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PubMed1985

[Rehabilitation programs for patients with cochlear implants as a function of acquired experience in logopedics for deaf children].

Rehabilitation of patients after cochlear implant surgery should be planified along the same basic principles as those that have been envolved for the adaptation of patients to a classical hearing aid or acoustic prosthesis. When this is adapted to a patient with a sensorineural hearing loss, the quality of hearing differs from that of normal hearing because the pathological inner ear introduces distorsions. The patient therefore has to be trained to equate the new auditory sensations with those he had previously, which is basically the same situation as with a cochlear implant. Some profoundly or totally deaf patients are fitted with vibro-tactile aids and they also have to be trained to make use of these new sensations in a meaningful way for an aid to speech understanding. For the above reasons the term "cochlear prosthesis" is considered particularly adequate. It also has the advantage of playing down the surgical aspect of this new technique, often overemphasized by the media and creating exaggerated emotional involvement of the patients. If the above facts are recognized, one should entrust the rehabilitation of patients fitted with cochlear prostheses to logopeds (speech therapists) well trained in the habilitation and prosthetic adaptation of profoundly deaf children. Only they have the expertise necessary to devise and apply a program founded upon experience. This will help avoid the pitfalls into which several surgically directed cochlear implant teams are currently falling. One of these is to design a training program in function of the tests meant to measure the patients' new capacities.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMed1995

Postural control and vestibular function in patients selected for cochlear implantation.

Postural control and vestibular and eye motor function were evaluated in 7 postlingually deaf patients before cochlear implantation as vibration toward the calf muscles or galvanic electrical stimulation of the vestibular nerves perturbed stance. The patients were compared with 21 control subjects. Vibration-induced bodysway was increased in the patients compared to the normals. Galvanic stimulation induced a bodysway that was not significantly different from that of the control group suggesting that the patients selected for cochlear implantation, and with otherwise reduced postural control, are sensitive to electrical stimulation of the vestibular nerve. This finding may contribute with a complementary hypothesis to the causes of dizziness among cochlear implant patients.

Adult↗

PubMed1995

Postural control and vestibulospinal function in patients selected for cochlear implantation.

Postural control, vestibular and eye motor function were evaluated in seven postlingually deaf patients before cochlear implantation and were compared with 21 control subjects. Vibration to the calf muscles or galvanic electrical stimulation of the vestibular nerves, perturbed stance and body sway velocity, statistical variance of antero-posterior body sway and identification of characteristic parameters of postural dynamics were all evaluated. Vibration-induced body sway was increased among the patients compared with the normal subjects and there were differences in characteristic parameters of postural dynamics, indicating decreased postural control. Galvanic stimulation induced a body sway not significantly different from the control group suggesting that the patients selected for cochlear implantation, and with an otherwise reduced postural control, are sensitive to electrical stimulation of the vestibular nerve. Thus, postlingually deaf subjects who perceive a sensation of sound at electrical promontorial stimulation also respond with increased body sway to electrical stimulation aimed at the vestibular nerves. This finding may contribute an additional hypothesis to the causes of dizziness among cochlear implant patients, complementary to the that of wrongly placed electrodes and peroperative vestibular lesions.

Adult↗

PubMed1997

The Paediatric Cochlear Implant Program at the Hospital for Sick Children, Toronto.

Ontario has a province-wide program for provision of cochlear implants. Toronto's Hospital for Sick Children is one of three designated centres that service the paediatric population. This cochlear implant program was established in 1989. Since that time, 37 children (as of May 1996) have been provided with cochlear implants. The program also services Ontario residents who were implanted elsewhere. In the following, we provide a detailed description of the program, including the processes through which children are selected as candidates, the follow-up studies that we carry out, and the roles of various health care professionals involved. We present a demographic survey of our patient population to date, and discuss some of the important issues relating to candidacy.

Child, Preschool↗

PubMedDate not supplied

Preservation of residual hearing in children and post-lingually deafened adults after cochlear implantation: an initial study.

