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PubMed1999

The middle ear bioelectronic microphone for a totally implantable cochlear hearing device for profound and total hearing loss.

BACKGROUND: A bioelectronic middle ear microphone (BMEM) has been developed in a laboratory bench model and successfully tested in fresh human temporal bones. A transducer actually has been bench-tested in our laboratory; it was implanted in chronic animal experiments (cats) as well as in humans for a period of 1 year as a driver of a semi-implantable electromagnetic middle ear hearing device (IDE, FDA approved). This BMEM is the result of the use of this same electromagnetic transducer used in a reverse mode. The applicability of the BMEM is for the development of a totally implantable cochlear implant using the eardrum as a diaphragm that transmits vibrations to a magnet cemented to the ossicles. This BMEM is to be powered by a lithium-ion implantable, rechargeable battery. MATERIALS AND METHODS: To test the efficacy of this BMEM, the experiment was divided into two parts: (1) bench model, and (2) fresh human temporal bones, using an air-core electromagnetic (EM) coil and a ferrite core EM coil for comparison. RESULTS: In the bench model, the average displacement at 3 kHz was 0.95 microns (peak) for 4 V p-p and 1.65 microns (peak) for 10 V p-p. At 5 kHz, the measurements were somewhat higher. In fresh human temporal bones, with sound source in the ear canal (60 dB HL and 90 dB HL), the result was better with the magnet implanted on the head of the malleus with the incus removed. The ferrite core EM coil with the magnet implanted on the malleus with the incus removed was compared with the air-core EM coil. At 60 dB HL, the ferrite core EM coil yielded more than four times the amplitude of the EM coil. At 90 dB HL, the ferrite core EM coil produced more than five times the amplitude compared with the air-core coil. CONCLUSION: This BMEM using an EM ferrite coil and a permanent magnet on the head of the malleus is more efficient when compared with an EM air-core coil. This BMEM may be applicable to the construction of a totally implantable cochlear implant. Further research is necessary to integrate this BMEM with the other components of the design concept of the totally implantable cochlear implant.

Animals↗
PubMed2004

Better place-coding of the fundamental frequency in cochlear implants.

In current cochlear implant systems, the fundamental frequency F0 of a complex sound is encoded by temporal fluctuations in the envelope of the electrical signals presented on the electrodes. In normal hearing, the lower harmonics of a complex sound are resolved, in contrast with a cochlear implant system. In the present study, it is investigated whether "place-coding" of the first harmonic improves the ability of an implantee to discriminate complex sounds with different fundamental frequencies. Therefore, a new filter bank was constructed, for which the first harmonic is always resolved in two adjacent filters, and the balance between both filter outputs is directly related to the frequency of the first harmonic. The new filter bank was compared with a filter bank that is typically used in clinical processors, both with and without the presence of temporal cues in the stimuli. Four users of the LAURA cochlear implant participated in a pitch discrimination task to determine detection thresholds for F0 differences. The results show that these thresholds decrease noticeably for the new filter bank, if no temporal cues are present in the stimuli. If temporal cues are included, the differences between the results for both filter banks become smaller, but a clear advantage is still observed for the new filter bank. This demonstrates the feasibility of using place-coding for the fundamental frequency.

Adult↗
PubMed1992

The use of static and dynamic vowel cues by multichannel cochlear implant users.

Multichannel cochlear implant users vary greatly in their word-recognition abilities. This study examined whether their word recognition was related to the use of either highly dynamic or relatively steady-state vowel cues contained in /bVb/ and /wVb/ syllables. Nine conditions were created containing different combinations of formant transition, steady-state, and duration cues. Because processor strategies differ, the ability to perceive static and dynamic information may depend on the type of cochlear implant used. Ten Nucleus and ten Ineraid subjects participated, along with 12 normal-hearing control subjects. Vowel identification did not differ between implanted groups, but both were significantly poorer at identifying vowels than the normal-hearing group. Vowel identification was best when at least two kinds of cues were available. Using only one type of cue, performance was better with excised vowels containing steady-state formants than in "vowelless" syllables, where the center vocalic portion was deleted and transitions were joined. In the latter syllable type, Nucleus subjects identified vowels significantly better when /b/ was the initial consonant; the other two groups were not affected by specific consonantal context. Cochlear implant subjects' word-recognition was positively correlated with the use of dynamic vowel cues, but not with steady-state cues.

