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Panario J, Bester C, O'Leary S. Predicting Postoperative Speech Perception and Audiometric Thresholds Using Intracochlear Electrocochleography in Cochlear Implant Recipients. Ear Hear 2024:00003446-990000000-00289. [PMID: 38816899 DOI: 10.1097/aud.0000000000001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Electrocochleography (ECochG) appears to offer the most accurate prediction of post-cochlear implant hearing outcomes. This may be related to its capacity to interrogate the health of underlying cochlear tissue. The four major components of ECochG (cochlear microphonic [CM], summating potential [SP], compound action potential [CAP], and auditory nerve neurophonic [ANN]) are generated by different cochlear tissue components. Analyzing characteristics of these components can reveal the state of hair and neural cell in a cochlea. There is limited evidence on the characteristics of intracochlear (IC) ECochG recordings measured across the array postinsertion but compared with extracochlear recordings has better signal to noise ratio and spatial specificity. The present study aimed to examine the relationship between ECochG components recorded from an IC approach and postoperative speech perception or audiometric thresholds. DESIGN In 113 human subjects, responses to 500 Hz tone bursts were recorded at 11 IC electrodes across a 22-electrode cochlear implant array immediately following insertion. Responses to condensation and rarefaction stimuli were then subtracted from one another to emphasize the CM and added to one another to emphasize the SP, ANN, and CAP. Maximum amplitudes and extracochlear electrode locations were recorded for each of these ECochG components. These were added stepwise to a multi-factor generalized additive model to develop a best-fit model predictive model for pure-tone audiometric thresholds (PTA) and speech perception scores (speech recognition threshold [SRT] and consonant-vowel-consonant phoneme [CVC-P]) at 3- and 12-month postoperative timepoints. This best-fit model was tested against a generalized additive model using clinical factors alone (preoperative score, age, and gender) as a null model proxy. RESULTS ECochG-factor models were superior to clinical factor models in predicting postoperative PTA, CVC-P, and SRT outcomes at both timepoints. Clinical factor models explained a moderate amount of PTA variance ( r2 = 45.9% at 3-month, 31.8% at 12-month, both p < 0.001) and smaller variances of CVC-P and SRT ( r2 range = 6 to 13.7%, p = 0.008 to 0.113). Age was not a significant predictive factor. ECochG models explained more variance at the 12-month timepoint ( r2 for PTA = 52.9%, CVC-P = 39.6%, SRT = 36.4%) compared with the 3-month one timepoint ( r2 for PTA = 49.4%, CVC-P = 26.5%, SRT = 22.3%). The ECochG model was based on three factors: maximum SP deflection amplitude, and electrode position of CM and SP peaks. Adding neural (ANN and/or CAP) factors to the model did not improve variance explanation. Large negative SP deflection was associated with poorer outcomes and a large positive SP deflection with better postoperative outcomes. Mid-array peaks of SP and CM were both associated with poorer outcomes. CONCLUSIONS Postinsertion IC-ECochG recordings across the array can explain a moderate amount of postoperative speech perception and audiometric thresholds. Maximum SP deflection and its location across the array appear to have a significant predictive value which may reflect the underlying state of cochlear health.
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Affiliation(s)
- Jared Panario
- Department Otolaryngology, University of Melbourne, Melbourne, Victoria, Australia
| | - Christofer Bester
- Department Otolaryngology, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen O'Leary
- Department Otolaryngology, University of Melbourne, Melbourne, Victoria, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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Choe G, Lim JW, Chun YJ, Han JH, Kim BJ, Choi BY. Clinical characteristics and hearing loss etiology of cochlear implantees undergoing surgery in their teens, 20s, and 30s. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08737-3. [PMID: 38802577 DOI: 10.1007/s00405-024-08737-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE This study aimed to investigate the etiology of hearing loss, including genetic variants, in individuals who underwent cochlear implantation (CI) in their teens to thirties. It also sought to analyze post-CI speech performance and identify prognostic factors affecting CI outcomes in this age group. METHODS We conducted a retrospective review of 421 cochlear implant patients at Seoul National University Bundang Hospital, focusing on 63 subjects aged 10-39 years who underwent their first CI by a single surgeon between July 2018 and June 2022. The study included audiologic evaluation, molecular genetic testing, and analysis of speech performance post-CI. Statistical analyses were performed using SPSS 25 and GraphPad Prism 7. RESULTS Among 63 participants (M:F, 24:39), nine underwent CI in their teens, 24 in their 20 s, and 30 in their 30 s. Most of them (40, 63.5%) had postlingual deafness. The study found that 65.2% (40/63) of subjects received a genetic diagnosis, with DFNB4 being the most common etiology (37.5%, 15/40). Post-CI speech evaluation showed an average sentence score of 80% across all subjects. Factors such as the onset of hearing loss, duration of deafness (DoD), and preoperative Speech Intelligibility Rating (SIR) significantly influenced CI outcomes. Notably, longer DoD was associated with poorer CI outcomes, but this did not affect individuals with postlingual hearing loss as much. CONCLUSION The study concludes that in individuals aged 10-39 undergoing CI, the onset of hearing loss and preoperative SIR are critical predictors of postoperative outcomes. CI is recommended for those with postlingual hearing loss in this age group, irrespective of the DoD. The study highlights the importance of genetic factors especially DFNB4 in hearing loss etiology and underscores the value of the relatively easy-to-evaluate factor, preoperative SIR in predicting CI outcomes.
