[Bilateral insertion of cochlear implants].
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Cochlear Implantation↗
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[Cochlear implants].
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Cochlear Implantation↗
Long-term effects of cochlear implants in children.
OBJECTIVE: Since 1987, when the use of multichannel cochlear implants was initiated in children, candidacy has expanded; many thousands of children have received these devices, and results have revealed a wide range of performance. However, few long-term studies exist on a large population of these children. There have been concerns expressed that cochlear implant function might degrade over time, that devices and electrodes might migrate and extrude in the growing child, or that there might even be a deleterious effect of long-term stimulation of the cochlear nerve. The purpose of this study was to explore the long-term effects of implantation as a function of performance over time, reimplantation, and educational factors. STUDY DESIGN AND SETTING: We studied 81 children who received implants at a major academic medical center and were followed for 5 to 13 years. RESULTS: Results revealed significant gains in speech perception, use of oral language, and ability to function in a mainstream environment. There was no decrease in performance over time and no significant incidence of device or electrode migration or extrusion, and device failure did not cause a deterioration in long-term outcome. CONCLUSIONS: Multichannel cochlear implants in children provide perception, linguistic, and educational advantages, which are not adversely affected by long-term electrical stimulation.
Adolescent↗
[Research advance of implementing schemes of cochlear implant and its speech processing algorithms].
This paper introduces the implementing schemes of cochlear implants, signal processing strategies and current state-of-the-art implant processors. The paper mainly discusses the key questions which would come up in designing cochlear implant system. Eventually we express our opinions about the development and further research of cochlear implants.
Algorithms↗
Some aspects of language development in normal-hearing children and children with cochlear implants.
OBJECTIVE: This article presents some important processes of normal child language acquisition and applies them to language acquisition data of children with cochlear implants. DATA SOURCES: Modern studies of language acquisition, covering various languages, have demonstrated a close link between linguistic and cognitive development. Sensorimotor intelligence provides a construction of reality on which the first grammatical structures are built, encoding a number of relations which hold between objects, persons, events, and localizations. When acquiring the more complex morphological and syntactic aspects of their mother-tongue, children use a number of characteristic information processing strategies which make some formal markings easier to learn than others. There is considerable variability across children with respect to rate of acquisition, the use of imitation, and analytic versus holistic processing strategies. Caregivers' language input can facilitate language acquisition, notably the use of expansions and reformulations, and a generally accepting style. EMPIRICAL STUDY OF CHILDREN WITH COCHLEAR IMPLANTS: Language acquisition data from two children with cochlear implants show great differences with respect to rate of acquisition, construction of the German case system, and syntax. Whereas one child discovers the regularities of the case inflectional system quickly, the other child appears to prefer holistic and rote learning processes and uses a sequential strategy for combining words. It is suggested that variability between children with cochlear implants may be due to different frequencies of actually processed linguistic items. CONCLUSIONS: Future research should compare language development in children with cochlear implants and those with normal hearing making use of psycholinguistic methods of research design and analysis.
Child↗
Approach to communication, speech perception and intelligibility after paediatric cochlear implantation.
The aim of this study was to explore the relationship between approach to communication, speech perception and speech intelligibility after cochlear implantation of young children with profound early deafness. A prospective speech perception and speech intelligibility assessment was undertaken on a consecutive group of implanted children. There were 46 children at the three-year, 26 at the four-year and 20 at the five-year intervals. All had been born deaf or deafened before the age of three and received cochlear implants before the age of seven. Their speech perception ability and the intelligibility of their speech were measured before cochlear implantation and annually thereafter. The children's communication had been classified by their teachers of the deaf at each interval into one of two categories: those using an oral approach and those using a signing approach. Results revealed that at all intervals, those children classified as using oral communication significantly exceeded those using signed communication on measures of speech perception and intelligibility (p<0.05). When those children who had changed from signed to oral communication were compared at the three-year interval with those who used oral communication throughout, there was no significant difference in their results. However, it remains to be explored whether children use oral communication after cochlear implantation because they are doing well, or whether they do well because they are using oral communication.
Child↗
Multichannel cochlear implantation with percutaneous pedestal.
In a prospective study by Cohen et al, the superiority of multichannel cochlear implant patient performance over single-channel cochlear implant performance was demonstrated. The Ineraid system described in this paper includes a percutaneous pedestal which has had a satisfactory patient experience. Only one pedestal removal has been necessary because of specific pedestal problems. Other less serious pedestal problems decrease in frequency with increasing time post-implantation. The auditory performance indicates significant communication skills improvement in patients with multichannel cochlear implants.
Cochlear Implants↗
Multielectrode cochlear implantation in children: the Quebec experience.
The Quebec Cochlear Implant Research Program has implanted three children since August 1987. This paper reports the results obtained with these children. All of them improved their auditory abilities with cochlear implantation and training. However, the abilities which spontaneously recovered following implantation, the speed of improvement, and the overall level of performance are different from one child to the other. Our data suggest that the age at onset of hearing loss, and possibly the number of years of deafness, may be related to the differences in performance.