OBJECTIVE: To investigate whether the residual hearing of severely hearing-impaired children and adults could be preserved using the soft surgery approach. PATIENTS AND METHODS: This project employed a prospective study design. All testing and surgery took place in the Institute of Physiology and Pathology of Hearing, Warsaw, Poland. Twenty-six patients (7 children and 19 post-lingually deafened adults) with residual hearing were assessed. Subjects were assessed using conventional pure-tone audiometry at least 1 month prior to surgery. Cochlear implant surgery with a Med-El Combi 40/40+ standard electrode array was conducted, using the soft surgery approach. Pure-tone audiometry thresholds were re-assessed at least 1 month after surgery. The researchers assessed change in auditory thresholds using pure-tone audiometry to determine preservation of residual hearing. RESULTS: Sixteen of 26 patients (62%) retained their residual hearing within 5 dB HL of pre-operative scores. Only 5 of 26 patients (19%) lost all measurable residual hearing after cochlear implantation. This suggests that surgeons are often able to preserve residual hearing during cochlear implant surgery using the soft surgery technique. CONCLUSIONS: Preservation of residual hearing is an important consideration in cochlear implantation in the light of changing selection criteria for cochlear implant candidates, and as younger children are receiving implants. This is important, as we do not know yet the long-term effects of inner ear damage due to traumatic insertions of electrodes. This finding suggests a good prognosis for future possibilities of re-implantation.

Adolescent↗

PubMed2004

Performance of subjects fit with the Advanced Bionics CII and Nucleus 3G cochlear implant devices.

OBJECTIVE: To determine if subjects who used different cochlear implant devices and who were matched on consonant-vowel-consonant (CNC) identification in quiet would show differences in performance on speech-based tests of spectral and temporal resolution, speech understanding in noise, or speech understanding at low sound levels. DESIGN: The performance of 15 subjects fit with the CII Bionic Ear System (CII Bionic Ear behind-the-ear speech processor with the Hi-Resolution sound processing strategy; Advanced Bionics Corporation) was compared with the performance of 15 subjects fit with the Nucleus 24 electrode array and ESPrit 3G behind-the-ear speech processor with the advanced combination encoder speech coding strategy (cochlear corporation). SUBJECTS: Thirty adults with late-onset deafness and above-average speech perception abilities who used cochlear implants. MAIN OUTCOME MEASURES: Vowel recognition, consonant recognition, sentences in quiet (74, 64, and 54 dB SPL [sound pressure level]) and in noise (+10 and +5 dB SNR [signal-to-noise ratio]), voice discrimination, and melody recognition. RESULTS: Group differences in performance were significant in 4 conditions: vowel identification, difficult sentence material at +5 dB and +10 dB SNR, and a measure that quantified performance in noise and low input levels relative to performance in quiet. CONCLUSIONS: We have identified tasks on which there are between-group differences in performance for subjects matched on CNC word scores in quiet. We suspect that the differences in performance are due to differences in signal processing. Our next goal is to uncover the signal processing attributes of the speech processors that are responsible for the differences in performance.

Adult↗

PubMedDate not supplied

Effects of the single-electrode cochlear implant on the vestibular system of the profoundly deaf adult.

Twenty-two profoundly deafened adults, implanted with the single-electrode cochlear implant, were involved in a study to observe the effects of cochlear electrical stimulation on the vestibular system. Previous investigators had found evidence that the implant might disrupt postural stability. As there had been no general complaints of dizziness or dysequilibrium by the implant subjects, a study was undertaken to replicate the earlier study and to compare the results to more standardized procedures. A Sono-postural Test was devised from the Ataxia Test Battery for the testing of balance with and without an auditory prosthesis. Electronystagmography was also performed on the subjects before and after surgery as a means of monitoring vestibular status over time. Results from the these tests indicate that the single-electrode implant does not disrupt the balance system to any significant degree. In fact, evidence indicates that postural stability may actually improve with the cochlear implant activated.

Adult↗

PubMedDate not supplied

Scala vestibuli insertion in cochlear implantation: a valuable alternative for cases with obstructed scala tympani.

