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Reiss LAJ, Stark G, Nguyen-Huynh AT, Spear KA, Zhang H, Tanaka C, Li H. Morphological correlates of hearing loss after cochlear implantation and electro-acoustic stimulation in a hearing-impaired Guinea pig model. Hear Res 2015; 327:163-74. [PMID: 26087114 DOI: 10.1016/j.heares.2015.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/30/2015] [Accepted: 06/03/2015] [Indexed: 01/25/2023]
Abstract
Hybrid or electro-acoustic stimulation (EAS) cochlear implants (CIs) are designed to provide high-frequency electric hearing together with residual low-frequency acoustic hearing. However, 30-50% of EAS CI recipients lose residual hearing after implantation. The objective of this study was to determine the mechanisms of EAS-induced hearing loss in an animal model with high-frequency hearing loss. Guinea pigs were exposed to 24 h of noise (12-24 kHz at 116 dB) to induce a high-frequency hearing loss. After recovery, two groups of animals were implanted (n = 6 per group), with one group receiving chronic acoustic and electric stimulation for 10 weeks, and the other group receiving no stimulation during this time frame. A third group (n = 6) was not implanted, but received chronic acoustic stimulation. Auditory brainstem responses were recorded biweekly to monitor changes in hearing. The organ of Corti was immunolabeled with phalloidin, anti-CtBP2, and anti-GluR2 to quantify hair cells, ribbons and post-synaptic receptors. The lateral wall was immunolabeled with phalloidin and lectin to quantify stria vascularis capillary diameters. Bimodal or trimodal diameter distributions were observed; the number and location of peaks were objectively determined using the Aikake Information Criterion and Expectation Maximization algorithm. Noise exposure led to immediate hearing loss at 16-32 kHz for all groups. Cochlear implantation led to additional hearing loss at 4-8 kHz; this hearing loss was negatively and positively correlated with minimum and maximum peaks of the bimodal or trimodal distributions of stria vascularis capillary diameters, respectively. After chronic stimulation, no significant group changes in thresholds were seen; however, elevated thresholds at 1 kHz in implanted, stimulated animals were significantly correlated with decreased presynaptic ribbon and postsynaptic receptor counts. Inner and outer hair cell counts did not differ between groups and were not correlated with threshold shifts at any frequency. As in the previous study in a normal-hearing model, stria vascularis capillary changes were associated with immediate hearing loss after implantation, while little to no hair cell loss was observed even in cochlear regions with threshold shifts as large as 40-50 dB. These findings again support a role of lateral wall blood flow changes, rather than hair cell loss, in hearing loss after surgical trauma, and implicate the endocochlear potential as a factor in implantation-induced hearing loss. Further, the analysis of the hair cell ribbons and post-synaptic receptors suggest that delayed hearing loss may be linked to synapse or peripheral nerve loss due to stimulation excitotoxicity or inflammation. Further research is needed to separate these potential mechanisms of delayed hearing loss.
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Affiliation(s)
- Lina A J Reiss
- Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Gemaine Stark
- Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Anh T Nguyen-Huynh
- Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Kayce A Spear
- Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Hongzheng Zhang
- Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Otolaryngology Head & Neck Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, China
| | - Chiemi Tanaka
- Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Honolulu, HI 96816, USA
| | - Hongzhe Li
- Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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Ramos BF, Tsuji RK, Bento RF, Goffi-Gomez MVS, Ramos HF, Samuel PA, Brito R. Hearing preservation using topical dexamethasone alone and associated with hyaluronic acid in cochlear implantation. Acta Otolaryngol 2015; 135:473-7. [PMID: 25719419 DOI: 10.3109/00016489.2014.995831] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CONCLUSION Topical dexamethasone associated with hyaluronic acid in cochlear implant surgery demonstrated a statistically significant difference in the preservation of low-frequency thresholds when compared with topical dexamethasone alone and a control group. Topical dexamethasone alone was not superior in hearing preservation when compared to the control group. OBJECTIVE To compare the effects of topical dexamethasone alone and associated with hyaluronic acid intraoperatively in hearing preservation in cochlear implantation. METHODS Eighteen severely to profoundly hearing-impaired adult patients with measurable hearing were divided into three groups preoperatively: cochlear implantation as a control group (group 1), cochlear implantation using topical dexamethasone intraoperatively (group 2), and cochlear implantation using topical dexamethasone associated with hyaluronic acid intraoperatively (group 3). Preimplant and postimplant low-frequency pure-tone averages (PTAs) were calculated from unaided audiograms at 125, 250, and 500 Hz. RESULTS The mean changes in the low-frequency PTA comparing postoperative against preoperative thresholds were 28.03 ± 6.77 dB in group 1, 30 ± 14.53 dB in group 2, and 7.23 ± 6.12 dB in group 3. There was statistical difference when comparing group 3 with groups 1 and 2 using one-way ANOVA (p = 0.002) followed by Scheffé post hoc test.