Adult↗
PubMed2004

[Results with the Contour cochlear implant in patients with cochlear otosclerosis].

BACKGROUND: Results after cochlear implant surgery may be complicated by postoperative facial nerve stimulation. Aim of the study presented was to evaluate postoperative results in implanting the straight Nucleus electrode array and the preformed Contour array in patients with deafness due to cochlear otosclerosis. METHODS: A retrospective analysis of intra- and postoperative reports of all patients with cochlear otosclerosis was carried out. Results with the Nucleus straight electrode array and the Contour array were compared with regard to postoperative facial nerve stimulation. RESULTS AND CONCLUSION: None of the Contour patients (n = 7) presented with postoperative facial nerve stimulation. This is in contrast to the majority (4 of 6) of patients being implanted with the straight electrode array. Our results indicate that the use of the Contour array is advantageous in patients being at risk for facial nerve stimulation. In addition intraoperative reports suggest a more reliable insertion of the Contour electrode array in cochlear otosclerosis with partial obliteration.

Cochlear Implants↗
PubMed1998

Speech discrimination scores of postlingually deaf adults implanted with the Combi 40 cochlear implant.

The aim of the study was to assess the speech discrimination ability of postlingually deaf adults implanted with the Combi 40 cochlear implant and to compare the results with the postoperative data published for other devices. The postoperative open and closed set speech perception performance of 21 consecutive patients was tested using a standardized test battery comprising a number, monosyllable, sentence, consonant and vowel discrimination test as well as a rhyme test in the sound only condition. Mean values achieved for each test 1, 6 and 12 months after "switch on" were evaluated. The results demonstrate that all patients have a substantial benefit from their implant and show a continuous improvement in their speech perception abilities with increased device experience. The mean percentages of correct answers after 12 months were 93.4 for numbers, 44.6 for monosyllables, 78.5 for sentences, 67.6 for the rhyme test, 59.8 for vowel, and 67.3 for consonant discrimination. Preoperatively, the mean discrimination score for monosyllables was 0%. The speech discrimination scores of our patients were similar or higher than described for similar patient groups implanted with other devices. The high stimulation rate of the implant system using the continuous interleaved speech processing strategy as well as a deep atraumatic electrode insertion into the apicalmost regions of the scala tympani may be the reason for good performance.

Adult↗
PubMed2005

Comparison of continuous interleaved sampling and simultaneous analog stimulation speech processing strategies in newly implanted adults with a Clarion 1.2 cochlear implant.

OBJECTIVE: This study consisted of a within-subjects comparison of speech recognition and patient preference when subjects used two different cochlear implant speech processing strategies with a Clarion 1.2 (enhanced bipolar) device: Simultaneous Analog Stimulation (SAS), and Continuous Interleaved Sampling (CIS). These two strategies used two different electrode configurations: the SAS strategy used bipolar stimulation, whereas the CIS strategy used monopolar stimulation. STUDY DESIGN: This was a multicenter study that used a within-subjects balanced crossover design. Experience with the two strategies was replicated in each subject using an ABAB design. Order of strategy use was balanced across all subjects. SETTING: The study was carried out at several cochlear implant centers affiliated with tertiary medical centers. PATIENTS: Subjects consisted of 25 postlingually deafened adults who received a Clarion cochlear implant. INTERVENTIONS: Total involvement by each subject was 14 weeks. Speech perception testing and sound quality assessments were performed after use with each strategy. MAIN OUTCOME MEASURES: Primary outcome measures include speech perception data and patient responses to questionnaires regarding speech and sound quality. RESULTS: Analyses revealed that performance did not differ significantly by the strategy encountered first as relative to the strategy encountered second and that the order in which a strategy was used did not appear to affect subjects' eventual preference for a particular strategy. Although speech recognition scores tended to be higher for CIS for most of the test measures at most of the test intervals, the analysis of variance to evaluate differences in strategy did not reveal a significant effect of strategy. Further analysis of scores obtained at the replication interval, however, revealed that scores obtained with CIS were significantly higher than scores obtained with SAS on the Hearing in Noise Test sentences in quiet and noise. In addition, significantly more patients indicated a final preference for the CIS strategy than for the SAS strategy. Importantly, both the analysis evaluating order and the analysis evaluating strategy revealed significant effects of evaluation period, indicating that time/experience with the implant had a significant effect on scores for each strategy, regardless of the order in which it was used (first or second). CONCLUSIONS: This study demonstrates that important learning occurs during the first several weeks of cochlear implant use, making it difficult to adequately compare performance with different speech processing strategies. However, the finding that patients often prefer the strategy they understand speech the best with supports the clinical practice of letting adult patients select their preferred strategy without formally evaluating speech perception with each available strategy.