Insertion of a sufficient number of electrodes is important for a successful use of cochlear implants. We investigated the results of scala vestibuli insertion for cochlear implantation in cases of obstructed scala tympani. In a series of 200 cochlear implantations, scala vestibuli insertion was successfully performed in 4 cases with obstruction of the scala tympani. Etiologies included a temporal bone fracture, severe otosclerosis and malformations of the cochlea. The maximum insertion depth obtained via the scala vestibuli was 30 mm. Postoperative results were comparable to patients in whom conventional scala tympani insertion was performed. No adverse effects related to the site of insertion were observed. Scala vestibuli insertion offers a valuable alternative in cases of obstructed scala tympani that can be employed for a variety of etiologies.

Adult↗

PubMed1998

[Deafness: the right to silence or the chance to hear with a cochlear implant? Human images and medicine in the world of the deaf and in the world of the hearing].

Cochlear implantation has evolved from its experimental state into a safe and effective therapy for the treatment of profound deafness. Although not applicable to all patients, it offers an alternative to a life in silence. In particular, in early detected and treated deafness in childhood inner ear prostheses have enabled affected persons to be integrated into the world of sound. In addition to the significant impact that therapy has on the life of the individual, there is a social and cultural consequence for society. This is epitomized in the criticism by the deaf community that has resulted in the total rejection of cochlear implants. A critical analysis reveals different personal images prevailing in the deaf community. Knowledge of these differences and their relevance is important for all clinicians involved in counselling a cochlear implant candidate.

Cochlear Implants↗

PubMed2005

A new instrument for minimal access surgery in cochlear implantation.

OBJECTIVE: Evaluation of usefulness and benefits of a new hand-held retractor for minimal invasive technique in cochlear implantation. SETTING: Tertiary medical center. PATIENTS: : Fourteen consecutive patients (age: 1-83; 4 = female and 10 = male) received a cochlear implant in minimal invasive technique using the new hand-held retractor. INTERVENTION: Standardized operation procedure in minimal invasive technique for cochlear implantation. A short retroauricular incision is used to perform the mastoidectomy with posterior tympanotomy and cochleostomy. RESULTS: The hand-held retractor allows drilling of the bony well for the receiver-stimulator package under direct vision from an anterior position of the surgeon. The sub-periosteal pocket is performed while maintaining continuous suction of irrigating fluids with no further assistance needed. CONCLUSION: With the new retractor, up to 70% of time to create the bony well is saved compared to previously used instrumentation. The retractor might be further useful in different fields of surgery where the operating field needs to be visualized with the integrated suction and light-device under protection of the surrounding tissue.

Adolescent↗

PubMed2004

Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations.

OBJECTIVE: To report the short- and long-term complications encountered in a large number of consecutive children undergoing implantation in a single center. The current study also describes the management and sequelae of each complication. STUDY DESIGN: Prospective study assessing the surgical findings and complications of deaf children undergoing implantation. SETTING: Pediatric tertiary referral center for cochlear implantation. PATIENTS: The present study includes 300 consecutive children undergoing implantation, with a mean age at implantation of 5.1 years, ranging from 1.3 to 16.9 years. Of these children, 196 (65%) had congenital deafness of unknown cause. The commonest known cause was meningitis (73 of 300 [24%]) followed by congenital cytomegalovirus infection (17 of 300 [6%]). Children have been followed up regularly after implantation, typically at yearly intervals after the first year. The mean duration of follow-up at the time of the study was 4 years (range, 0.1-14 yr). RESULTS: There were no major perioperative (within 1 d after surgery) or major early postoperative (within 1 wk after surgery) complications. In the same periods, there were 19 and 15 minor complications, respectively. These complications (e.g., eardrum perforation, hematoma, flap swelling, wound infection, temporary facial weakness) settled with conservative treatment or minor intervention. With regard to the late surgical complications (>1 wk after surgery), there were 7 major (e.g., severe flap infection requiring explantation, cholesteatoma, persistent eardrum perforation) and 14 minor complications (e.g., mild flap infection, flap swelling, hematoma). A number of complications were encountered even 14 years after the original operation, and some of them needed repeated interventions, highlighting the importance of long-term follow-up. However, most of the complications occurred very close to the surgical procedure (<1 yr). CONCLUSION: An overall rate of 2.3% for major surgical complications and an overall rate of 16% for minor surgical complications suggest that cochlear implantation is a relatively safe surgical operation in experienced centers. Most surgical complications are minor and can be managed with conservative treatment or minor surgical intervention. However, meticulous attention to surgical detail, especially handling soft tissues and leaving the posterior canal wall intact, and long-term follow-up are of paramount importance in minimizing the incidence of surgical complications.