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Affiliation(s)
- Goun Choe
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong Woo Lim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ye Jun Chun
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin Hee Han
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Bong Jik Kim
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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Lamounier P, Carasek N, Daher VB, Costa CC, Ramos HVL, Martins SDC, Borges ALDF, Oliveira LAT, Bahmad Jr F. Cochlear Implants after Meningitis and Otosclerosis: A Comparison between Cochlear Ossification and Speech Perception Tests. J Pers Med 2024; 14:428. [PMID: 38673055 PMCID: PMC11050886 DOI: 10.3390/jpm14040428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can influence CI performance. (2) Methods: Retrospective analysis of CI performance in patients with etiological diagnosis of meningitis or otosclerosis, comparing the etiologies and analyzing the image findings, along with electrode array insertion status and technique. (3) Results: Speech recognition in CI patients with otosclerosis improves faster than in patients with meningitis. Other features such as radiological findings, degree of cochlear ossification, surgical technique used and total or partial insertion of electrodes do not seem to be directly related to speech recognition test performance. (4) Conclusions: Patients should be warned that their postoperative results have a strong correlation with the disease that caused their hearing loss and that, in cases of meningitis, a longer duration of speech-language training may be necessary to reach satisfactory results.
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Affiliation(s)
- Pauliana Lamounier
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Natalia Carasek
- Department of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; (N.C.); (L.A.T.O.)
| | - Valeria Barcelos Daher
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Claudiney Cândido Costa
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Hugo Valter Lisboa Ramos
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Sergio de Castro Martins
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
- Otorhinolaryngology Department, Universidade Estadual de Goiás (UEG), Itumbiara 75536-100, Brazil
| | - Alda Linhares de Freitas Borges
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | | | - Fayez Bahmad Jr
- Department of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; (N.C.); (L.A.T.O.)
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Kopsch AC, Rahne T, Plontke SK, Wagner L. Influence of the Spread of the Electric Field on Speech Recognition in Cochlear Implant Users. Otol Neurotol 2024; 45:e221-e227. [PMID: 38238910 DOI: 10.1097/mao.0000000000004086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To investigate the correlation of word recognition with cochlear implant (CI) and spread of the electric field. STUDY DESIGN Prospective, noninterventional, experimental study. SETTING A tertiary referral center. PATIENTS Thirty-eight adult CI users with poor (n = 11), fair (n = 13), and good (n = 16) word recognition performance. MAIN OUTCOME MEASURE Transimpedances were measured after 37 μs. Word recognition score was recorded at 65 dB SPL for German monosyllables in quiet. Transimpedance half widths were calculated as a marker for spread of the electric field. RESULTS Narrow and broad spread of the electric field, i.e., small and large half widths, were observed in all word recognition performance groups. Most of the transimpedance matrices showed a pattern of expansion along the diagonal toward the apical electrode contacts. Word recognition was not correlated with transimpedance half widths. CONCLUSIONS The half width of the spread of the electric field showed no correlation with word recognition scores in our study population.
