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A multiple-channel cochlear implant. Evaluation using speech tracking.

Two totally deaf patients who had received multiple-channel cochlear implants were tested using a speech "tracking" procedure in which they had to repeat verbatim passages of connected discourse. Their performance was assessed by calculating the tracking rate (words per minute) each session. Testing was carried out under two conditions--lipreading alone and lipreading in conjunction with a multiple-channel cochlear implant and laboratory speech processor. Lipreading with the cochlear implant increased the tracking rates by a factor of four for one patient and by a factor of two for the other when compared with lipreading alone.

Cochlear Implants↗

Technical Note: minimal access surgery for cochlear implantation with MED-EL devices.

BACKGROUND: Minimally invasive techniques have been described for cochlear implant surgery, but so far this had not been the case for Med-EL devices. OBJECTIVE: To describe a newly developed minimal access approach for the implantation of Med-EL devices and report our results after up to 1 year of follow-up in 52 patients. DISCUSSION: The use of a minimally invasive approach without raising a flap or extensive drilling of a bony well was feasible in all 52 patients of this series. It shortened the surgical time to an average of 45 min and there were no specific postoperative complications. The average follow-up of 8.4 months was uneventful with the implants well covered and fixed in their position. The described approach therefore appears to be a safe, time- and cost-effective alternative to the standard procedure in cochlear implant surgery using Med-EL devices.

Adolescent↗

Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children?

OBJECTIVES: The Würzburg bilateral cochlear implant (CI) program was started with the aim to improve the patients' communicative abilities in complex listening situations. In this study, the auditory skills of children using bilateral cochlear implants were evaluated. STUDY DESIGN AND SETTINGS: Qualitative data based on free observations in the rehabilitation setup were collected in 39 bilaterally implanted children. A speech discrimination in noise test was performed in 18 of these children; lists of bisyllabic words were presented in noise at a signal to noise ratio (SNR) of +15 dB. RESULTS: Qualitative and quantitative data show clearly that bilateral CI improves the children's communicative behaviour, especially in complex listening situations. Children examined with the speech in noise test scored significantly better under the bilateral condition compared to the unilateral condition. Integration of the second implanted side and use of binaural information was observed to be easier and faster in children with a short time lag between both implants. CONCLUSIONS: To be able to obtain optimal benefit from bilateral cochlear implants, an intensive rehabilitation program is necessary. The important aspects of such a program are creating realistic expectations in older children before implantation; performing the first processor fitting of the second side with the first side switched on; and separate intensive training with the new system in order to balance out the hearing competence of the second CI with that of the first.

Adolescent↗

[The prognostic value preoperative promontory testing in Japanese cochlear implant patients].

The prognostic value of preoperative promontory testing was evaluated in Japanese cochlear implant patients. Promontory testing consisted of measurement of electrical thresholds (T), uncomfortable level (UCL), dynamic range (DR), gap detection (GAP), and temporal difference limen (TDL). Patients' performances were measured at 3 months (n = 46) and 1 year (n = 20) postoperatively, using a standard Japanese audiologic test battery without lip-reading. This study included only postlingual deaf patients who received the Nucleus multichannel cochlear implant. Wide DRs at low frequencies (50,100,200 Hz) and good GAP detection (< 20 ms) emerged as excellent preoperative predictors of the 3-month postoperative performances (P < 0.05). In contrast, any measurements could not serve as a good predictor of the 1-year performances. These results suggest that the preoperative promontory testing provides useful information only for early postoperative performances but that it could not predict the final language performances.

Adolescent↗

[Cochlear implants in patients with radical cavity].

Treatment of patients with severe bilateral hearing loss by cochlear implants usually requires normal temporal bone anatomy. The authors report one case in which the electrophysiological criteria for cochlear implant were fulfilled. However, the patient showed unfavourable anatomy because of a radical mastoid cavity on the suitable side and a congenital anomaly on the opposite side. As a first step the radical cavity was opened from a retroauricular incision and completely de-epithelialized. Thereafter, a retroauricular full-thickness skin flap was formed and rotated into the cavity; the retroauricular incision was not closed. Six months later a cochlear implant (Clark-Nucleus system) was positioned after undermining the flap described above. This surgical technique allows us to provide patients with radical cavities with implants under the usual sterile conditions and avoids contact of the implant with the body surface.

Cochlear Implants↗

Cochlear implant after reconstruction of the external bony canal wall and tympanic cavity in radically mastoidectomized patients with cholesteatoma.

One of the postoperative complications of cochlear implants in patients, who previously received radical mastoidectomy, is an exposure of electrode by breakdown of thin epithelium in the open mastoid cavity. To avoid such complications, in the first stage, radical mastoidectomy with the reconstruction of the posterior bony canal wall and mastoid obliteration with bone chips and plates and the creation of the new tympanic cavity, were performed. One or 3 years later, implantation of a 22-channel cochlear implant, as the second stage procedure, was successfully performed in three patients with profound sensorineural hearing loss, due to cholesteatoma in the side of the ear in which cochlear implantation was indicated. The advantages of this technique are as follows: (1) Electrode is protected from the cavity problems, such as chronic infection or erosion of the epithelium in the open mastoid cavity; and (2) reconstruction of the new tympanic cavity and tympanic membrane is beneficial for avoidance of electrode exposure in the mastoid and tympanic cavity.

