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PubMed2000

[Cochlear implantation in adults. Results and significance for communication and quality of life].

The aim of this study was to assess the benefits and complications from cochlear implantation and to evaluate the average implant usage per day. Ten profoundly deaf adults were implanted during the period April 1994 to September 1997. The patients answered questionnaires one year or more after receiving their cochlear implants. The average implant usage per day was 16 hours. The patients would again opt for a cochlear implant and would recommend a cochlear implant for a deaf friend. A paired comparison showed that the implants led to statistically significant improvement in a number of factors; self perceived communication skills, frequency of conversation with others, telephone usage, self-confidence, and the hearing impairment's impact on family life. No serious surgical complications were found.

Adult↗

PubMed2004

Examining multiple sources of influence on the reading comprehension skills of children who use cochlear implants.

Children with profound deafness are at risk for serious reading difficulties. Multiple factors affect their development of reading skills, including use of cochlear implants. Further, multiple factors influence the overall success that children experience with their cochlear implants. These factors include the age at which they receive an implant, method of communication, vocabulary skills, preoperative residual hearing, and socioeconomic status. Ninety-one children with prelingual and profound hearing impairments who received cochlear implants at varying ages participated in the study. Structural equation modeling confirmed that multiple factors affected young cochlear implant users' reading comprehension skills and that there were significant associations between the predictors of reading comprehension. Pre-implant vocabulary had an indirect positive effect on reading through postimplant vocabulary, which had a direct positive effect on reading. Overall, children with stronger language skills demonstrated stronger reading outcomes. Age at implantation both directly and indirectly, through postimplant vocabulary, affected reading outcomes, and the total effect was large. Children who were younger when they received their implants tended to have higher reading comprehension scores. Socioeconomic status negatively affected reading. Children who used total communication prior to implantation tended to have stronger pre-implant vocabulary scores, but the total effect of pre-implant communication method on children's reading skills was negligible. Research and educational implications are discussed.

Chi-Square Distribution↗

PubMed1989

Cochlear implant revision: effects of reimplantation on the cochlea.

The removal of an indwelling cochlear implant electrode followed by reinsertion of a new device has been a maneuver of uncertain consequences to the cochlea and its surviving neural population. The present study was conducted in an attempt to elucidate the factors that determine whether a reimplantation procedure will be successful. Cochlear implantation followed by explantation and subsequent reimplantation was performed in eight adult cats. Evaluation of cochlear histopathology suggested a significant increase in electrode insertion trauma when there was proliferation of granulation tissue in the round window area and scala tympani. In other cases, atraumatic reinsertion was achieved without apparent injury to the cochlea. The results of a survey of cochlear implant manufacturers and surgeons indicate that electrode replacement can usually be accomplished without adverse effects. Difficulties have been encountered, however, in removing implants with protuberant electrodes and when reimplantation was attempted on a delayed basis following explantation.

Acute Disease↗

PubMed2005

The effect of auditory experience on speech perception, localization, and functional performance of children who use a cochlear implant and a hearing aid in opposite ears.

This study was aimed at determining the effect of auditory experience on binaural benefits from using a cochlear implant and a hearing aid in opposite ears. Eighteen children were evaluated using tests of speech perception, horizontal localization, and functional performance when they used either a cochlear implant alone (CI) or a cochlear implant with a hearing aid (CIHA). Eight were experienced CIHA users, whereas ten had not worn a hearing aid in the non-implanted ear for up to eight years prior to participation. All children were fitted with a hearing aid in the non-implanted ear using the NAL-RP prescription, and the hearing aids were fine-tuned individually using a paired-comparisons procedure and a loudness balancing test. Evaluation results indicated that performance for all measures was significantly better with CIHA than with CI for both groups of children. We conclude that children who receive a unilateral cochlear implant should be encouraged to wear a hearing aid in the opposite ear where there is usable residual hearing.

Acoustic Stimulation↗

PubMed2004

[Image examination of postoperative evaluation for the cochlear implanted electrode].