Age Factors↗
Use of botulinum toxin to prevent facial nerve stimulation following cochlear implantation.
Facial nerve stimulation can develop because of the electric fields generated from an activated cochlear implant. This problem can usually be ameliorated by reducing or eliminating the current through the electrodes causing the undesirable stimulation. Occasionally there may be numerous electrodes that have to be deactivated in order to eliminate the facial nerve stimulation, and this may result in a marked reduction of auditory benefit to the cochlear implant user. Botulinum toxin causes transient neuromuscular blockade and has been shown to be effective in reducing or eliminating facial nerve hyperactivity due to a variety of causes. This report details the use of botulinum toxin in a patient with a cochlear implant who developed excessive facial nerve stimulation that necessitated the deactivation of 15 of the implant's 22 electrodes. After treatment with botulinum toxin, twice as many electrodes could be comfortably activated without causing facial nerve stimulation. The dynamic range was increased in 4 of the remaining 6 electrodes that were activated prior to treatment. The patient reported a marked improvement in sound quality and understanding of speech without lipreading as compared to her pretreatment performance. Treatment with botulinum toxin appears to be useful for patients who have excessive facial nerve stimulation after cochlear implantation.
Botulinum Toxins↗
[Cochlear implant in patients with congenital malformation of inner ear].
OBJECTIVE: To study surgical difficulty and key of the cochlear implant in patients with congenital malformation of inner ear. METHODS: The cochlear implantations were performed in our department from Jan. 2001 to Apr. 2003 for 18 patients with the malformation of inner ear. RESULTS: In this series, there were 11 cases of large vestibular aqueduct syndrome (LVAS), 3 cases of Waardenberg syndrome, 3 cases of Mondini malformation, and 1 case of Usher syndrome. All 18 patients accepted the Nucleus 24-channel cochlear implantations, including Nucleus straight electrode in 13 cases but Contour implantation in 5 cases of LVAS. During operations, leakage of perilymph but not cerebrospinal fluid (CSF) from the open of scala tympani occurred in 11 cases of LVAS, however, the electrode was inserted successfully. The abnormalities of round window occurred in one of 3 cases of Waardenberg syndrome and 3 cases of Mondini malformation, respectively. CONCLUSION: The cochlear implant could be conducted successfully for the LVAS, and the postoperative effect was same as the ones for the deafness persons with normal development of inner ear. However, for the patients with Mondini syndrome and common cavity, it is important to accurately assess the extent of abnormalities in the inner ear and accompanied malformation before operation, and to evaluate the full extent of difficulties of the operation in order to minimize the risk of CSF leakage and meningitis.
Adolescent↗
Audiological results in children with a cochlear implant.
Audiological data collected through June 1984 were analyzed for 126 children with the cochlear implant. Preimplant hearing aid results were compared to cochlear implant results at 6-month follow-up test intervals. Auditory thresholds to warble tones and speech stimuli, and auditory discrimination test scores were significantly better with the cochlear implant at all test intervals than preoperatively with a hearing aid. Electrical measurements were also monitored. Mean thresholds remained consistent over time. Electrical comfort levels increased slightly over time, indicating a widening of the electrical dynamic range. Results have been extremely encouraging. Some trends are beginning to develop, but more long-term data are needed to define the potential benefit of the implant in children.
Adolescent↗
Implications of developmental plasticity for the language acquisition of deaf children with cochlear implants.
The study of language acquisition in profoundly deaf children with cochlear implants informs us about the developmental plasticity of the auditory system. Sensory activity leads to neural development, and the sustained effects of sensory inactivity can lead to a loss of responsiveness. These effects may be reversed by the subsequent provision of sensory stimulation, such as that delivered by cochlear implants. Behavioral and electrophysiological research on the effects of speech deprivation on language acquisition shows that the age and modality of language acquisition is an important determinant of adult linguistic performance. Studies on profoundly deaf children deprived of speech stimulation, and then provided with a cochlear implant giving them access to the speech frequencies, shows that congenitally deaf children implanted under the age of around 5 years are likely to perform better on speech perception and speech production tasks than children implanted at an older age. Further investigation is required to understand why these large individual differences exist. In addition, other key issues for research are the effects of compensatory visual and somatosensory development prior to implantation, whether there is a maturational delay that approximates to the period of speech deprivation prior to implantation, and whether there are a number of sensitive periods that together describe the cascade of processes that underlies language acquisition.
Adult↗
Nucleus multichannel cochlear implantation in partially ossified cochleas using the Steenerson procedure.