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Affiliation(s)
- Anna C Kopsch
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle (Saale), Germany
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Quass GL, Kral A. Tripolar configuration and pulse shape in cochlear implants reduce channel interactions in the temporal domain. Hear Res 2024; 443:108953. [PMID: 38277881 DOI: 10.1016/j.heares.2024.108953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
The present study investigates effects of current focusing and pulse shape on threshold, dynamic range, spread of excitation and channel interaction in the time domain using cochlear implant stimulation. The study was performed on 20 adult guinea pigs using a 6-channel animal cochlear implant, recording was performed in the auditory midbrain using a multielectrode array. After determining the best frequencies for individual recording contacts with acoustic stimulation, the ear was deafened and a cochlear implant was inserted into the cochlea. The position of the implant was controlled by x-ray. Stimulation with biphasic, pseudomonophasic and monophasic stimuli was performed with monopolar, monopolar with common ground, bipolar and tripolar configuration in two sets of experiments, allowing comparison of the effects of the different stimulation strategies on threshold, dynamic range, spread of excitation and channel interaction. Channel interaction was studied in the temporal domain, where two electrodes were activated with pulse trains and phase locking to these pulse trains in the midbrain was quantified. The results documented multifactorial influences on the response properties, with significant interaction between factors. Thresholds increased with increasing current focusing, but decreased with pseudomonophasic and monophasic pulse shapes. The results documented that current focusing, particularly tripolar configuration, effectively reduces channel interaction, but that also pseudomonophasic and monophasic stimulation and phase duration intensity coding reduce channel interactions.
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Affiliation(s)
- Gunnar L Quass
- Institute for AudioNeuroTechnology (VIANNA) & Department of Experimental Otology, Otolaryngology Clinics, Hannover Medical School, Hannover, Germany; Cluster of Excellence "Hearing4All" (EXC 2177), Germany.
| | - Andrej Kral
- Institute for AudioNeuroTechnology (VIANNA) & Department of Experimental Otology, Otolaryngology Clinics, Hannover Medical School, Hannover, Germany; Cluster of Excellence "Hearing4All" (EXC 2177), Germany; Australian Hearing Hub, School of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Bruschini L, Canzi P, Canale A, Covelli E, Laborai A, Monteforte M, Cinquini M, Barbara M, Beltrame MA, Bovo R, Castigliano B, De Filippis C, Della Volpe A, Dispenza F, Marsella P, Mainardi A, Orzan E, Piccirillo E, Ricci G, Quaranta N, Cuda D. Implantable hearing devices in clinical practice. Systematic review and consensus statements. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:52-67. [PMID: 38165206 PMCID: PMC10914359 DOI: 10.14639/0392-100x-n2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/21/2023] [Indexed: 01/03/2024]
Abstract
Objective Implantable hearing devices represent a modern and innovative solution for hearing restoration. Over the years, these high-tech devices have increasingly evolved but their use in clinical practice is not universally agreed in the scientific literature. Congresses, meetings, conferences, and consensus statements to achieve international agreement have been made. This work follows this line and aims to answer unsolved questions regarding examinations, selection criteria and surgery for implantable hearing devices. Materials and methods A Consensus Working Group was established by the Italian Society of Otorhinolaryngology. A method group performed a systematic review for each single question to identify the current best evidence on the topic and to guide a multidisciplinary panel in developing the statements. Results Twenty-nine consensus statements were approved by the Italian Society of Otorhinolaryngology. These were associated with 4 key area subtopics regarding pre-operative tests, otological, audiological and surgical indications. Conclusions This consensus can be considered a further step forward to establish realistic guidelines on the debated topic of implantable hearing devices.