OBJECTIVE: To evaluate the image feature of the X-ray plain film, the spiral computed tomography (CT) scans and three dimension reconstruction of inner ear with implanted electrode. METHODS: Eighteen patients of cochlear implant (MEDEL Combi 40+) recipients were involved in this study. The implanted electrode of all patients were examined on the fifth to seventh postoperative day, by the use of X-ray plain film with either anteroposterior transorbital projection (nine cases) or lateral position with coronal 60 degrees away from the examine table (nine cases). Three of the cochlear implant recipients were examined by the way of spiral CT scans with axial 1 mm image slices. The data of the CT scans was transferred to workstation for three-dimensioned reconstruction (direct volume rendering) of the inner ear. RESULTS: The X-ray plain film from both of anteroposterior projection and lateral with coronal 60 degrees projection provide satisfactory image of implanted electrode including the shape and the position in the temporal bone. The insertion depth of the electrode can be evaluated indirectly. In contrast, the images from CT scans with 3D reconstruction of the inner ear demonstrate more accurately the shape, the position, and the insertion depth of the electrode. Moreover, each of the electrode pairs can be identified clearly. CONCLUSIONS: X-ray plain film can meet the routine needs of postoperative evaluation of the implanted electrode with several kinds of head position of projection. But CT scans with 3D reconstruction of inner ear provide more accurate image of the spacial relationship of the electrode in the cochlear canal with direct demonstration of electrode insertion depth in the cochlea.

Adolescent↗

PubMed1989

[Prognostic indications within the scope of the selection of cochlear implant patients].

The common selection criteria for cochlear implant patients do not allow any prognostic indication on the final result. On the other hand, some postoperative data (threshold, TDL, dynamic range, duration of deafness) corresponds clearly with the results, some of them also correspond with the preoperative data. Preoperative TDL, dynamic range as well as duration of deafness can therefore be used as suitable prognostic indicators.

Auditory Threshold↗

PubMed2005

[Analysis of factors effecting satisfaction of cochlear implants in prelingually deafened adolescents].

OBJECTIVE: By means of investigating how the benefit and the influence factors are for the pre-lingual deaf adolescents who received cochlear implantation (CI) METHODS: A questionnaire survey was conducted among 30 prelingually deaf adolescents-cochlear implant recipients, aged 9 approximately 20, 15 of which began to use hearing aid before the age of 6, and 19 of which had received speech testing after the CI, and their families to understand the degree of satisfaction, anticipation of the outcome. Nine of the 15 patients who began to use hearing aid before the age of 6 communicated by the oral communication/labial reading model (oral group), and 10 of the other 15 patients who had not used hearing aid after the age of 6 mainly communicated by sign language (sign group). RESULTS: The satisfaction score of the group with a hearing aid fitting history was 3.93 +/- 0.88, significantly higher than that of the group without a hearing aid fitting history (3.00 +/- 1.13, P < 0.05). The scores of speech production ability in vowel, consonant, single syllable, disyllable, trisyllable, and short sentence in the groups with and without a hearing aid fitting history were 76%/52%, 64%/45%, 71%/26%, 82%/96%, 68%/12%, and 49%/13% respectively (all P < 0.05), and there was no significant difference in the speech production ability in tone (P > 0.05) between these 2 groups. There were no significant differences in the total satisfaction degree, satisfaction degree in speech sound, and satisfaction degree in environmental sound between the oral group and sign group (all P > 0.05). The scores in vowel, consonant, single syllable, disyllable, trisyllable, short sentence, and tone of the oral and sign group were 74%, 60%, 64%, 61%, 57%, 43%, 27% and 43%, 39%, 26%, 26%, 20%, 6%, 5% respectively (all P > 0.01). The anticipation of the patient and the parents about outcome before implantation was negatively correlated with the satisfaction degree after implantation, (gamma = -0.479, P < 0.05). CONCLUSION: Cochlear implantation benefits greatly the deaf adolescent; however, it is necessary to establish a specific evaluation system according to recipients' needs.

Adolescent↗

PubMed2002

Sound-direction identification, interaural time delay discrimination, and speech intelligibility advantages in noise for a bilateral cochlear implant user.