Aged↗

Do Fourteenth Amendment considerations outweigh a potential state interest in mandating cochlear implantation for deaf children?

Currently, the decision concerning pediatric cochlear implantation for children remains a personal choice for parents to make. Economic factors, educational outcomes, and societal attitudes concerning deafness could result in an increased governmental interest in this choice. This article examines case law related to the issue of parental autonomy to determine whether the state, acting in the role of parens patriae, could use economic and social reasons to mandate the provision of cochlear implants for all eligible children. The author uses previous cases as a framework to develop an opinion on whether a constitutional protection for parents may exist.

Cochlear Implantation↗

[Cochlear implantation, new prosthetic alternative in the management of the profoundly deaf child].

Cochlear implants are new medical devices. In contrast to acoustic hearing aids which work by amplification, cochlear implants directly stimulate the hearing neurons via electrode implanted in the cochlear tympanic ramp. They are indicated in case of profound hearing deficiency or in cases of bilateral cophosis, congenital or acquired. Implanted early, they allow deaf children to improve their speech comprehension and their verbal expression considerably, thereby favouring social integration. A concurrent system of support including the use of visual-manual means of communication nevertheless remains vital for the first years. The frequency and duration of such support varies according to the individual.

Child↗

Synthetic vowel studies on cochlear implant patients.

Speech perception studies were conducted on three cochlear implant patients to investigate the relative merits of six speech processing schemes for presenting speech information to these patients. Electrical stimuli, described in this article as synthetic vowels, were constructed using tabulated data of formant frequencies of natural vowels. The six schemes differed in the number of formant frequencies encoded on the electrical signal dimension of electrode position, and/or in the range of electrode position used for encoding each formant frequency. Eleven synthetic vowels (i, I, E, ae, a, c, U, u, v, E, D) were used and were presented in a single-interval procedure for absolute identification. Single-formant vowels were used in two of the six schemes, two-formant vowels in three schemes, and three-formant vowels in the remaining scheme. The confusion matrices were subjected to conditional information transmission analysis on the basis of previous psychophysiological findings. Comparisons among the schemes in terms of the analyzed results showed that training, experience, and adaptability to new speech processing schemes were major factors influencing the identification of synthetic vowels. For vowels containing more than one formant, the information about each formant affected the perception of the other formants. In addition, there appeared to be differences between the perceptual processes for vowels containing more than one formant and the processes for single-formant vowels. Taking into consideration the effects of training, experience, and adaptability, the three-formant speech processing scheme appeared, on the basis of perceptual performance comparisons among the six schemes, to be the logical choice for implementation in speech processors for cochlear implant patients.

Aged↗

Measurements of electrode position inside the cochlea for different cochlear implant systems.

CONCLUSIONS: This study demonstrates that the exact location of an electrode inside the cochlea needs to be assessed using two complementary measures, namely the length and angle of insertion, both of which are mandatory if one wants to prevent erroneous outcomes. Knowledge of the contact position may become very useful when tuning a cochlear implant processor in a patient with contralateral residual hearing, or in cases of binaural implants. OBJECTIVE: Multichannel cochlear implants restore useful hearing to deaf patients. However, several types of intracochlear electrodes are presently available, each featuring a specific technology or design. The aim of this study was to determine precisely the intracochlear position of the contacts for different electrode arrays. MATERIAL AND METHODS: Electrode array insertions were estimated using special radiographs. A total of 26 cochlear implantations were included in the study: 6 Ineraid; 5 Clarion HiFocus I; 11 Clarion HiFocus II; and 4 Med-El Combi40+. In each case, a measurable reference or marker ring placed close to the round window (within 2 mm) could be identified. Insertion lengths and angles were measured and then plotted on a graphl based on 3D reconstructions. RESULTS: Both Clarion HiFocus I and II electrode arrays were found to be placed close to the inner wall of the cochlea. Ineraid and Med-El Combi40+ electrode arrays were both placed close to the organ of Corti, the Med-El Combi40+ arrays demonstrating the deepest insertions overall. In spite of marked differences in the positions of the contacts, we did not find any correlation with speech perception performance for the different types of implants studied.

Adult↗

Cochlear implantation and variation of facial nerve anatomy: a case report.

Cochlear implantation becomes more common with every passing year. Since adequate exposure of the round window requires a facial recess approach, facial nerve variation and anomalies could potentially alter the surgical approach significantly. We report the case of a patient with a variation of facial nerve anatomy. The nerve was found to be lateral to the annulus in its mastoid segment and required retrofacial dissection to approach the round window. A good result was achieved in this patient, demonstrating that facial nerve anomalies need not be a barrier to successful implantation. The reported congenital anomalies of the facial nerve are discussed, along with their influence on cochlear implantation. A knowledge of these variations is mandatory for those engaged in implant surgery.

Adult↗

Multivariate predictors of audiological success with multichannel cochlear implants.