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Affiliation(s)
- Bernardo Faria Ramos
- Department of Otolaryngology, University of São Paulo School of Medicine , São Paulo , Brazil
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Yawn R, Hunter JB, Sweeney AD, Bennett ML. Cochlear implantation: a biomechanical prosthesis for hearing loss. F1000PRIME REPORTS 2015; 7:45. [PMID: 26097718 PMCID: PMC4447036 DOI: 10.12703/p7-45] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cochlear implants are a medical prosthesis used to treat sensorineural deafness, and one of the greatest advances in modern medicine. The following article is an overview of cochlear implant technology. The history of cochlear implantation and the development of modern implant technology will be discussed, as well as current surgical techniques. Research regarding expansion of candidacy, hearing preservation cochlear implantation, and implantation for unilateral deafness are described. Lastly, innovative technology is discussed, including the hybrid cochlear implant and the totally implantable cochlear implant.
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Affiliation(s)
- Robert Yawn
- The Otology Group, Department of Otolaryngology-Head and Neck Surgery The Bill Wilkerson Center for Otolaryngology & Communication Sciences 7209 Medical Center East, South Tower 1215 21st Avenue South, Nashville, TN 37232 USA
| | - Jacob B Hunter
- The Otology Group, Department of Otolaryngology-Head and Neck Surgery The Bill Wilkerson Center for Otolaryngology & Communication Sciences 7209 Medical Center East, South Tower 1215 21st Avenue South, Nashville, TN 37232 USA
| | - Alex D Sweeney
- The Otology Group, Department of Otolaryngology-Head and Neck Surgery The Bill Wilkerson Center for Otolaryngology & Communication Sciences 7209 Medical Center East, South Tower 1215 21st Avenue South, Nashville, TN 37232 USA
| | - Marc L Bennett
- The Otology Group, Department of Otolaryngology-Head and Neck Surgery The Bill Wilkerson Center for Otolaryngology & Communication Sciences 7209 Medical Center East, South Tower 1215 21st Avenue South, Nashville, TN 37232 USA
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Deep electrode insertion and sound coding in cochlear implants. Hear Res 2015; 322:14-23. [DOI: 10.1016/j.heares.2014.10.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022]
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Sun CH, Hsu CJ, Chen PR, Wu HP. Residual hearing preservation after cochlear implantation via round window or cochleostomy approach. Laryngoscope 2015; 125:1715-9. [DOI: 10.1002/lary.25122] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Chuan-Hung Sun
- Department of Otolaryngology; Buddhist Tzu Chi General Hospital; Hualien Taiwan
| | - Chuan-Jen Hsu
- Department of Otolaryngology; Taichung Tzuchi General Hospital, The Buddhist Tzuchi Medical Foundation; Taichung Taiwan
- School of Medicine; Tzu Chi University; Hualien Taiwan
| | - Peir-Rong Chen
- Department of Otolaryngology; Buddhist Tzu Chi General Hospital; Hualien Taiwan
- School of Medicine; Tzu Chi University; Hualien Taiwan
| | - Hung-Pin Wu
- Department of Otolaryngology; Taichung Tzuchi General Hospital, The Buddhist Tzuchi Medical Foundation; Taichung Taiwan
- School of Medicine; Tzu Chi University; Hualien Taiwan
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Young Age Is a Positive Prognostic Factor for Residual Hearing Preservation in Conventional Cochlear Implantation. Otol Neurotol 2015; 36:28-33. [DOI: 10.1097/mao.0000000000000586] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zeng FG, Rebscher SJ, Fu QJ, Chen H, Sun X, Yin L, Ping L, Feng H, Yang S, Gong S, Yang B, Kang HY, Gao N, Chi F. Development and evaluation of the Nurotron 26-electrode cochlear implant system. Hear Res 2014; 322:188-99. [PMID: 25281795 DOI: 10.1016/j.heares.2014.09.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/18/2014] [Accepted: 09/03/2014] [Indexed: 11/29/2022]
Abstract