OBJECTIVES: To characterize some of the benefits available from using two cochlear implants compared with just one, sound-direction identification (ID) abilities, sensitivity to interaural time delays (ITDs) and speech intelligibility in noise were measured for a bilateral multi-channel cochlear implant user. METHODS: Sound-direction ID in the horizontal plane was tested with a bilateral cochlear implant user. The subject was tested both unilaterally and bilaterally using two independent behind-the-ear ESPRIT (Cochlear Ltd.) processors, as well as bilaterally using custom research processors. Pink noise bursts were presented using an 11-loudspeaker array spanning the subject's frontal 180 degrees arc in an anechoic room. After each burst, the subject was asked to identify which loudspeaker had produced the sound. No explicit training, and no feedback were given. Presentation levels were nominally at 70 dB SPL, except for a repeat experiment using the clinical devices where the presentation levels were reduced to 60 dB SPL to avoid activation of the devices' automatic gain control (AGC) circuits. Overall presentation levels were randomly varied by +/- 3 dB. For the research processor, a "low-update-rate" and a "high-update-rate" strategy were tested. Direct measurements of ITD just noticeable differences (JNDs) were made using a 3 AFC paradigm targeting 70% correct performance on the psychometric function. Stimuli included simple, low-rate electrical pulse trains as well as high-rate pulse trains modulated at 100 Hz. Speech data comparing monaural and binaural performance in noise were also collected with both low, and high update-rate strategies on the research processors. Open-set sentences were presented from directly in front of the subject and competing multi-talker babble noise was presented from the same loudspeaker, or from a loudspeaker placed 90 degrees to the left or right of the subject. RESULTS: For the sound-direction ID task, monaural performance using the clinical devices showed large mean absolute errors of 81 degrees and 73 degrees, with standard deviations (averaged across all 11 loud-speakers) of 10 degrees and 17 degrees, for left and right ears, respectively. Fore bilateral device use at a presentation level of 70 dB SPL, the mean error improved to about 16 degrees with an average standard deviation of 18 degrees. When the presentation level was decreased to 60 dB SPL to avoid activation of the automatic gain control (AGC) circuits in the clinical processors, the mean response error improved further to 8 degrees with a standard deviation of 13 degrees. Further tests with the custom research processors, which had a higher stimulation rate and did not include AGCs, showed comparable response errors: around 8 or 9 degrees and a standard deviation of about 11 degrees for both update rates. The best ITD JNDs measured for this subject were between 350 to 400 microsec for simple low-rate pulse trains. Speech results showed a substantial headshadow advantage for bilateral device use when speech and noise were spatially separated, but little evidence of binaural unmasking. For spatially coincident speech and noise, listening with both ears showed similar results to listening with either side alone when loudness summation was compensated for. No significant differences were observed between binaural results for high and low update-rates in any test configuration. Only for monaural listening in one test configuration did the high rate show a small significant improvement over the low rate. CONCLUSION: Results show that even if interaural time delay cues are not well coded or perceived, bilateral implants can offer important advantages, both for speech in noise as well as for sound-direction identification.

Adult↗

PubMedDate not supplied

Effects of insertion depth of cochlear implant electrodes upon speech perception.

OBJECTIVE: To investigate whether the insertion depth of a cochlear implant array affects postoperative speech perception. DESIGN: The subjects were 48 postlingually deaf adults who received either the Nucleus 22 or the Nucleus 24 cochlear implant with a straight array. A postoperative radiograph of the cochlear electrode was used to estimate insertion depth, as either the angle of the electrode tip (angle) or the intracochlear length of the electrode (length). Other estimates of insertion depth included the numbers of active electrodes and channels used by the speech processor. Electrode depth, together with the duration of deafness, hearing aid usage, pre-operative speech perception score and pre-operative pure-tone averages were independent variables in a forward stepwise multiple regression analysis, where the dependent variables were postoperative CNC words and CNC phonemes. RESULTS: Duration of deafness and insertion depth (angle, insertion length or active electrodes) were the predictive variables for CNC words or CNC phonemes. Angle was the best 'depth-related' predictor of postoperative speech perception. An even clearer relationship was found between CUNY sentences in noise and angle, in a subset of 26 patients. CONCLUSION: Depth of electrode insertion affects postoperative speech perception.

Adult↗

PubMed1995

Cochlear implant results: a comparison of live-voice and videotaped tests.

The Cambridge Cochlear Implant Programme has so far implanted the Ineraid multichannel cochlear implant in 16 profoundly deaf adult patients; there has been a 9-month or longer follow-up period with these patients. We have evaluated these patients by open-set Bamford-Kowal-Bench (BKB) Standard Sentence List testing in two different delivery strategies, live-speaker testing by the same speaker and high-resolution videotaped testing. The performance in lip reading both before and 9 months after implantation has been tested, as well as performance with the implant alone and with the implant in conjunction with lip reading at the 9-month stage. We have compared the performance in these two delivery strategies and have found a significantly better performance in the live-speaker tests that is attributable to slower and perhaps more sympathetic delivery. We have also found evidence of a ceiling effect in the performance of the implant with lip reading in the live-speaker mode and, of greater importance, a floor effect in the performance of the implant alone with the videotaped test. These results and the implications for a complementary role of these two test-delivery modes are discussed.