Adolescent↗

PubMed1997

Cochlear implant use by prelingually deafened children: the influences of age at implant and length of device use.

This study focused on long-term speech perception performances of 34 prelingually deafened children who received multichannel cochlear implants manufactured by Cochlear Corporation. The children were grouped by the age at which they received cochlear implants and were characterized by the amount of time they used their device per day. A variety of speech perception tests were administered to the children at annual intervals following the connection of the external implant hardware. No significant differences in performance are evident for children implanted before age 5 compared to children implanted after age 5 on closed-set tests of speech perception ability. All children demonstrated an improvement in performance compared to the pre-operative condition. Open-set word recognition performance is significantly better for children implanted before age 5 compared to children implanted after age 5 at the 36-month test interval and the 48-month test interval. User status, defined by the amount of daily use of the implant, significantly affects all measures of speech perception performance except pattern perception.

Adolescent↗

PubMedDate not supplied

Short-term effect of auditory feedback on fundamental frequency after cochlear implantation.

The present study evaluates the short-term effect of cochlear implantation on the fundamental frequency (FO) of 13 deaf patients. All patients were provided with the Combi 40+ cochlear implant. Voice recording was made pre- and 3 months post-implantation. The FO was analysed using X-Tools software. The results showed that 38 per cent of our subjects had a statistically significant decrease of their mean F0 (p=0.001) at 3 months following implantation. It was also observed that the patients tended to have a lower F0 postoperatively approaching the normal range of F0. A large variability in F0 was noticed among the deaf subjects but no correlation with the duration of deafness was seen. There was also no correlation between speech recognition and speech production.

Adult↗

PubMed2000

A retrospective analysis of high resolution computed tomography in the assessment of cochlear implant patients.

High resolution computed tomography (HRCT) of the temporal bone is performed routinely in the preoperative evaluation for cochlear implantation. The largest multicentre retrospective analysis of data was undertaken to compare the findings on HRCT with the surgical findings in an attempt to determine the accuracy of HRCT. Of the 1009 patients referred, 525 were scanned of whom 335 were implanted. As part of this study we were also able to identify both radiological and non-radiological reasons for rejection of patients for cochlear implantation. the commonest cause being adequate residual hearing. The accuracy of HRCT in predicting cochlear ossification was 94.6%, with a 100% specificity and a 71%, sensitivity. Meningitis was the leading cause of cochlear ossification (44%). We conclude from this extensive multicentre study of both adult and paediatric patients that HRCT is accurate in predicting cochlear abnormality. In post-meningitic patients magnetic resonance imaging (MRI) may be a useful additional investigation.

Adult↗

PubMed2000

[Factors influencing satisfaction of cochlear implant users--a questionnaire-based study].

We surveyed on cochlear implant (CI) users using a questionnaire to determine how they use their CIs in daily life and to what degree they are satisfied with them. We also studied the relationship between the degree of satisfaction and speech perception score, age at operation, and deafness duration. Subjects were 37, postlingually-deafened adult CI users were subjected to this study. Average CI use per day was 13.6 hours. Some 60% of subjects understood person-to-person conversation without lipreading, but most could not communicate on the telephone, in meetings, or in noisy places, for example. Most--about 80%--were satisfied with CI, but 20% were not. Those not satisfied tended to be unable to understand person-to-person conversation even with CI and lipreading, indicating that understanding person-to-person conversation is one of the most important reasons for satisfaction in CI users. Speech recognition scores improved in all cases after implantation. Most patients with high speech recognition score-->40% in consonant recognition--were satisfied with CI, but those with recognition scores < 40% in consonant recognition, the degree of satisfaction varied. These results indicate that the degree of satisfaction in CI users does not always correspond to the degree of improvement in speech recognition score. Two patients not satisfied with CI had undergone surgery after the age of 65 years and deafness duration exceeding 20 years. Advanced age and a long deafness duration may thus reduce satisfaction with CIs.