Although the cochlear implant has been widely acknowledged as the most successful neural prosthesis, only a fraction of hearing-impaired people who can potentially benefit from a cochlear implant have actually received one due to its limited awareness, accessibility, and affordability. To help overcome these limitations, a 26-electrode cochlear implant has been developed to receive China's Food and Drug Administration (CFDA) approval in 2011 and Conformité Européenne (CE) Marking in 2012. The present article describes design philosophy, system specification, and technical verification of the Nurotron device, which includes advanced digital signal processing and 4 current sources with multiple amplitude resolutions that not only are compatible with perceptual capability but also allow interleaved or simultaneous stimulation. The article also presents 3-year longitudinal evaluation data from 60 human subjects who have received the Nurotron device. The objective measures show that electrode impedance decreased within the first month of device use, but was stable until a slight increase at the end of two years. The subjective loudness measures show that electric stimulation threshold was stable while the maximal comfort level increased over the 3 years. Mandarin sentence recognition increased from the pre-surgical 0%-correct score to a plateau of about 80% correct with 6-month use of the device. Both indirect and direct comparisons indicate indistinguishable performance differences between the Nurotron system and other commercially available devices. The present 26-electrode cochlear implant has already helped to lower the price of cochlear implantation in China and will likely contribute to increased cochlear implant access and success in the rest of the world. This article is part of a Special Issue entitled <Lasker Award>.
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Affiliation(s)
- Fan-Gang Zeng
- Center for Hearing Research, University of California, Irvine, CA 92697, USA.
| | - Stephen J Rebscher
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA 94143, USA
| | - Qian-Jie Fu
- Department of Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, CA 90095, USA
| | - Hongbin Chen
- Nurotron Biotechnology Inc., Hangzhou, Zhejiang 310011, China
| | - Xiaoan Sun
- Nurotron Biotechnology Inc., Hangzhou, Zhejiang 310011, China
| | - Li Yin
- Nurotron Biotechnology Inc., Hangzhou, Zhejiang 310011, China
| | - Lichuan Ping
- Nurotron Biotechnology Inc., Hangzhou, Zhejiang 310011, China
| | - Haihong Feng
- Shanghai Acoustics Laboratory, Institute of Acoustics, Chinese Academy of Sciences, Shanghai 200032, China
| | - Shiming Yang
- Department of Otolaryngology - Head and Neck Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Shusheng Gong
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital of Capital Medical University, Beijing 100730, China
| | - Beibei Yang
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou 310000, China
| | - Hou-Yong Kang
- Department of Otolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Na Gao
- Department of Otolaryngology - Head and Neck Surgery, The Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Fanglu Chi
- Department of Otolaryngology - Head and Neck Surgery, The Eye and ENT Hospital of Fudan University, Shanghai 200031, China.
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Electroacoustic stimulation: now and into the future. BIOMED RESEARCH INTERNATIONAL 2014; 2014:350504. [PMID: 25276779 PMCID: PMC4168031 DOI: 10.1155/2014/350504] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/04/2014] [Indexed: 12/22/2022]
Abstract
Cochlear implants have provided hearing to hundreds of thousands of profoundly deaf people around the world. Recently, the eligibility criteria for cochlear implantation have been relaxed to include individuals who have some useful residual hearing. These recipients receive inputs from both electric and acoustic stimulation (EAS). Implant recipients who can combine these hearing modalities demonstrate pronounced benefit in speech perception, listening in background noise, and music appreciation over implant recipients that rely on electrical stimulation alone. The mechanisms bestowing this benefit are unknown, but it is likely that interaction of the electric and acoustic signals in the auditory pathway plays a role. Protection of residual hearing both during and following cochlear implantation is critical for EAS. A number of surgical refinements have been implemented to protect residual hearing, and the development of hearing-protective drug and gene therapies is promising for EAS recipients. This review outlines the current field of EAS, with a focus on interactions that are observed between these modalities in animal models. It also outlines current trends in EAS surgery and gives an overview of the drug and gene therapies that are clinically translatable and may one day provide protection of residual hearing for cochlear implant recipients.