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Affiliation(s)
- Luca Bruschini
- Otolaryngology, ENT Audiology and Phoniatrics Unit, University Hospital of Pisa, Pisa, Italy
| | - Pietro Canzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Canale
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Andrea Laborai
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Marta Monteforte
- Laboratory of systematic review methodology and guidelines production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michela Cinquini
- Laboratory of systematic review methodology and guidelines production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Millo Achille Beltrame
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Bovo
- Department of Neuroscience DNS, Otolaryngology Section, Padua University, Padua, Italy
| | - Bruno Castigliano
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Cosimo De Filippis
- Department of Neuroscience, Audiology Section, University of Padua, Treviso, Italy
| | - Antonio Della Volpe
- Otology and Cochlear Implant Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Francesco Dispenza
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico ‘’Paolo Giaccone’’, University of Palermo, Palermo, Italy
| | - Pasquale Marsella
- Audiology and Otosurgery Department, “Bambino Gesù” Children’s Hospital, Rome, Italy
| | - Anna Mainardi
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Eva Orzan
- ENT and Audiology Unit, Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Giampietro Ricci
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy
| | - Nicola Quaranta
- Translational Biomedicine and Neurosciences Department, University of Bari, Bari, Italy
| | - Domenico Cuda
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Pantaleo A, Murri A, Cavallaro G, Pontillo V, Auricchio D, Quaranta N. Single-Sided Deafness and Hearing Rehabilitation Modalities: Contralateral Routing of Signal Devices, Bone Conduction Devices, and Cochlear Implants. Brain Sci 2024; 14:99. [PMID: 38275519 PMCID: PMC10814000 DOI: 10.3390/brainsci14010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Single sided deafness (SSD) is characterized by significant sensorineural hearing loss, severe or profound, in only one ear. SSD adversely affects various aspects of auditory perception, including causing impairment in sound localization, difficulties with speech comprehension in noisy environments, and decreased spatial awareness, resulting in a significant decline in overall quality of life (QoL). Several treatment options are available for SSD, including cochlear implants (CI), contralateral routing of signal (CROS), and bone conduction devices (BCD). The lack of consensus on outcome domains and measurement tools complicates treatment comparisons and decision-making. This narrative overview aims to summarize the treatment options available for SSD in adult and pediatric populations, discussing their respective advantages and disadvantages. Rerouting devices (CROS and BCD) attenuate the effects of head shadow and improve sound awareness and signal-to-noise ratio in the affected ear; however, they cannot restore binaural hearing. CROS devices, being non-implantable, are the least invasive option. Cochlear implantation is the only strategy that can restore binaural hearing, delivering significant improvements in speech perception, spatial localization, tinnitus control, and overall QoL. Comprehensive preoperative counseling, including a discussion of alternative technologies, implications of no treatment, expectations, and auditory training, is critical to optimizing therapeutic outcomes.
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Affiliation(s)
- Alessandra Pantaleo
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
| | - Alessandra Murri
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
| | - Giada Cavallaro
- Otolaryngology Unit, Madonna delle Grazie Hospital, 75100 Matera, Italy;
| | - Vito Pontillo
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
| | - Debora Auricchio
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
| | - Nicola Quaranta
- Otolaryngology Unit, Department of BMS, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy; (A.P.); (A.M.); (V.P.); (D.A.)
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Patro A, Lindquist NR, Schauwecker N, Holder JT, Perkins EL, Haynes DS, Tawfik KO. Comparison of Speech Recognition and Hearing Preservation Outcomes Between the Mid-Scala and Lateral Wall Electrode Arrays. Otol Neurotol 2024; 45:52-57. [PMID: 38013487 PMCID: PMC10842140 DOI: 10.1097/mao.0000000000004064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To assess speech recognition and hearing preservation (HP) outcomes with the Advanced Bionics Mid-Scala and SlimJ electrodes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS A total of 237 adult patients implanted between 2013 and 2020 (Mid-Scala, n = 136; SlimJ, n = 101). MAIN OUTCOME MEASURES Consonant-nucleus-consonant (CNC) and AzBio (Arizona Biomedical) scores at 6 and 12 months; postoperative HP, defined as low-frequency pure-tone average ≤ 80 dB HL; scalar position. RESULTS Mean CNC scores did not significantly differ between Mid-Scala and SlimJ recipients at 6 (45.8% versus 46.0%, p = 0.962) and 12 (51.9% versus 48.8%, p = 0.363) months. Similarly, mean AzBio in quiet scores were equivalent for both groups at 6 (55.1% versus 59.2%, p = 0.334) and 12 (60.6% versus 62.3%, p = 0.684) months. HP rates were significantly higher with the SlimJ (48.4%) than the Mid-Scala (30.8%; p = 0.033). Scalar translocations were 34.8 and 16.1% for the Mid-Scala and SlimJ groups, respectively ( p = 0.019). Ears with postoperative HP had significantly fewer scalar translocations (16.7% versus 37.2%, p = 0.048), and postoperative HP was associated with higher AzBio in noise scores at the most recent follow-up interval (38.7% versus 25.1%, p = 0.042). CNC, AzBio in quiet and noise, low-frequency pure-tone average shifts, and PTA at 6 and 12 months were not significantly different between patients with scala tympani insertions of the SlimJ versus the Mid-Scala ( p > 0.05). CONCLUSIONS Compared with the Mid-Scala, the lateral wall electrode has superior HP rates and fewer scalar translocations, whereas speech recognition scores are equivalent between both electrode arrays. These findings can help providers with electrode selection and patient counseling.