Adult↗

PubMed2003

Risk of bacterial meningitis in children with cochlear implants.

BACKGROUND: In June 2002, the Food and Drug Administration received reports of bacterial meningitis in patients with cochlear implants for treatment of hearing loss. Implants that included a positioner (a wedge inserted next to the implanted electrode to facilitate transmission of the electrical signal by pushing the electrode against the medial wall of the cochlea) were voluntarily recalled in the United States in July 2002. METHODS: We identified patients with meningitis and conducted a cohort study and a nested case-control investigation involving 4264 children who had received cochlear implants in the United States between January 1, 1997, and August 6, 2002, and who were less than six years of age when they received the implants. We calculated the incidence of meningitis in the cohort and assessed risk factors for meningitis among patients and among 199 controls, using data from interviews with parents and abstracted from medical records. RESULTS: We identified 26 children with bacterial meningitis. The incidence of meningitis caused by Streptococcus pneumoniae was 138.2 cases per 100,000 person-years--more than 30 times the incidence in a cohort of the same age in the general U.S. population. Postimplantation bacterial meningitis was strongly associated with the use of an implant with a positioner (odds ratio, 4.5 [95 percent confidence interval, 1.3 to 17.9], with adjustment for medical, surgical, and environmental factors) and with the joint presence of radiographic evidence of a malformation of the inner ear and a cerebrospinal fluid leak (adjusted odds ratio, 9.3 [95 percent confidence interval, 1.2 to 94.5]). The incidence of meningitis among patients who had received an implant with a positioner remained higher than the incidence among those whose implants did not have a positioner for the duration of follow-up (24 months from the time of implantation). CONCLUSIONS: Parents and health care providers should ensure that all children who receive cochlear implants are appropriately vaccinated and are then monitored and treated promptly for any bacterial infections after receiving the implant.

Bacterial Vaccines↗

PubMed1998

Histopathological features of a cochlear implant and otogenic meningitis in Mondini dysplasia.

The temporal bones of a 6-year-old boy with a cochlear implant for profound hearing loss associated with Mondini dysplasia were studied histopathologically. Despite having severe Mondini dysplasia, he was able to detect sound with the implant. On histological examination of the temporal bone, he had more than 10000 spiral ganglion cells. Histopathological changes in the inner ear associated with the cochlear implant were minimal. Patients with severe Mondini dysplasia and profound hearing loss may, therefore, benefit from cochlear implantation. In the contralateral ear, the patient had suppurative labyrinthitis and meningitis associated with chronic otitis media. Histopathological evidence of inflammatory necrosis of the round window membrane was consistent with suppurative labyrinthitis secondary to otitis media.

Abnormalities, Multiple↗

PubMed1999

Surgical considerations regarding cochlear implantation in the congenitally malformed cochlea.

A 4-year-old girl with congenital profound deafness underwent cochlear implant surgery. Preoperative CT and MRI revealed that her inner ears had common-cavity or aplasia-type malformation. The bilateral internal auditory meatus were markedly narrowed. Audiometric examination demonstrated that only slight residual hearing remained in the low-frequency range and that a hearing aid would be of no benefit. Cochlear implantation was performed in her left ear. Because of the abnormal position of the facial nerve, the routine facial recess approach could not be performed. A canal-wall-down mastoidectomy was performed, and multichannel cochlear implant electrodes were inserted by careful drilling of the bony wall of the semicircular canal area. All 22 electrodes were completely inserted into the cavity. The patient can perceive sounds and her hearing ability is progressively improving.

Child, Preschool↗