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PubMed2004

Telephone use and understanding in patients with cochlear implants.

We conducted a mail survey ofpatients who had received cochlear implants to ascertain their ability to communicate on the telephone. Of 86 patients who responded, 38 (44%) did not use the telephone at all, 36 (42%) were able to use the telephone without assistance (independent users), and 12 (14%) were able to use the telephone with some type of assistance. Factors associated with independent use were male sex, older age at the onset of hearing loss, longer duration of hearing loss, successful use of hearing aids prior to cochlear implantation, implantation with a MED-EL Combi 40+ device, and a shorter duration of implant use. But regardless of circumstances, our findings suggest that many cochlear implant patients can use the telephone during daily activity without the need for assistive devices or relay services.

Adolescent↗

PubMed2001

[The intraoperative application of neural response telemetry with the nucleus CI24M cochlear implant].

OBJECTIVE: To test device integrity and objective auditory reaction for cochlear implant patients intraoperatively. METHODS: Our protocol for intraoperative testing of the implant device includes device electrode impedance test and neural response telemetry (NRT), which measures the electrically evoked auditory nerve compound action potentials (ECAP). RESULTS: We completed electrode integrity tests and NRT intraoperatively on 40 patients with the Nucleus CI24M cochlear implant. We have measured normal implant function on all 40 patients and obtained ECAP results from 39 patients. Out of 33 patients with normal inner ear, typical ECAPs were recorded in 195 electrodes in all 198 testing electrodes(98.5%). In 7 patients with inner ear Mondini dysphasia, affirmative ECAP waveforms were recorded in 26 electrodes in all 42 testing electrodes. The basal electrode ECAP threshold was higher than that of the epical one. CONCLUSIONS: The intraoperative measurements of device function and NRT are quite simple, quick and with high accuracy. Inner ear malformation is an important factor that may affect NRT results.

Action Potentials↗

PubMed1997

Cochlear implants in children: what constitutes a complication?

The surgeon must ultimately accept the responsibility for any complications that occur as the result of a cochlear implant. Listening to the cochlear implant team members and responding to their needs may enhance the child's progress. Surgical complications, (i.e., skinflap problems, infection, and facial paralysis) are indeed infrequent, but nonsurgical problems are not. Surgical and nonsurgical experiences were reviewed in 55 children. Ages ranged from 23 months to 18 years at the time of cochlear implantation, which occurred from 1984 to 1995. There were no surgical complications. However, the most common surgical obstacle was ossification, which was present in 40% and undetected by computed tomographic scanning in 16.3% of children. Ossification occurred at the round window and scala tympani in 32.7% and involved the cochlea more extensively in 7.3% of children. In only one child was the cochlea entirely ossified. There were, however, many nonsurgical problems that were viewed as complications in patient management. The single most important complication was device failure. This occurred in 10.9% (5/46) of children with the Cochlear Corporation multichannel implant. Head banging and other temper tantrums, parental interference with rehabilitation, socioeconomic factors, poor compliance by the family unit, equipment problems, educational deficiencies, and impatience with habilitative training were some of the other problems.

Adolescent↗

PubMed1997

[Initial experiences with the Combi-40 cochlear implant. Surgical aspects].

The rehabilitation of profoundly deaf patients by means of cochlear implants has become a well established form of therapy. Recently, large scale studies have pointed out a variety of surgical complications. A multiplicity of new implant types are each placing more specific demands on the surgeons. Based on the experience with about 160 cochlear implantations in total, the most suitable surgical technique for the implantation of the Combi 40 cochlear implant which has been used in 41 cases is presented. An extended retroauricular incision is made and a caudally based flap is fashioned. The implant bed is drilled 0.5-1 cm behind and above the mastoid cavity. Between the implant bed and the mastoid cavity a groove for the electrodes is drilled cranial of the implant site in the right ear and caudal in the left ear. Access to the scala tympani is gained by a promontory cochleostomy via a posterior tympanotomy of 2x3 mm. Videocontrolled microendoscopes are used to inspect the scala tympani prior to electrode insertion. Electrode insertions depths of up to 30 mm are usually achieved. The electrode and the implant are secured with ionomer-based cement. The described technique has up to now been successfully performed in 30 adults and 11 children.