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Affiliation(s)
- Ankita Patro
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathan R. Lindquist
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natalie Schauwecker
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jourdan T. Holder
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L. Perkins
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S. Haynes
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kareem O. Tawfik
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Breitsprecher TM, Baumgartner WD, Brown K, Dazert S, Doyle U, Dhanasingh A, Großmann W, Hagen R, Van de Heyning P, Mlynski R, Neudert M, Rajan G, Rak K, Van Rompaey V, Schmutzhard J, Volkenstein S, Völter C, Wimmer W, Zernotti M, Weiss NM. Effect of Cochlear Implant Electrode Insertion Depth on Speech Perception Outcomes: A Systematic Review. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e045. [PMID: 38516541 PMCID: PMC10950166 DOI: 10.1097/ono.0000000000000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/29/2023] [Indexed: 03/23/2024]
Abstract
Objective The suitable electrode array choice is broadly discussed in cochlear implantation surgery. Whether to use a shorter electrode length under the aim of structure preservation versus choosing a longer array to achieve a greater cochlear coverage is a matter of debate. The aim of this review is to identify the impact of the insertion depth of a cochlear implant (CI) electrode array on CI users' speech perception outcomes. Databases Reviewed PubMed was searched for English-language articles that were published in a peer-reviewed journal from 1997 to 2022. Methods A systematic electronic search of the literature was carried out using PubMed to find relevant literature on the impact of insertion depth on speech perception. The review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines of reporting. Studies in both, children and adults with pre- or postlingual hearing loss, implanted with a CI were included in this study. Articles written in languages other than English, literature reviews, meta-analyses, animal studies, histopathological studies, or studies pertaining exclusively to imaging modalities without reporting correlations between insertion depth and speech outcomes were excluded. The risk of bias was determined using the "Risk of Bias in Nonrandomized Studies of Interventions" tool. Articles were extracted by 2 authors independently using predefined search terms. The titles and abstracts were screened manually to identify studies that potentially meet the inclusion criteria. The extracted information included: the study population, type of hearing loss, outcomes reported, devices used, speech perception outcomes, insertion depth (linear insertion depth and/or the angular insertion depth), and correlation between insertion depth and the speech perception outcomes. Results A total of 215 relevant studies were assessed for eligibility. Twenty-three studies met the inclusion criteria and were analyzed further. Seven studies found no significant correlation between insertion depth and speech perception outcomes. Fifteen found either a significant positive correlation or a positive effect between insertion depth and speech perception. Only 1 study found a significant negative correlation between insertion depth and speech perception outcomes. Conclusion Although most studies reported a positive effect of insertion depth on speech perception outcomes, one-third of the identified studies reported no correlation. Thus, the insertion depth must be considered as a contributing factor to speech perception rather than as a major decisive criterion. Registration This review has been registered in PROSPERO, the international prospective register of systematic reviews (CRD42021257547), available at https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Tabita M. Breitsprecher
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Wolf-Dieter Baumgartner
- Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten, Medizinische Universität Wien, Wien, Austria
| | - Kevin Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Una Doyle
- MED-EL Elektromedizinische Geraete Gesellschaft m.b.H., Innsbruck, Austria
| | - Anandhan Dhanasingh
- MED-EL Elektromedizinische Geraete Gesellschaft m.b.H., Innsbruck, Austria
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wilma Großmann
- Department of Otorhinolaryngology, Head and Neck Surgery, “Otto Körner,” Rostock University Medical Center, Rostock, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Paul Van de Heyning
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, “Otto Körner,” Rostock University Medical Center, Rostock, Germany
| | - Marcus Neudert
- Department of Otorhinolaryngology Head and Neck Surgery, Technische Universität Dresden (oder TU Dresden), Faculty of Medicine (and University Hospital) Carl Gustav Carus, Dresden, Germany
| | - Gunesh Rajan
- Otolaryngology, Head and Neck Surgery, Medical School, University of Western Australia, Perth, Australia
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Kristen Rak
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Vincent Van Rompaey
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Volkenstein
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, Johannes Wesling Klinikum Minden, Bochum, Germany
| | - Christiane Völter
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Wilhelm Wimmer
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Mario Zernotti
- Division of Otolaryngology and Head and Neck Surgery, Sanatorio Allende, Catholic University of Córdoba and National University of Córdoba, Córdoba, Argentina
| | - Nora M. Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum Rechts der Isar, Munich, Germany