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Analysis of intersubject variations in intracochlear and middle ear surface anatomy for cochlear implantation. Otol Neurotol 2014; 34:1675-80. [PMID: 24232065 DOI: 10.1097/mao.0b013e3182a1a7e6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
HYPOTHESIS We hypothesize that surface landmarks surrounding the round window typically used to guide electrode placement during cochlear implantation (CI) exhibit substantial variability with respect to intracochlear anatomy. BACKGROUND Recent publications suggest that both atraumatic electrode insertion and electrode location within the scala tympani can affect auditory performance after CI. However, current techniques for electrode insertion rely on surface landmarks alone for navigation, without actual visualization of intracochlear structures other than what can be seen through a surgically created cochleostomy. In this study, we quantify how well the position of intracochlear anatomy is predicted by surface landmarks surrounding the round window. METHODS Structures representing middle ear surface and intracochlear anatomy were reconstructed in μCT scans of 10 temporal bone specimens. These structures were then reoriented into a normalized coordinate system to facilitate measurement of inter-subject anatomical shape variations. RESULTS Only minor intersubject variations were detected for intracochlear anatomy (maximum deviation, 0.71 mm; standard deviation, 0.21 mm), with greatest differences existing near the hook and apex. Larger intersubject variations in intracochlear structures were detected when considered relative to surface landmarks surrounding the round window (maximum deviation, 0.83 mm; standard deviation, 0.54 mm). CONCLUSION The cochlea and its scala exhibit considerable variability in relation to middle ear surface landmarks. While support for more precise, atraumatic CI electrode insertion techniques is growing in the otologic community, landmark guided insertion techniques have limited precision. Refining the CI insertion process may require the development of image-guidance systems for use in otologic surgery.
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Definition of metrics to evaluate cochlear array insertion forces performed with forceps, insertion tool, or motorized tool in temporal bone specimens. BIOMED RESEARCH INTERNATIONAL 2014; 2014:532570. [PMID: 25126565 PMCID: PMC4122132 DOI: 10.1155/2014/532570] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/17/2014] [Indexed: 11/18/2022]
Abstract
Introduction. In order to achieve a minimal trauma to the inner ear structures during array insertion, it would be suitable to control insertion forces. The aim of this work was to compare the insertion forces of an array insertion into anatomical specimens with three different insertion techniques: with forceps, with a commercial tool, and with a motorized tool. Materials and Methods. Temporal bones have been mounted on a 6-axis force sensor to record insertion forces. Each temporal bone has been inserted, with a lateral wall electrode array, in random order, with each of the 3 techniques. Results. Forceps manual and commercial tool insertions generated multiple jerks during whole length insertion related to fits and starts. On the contrary, insertion force with the motorized tool only rose at the end of the insertion. Overall force momentum was 1.16 ± 0.505 N (mean ± SD, n = 10), 1.337 ± 0.408 N (n = 8), and 1.573 ± 0.764 N (n = 8) for manual insertion with forceps and commercial and motorized tools, respectively. Conclusion. Considering force momentum, no difference between the three techniques was observed. Nevertheless, a more predictable force profile could be observed with the motorized tool with a smoother rise of insertion forces.
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Wanna GB, Noble JH, Carlson ML, Gifford RH, Dietrich MS, Haynes DS, Dawant BM, Labadie RF. Impact of electrode design and surgical approach on scalar location and cochlear implant outcomes. Laryngoscope 2014; 124 Suppl 6:S1-7. [PMID: 24764083 DOI: 10.1002/lary.24728] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/16/2014] [Accepted: 04/21/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Three surgical approaches: cochleostomy (C), round window (RW), and extended round window (ERW); and two electrodes types: lateral wall (LW) and perimodiolar (PM), account for the vast majority of cochlear implantations. The goal of this study was to analyze the relationship between surgical approach and electrode type with final intracochlear position of the electrode array and subsequent hearing outcomes. STUDY DESIGN Comparative longitudinal study. METHODS One hundred postlingually implanted adult patients were enrolled in the study. From the postoperative