Adult↗

PubMed2000

Speech perception performance in prelingually deaf children with cochlear implants.

The goals of this study were to report on mean values of speech perception performance in prelingually deaf children implanted with a Combi 40/40 + cochlear implant. A total of 31 patients were included in the study. The time span ranged over 3 years, during which time the Evaluation of Auditory Responses to Speech (EARS) test battery was used with the children. The EARS battery contains four measures of closed-set speech perception and three open-set tests. The mean test results exhibited steady improvement on all parts of the EARS test battery, even up to 3 years post-implantation. The preoperative scores for the Listening Progress Profile (LiP) were 4%, rising to 93% at 36 months post-implantation. Results for the open-set testing measures were most encouraging, with some children reaching fairly high levels of speech perception, receiving scores as high as 100%, by the 36-month evaluation. The congenitally and prelingually deaf children in our study showed continuous improvement in both closed and open set speech perception following cochlear implantation, although variability in individual performance among the children was noted.

Adolescent↗

PubMed2002

Outcome of cochlear implantation in pediatric auditory neuropathy.

OBJECTIVE: Auditory neuropathy, characterized by absence or abnormality of auditory brainstem responses and normal otoacoustic emissions, is often associated with particularly poor response to amplification. Outcome data from four such pediatric patients who received cochlear implants are discussed. STUDY DESIGN: Four patients from the Carolina Children's Communicative Disorders Program were identified as having received a diagnosis of auditory neuropathy before implantation with a Clarion cochlear implant. Speech data collected after implantation were compared with data from control pediatric implant patients, matched for age at implantation and duration of implant use. Electrically evoked auditory brainstem response data and electrically evoked acoustic reflex data were also obtained. METHODS: Routine clinical procedures were used to obtain speech outcome data. A 75-micros biphasic 21.1-Hz pulse train served as the eliciting stimulus for both evoked auditory brainstem responses and reflex measures, which were obtained contralateral to the implant. RESULTS: Speech data were comparable with those obtained from the general population of pediatric patients receiving cochlear implants at this center. Identifiable evoked auditory brainstem response data were obtained in all subjects on at least two of the three electrodes tested, and variability was comparable with that observed in other children with implants. A robust electrically evoked acoustic reflex with no decay was observed at estimated M-level in all children. CONCLUSION: The data gathered to date suggest that the outcome of cochlear implantation in these four patients is not significantly different from that in other pediatric implant patients. Physiologic data suggest that the implant was able to overcome the desynchronization hypothesized to underlie auditory neuropathy.

Child, Preschool↗

PubMed2000

[Clinical utilization of magnetic resonance imaging for patients with cochlear implants].

To date, MR imaging is absolutely contraindicated in cochlear-implanted patients. The aim of this study is to document the potential value of MR imaging in such patients, without injurious or side effects and without technical device failure. After in vitro experimental testing, 25 cochlear implanted patients underwent MRI. Radiological evaluation was also possible. The use of 1-Tesla fast spin echo sequences minimised artifacts. All cochlear implants are still in working order; no changes in fitting data or a reduction in speech understanding were observed. MR helped to avoid other invasive medical procedures.

Austria↗

PubMed2005

[Cochlear implantation in patients with otitis media-related lesions].

OBJECTIVE: To present the experiences of cochlear implantation (CI) in patients with otitis media-related lesions. METHOD: Of the 9 patients with otitis media-related lesions studied for cochlear implantation, one was implanted cochlear in second-stage operation after mastoidectomy and received reconstruction of the posterior ear canal wall with cartilage with perichondrium; one with chronic otitis media (perforation) had CI and tympanoplasty with cartilage with perichondrium in one-stage operation; three with silent otitis media had CI and modified mastoidectomy in one-stage operation; three with mastoid dysplasia and middle ear adhesions had CI and tympanic exploration in one-stage operation; one with cholesteatoma localizedin attic had CI and atticotomy and reconstruction with cartilage with perichondrium. RESULT: All devices worked properly. There were no otitis media-related complications. CONCLUSION: Patients with chronic suppurative otitis media must have all disease eradicated and do the utmost to reserve anatomic landmark before CI. Patients with silent otitis media can have CI in one-stage operation, if the drainage of Eustachian tube, attic and antrum is satisfying. Patients with cholesteatoma localizedin attic can have CI in one-stage operation, but it is necessary to remove all lesions and reconstruct attic. The infection maybe an important cause of mastoid dysplasia and serious sensorineural deafness. Implanting electrode though the ear canal and promontony is a good method if the mastoid is sclerotic type and it is too difficult to implant though the facial recess. In order to avoid the retraction of drum and electrode dropping off, we can use cartilage with perichondrium to rebuild the drum, the posterior ear canal wall and the attic.