- International Graduate School of Neuroscience, Ruhr-University Bochum, Bochum, Germany
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10
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Skidmore J, Oleson JJ, Yuan Y, He S. The Relationship Between Cochlear Implant Speech Perception Outcomes and Electrophysiological Measures of the Electrically Evoked Compound Action Potential. Ear Hear 2023; 44:1485-1497. [PMID: 37194125 DOI: 10.1097/aud.0000000000001389] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study assessed the relationship between electrophysiological measures of the electrically evoked compound action potential (eCAP) and speech perception scores measured in quiet and in noise in postlingually deafened adult cochlear implant (CI) users. It tested the hypothesis that how well the auditory nerve (AN) responds to electrical stimulation is important for speech perception with a CI in challenging listening conditions. DESIGN Study participants included 24 postlingually deafened adult CI users. All participants used Cochlear Nucleus CIs in their test ears. In each participant, eCAPs were measured at multiple electrode locations in response to single-pulse, paired-pulse, and pulse-train stimuli. Independent variables included six metrics calculated from the eCAP recordings: the electrode-neuron interface (ENI) index, the neural adaptation (NA) ratio, NA speed, the adaptation recovery (AR) ratio, AR speed, and the amplitude modulation (AM) ratio. The ENI index quantified the effectiveness of the CI electrodes in stimulating the targeted AN fibers. The NA ratio indicated the amount of NA at the AN caused by a train of constant-amplitude pulses. NA speed was defined as the speed/rate of NA. The AR ratio estimated the amount of recovery from NA at a fixed time point after the cessation of pulse-train stimulation. AR speed referred to the speed of recovery from NA caused by previous pulse-train stimulation. The AM ratio provided a measure of AN sensitivity to AM cues. Participants' speech perception scores were measured using Consonant-Nucleus-Consonant (CNC) word lists and AzBio sentences presented in quiet, as well as in noise at signal-to-noise ratios (SNRs) of +10 and +5 dB. Predictive models were created for each speech measure to identify eCAP metrics with meaningful predictive power. RESULTS The ENI index and AR speed individually explained at least 10% of the variance in most of the speech perception scores measured in this study, while the NA ratio, NA speed, the AR ratio, and the AM ratio did not. The ENI index was identified as the only eCAP metric that had unique predictive power for each of the speech test results. The amount of variance in speech perception scores (both CNC words and AzBio sentences) explained by the eCAP metrics increased with increased difficulty under the listening condition. Over half of the variance in speech perception scores measured in +5 dB SNR noise (both CNC words and AzBio sentences) was explained by a model with only three eCAP metrics: the ENI index, NA speed, and AR speed. CONCLUSIONS Of the six electrophysiological measures assessed in this study, the ENI index is the most informative predictor for speech perception performance in CI users. In agreement with the tested hypothesis, the response characteristics of the AN to electrical stimulation are more important for speech perception with a CI in noise than they are in quiet.
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Affiliation(s)
- Jeffrey Skidmore
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Jacob J Oleson
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Yi Yuan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Shuman He
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
- Department of Audiology, Nationwide Children's Hospital, Columbus, Ohio, USA
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11
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Atak HBO, Sennaroglu G, Sennaroglu L. Speech recognition and quality of life outcomes of adults with cochlear implants following a quarter-century of deafness: what should be the maximum duration? Eur Arch Otorhinolaryngol 2023; 280:4903-4913. [PMID: 37672104 DOI: 10.1007/s00405-023-08214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE This study was aimed at examining the pre- and post-cochlear implant (CI) speech recognition and quality of life results of postlingually deaf adult CI users with a duration of deafness (DoD) > 25 years and determining the maximum DoD limit. METHODS We enrolled 54 postlingually deaf CI users and divided them into ages ≤ 60 and > 60 years and DoDs ≤ 25 and > 25 years. All participants were evaluated using multisensory measures (auditory and auditory + visual) and open-set Speech Recognition Test (SRT) before CI and 3 years postoperatively. They were administered with The Hearing Handicap Inventory for the Elderly (HHIE) to determine the effects of hearing impairment on daily life. RESULTS DoD and open-set SRT for auditory and auditory + visual stimuli showed a strong negative linear relationship (r = - 0.506, p < 0.01). Open-set SRT scores of patients with DoD aged ≤ 25 and > 25 years (p < 0.01) differed significantly. The chronological age and HHIE scores in social and emotional subfactors showed a strong negative linear relationship (r = - 0.519, p < 0.01). CONCLUSIONS The present study showed that the number of years was a major factor determining that postlingual adults with profound hearing loss had hearing loss. The results support CI use as soon as possible in adults to prevent degeneration of the auditory pathways and possible central remodeling. However, auditory rehabilitation outcomes in adults using CI vary widely. Investigating the causes of this variability contributes to audiology.