Aged↗
PubMed2004

Auditory brainstem implant as a salvage treatment after unsuccessful cochlear implantation.

OBJECTIVE: The present article investigates on an individual basis the performance achieved with the auditory brainstem implant in patients who had been treated unsuccessfully with a cochlear implant. STUDY DESIGN: An intrasubject comparison between results achieved with the cochlear implant and the auditory brainstem implant is reported. SETTING: Tertiary referral care. PATIENTS: Five subjects were fitted with an auditory brainstem implant in our department because of the poor results achieved with cochlear implants. Two were children, one with bilateral cochlear nerve aplasia and one suffering from auditory neuropathy. Three were adults with complete cochlear ossification. INTERVENTION: A retrosigmoid approach was used in all subjects. Electrically evoked auditory brainstem responses and neural response telemetry were used to monitor electrode positioning. RESULTS: No complications were observed due to implantation surgery or related to activation or long-term use of the auditory brainstem implant. Auditory sensations were induced in all patients with varying numbers of electrodes (from 9-16). In all three adults, the cochlear implant did not allow either word/sentence discrimination or speech tracking, whereas the auditory brainstem implant permitted discrimination of two- or three-syllable words with scores from 85 to 100%. In the two adults with a follow-up of 5 and 6 months after auditory brainstem implant activation, the open-set sentence recognition scores (auditory-only mode) were 70% and 100%, respectively, and the speech-tracking scores were 27 and 40 words/min, respectively. One patient with a follow-up of only 3 months scored 0% in both sentence recognition and speech tracking. The two children who had achieved no hearing ability with the cochlear implant were already able to detect sounds and words as early as 2 months after activation of the auditory brainstem implant and are showing progressive improvement in their performance. CONCLUSION: Auditory brainstem implantation may be a very powerful rehabilitative treatment after cochlear implant failure. The possibility of using the auditory brainstem implant as first-choice therapy in some categories of deaf patients (e.g., subjects with auditory neuropathy or cochlear ossification) who are currently treated with cochlear implantation is discussed.

Adult↗
PubMed2005

MED-EL Combi40+ cochlear implantation in adults.

OBJECTIVE/HYPOTHESIS: Cochlear implantation is currently the treatment of choice for severe to profound sensorineural hearing loss. The MED-EL Combi40+ (Innsbruck, Austria) cochlear implant system was approved for use in the United States in 2001. This device employs a 31-mm-long electrode array, ceramic case, and continuous interleaved sampling with Hilbert transformation for envelope extraction. A single institution's experience with the Combi40+ implant in adult patients was reviewed. STUDY DESIGN: Retrospective chart review. METHODS: Medical-surgical and audiological data were collected from 112 patients who received a MED-EL Combi40+ cochlear implant between December 1998 and April 2004. RESULTS: The rate of surgical complications and speech perception testing results compared favorably with those of other cochlear implant systems. For postlingually deafened adults, mean CNC word, HINTQ, CUNY, and HINT + 10 dB signal-to-noise ratio scores after 1 year of implant usage were 54%, 87%, 96%, and 64%, respectively. Prelingually deafened adults also derived significant benefit, but plateau performance for these patients was well below that for patients with later onset of deafness and significant variability was seen in this group. Repeat implantation for suspected device malfunction was undertaken in seven cases (6% of devices) (mean duration of use, 28 +/- 12 mo) with ultimate resolution of the presenting problem. CONCLUSION: The study results support the safety and efficacy of cochlear implantation with the MED-EL Combi40+ cochlear implant system.

Adolescent↗
PubMed2000

[Rehabilitation and assessment of aural-oral speech development in children with cochlear implants].