Adolescent↗

PubMed2001

Radical cavities and cochlear implantation.

Profoundly deaf patients with chronic suppurative otitis media have been contraindicated for cochlear implantation in the past. Complications such as infection of the radical cavity, fat necrosis, skin flap problems, change in electrode position and cholesteatoma have occurred in subjects with radical cavities. The aim is to create a dry, self-cleansing, infection-free cavity. This is essential in patients about to receive a cochlear implant, as infection may be introduced into the cochlea at the implantation site and destroy any remaining neural elements. The aim of this paper was to show that it is possible to obliterate the radical cavity and perform cochlear implantation using a one-step surgical technique. Eight patients suffering from long-term bilateral chronic middle ear diseases with chronic sepsis leading to severe hearing impairment underwent cochlear implant surgery. No major complications were observed in these subjects.

Adult↗

PubMed2004

Children with cochlear implants: changing parent and deaf community perspectives.

OBJECTIVE: To examine changing parent and deaf community perspectives related to pediatric cochlear implantation. DESIGN: This research is based primarily on 2 nonrandom study designs. In the first study, conducted by the Gallaudet University Research Institute, Washington, DC, in the spring of 1999, a 12-page questionnaire was distributed to 1841 parents of children with cochlear implants; 439 questionnaires were returned. In the second study, we conducted 56 interviews with parents of 62 children with implants (and 1 without). SUBJECTS: Parents of children with cochlear implants; Gallaudet University faculty, staff, students, and alumni. RESULTS: While parents frequently receive conflicting information about educational and communication options for their child, they generally support signing before and after implantation. The parents of a child with an implant have a great interest in their child's spoken language development, and most would like to have had their child receive an implant earlier. Children with implants are educated in a variety of educational settings. Mainstreamed children with implants often continue to require classroom support services, and children with implants are frequently not isolated from both deaf and hearing peers. Parents have mixed experiences when getting information from persons in the deaf community. COMMENT: Opposition to pediatric cochlear implantation within the deaf community is giving way to the perception that it is one of a continuum of possibilities for parents to consider. To ensure optimal use of the cochlear implant, parents need to remain involved in their child's social and educational development.

Adolescent↗

PubMed2006

Professional occupation after cochlear implantation.

The aims of this study were to verify whether cochlear implants helped profoundly deaf adults to maintain or even to develop their professional occupations, and to identify other elements that may contribute to or, on the contrary, impede such patients' professional success. All adult patients received a questionnaire concerning their professional activities before and after implantation. Demographic data, health information, hearing performance and degree of satisfaction with the implant were also considered. Sixty-seven adults had been implanted, with three different devices, since 1985. At the time of implantation, 34 had been professionally active. After implantation, 29 had remained professionally active, four of whom reported positive developments in their careers. Five patients had become professionally inactive. Those patients who had previously been professionally inactive remained so. There had been no difference in performance, either between different types of cochlear implants or between professionally active or inactive patients. The implanted patients had kept their jobs and many of them had developed their professional skills. In spite of this, cochlear implants may still be perceived as proving insufficiently satisfactory hearing to enable professionally inactive patients to reintegrate and to facilitate further learning or career developments.

Adolescent↗

PubMedDate not supplied

[Evaluation of hearing performance in cochlear implant patients].