scan, intracochlear electrode location was determined and using rigid registration, transformed back to the preoperative computed tomography which had intracochlear anatomy (scala tympani and scala vestibuli) specified using a statistical shape model based on 10 microCT scans of human cadaveric cochleae. Likelihood ratio chi-square statistics were used to evaluate for differences in electrode placement with respect to surgical approach (C, RW, ERW) and type of electrode (LW, PM). RESULTS Electrode placement completely within the scala tympani (ST) was more common for LW than were PM designs (89% vs. 58%; P < 0.001). RW and ERW approaches were associated with lower rates of electrode placement outside the ST than was the cochleostomy approach (9%, 16%, and 63%, respectively; P < 0.001). This pattern held true regardless of whether the implant was LW or PM. When examining electrode placement and hearing outcome, those with electrode residing completely within the ST had better consonant-nucleus-consonant word scores than did patients with any number of electrodes located outside the ST (P = 0.045). CONCLUSION These data suggest that RW and ERW approaches and LW electrodes are associated with an increased likelihood of successful ST placement. Furthermore, electrode position entirely within the ST confers superior audiological outcomes. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
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Intracochlear pressure changes due to round window opening: a model experiment. ScientificWorldJournal 2014; 2014:341075. [PMID: 24982942 PMCID: PMC4055591 DOI: 10.1155/2014/341075] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022] Open
Abstract
To preserve residual hearing in cochlea implantation, the electrode design has been refined and an atraumatic insertion of the cochlea electrode has become one aspect of cochlea implant research. The opening of the round window can be assumed to be a contributing factor in an atraumatic concept. The aim of our study was to observe intracochlear pressure changes due to different opening conditions of an artificial round window membrane. The experiments were performed in an artificial cochlea model. A round window was simulated with a polythene foil and a pressure sensor was placed in the helicotrema area to monitor intraluminal pressure changes. Openings of the artificial round window membrane were performed using different ways. Opening the artificial round window mechanically showed a biphasic behaviour of pressure change. Laser openings showed a unidirectional pressure change. The lowest pressure changes were observed when opening the artificial round window membrane using a diode laser. The highest pressure changes were seen when using a needle. The openings with the CO2 laser showed a negative intracochlear pressure and a loss of fluid. In our model experiments, we could prove that the opening of the artificial round window membrane causes various intracochlear pressure changes.
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Nittrouer S, Tarr E, Bolster V, Caldwell-Tarr A, Moberly AC, Lowenstein JH. Low-frequency signals support perceptual organization of implant-simulated speech for adults and children. Int J Audiol 2014; 53:270-84. [PMID: 24456179 PMCID: PMC3954900 DOI: 10.3109/14992027.2013.871649] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Using signals processed to simulate speech received through cochlear implants and low-frequency extended hearing aids, this study examined the proposal that low-frequency signals facilitate the perceptual organization of broader, spectrally degraded signals. DESIGN In two experiments, words and sentences were presented in diotic and dichotic configurations as four-channel noise-vocoded signals (VOC-only), and as those signals combined with the acoustic signal below 0.25 kHz (LOW-plus). Dependent measures were percent correct recognition, and the difference between scores for the two processing conditions given as proportions of recognition scores for VOC-only. The influence of linguistic context was also examined. STUDY SAMPLE Participants had normal hearing. In all, 40 adults, 40 seven-year-olds, and 20 five-year-olds participated. RESULTS Participants of all ages showed benefits of adding the low-frequency signal. The effect was greater for sentences than words, but no effect of diotic versus dichotic presentation was found. The influence of linguistic context was similar across age groups, and did not contribute to the low-frequency effect. Listeners who had poorer VOC-only scores showed greater low-frequency effects. CONCLUSION The benefit of adding a low-frequency signal to a broader, spectrally degraded signal derives in some part from its facilitative influence on perceptual organization of the sensory input.