Updated models of cochlear implants provide good speech audibility and thus complete rehabilitation of children who have lost hearing after learning speech. All the children who lost hearing before learning speech can hear sounds of normal loudness and orient in sound media by means of cochlear implant. However, they need long-term audio-vocal rehabilitation the results of which depend on the age of the child's operation and hi(her) individual traits. Cochlear implants in children aged under 3 years are most perspective. Russian language methodology including 7 tests and 2 questionnaires is described. It is intended for assessment of audio-vocal development in children with cochlear implants and results of audio-vocal rehabilitation as well as of effectiveness of using cochlear implant in children over 2 years of age. Establishment of centers for cochlear implantation and introduction of cochlear implantation state program are recommended.

Age Factors↗
PubMedDate not supplied

Pediatric and adult cochlear implantation.

The frequency of cochlear implantation has increased tremendously over the past decade. Cochlear implantation is often performed as an outpatient procedure and is considered an acceptable treatment for severe to profound sensorineural hearing loss in patients who are refractory to conventional hearing augmentation. Imaging plays an important part in the work-up of cochlear implant candidates, and an understanding of imaging evaluation procedures is essential. The radiologist must be familiar with imaging findings that contraindicate implantation (absence of the cochlea or cochlear nerve) and with those that could significantly alter surgery (facial nerve dehiscence, cochlear ossification). It is also imperative to be familiar with the growing number of imaging options (particularly magnetic resonance [MR] imaging pulse sequences) to optimize evaluation of cochlear implant candidates. Imaging choices will be substantially influenced by the manufacturer of the computed tomographic scanner or MR imager. Radiologists will assume an expanding role in evaluating affected patients as the frequency of cochlear implantation continues to increase.

Adult↗
PubMed1991

Audiological and medical considerations for children with cochlear implants.

Recent advancements in technology have resulted in the development of implantable devices--cochlear implants--designed to maximize the sensation of hearing in the hearing-impaired population. For children who meet the numerous preselection criteria, the cochlear implant can be effective and beneficial. The implants must be inserted surgically, which involves placing an electrode array in the cochlea and attaching the receiver/stimulator to the skull. The child can usually be discharged from the hospital by the third postoperative day. The external device is fitted and initially stimulated about four to six weeks after surgery. During initial stimulation, all 22 electrodes are individually adjusted, or mapped. The electrodes are readjusted and remapped at frequent intervals during the initial months following stimulation. These follow-up visits also allow the audiologist to evaluate the child's progress in the home and educational environments.

Aftercare↗
PubMed1992

Cochlear implants in children, adolescents, and prelinguistically deafened adults: speech perception.

A group of 10 children, adolescents, and prelinguistically deafened adults were implanted with the 22-electrode cochlear implant (Cochlear Pty Ltd) at the University of Melbourne Cochlear Implant Clinic and have used the prosthesis for periods from 12 to 65 months. Postoperative performance on the majority of closed-set speech perception tests was significantly greater than chance, and significantly better than preoperative performance for all of the patients. Five of the children have achieved substantial scores on open-set speech tests using hearing without lipreading. Phoneme scores in monosyllabic words ranged from 30% to 72%; word scores in sentences ranged from 26% to 74%. Four of these 5 children were implanted during preadolescence (aged 5:5 to 10:2 years) and the fifth, who had a progressive loss, was implanted during adolescence (aged 14:8 years). The duration of profound deafness before implantation varied from 2 to 8 years. Improvements were also noted over postoperative data collection times for the younger children. The remaining 5 patients who did not demonstrate open-set recognition were implanted after a longer duration of profound deafness (aged 13:11 to 20:1 years). The results are discussed with reference to variables that may affect implant performance, such as age at onset of loss, duration of profound loss, age at implantation, and duration of implantation. They are compared with results for similar groups of children using hearing aids and cochlear implants.

Adolescent↗
PubMed1989

A complex case of cochlear implant electrode placement.

Cochlear implantation is becoming an increasingly accepted rehabilitative procedure for post lingually deafened adults. The testing, evaluation, and surgery have become standardized procedures. In this case results of two different promontory tests were contradictory. A constant voltage stimulation test was negative, while a later constant current stimulation test indicated good residual function. The CT scan accurately predicted the location of the round window remanent. In order to gain access to the cochlea, a partial labyrinthectomy was performed. Successful implantation was ultimately achieved. This implies that a previous labyrinthectomy may not be an absolute contraindication to cochlear implantation.

Adult↗
PubMed2006

Bilateral cochlear implants in children: localization acuity measured with minimum audible angle.