Cochlear Implants↗

PubMed2006

Orbital sequelae of rhinosinusitis after cochlear implantation in children.

OBJECTIVES: The objectives of this retrospective case review were to describe orbital complications in children after cochlear implantation, to define rhinosinusitis as a possible preoperative risk factor, and to suggest a possible pathophysiological mechanism for this previously unreported occurrence. METHODS: Records of children undergoing cochlear implantation over a 7-year period at a tertiary academic medical center were reviewed. Four children who experienced postoperative orbital sequelae were identified. We describe the demographics, clinical course, and radiologic findings in these children. RESULTS: The records of 91 children who underwent cochlear implantation were reviewed. The mean age was 6.0 years (range, 0.9-16.9 years). Forty-nine children (54%) were female and 51 (56%) were white. Four children developed postoperative orbital complications on the ipsilateral side to implantation. Orbital complications were characterized by periorbital edema and preseptal cellulitis necessitating prolonged hospitalization in all four children (mean length of stay, 3.3 days). Each child's orbital complication resolved with medical therapy that included intravenous antibiotics and nasal saline. Temporal bone images before implantation showed evidence of rhinosinusitis in all four cases. Of 76 available preoperative scans from the unaffected children, only 11 (14%) studies showed evidence of rhinosinusitis. CONCLUSIONS: Children with preoperative radiologic evidence of rhinosinusitis may be at risk of orbital sequelae after cochlear implantation. Positioning of the patient during surgery, length of surgery, and minor trauma to the lamina papyracea during drilling of the mastoid may be important etiologic factors. A careful review of medical history and computed tomography imaging before implantation may identify at-risk children.

Adolescent↗

PubMed2006

[The measurement of pneumatized mastoid and facial recess in cochlear implant recipients younger than three years old].

OBJECTIVE: To evaluate the postnatal growth of mastoid air cells and facial recess and the implications for cochlear implantation in very young children. METHOD: Thirty-two pediatric cochlear implant recipients younger than three years were enrolled in this study. Before implantation, pneumatized mastoid and facial recess were measured by high resolution computed tomography (HRCT) and compared with direct anatomical measurement in implantation. RESULT: We found the similar result in two measurements. All recipients had facial recess and there was no significant difference of the volume between the recipients in this study and the children in another group who were older than seven years old (P >0.05). The size of pneumatized mastoid was significantly different between recipients younger than 16 months and those older (P <0.05). CONCLUSION: (1) HRCT is very clinically valuable in making accurate diagnosis and surgical plan. (2) The facial recess is already adult size in children younger than three years old. (3) The size of pneumatized mastoid may affect mastoidectomy in cochlear implantation in very young children.

Child, Preschool↗

PubMed2004

Outcomes and achievement of students who grew up with access to cochlear implants.

OBJECTIVES/HYPOTHESIS: To provide long-term speech perception and production, educational, vocational, and achievement outcome data for pediatric cochlear implant recipients. STUDY DESIGN: This is a retrospective study using consecutive referrals of prelingually, profoundly deaf children at the University of Iowa Hospitals and Clinics. METHODS: Twenty-seven prelingually deaf young adults who received a cochlear implant between the ages of 2 and 12 years participated. Outcome measures included device-use information, perceptual information, reading results for all participants and educational achievement results for 17 of 27 participants, educational placement information/vocational information for all students, as well as a comparison of the child's educational/vocational outcome with that of the parent's educational/vocational outcome. RESULTS: Speech perception and production scores were highly correlated. Achievement test results indicated that scores were within 1 SD from normative data based on hearing individuals. Over 50% of the college-age eligible students enrolled in college. This initial group of implant users had a nonuse rate of 11% in the first 3 years. Eighty-nine percent of the users maintained full-time use for 7 years, and 71% of this group have maintained full-time use to date. CONCLUSIONS: This cohort of cochlear implant users compared favorably with their hearing peers on academic achievement measures. Although there was a wide distribution of educational and vocational outcomes, the children tended to follow the educational/vocational patterns of their parents. As age of implantation decreases, it will be important to compare achievement outcomes of this first generation with those of subsequent generations of cochlear implant users.

Adolescent↗

PubMed1994

Cochlear implants in children.