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Affiliation(s)
- Susan Nittrouer
- Department of Otolaryngology, The Ohio State University , Columbus , USA
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Cochlear implantation with hearing preservation yields significant benefit for speech recognition in complex listening environments. Ear Hear 2014; 34:413-25. [PMID: 23446225 DOI: 10.1097/aud.0b013e31827e8163] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the benefit of having preserved acoustic hearing in the implanted ear for speech recognition in complex listening environments. DESIGN The present study included a within-subjects, repeated-measures design including 21 English-speaking and 17 Polish-speaking cochlear implant (CI) recipients with preserved acoustic hearing in the implanted ear. The patients were implanted with electrodes that varied in insertion depth from 10 to 31 mm. Mean preoperative low-frequency thresholds (average of 125, 250, and 500 Hz) in the implanted ear were 39.3 and 23.4 dB HL for the English- and Polish-speaking participants, respectively. In one condition, speech perception was assessed in an eight-loudspeaker environment in which the speech signals were presented from one loudspeaker and restaurant noise was presented from all loudspeakers. In another condition, the signals were presented in a simulation of a reverberant environment with a reverberation time of 0.6 sec. The response measures included speech reception thresholds (SRTs) and percent correct sentence understanding for two test conditions: CI plus low-frequency hearing in the contralateral ear (bimodal condition) and CI plus low-frequency hearing in both ears (best-aided condition). A subset of six English-speaking listeners were also assessed on measures of interaural time difference thresholds for a 250-Hz signal. RESULTS Small, but significant, improvements in performance (1.7-2.1 dB and 6-10 percentage points) were found for the best-aided condition versus the bimodal condition. Postoperative thresholds in the implanted ear were correlated with the degree of electric and acoustic stimulation (EAS) benefit for speech recognition in diffuse noise. There was no reliable relationship among measures of audiometric threshold in the implanted ear nor elevation in threshold after surgery and improvement in speech understanding in reverberation. There was a significant correlation between interaural time difference threshold at 250 Hz and EAS-related benefit for the adaptive speech reception threshold. CONCLUSIONS The findings of this study suggest that (1) preserved low-frequency hearing improves speech understanding for CI recipients, (2) testing in complex listening environments, in which binaural timing cues differ for signal and noise, may best demonstrate the value of having two ears with low-frequency acoustic hearing, and (3) preservation of binaural timing cues, although poorer than observed for individuals with normal hearing, is possible after unilateral cochlear implantation with hearing preservation and is associated with EAS benefit. The results of this study demonstrate significant communicative benefit for hearing preservation in the implanted ear and provide support for the expansion of CI criteria to include individuals with low-frequency thresholds in even the normal to near-normal range.
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Labadie RF, Balachandran R, Noble JH, Blachon GS, Mitchell JE, Reda FA, Dawant BM, Fitzpatrick JM. Minimally invasive image-guided cochlear implantation surgery: first report of clinical implementation. Laryngoscope 2014; 124:1915-22. [PMID: 24272427 DOI: 10.1002/lary.24520] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 10/23/2013] [Accepted: 11/11/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Minimally invasive image-guided approach to cochlear implantation (CI) involves drilling a narrow, linear tunnel to the cochlea. Reported herein is the first clinical implementation of this approach. STUDY DESIGN Prospective cohort study. METHODS On preoperative computed tomography (CT), a safe linear trajectory through the facial recess targeting the scala tympani was planned. Intraoperatively, fiducial markers were bone-implanted, a second CT was acquired, and the trajectory was transferred from preoperative to intraoperative CT. A customized microstereotactic frame was rapidly designed and constructed to constrain a surgical drill along the desired trajectory. Following sterilization, the frame was employed to drill the tunnel to the middle ear. After lifting a tympanomeatal flap and performing a cochleostomy, the electrode array was threaded through the drilled tunnel and into the cochlea. RESULTS Eight of nine patients were successfully implanted using the proposed approach with six insertions completely within the scala tympani. Traditional mastoidectomy was performed on one patient following difficulty threading the electrode array via the narrow tunnel. Other difficulties encountered included use of the backup implant when an electrode was dislodged during threading via the tunnel, tip fold-over, and facial nerve paresis (House-Brackmann II/VI at 12 months) secondary to heat during drilling. The average time of intervention was 182 ± 36 minutes. CONCLUSIONS Minimally invasive image-guided CI is clinically achievable. Further clinical study is necessary to address technological difficulties during drilling and insertion, and to assess potential benefits including decreased time of intervention, standardization of surgical intervention, and decreased tissue dissection potentially leading to shorter recovery and earlier implant activation.
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Affiliation(s)
- Robert F Labadie
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, U.S.A.; Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
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The Effects of Residual Hearing in Traditional Cochlear Implant Candidates After Implantation With a Conventional Electrode. Otol Neurotol 2013; 34:516-21. [DOI: 10.1097/mao.0b013e3182785210] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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170
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Távora-Vieira D, Rodrigues S. The use of Nucleus CI422 in a ski-slope high-frequency hearing loss and chronic external ear pathology: a case study. Cochlear Implants Int 2013; 14:291-4. [PMID: 23485411 DOI: 10.1179/1754762812y.0000000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE AND IMPORTANCE This case report illustrates the ongoing extending criteria for cochlear implantation (CI). It reinforces the statement that patients who do not fulfill the standard criteria for CI should be carefully considered on an individual basis. CLINICAL PRESENTATION The patient on this report presented with a ski-slope high-frequency hearing loss and chronic external ear canal infections. The latter precluded the consistent use of hearing aids with moulds. His speech discrimination in quiet and in noise was poor and his hearing loss was interfering with his ability to work. INTERVENTION After years of frustration, this patient decided to risk losing his low-frequency residual hearing and was implanted with the new Nucleus CI422 (Cochlear Ltd). CONCLUSION Hearing preservation was achieved and he gained a remarkable improvement in his hearing performance. It is thought that his outcomes are the result of the combination of hearing presentation surgery, electrode design, and intensive auditory training.