OBJECTIVES: To determine the speech perception levels of cochlear implant patients and to evaluate the possible effects of implant type, duration of deafness, and bacterial meningitis on the patients' hearing performance. PATIENTS AND METHODS: A three-section test battery on speech perception was administered to 21 cochlear implant patients (12 males, 9 females; mean age 25 years; range 9 to 40 years). The patients' performance was assessed with respect to single- or multi-channel implant design, duration of hearing loss, and etiologic factors of hearing loss. RESULTS: The overall mean success score was 74.6 (range 49-100). No significant difference was found between patients using single- or multi-channel implants. The mean score of 12 patients whose duration of hearing loss was below the average (8.2 years) was significantly higher than those of nine patients with a longer history of hearing loss (85.7 versus 59.6, p=0.001). Patients with meningitis-associated hearing loss exhibited a significantly lower performance than those presenting with other etiologic factors (61.9 versus 84.1, p=0.001). CONCLUSION: Early diagnosis and rehabilitation are essential to achieve better performance following cochlear implantation.

Adolescent↗

PubMed2003

Variables affecting speech perception in postlingually deaf adults following cochlear implantation.

OBJECTIVE: To evaluate the time span over which there is greatest improvement in postlingually deaf adults undergoing cochlear implantation. Additionally, to quantify potential patient and device factors that may predict the postoperative results. MATERIAL AND METHODS: A longitudinal study was conducted. Numbers, monosyllables and sentence test results were collected for 66 cochlear implant subjects [Combi 40/40 +, n = 60; Clarion HF2, n = 2; Nucleus 24m/k, n = 4] at regular intervals for up to 6 years following cochlear implantation. RESULTS: All patients showed a steady improvement over time on all tests. Progress during the first 12 months was statistically significant, with further improvements being recorded after the 12-month testing period. The duration of deafness and the number of electrodes (8 for the Combi 40, 12 for the Combi 40 + ) appeared to be weakly correlated with postoperative performance. Re-implantation after device failure had no negative effect on speech reception. Subjects who were "upgraded" from an analogue to a digital cochlear implant improved their test results almost twofold. CONCLUSION: All the patients in our study gained substantial benefit from their cochlear implants. It is encouraging to note that the factors examined were not deemed to be relevant predictors of performance. Even long-term deaf subjects and re-implantees are able to achieve an excellent level of speech perception.

Cochlear Implantation↗

PubMedDate not supplied

Contralateral masking in cochlear implant users with residual hearing in the non-implanted ear.

Contralateral masking was investigated in cochlear implant users with residual hearing in the non-implanted ear. Threshold elevations for acoustic probes were observed when electrical maskers were presented in the opposite ear. Also, threshold elevations for electrical probes were observed when acoustic contralateral maskers were presented. The amount of threshold shift expressed in decibels charge or decibels sound pressure level produced by either contralateral acoustic or electric maskers was within the range found in normal listeners for similar stimuli (i.e. 4-8 dB). There was a correlation between the sensation level of acoustic maskers and the maximum amount of masking observed which is consistent with data for normally hearing subjects. The width of the masking patterns was similar to that expected from forward masking patterns in severely sensorineurally impaired ears and implanted ears. The maximum amount of acoustic masking tended to occur for electrode positions that were more basal than expected from characteristic frequency positions. However, where a relatively high-frequency 4-kHz masker could be used, there was a good match between the characteristic frequency position of the maximum threshold elevation and that of the masker.

Adult↗

PubMed1996

Advantages and disadvantages expected and realized by pediatric cochlear implant recipients as reported by their parents.

Studies documenting subjective changes in quality of life of pediatric cochlear implant recipients are limited. In this study, parents of cochlear implant recipients completed a questionnaire requesting them to list advantages and disadvantages associated with their children's cochlear implant use. Preimplantation, benefits expected by parents included awareness of environmental sounds (89% of parents), improved speech perception (50%), and improved speech production (36%). Disadvantages expected included equipment maintenance and repair (21% of parents), slow progression of auditory and speech skills (21%), and resistance to wearing the device (18%). One year postimplantation, benefits reported by parents included environmental sound perception (76% of parents), speech perception (64%), and speech production (52%). Two years postimplantation, benefits reported by parents included perception of environmental sounds (76% of parents), speech perception (67%), and speech production (57%). Three years postimplantation, benefits reported included perception of environmental sounds (61% of parents), speech perception (78%), and speech production (74%). Postimplantation, 36%, 24%, and 52% of the parents had no disadvantages to report at the 1, 2, and 3-year intervals, respectively. At all postimplant intervals, disadvantages associated with the size and maintenance of equipment were listed most frequently (36%, 48%, and 22% of parents, respectively). Open-ended questionnaires may be useful when evaluating a child before or after cochlear implantation.