Children with such profound deafness that they are not helped by hearing aids are now candidates for cochlear implantation. This technology permits us to provide these children with a significant degree of useful hearing. The degree of improvement in speech perception and spoken language in pediatric cochlear implant recipients varies. However, the younger the children and the less time they have been completely deprived of auditory stimuli, the more likely they are to make significant progress. The evaluation of the deaf child for implantation is best done by a multidisciplinary team who understands the needs of hearing-impaired children and who can work with the family, the child, and classroom teachers, as well as other school professionals. The decision to proceed with cochlear implantation in a child is one that requires long-term commitment on the part of the family and the cochlear implant team.

Age Factors↗

PubMed1999

Cochlear implants and electrical brainstem stimulation in sensorineural hearing loss.

Cochlear implants and multichannel auditory brainstem implants enable patients with bilateral total or profound hearing loss to receive at least acoustic information. Both types of prosthesis are based on electrical stimulation of the auditory pathway. Different speech coding strategies and the number of electrodes used may influence the postoperative results. The preoperative evaluation of patients is of utmost importance. The cochlear implant is suitable for patients with hearing loss due to inner ear disorders, but who have functioning hearing nerve. Patients with a defect of the hearing nerve can be provided with an auditory brainstem implant.

Brain Stem↗

PubMed2004

Parents and their cochlear implanted child: questionnaire development to assess parental views and experiences.

OBJECTIVES: To test the reliability of a validated closed-format questionnaire assessing parental views following cochlear implantation of their child. DESIGN: Parents were surveyed using a closed-format questionnaire developed in earlier work. The same parents were surveyed 1 month later and responses compared. Test-retest reliability was thereby assessed. SETTING: Tertiary referral Pediatric Cochlear Implant Centre in the UK. SUBJECTS AND METHODS: The parents of 20 children who had been born deaf or were deafened by age 3 years and who had been implanted for at least 2 years were drawn at random from patient lists. Parents were surveyed using a closed-format questionnaire whose validity had been previously assessed and re-surveyed 1 month later. Responses over time were compared. RESULTS: For the majority of items in the questionnaire, the replication of the item would lead to the same response on at least 95% of occasions. The text of the closed-format questionnaire is reproduced in full. CONCLUSION: This validated closed-format questionnaire appears to be unique in respect of cochlear implantation, being based explicitly on issues thought important by the parents. The high test-retest reliability indicates that it is capable of eliciting parental views in a meaningful manner. This information that is not currently available by other means can then be used as part of an overall assessment of outcomes, to inform efforts aimed at quality improvement as well as demonstrating accountability to purchasers and policymakers. Moreover, a wider use of this instrument can result in valid comparisons of outcomes among different cochlear implant centres.

Adult↗

PubMed1991

[Postoperative conventional tomography of the temporal bone in the assessment of inadequate perception in patients with cochlear implants].

Between August 1984 and August 1990, 166 patients received a 22-channel cochlear implant (Nucleus) in the ENT clinic in Hannover. Some of these patients who were able to understand speech nevertheless complained of inadequate perception. To study this further a phantom skull with a cochlear implant was examined by CT and by conventional tomography of the petrous bone in various image planes. The method of choice for evaluating the position and appearance of the cochlear implant proved to be conventional tomography of the petrous bone in the frontal transorbital plane. In 7/23 patients examined it was possible to demonstrate dislocation of the electrodes; this is evidently responsible for the faulty perception.

Adolescent↗

PubMed2006

Factors influencing spoken language outcomes in children following early cochlear implantation.

Development of spoken language is an objective of virtually all English-based educational programs for children who are deaf or hard of hearing. The primary goal of pediatric cochlear implantation is to provide critical speech information to the child's auditory system and brain to maximize the chances of developing spoken language. Cochlear implants have the potential to accomplish for profoundly deaf children what the electronic hearing aid made possible for hard of hearing children more than 50 years ago. Though the cochlear implant does not allow for hearing of the same quality as that experienced by persons without a hearing loss, it nonetheless has revolutionized the experience of spoken language acquisition for deaf children. However, the variability in performance remains quite high, with limited explanation as to the reasons for good and poor outcomes. Evaluating the success of cochlear implantation requires careful consideration of intervening variables, the characteristics of which are changing with advances in technology and clinical practice. Improvement in speech coding strategies, implantation at younger ages and in children with greater preimplant residual hearing, and rehabilitation focused on speech and auditory skill development are leading to a larger proportion of children approaching spoken language levels of hearing age-mates.

Child↗