIONS: Children with cochlear implants developed their vocabularies at rates that were sufficient to prevent an increase in their gap indices as related to ideal scores at testing. A late age at implantation does not singularly preclude beneficial development of vocabulary.

Age Factors↗

PubMed2003

Personal, social, and family adjustment in school-aged children with a cochlear implant.

OBJECTIVE: The present study sought to document the psycho-social adjustment of 181 school-aged deaf children who have had a cochlear implant for 4 or more yr and to examine parental satisfaction with the outcome of the implantation process on their child's life and on their family's life in general. DESIGN: Three measures were employed. One measure was a self-report instrument designed to assess perceived self-competence in children, one was a rating scale completed by parents that sought to assess the degree of their child's personal-social adjustment, and the third was a questionnaire given to parents on which they rated their satisfaction with aspects of the cochlear implant and how it had affected their child's functioning within the context of family life. RESULTS: Children generally perceived themselves (and parents perceived their children) as being competent and well adjusted in most aspects of daily life. Parents expressed a generally positive view of cochlear implantation and its effects on family life. None of the social-emotional adjustment measures was significantly related to the speech perception, speech production or language skills the child achieved postimplant. However, the parents' satisfaction with their child's cochlear implantation was significantly related to their child's speech and language achievements. On the perceived self-competence instrument, younger children and those with longer use of the updated SPEAK speech processor gave themselves higher ratings. Parent ratings of their child's adjustment tended to be higher for girls than for boys, for more rather than less intelligent children, and for children enrolled in private as opposed to public school settings. CONCLUSIONS: Deaf children who have used a cochlear implant for 4 to 6 yr report that they are coping successfully with the demands of their social and school environment, regardless of their speech and language achievements after implantation. Parents' ratings indicate that these children are emotionally and socially well adjusted and that they have benefited from cochlear implantation. To the extent that the children and their parents accurately reported their attitudes and feelings regarding their experiences at home and at school, these results represent an impressive level of personal and social adjustment when compared with previous literature on adjustment problems in deaf children. The extent to which these results are associated with cochlear implantation has not been determined and awaits comparative data from children without implants.

Adaptation, Psychological↗

PubMed1992

Cochlear implants in the management of bilateral acoustic neuromas.

Multichannel cochlear implants currently provide the only modality for successful auditory rehabilitation of patients with bilateral profound sensorineural hearing loss who derive no benefit from amplification. We have developed a protocol for patients with neurofibromatosis and bilateral acoustic neuromas in which every effort is made to preserve hearing in at least one ear. Failing that, the cochlear nerve is spared, potentially allowing for the insertion of a cochlear implant. We present our data on one such patient whose auditory function was restored with a Nucleus mini 22-channel cochlear implant following removal of his acoustic neuroma.

Adult↗

PubMed1998

Surgical outcomes of paediatric cochlear implantation: the Hospital for Sick Children's experience.

OBJECTIVE: Cochlear implantation in children represents a special challenge for the otologist because of such factors as skull dimensions and postimplantation temporal bone growth. As implant programs accrue increasing numbers of children, surgical factors relating to outcomes can be analyzed. METHOD: A retrospective study was performed of all children receiving a cochlear implant from January 1990 through May 1997 at The Hospital for Sick Children (HSC). The surgical procedure as well as the complications encountered were examined. Fifty two children, 28 females (54%) and 24 males (46%) were implanted. RESULTS: Overall, the average age at time of implantation was 7.0 years (range, 1.9-17.3 yr). The presumed cause of deafness was acquired in five children (10%) and congenital in the remaining 47 patients (90%). A recognized syndrome was associated with the hearing loss in only three patients. There were two minor complications (3.8%) and two major complications (3.8%) with an overall complication rate of 7.6%. There were no episodes of device or electrode migration. Two surgical innovations are also discussed: 1) a new periosteal flap design which decreases device mobility, and 2) a new technique for electrode fixation (NED's knot). CONCLUSION: The HSC experience represents the largest paediatric cochlear implant series in Canada. The findings indicate that the procedure is safe and is associated with infrequent morbidity.

Adolescent↗

PubMed1994

Advantages of disadvantages expected and reported by cochlear implant patients.

An open-ended questionnaire was administered to 20 patients using the Nucleus multichannel cochlear implant and 21 patients using the Ineraid multichannel cochlear implant. Before surgery, they were asked to list the advantages and disadvantages that they expected from their cochlear implant. Advantages were expected in the categories of: (1) speech perception when speechreading can be used (65%); (2) environmental sound perception (58%); (3) psychological effects (14%); (4) speech perception when speechreading cannot be used (49%); (5) lifestyle and social effects (42%); and (6) speech production (5%). Disadvantages were expected in: (1) equipment malfunction (42%); (2) environmental sound perception (28%); (3) speech perception when speechreading can be used (7%); (4) psychological effects (24%); (5) speech perception when speechreading is not used (7%); and (6) lifestyle and social effects (7%). Concerns were also raised about the risk of surgery (9%). After several months (4-60 mo) of using their implant, patients were asked to list the advantages and disadvantages that they actually experienced. Advantages were reported in the categories of: (1) speech perception when speechreading can be used (86%); (2) environmental sound perception (79%); (3) psychological effects (49%); (4) speech perception when speechreading cannot be used (56%); (5) lifestyle and social effects (40%); (6) speech production (14%); and (7) the reduction of tinnitus (7%). Disadvantages were reported in: (1) equipment malfunction (54%); (2) environmental sound perception (53%); (3) speech perception when speechreading can be used (26%); (4) psychological effects (12%); (5) speech perception when speechreading is not used (21%); and (6) lifestyle and social effects (9%). Concerns were also noted about the cost of surgery (14%). Thirty patients had tinnitus preoperatively. Without hearing sound through the implant, 70 percent of these indicated that the cochlear implant had a positive effect on their tinnitus. When listening to speech through the implant, 83 percent reported that their tinnitus was reduced.

Adult↗

PubMed1999

[Extended indications for cochlear implantation. The Freiburg results in patients with residual hearing].

The usual indication for a cochlear implant (CI) is acquired deafness in patients for whom conventional hearing aids are of no benefit. The question is whether CI is superior to the best conventional hearing aids for patients with some residual hearing, but who achieve only minimal speech recognition (< 30% in the Freiburg monosyllable word test at 70 dB (I) SPL) with optimal hearing aids. We report our experience with five patients with residual hearing who underwent cochlear implantation (Nucleus Mini 22 and 24) on the worse side. The patients were examined preoperatively and at 1, 6 and 12 months following activation of the implant. The Freiburg monosyllabic word test, the Göttingen sentence test and consonant recognition were used to assess postoperative results. All patients benefitted from CI when test scores were compared with preoperative ones. All patients achieved a score in the Freiburg monosyllabic word test of more than 60% at 70 dB (I) SPL 12 months post switch-on. Four patients achieved a score of more than 85% in the Göttingen sentence test. These results and the progress made in cochlear implant technology are an impetus to continue discussions of various considerations of criteria for cochlear implants and possibly extend these for patients with severe hearing impairment.

Adult↗