Adolescent↗

PubMedDate not supplied

Creating the evidence: lessons from cochlear implants.

This paper compares the evidence-based outcomes between cochlear implants and hearing aids during the past several decades. Despite many similarities, there are also some important differences that define the progress for the two disciplines. Perhaps the most significant distinction exists in terms of the difference between the Food and Drug Administration's treatment of hearing aids as Class I medical devices, while cochlear implants are defined as Class III devices. Another point of divergence has been the number of publications in archival, peer-reviewed journals; implant papers have been steadily increasing during the past decade, while hearing aid papers have declined during the same period. The impact of these differences on the past, present, and future of hearing aid and cochlear implant research, technology, and clinical practice is discussed.

Cochlear Implants↗

PubMed2003

A phone-assistive device based on Bluetooth technology for cochlear implant users.

Hearing-impaired people, and particularly hearing-aid and cochlear-implant users, often have difficulty communicating over the telephone. The intelligibility of telephone speech is considerably lower than the intelligibility of face-to-face speech. This is partly because of lack of visual cues, limited telephone bandwidth, and background noise. In addition, cellphones may cause interference with the hearing aid or cochlear implant. To address these problems that hearing-impaired people experience with telephones, this paper proposes a wireless phone adapter that can be used to route the audio signal directly to the hearing aid or cochlear implant processor. This adapter is based on Bluetooth technology. The favorable features of this new wireless technology make the adapter superior to traditional assistive listening devices. A hardware prototype was built and software programs were written to implement the headset profile in the Bluetooth specification. Three cochlear implant users were tested with the proposed phone-adapter and reported good speech quality.

Cochlear Implants↗

PubMed2002

Neurophysiology of cochlear implant users II: comparison among speech perception, dynamic range, and physiological measures.

OBJECTIVE: The overall objective of this study was to relate electrically evoked potentials recorded from different levels of the auditory pathway with behavioral measures obtained from adult cochlear implant subjects. The hypothesis was that adult recipients of cochlear implants who have open-set speech perception and those recipients with no open-set speech perception would differ in their neurophysiologic responses recorded at one or more levels of the auditory pathway. DESIGN: The subjects were 11 adults implanted with the Clarion cochlear implant. The electrical auditory brainstem response (EABR, Wave V), electrical auditory middle latency response (EAMLR, Na-Pa complex), and the electrical late auditory response (ELAR, N1-P2 complex), were recorded from three intra-cochlear electrodes. The stimuli used to record the evoked potentials varied in rate and amplitude. Behavioral measures (between threshold and upper limit of comfortable loudness) were used to define the subject's dynamic range at the different stimulus rates. Word and sentence recognition tests evaluated subjects' speech perception in quiet and noise. Evoked potential and behavioral measures were examined for statistical significance using analysis of variance for repeated measures and correlational analyses. RESULTS: Subjects without open-set speech recognition demonstrated 1) poorly formed or absent evoked potential responses, 2) reduced behavioral dynamic ranges, 3) lack of change in the size of the dynamic range with a change in stimulus rate, and 4) longer periods of auditory deprivation. The variables that differentiated the best performers included 1) presence of responses at all three levels of the auditory pathway, with large normalized amplitudes for the EAMLR, 2) lower evoked potential thresholds for the Na-Pa complex, 3) relatively large dynamic ranges, and 4) changes in the size of the dynamic range with changes in stimulus rate. CONCLUSIONS: In this study, the inability to follow changes in the temporal characteristics of the stimulus was associated with poor speech perception performance. Results also illustrate that variability in speech perception scores of cochlear implant recipients relates to neurophysiologic responses at higher cortical levels of the auditory pathway. Presumably, limited neural synchrony for elicitation of electrophysiologic responses underlies limited speech perception. Results confirm that neural encoding with electrical stimulation must provide sufficient physiologic responses of the central nervous system to perceive speech through a cochlear implant.

Adult↗