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Affiliation(s)
- Hilal Burcu Ozkan Atak
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey.
| | - Gonca Sennaroglu
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey
| | - Levent Sennaroglu
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
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12
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Ullah MN, Cevallos A, Shen S, Carver C, Dunham R, Marsiglia D, Yeagle J, Della Santina CC, Bowditch S, Sun DQ. Cochlear implantation in unilateral hearing loss: impact of short- to medium-term auditory deprivation. Front Neurosci 2023; 17:1247269. [PMID: 37877013 PMCID: PMC10591100 DOI: 10.3389/fnins.2023.1247269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Single sided deafness (SSD) results in profound cortical reorganization that presents clinically with a significant impact on sound localization and speech comprehension. Cochlear implantation (CI) has been approved for two manufacturers' devices in the United States to restore bilateral function in SSD patients with up to 10 years of auditory deprivation. However, there is great variability in auditory performance and it remains unclear how auditory deprivation affects CI benefits within this 10-year window. This prospective study explores how measured auditory performance relates to real-world experience and device use in a cohort of SSD-CI subjects who have between 0 and 10 years of auditory deprivation. Methods Subjects were assessed before implantation and 3-, 6-, and 12-months post-CI activation via Consonant-Nucleus-Consonant (CNC) word recognition and Arizona Biomedical Institute (AzBio) sentence recognition in varying spatial speech and noise presentations that simulate head shadow, squelch, and summation effects (S0N0, SSSDNNH, SNHNSSD; 0 = front, SSD = impacted ear, NH = normal hearing ear). Patient-centered assessments were performed using Tinnitus Handicap Inventory (THI), Spatial Hearing Questionnaire (SHQ), and Health Utility Index Mark 3 (HUI3). Device use data was acquired from manufacturer software. Further subgroup analysis was performed on data stratified by <5 years and 5-10 years duration of deafness. Results In the SSD ear, median (IQR) CNC word scores pre-implant and at 3-, 6-, and 12-months post-implant were 0% (0-0%), 24% (8-44%), 28% (4-44%), and 18% (7-33%), respectively. At 6 months post-activation, AzBio scores in S0N0 and SSSDNNH configurations (n = 25) demonstrated statistically significant increases in performance by 5% (p = 0.03) and 20% (p = 0.005), respectively. The median HUI3 score was 0.56 pre-implant, lower than scores for common conditions such as anxiety (0.68) and diabetes (0.77), and comparable to stroke (0.58). Scores improved to 0.83 (0.71-0.91) by 3 months post-activation. These audiologic and subjective benefits were observed even in patients with longer durations of deafness. Discussion By merging CI-associated changes in objective and patient-centered measures of auditory function, our findings implicate central mechanisms of auditory compensation and adaptation critical in auditory performance after SSD-CI and quantify the extent to which they affect the real-world experience reported by individuals.