OBJECTIVE: To evaluate sound localization acuity in a group of children who received bilateral (BI) cochlear implants in sequential procedures and to determine the extent to which BI auditory experience affects sound localization acuity. In addition, to investigate the extent to which a hearing aid in the nonimplanted ear can also provide benefits on this task. DESIGN: Two groups of children participated, 13 with BI cochlear implants (cochlear implant + cochlear implant), ranging in age from 3 to 16 yrs, and six with a hearing aid in the nonimplanted ear (cochlear implant + hearing aid), ages 4 to 14 yrs. Testing was conducted in large sound-treated booths with loudspeakers positioned on a horizontal arc with a radius of 1.5 m. Stimuli were spondaic words recorded with a male voice. Stimulus levels typically averaged 60 dB SPL and were randomly roved between 56 and 64 dB SPL (+/-4 dB rove); in a few instances, levels were held fixed (60 dB SPL). Testing was conducted by using a "listening game" platform via computerized interactive software, and the ability of each child to discriminate sounds presented to the right or left was measured for loudspeakers subtending various angular separations. Minimum audible angle thresholds were measured in the BI (cochlear implant + cochlear implant or cochlear implant + hearing aid) listening mode and under monaural conditions. RESULTS: Approximately 70% (9/13) of children in the cochlear implant + cochlear implant group discriminated left/right for source separations of <or=20 degrees , and, of those, 77% (7/9) performed better when listening bilaterally than with either cochlear implant alone. Several children were also able to perform the task when using a single cochlear implant, under some conditions. Minimum audible angle thresholds were better in the first cochlear implant than the second cochlear implant listening mode for nearly all (8/9) subjects. Repeated testing of a few individual subjects over a 2-yr period suggests that robust improvements in performance occurred with increased auditory experience. Children who wore hearing aids in the nonimplanted ear were at times also able to perform the task. Average group performance was worse than that of the children with BI cochlear implants when both ears were activated (cochlear implant + hearing aid versus cochlear implant + cochlear implant) but not significantly different when listening with a single cochlear implant. CONCLUSIONS: Children with sequential BI cochlear implants represent a unique population of individuals who have undergone variable amounts of auditory deprivation in each ear. Our findings suggest that many but not all of these children perform better on measures of localization acuity with two cochlear implants compared with one and are better at the task than children using the cochlear implant + hearing aid. These results must be interpreted with caution, because benefits on other tasks as well as the long-term benefits of BI cochlear implants are yet to be fully understood. The factors that might contribute to such benefits must be carefully evaluated in large populations of children using a variety of measures.

Adolescent↗
PubMed1996

Cochlear implant mechanical failures.

Cochlear implants have proven to be an effective treatment for profoundly deafened individuals. Unfortunately, like most mechanical devices, these implants occasionally cease to function. The rate at which the cochlear implant fails, however, does not appear to be the same in adults and children. The failure rate for children far exceeds that observed in adults. The overall failure rate reported by Cochlear Corporation notes that whereas only 3% of the adults have had this type of problem, 9% of the children have had failed internal receivers. This research reports on the experiences of a large implant facility in the Northeast. The clinical presentation and the evaluation of children suspected of having an implant failure are reviewed. The mechanical causes for failures are analyzed. Intraoperative findings and results of reimplantation surgery are presented. The possible causes for the increased incidence of failure in children are discussed.

Age Factors↗
PubMed1994

Communication strategies of adult cochlear implant candidates.

Adult cochlear implant candidates' abilities to cope with communication breakdown were assessed using the Communication Strategies Task (CST). Forty adult cochlear implant candidates with acquired hearing losses and 10 adults with normal hearing served as subjects. Appropriateness of responses to the CST were rated by 10 certified speech-language pathologists and audiologists. Seventy-six percent of the subjects demonstrated difficulty identifying onset or resolution of communication breakdown, communicators' feelings, factors contributing to communication breakdown, and appropriate repair strategies. The responses of individuals with sudden hearing losses did not differ significantly from the responses of individuals with progressive hearing losses. Response patterns did not correlate with the age of onset of the hearing loss, duration of deafness, age at the time of evaluation, or educational background. The results of this study suggest that ability to cope with communication breakdown must be evaluated on an individual basis.

Adaptation, Psychological↗