To predict the audiological outcomes of 2 multichannel cochlear implants, a preoperative battery of historical, audiological, electrophysiologic, and psychologic variables from 48 postlingually deafened adults was tested in a prospective randomized clinical trial. Multivariate analyses were used to select and combine these preoperative variables in a predictive index that was significantly related to audiological outcome at 9 months. The preoperative variables included in the predictive index were duration of profound deafness, speech reading ability, residual hearing, cognitive ability, measures of compliance and engagement with treatment, and use of nonverbal communication strategies. The preoperative predictive index had correlations of .81 with the Iowa Sentences Test, and .78 with the NU-6 word understanding scores, both obtained in a sound-only test. Probability and percentile curves generated from these data offer considerable optimism in forecasting the range of likely audiological outcomes that would be realized by postlingually deafened adult candidates for multichannel cochlear implants.

Adult↗

[Management of a deaf-blind patient with a 12-channel cochlear implant].

A case study of a deaf-blind patient implanted with the COMBI40+ cochlear implant is presented. The patient is a 70-year-old woman who has been blind since the age of 40. Since 1977 the hearing loss continuously increased. Before surgery she had a very small residual hearing (with hearing aid: 40% speech intelligibility by four syllable numbers) and she used Braille and finger-spelling on her hand to communicate with other people. The patient has a high intelligence and so she did not have any problems when the speechprocessor was fitted and during the hearing therapy. After one month she had an open-set-speech recognition. The quality of her life is much better than before surgery. The communication by finger-spelling on her hand is not necessary any longer.

Aged↗

Speech production changes with the use of a multichannel cochlear implant in a postlingually hearing impaired adult.

Profoundly deaf cochlear implant users provide an interesting population in which to assess the role of distorted auditory feedback in speech, since their electrically stimulated hearing is significantly different from normal hearing. The aim of the study was to evaluate, by means of spectrographic and listener analyses, the speech production changes in a postlingually deafened adult with the use of a multichannel cochlear implant over time, compared to that of hearing aids as well as no-amplification. The results indicated significant improvements in the use of suprasegmental speech features as well in the production of specific segmental features of speech.

Adult↗

Economic evaluation of the cochlear implant.

OBJECTIVE: To examine the economic efficiency of current cochlear implant technology under Australian conditions in profoundly deaf adults, partially deafened adults, and children. METHODS: Cost-utility study, with weights based on judgments from persons experienced with the technology, and cost data from Australian sources. RESULTS: Quality-of-life improvements due to functional consequences of hearing improvement were greater than those due to amelioration of hearing disability. Costs in Australian dollars per QALY (15-year assessment) ranged from $5,070-$11,100 for children, $11,790-$38,150 for profoundly deaf adults, and $14,410-$41,000 for partially deaf adults. CONCLUSIONS: Results suggest cochlear implantation is acceptable value for money when compared with other health programs to which resources are committed in Australia.

Adult↗

Far-advanced otosclerosis. Cochlear implantation vs stapedectomy.

In 1981, our group, as part of a Food and Drug Administration investigator team directed by William House, performed Illinois' first cochlear implantation. We have since performed cochlear implantations in ten other persons. Since May 1980, approximately 35 severely to profoundly deaf persons per year have been referred to our clinic for evaluation. A small number of these patients had far-advanced otosclerosis. In these cases, exploratory tympanotomy and stapedectomy followed by rehabilitation with a hearing aid was a more appropriate management than cochlear implantation. Case histories and a temporal bone study of far-advanced otosclerosis are presented.

Aged↗

[The cochlear implant and phonetics: an analysis of a case with the French implant Chorimac 12].

This paper reports on the rehabilitation following implantation of the French cochlear implant, Chorimac 12, in a 66-year-old woman. The electrical stimulation of the device should normally stimulate on a 400-6000 Hz bandwidth. However, tests that had been run after the four-month rehabilitation period indicate that there is no stimulation under 1000 Hz, 2000 Hz seems to be the best bandwidth for stimulation, and over 4000 Hz, almost nothing is audible. An "analytico-global" rehabilitation process has yielded results on vowel, consonant and sentence discrimination: pairs of vowels which offer major contrasts are best discriminated; fricatives are easier to recognize than stops; the longer a sentence is, the easier the patients can identify key words that facilitate identification; also, the more sentences carry phonetic differences, the easier it is to identify them. The results from the analysis of the phonetic material used during the rehabilitation, the new hearing impressions described by the patient and the acoustical measures from acoustic researchers allow us to quantify the restored hearing, define the acquired phonetic code and describe the level of performance reached by the patient.

Aged↗

[Initial experience with rehabilitation of patients after cochlear implants].

The authors describe the first results with rehabilitation of patients with czechoslovak single - channel cochlear implant. The implantation was performed in three postlingually deaf adults. The deafness lasted from 8-28 years. The information about the presence of a sound is considered as the contribution of the cochlear implant. The patients were able to differentiate ten common sounds after the rehabilitation, their ability of understanding speech sounds was better with lipreading and cochlear implant than before implantation.

Adult↗