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Affiliation(s)
- Dayse Távora-Vieira
- University of Western Australia and Medical Audiology Services, Perth, Australia
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171
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Kang BJ, Kim AH. Comparison of Cochlear Implant Performance after Round Window Electrode Insertion Compared with Traditional Cochleostomy. Otolaryngol Head Neck Surg 2013; 148:822-6. [DOI: 10.1177/0194599813479576] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To compare speech perception after undergoing round window (RW) electrode insertion with those who underwent traditional cochleostomy (C) cochlear implant (CI) surgery. Study Design Case series with chart review. Setting Academic cochlear implant center. Subjects Patients who met CI criteria with favorable intraoperative RW anatomy who underwent RW CI electrode insertion. Patients who underwent traditional C surgery were matched for age, duration of deafness, and preoperative hearing. Methods Postoperative speech performance using the consonant-nucleus-consonant (CNC) test, Northwestern University Children’s Perception of Speech (NUCHIPS), and Hearing in Noise Test (HINT) between 3 and 48 months after CI. Results A total of 84 patients underwent RW insertion between 2004 and 2011. Of these, 55 had pre- and postoperative speech perception data for analysis. Average age of implantation ranged from 2.4 to 87.3 years (mean ± SD, 42.1 ± 24.2 years) for RW patients. Average age of implantation for matched traditional C patients ranged from 2.3 to 85.6 years (mean ± SD, 43.3 ± 25.0 years). No significant differences in postoperative CI speech perception scores were noted between the RW and C groups at 12 months post-CI (RW group, 55.28% ± 23.26% vs C group, 53.19% ± 24.14%; P = .70). Conclusion Our study found that patients with favorable RW anatomy who underwent RW CI electrode insertion demonstrated comparable speech perception compared with the traditional cochleostomy insertion group.
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Affiliation(s)
| | - Ana H. Kim
- New York Eye and Ear Infirmary, New York, New York, USA
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173
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Eshraghi AA, Gupta C, Van De Water TR, Bohorquez JE, Garnham C, Bas E, Talamo VM. Molecular mechanisms involved in cochlear implantation trauma and the protection of hearing and auditory sensory cells by inhibition of c-jun-N-terminal kinase signaling. Laryngoscope 2013; 123 Suppl 1:S1-14. [DOI: 10.1002/lary.23902] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 01/20/2023]
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Szyfter W, Wróbel M, Karlik M, Borucki L, Stieler M, Gibasiewicz R, Gawęcki W, Sekula A. Observations on hearing preservation in patients with hybrid-L electrode implanted at Poznan University of Medical Sciences in Poland. Eur Arch Otorhinolaryngol 2012; 270:2637-40. [PMID: 23223855 PMCID: PMC3758514 DOI: 10.1007/s00405-012-2263-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 11/02/2012] [Indexed: 11/10/2022]
Abstract
The objective of the paper is to evaluate the hearing preservation rate in patients with high frequency hearing loss, treated with Cochlear Nucleus Freedom Hybrid-L implant in the Otolaryngology Department, Poznan University of Medical Sciences in Poland. Study was designed as the retrospective analysis. Twenty-one patients were operated and implanted with Nucleus Freedom Hybrid-L implant. Pure tone thresholds were recorded prior to the surgery and at the time of speech processor switch-on. Patients were subdivided into two groups with respect to their PTA thresholds: group A—classic indications and group B—extended indications. Average PTA for three frequencies (250, 500, 1,000 Hz) were calculated for each patient pre- and postoperatively. In the group of 21 implanted patients in 17 cases we have observed preservation of hearing (12 patients from group A, 5 patients from group B) with a mean value of 13.1 dB. In 4 out of 21 patients deafness on the implanted ear was noted. Our results clearly indicate that with standard procedure hearing preservation can be obtained in majority of patients. Hearing preservation was not achieved in 19 %, but owing to design of the electrode of the Cochlear Nucleus Hybrid-L that enables to work as CI platform alone, in patients who lost their hearing after surgery re-implantations were not required. This proves that EAS is a safe and reliable method to help patients with specific type of hearing loss.