OBJECTIVE: The purpose of this study was to report hearing results obtained in a group of subjects who received scala vestibuli implantation because of cochlear ossification and to compare these results to those in patients with scala tympani implantation. STUDY DESIGN: Retrospective analysis of consecutive cochlear implant procedures. SETTING: Department of Otolaryngology, University of Parma. PATIENTS: Five postlingually deafened adults with an electrode array placed into the scala vestibuli were compared with the speech performance of matched controls who had the electrode array inserted into the scala tympani. MAIN OUTCOME MEASURES: Measures included vowel and consonant speech identification scores, bisyllabic word and sentence speech recognition scores, and common phrases comprehension scores. RESULTS: No significant difference was detected on speech performances between the subjects with scala vestibuli implantation and the control group. CONCLUSION: Scala vestibuli implantation appears to be an excellent alternative in cases in which scala tympani is found to be not patent.
Adult↗
Cochlear implantation in children: implications for the primary care provider.
PURPOSE: To define hearing loss (HL), discuss the impact of HL on child development, and review the literature on cochlear implantation in children. The criteria for and the benefits and limitations of cochlear implantation in children, as well as the implications for the primary care provider with regard to children who have cochlear implants, are presented. DATA SOURCES: Review of published literature on the topic. CONCLUSIONS: A child's future development depends greatly on speech and language skills. Any type of HL can impact and may even hinder speech and language acquisition. It is therefore crucial to enforce early identification of HL. For severe to profoundly hearing-impaired children, cochlear implantation serves as an avenue for hearing and language development. IMPLICATIONS FOR PRACTICE: Nurse practitioners ought to be up to date with criteria for and the benefits and risks of cochlear implantation. Health-related issues, such as vaccination, otitis media, and meningitis, must be assessed for and managed promptly.
Age Factors↗
Early speech changes in children with multichannel cochlear implants.
A number of studies have demonstrated that cochlear implants provide an improved auditory signal and enhance the development of speech-perception and production skills for profoundly deaf children. However, exactly when these early speech skills begin to develop remains unclear. To explore this issue, we observed, for a 1-year period, four prelingually deaf children who underwent implantation consecutively within 1 month of each other, and we paid particular attention to the first few months of rehabilitation. We found immediate speech scores as early as the first day of implant tune-up. Speech production continued to improve rapidly throughout the first 4 months but exhibited a generally slower rate of progress in some of the speech-production skills at 1 year. We also found vowel-production skills to be the easiest to achieve, with word-pattern recognition and consonant voicing of intermediate difficulty. Consonant placing and manner of consonant production were the hardest skills to achieve. Results of speech-perception tests 1 year after implantation were markedly improved over preimplantation levels in three of the four children. These early speech changes stress the need for maximization of the capability of the cochlear implant by institution of immediate and intensive speech rehabilitation efforts for prelingually deaf children.
Child↗
Chronic middle ear disease and cochlear implantation.
We have presented three patients with bilateral CSOM who were otherwise suitable for cochlear implantation. These patients had conventional surgical management of CSOM and were implanted after a period of 6 months through apparently healthy middle ears. However, all three had a recurrence of middle ear disease requiring further surgery, and one had a potentially life-threatening complication necessitating removal of the implant. Before considering cochlear implantation in patients with bilateral CSOM, it is essential to eradicate all disease, and radical mastoidectomy with obliteration may be necessary. The use of a cochlear sealing device may further ensure prevention of infection spreading into the cochlea.
Aged↗
Electrosurgery after cochlear implantation: eighth nerve electrophysiology.
HYPOTHESIS: Monopolar electrosurgery below the neck in cochlear implant recipients can be performed without damage to the internal cochlear stimulator, electrode array, and the cochlear nerve. STUDY DESIGN: Prospective pre- and postintervention electrically evoked compound action potential (ECAP) study of cochlear nerve function and behavioral sound perception assessment. METHODS: Neural response telemetry (NRT) was used to measure ECAPs before and after the use of monopolar electrosurgery during coronary artery bypass surgery to assess prosthetic device function and electrophysiologic function of the cochlear nerve. In addition, electrode voltage impedances and behavioral sound perception was measured at the same time intervals. RESULTS: ECAPs, behavioral sound perception, and electrode voltage impedances were within the normal range, within compliance, and similar preoperatively and on postoperative day 6. CONCLUSION: The studies reported herein were a series of measurements designed to test neural integrity and prosthetic device function before and after the use of monopolar electrosurgery. With appropriate precautions, use of monopolar electrosurgery below the neck in cochlear implant recipients can be performed safely.
Blood Loss, Surgical↗
Current status of cochlear implants in Latin America.
In recent years there has been sufficient clinical evidence gathered to show that cochlear implants can benefit a large number of postlingually and prelingually profoundly deaf patients who could not be helped with conventional hearing aids. The number of implanted patients is increasing rapidly around the world in spite of the diverse difficulties in diagnostic, surgical, and rehabilitation procedures involved in this new technology and the controversy among some otologists. Cochlear implant programs started in Latin America more than 10 years ago, and lately the number of cochlear implant teams and implanted patients have increased rapidly. It is the aim of this report to present the results of a recently completed survey regarding the current status of cochlear implant surgery and rehabilitation in Latin America.
Adult↗