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Affiliation(s)
- Witold Szyfter
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, Ul. Przybyszewskiego 49, 60-355 Poznan, Poland
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175
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Reiss LAJ, Turner CW, Karsten SA, Erenberg SR, Taylor J, Gantz BJ. Consonant recognition as a function of the number of stimulation channels in the Hybrid short-electrode cochlear implant. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2012; 132:3406-3417. [PMID: 23145621 PMCID: PMC3505213 DOI: 10.1121/1.4757735] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 09/18/2012] [Accepted: 09/21/2012] [Indexed: 06/01/2023]
Abstract
Consonant recognition was measured as a function of the number of stimulation channels for Hybrid short-electrode cochlear implant (CI) users, long-electrode CI users, and normal-hearing (NH) listeners in quiet and background noise. Short-electrode CI subjects were tested with 1-6 channels allocated to a frequency range of 1063-7938 Hz. Long-electrode CI subjects were tested with 1-6, 8, or 22 channels allocated to 188-7938 Hz, or 1-6 or 15 channels from the basal 15 electrodes allocated to 1063-7938 Hz. NH listeners were tested with simulations of each CI group/condition. Despite differences in intracochlear electrode spacing for equivalent channel conditions, all CI subject groups performed similarly at each channel condition and improved up to at least four channels in quiet and noise. All CI subject groups underperformed relative to NH subjects. These preliminary findings suggest that the limited channel benefit seen for CI users may not be due solely to increases in channel interactions as a function of electrode density. Other factors such as pre-operative patient history, location of stimulation in the base versus apex, or a limit on the number of electric channels that can be processed cognitively, may also interact with the effects of electrode contact spacing along the cochlea.
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Affiliation(s)
- Lina A J Reiss
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa 52242, USA.
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176
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Kratchman LB, Schurzig D, McRackan TR, Balachandran R, Noble JH, Webster RJ, Labadie RF. A manually operated, advance off-stylet insertion tool for minimally invasive cochlear implantation surgery. IEEE Trans Biomed Eng 2012; 59:2792-800. [PMID: 22851233 DOI: 10.1109/tbme.2012.2210220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current technique for cochlear implantation (CI) surgery requires a mastoidectomy to gain access to the cochlea for electrode array insertion. It has been shown that microstereotactic frames can enable an image-guided, minimally invasive approach to CI surgery called percutaneous cochlear implantation (PCI) that uses a single drill hole for electrode array insertion, avoiding a more invasive mastoidectomy. Current clinical methods for electrode array insertion are not compatible with PCI surgery because they require a mastoidectomy to access the cochlea; thus, we have developed a manually operated electrode array insertion tool that can be deployed through a PCI drill hole. The tool can be adjusted using a preoperative CT scan for accurate execution of the advance off-stylet (AOS) insertion technique and requires less skill to operate than is currently required to implant electrode arrays. We performed three cadaver insertion experiments using the AOS technique and determined that all insertions were successful using CT and microdissection.
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Affiliation(s)
- Louis B Kratchman
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA.
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de Carvalho GM, Valente JPP, Duarte ASM, Muranaka ÉB, Guimarães AC, Soki MN, Bianchini WA, Castilho AM, Paschoal JR. Electro acoustic stimulation of the auditory system: UNICAMP's surgical approach. Braz J Otorhinolaryngol 2012; 78:43-50. [PMID: 22392237 PMCID: PMC9443873 DOI: 10.1590/s1808-86942012000100007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 12/04/2011] [Indexed: 11/22/2022] Open
Abstract
A new era has arrived in auditory rehabilitation with the introduction of new technologies such as electroacoustic stimulation (EAS). EAS is indicated for patients with residual hearing at low frequencies and severe or profound hearing loss at high frequencies. These patients have no indication for conventional cochlear implant and have difficulties in adapting to individual sound amplification devices. Preservation of hearing is vital in this process; the surgical technique must be based on this concept. Objectives To present the cochlear implant surgical technique with MED-EL Mand FlexEAS to preserve hearing in patients with hearing loss at high frequencies and to maintain low frequency hearing. We are the first institution to carry out this treatment in Brazil. Methods A case report of the surgical technique carried out in four patients; the procedure was carried out by the cochlear implant group of a specialized clinical hospital. Results The procedures were successful and uneventful. Conclusion We described the technique used at our institution for implants using EAS; the surgical technique is complex and includes steps for preservation of hearing.
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