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Affiliation(s)
- Mohammed N. Ullah
- Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Ashley Cevallos
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Sarek Shen
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Courtney Carver
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Rachel Dunham
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Dawn Marsiglia
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Jennifer Yeagle
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Charles C. Della Santina
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Steve Bowditch
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Daniel Q. Sun
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
- Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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13
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Oh M, Oh EJ, Jung B, Yoo MH, Yoo SY, Jung DJ, Lee KY. Cochlear Implantation in the Elderly: Speech Performance, Associated Factor, Complication, and Surgical Safety. J Audiol Otol 2023; 27:205-211. [PMID: 37872754 PMCID: PMC10603278 DOI: 10.7874/jao.2023.00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The guidelines for cochlear implantation (CIs) are expanding, and the number of CI procedures performed on the elderly is increasing. The purpose of this study was to analyze the results and safety of cochlear implantation in the elderly, as well as to evaluate the predictive factors on CI outcomes. SUBJECTS AND METHODS The study included 56 patients aged ≥40 years, who received CIs between 2009 and 2020. They were divided into two groups: 27 younger adults (40-64 years) and 29 elderly (>64 years). The study compared their pre- and postoperative speech perception and category of auditory performance (CAP) scores, surgical complications, and hospitalization periods. It also evaluated associated factors in the elderly group by examining categorical and continuous variables and postoperative CAP score. RESULTS There was a significant improvement in speech recognition tests (both word and sentence) and CAP scores in both groups compared to the pre-implantation scores (p<0.001). Postoperative results were slightly lower in the elderly group than in younger adults for sentence recognition and CAP scores, except for word recognition. No significant associated factors were found on postoperative CAP scores, except for etiology. Postoperative CAP significantly improved in the sudden hearing loss group compared to the groups with other etiologies (p=0.045). The elderly group had more comorbidities than that in the younger adult group (p=0.026), but there were no significant differences in postoperative complications and hospitalization periods. CONCLUSIONS While speech recognition and CAP scores were relatively lower in the elderly group compared to the younger adults, the elderly group showed significant improvements in audiological results after CI. Moreover, CI was safe and well tolerated in elderly patients.
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Affiliation(s)
- Minji Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Jung Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Boseung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Hoon Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | | | - Da Jung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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14
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An S, Jo E, Jun SB, Sung JE. Effects of cochlear implantation on cognitive decline in older adults: A systematic review and meta-analysis. Heliyon 2023; 9:e19703. [PMID: 37809368 PMCID: PMC10558942 DOI: 10.1016/j.heliyon.2023.e19703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 08/20/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Background Hearing loss has been reported as the most significant modifiable risk factor for dementia, but it is still unknown whether auditory rehabilitation can practically prevent cognitive decline. We aim to systematically analyze the longitudinal effects of auditory rehabilitation via cochlear implants (CIs). Methods In this systematic review and meta-analysis, we searched relevant literature published from January 1, 2000 to April 30, 2022, using electronic databases, and selected studies in which CIs were performed mainly on older adults and follow-up assessments were conducted in both domains: speech perception and cognitive function. A random-effects meta-analysis was conducted for each domain and for each timepoint comparison (pre-CI vs. six months post-CI; six months post-CI vs. 12 months post-CI; pre-CI vs. 12 months post-CI), and heterogeneity was assessed using Cochran's Q test. Findings Of the 1918 retrieved articles, 20 research papers (648 CI subjects) were included. The results demonstrated that speech perception was rapidly enhanced after CI, whereas cognitive function had different speeds of improvement for different subtypes: executive function steadily improved significantly up to 12 months post-CI (g = 0.281, p < 0.001; g = 0.115, p = 0.003; g = 0.260, p < 0.001 in the order of timepoint comparison); verbal memory was significantly enhanced at six months post-CI and was maintained until 12 months post-CI (g = 0.296, p = 0.002; g = 0.095, p = 0.427; g = 0.401, p < 0.001); non-verbal memory showed no considerable progress at six months post-CI, but significant improvement at 12 months post-CI (g = -0.053, p = 0.723; g = 0.112, p = 0.089; g = 0.214, p = 0.023). Interpretation The outcomes demonstrate that auditory rehabilitation via CIs could have a long-term positive impact on cognitive abilities. Given that older adults' cognitive abilities are on the trajectory of progressive decline with age, these results highlight the need to increase the adoption of CIs among this population.
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Affiliation(s)
- Sora An
- Department of Communication Disorders, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Eunha Jo
- Department of Communication Disorders, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Sang Beom Jun
- Department of Electronic and Electrical Engineering, Ewha Womans University, Seoul, 03760, Republic of Korea
- Graduate Program in Smart Factory, Ewha Womans University, Seoul, 03760, Republic of Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Jee Eun Sung
- Department of Communication Disorders, Ewha Womans University, Seoul, 03760, Republic of Korea
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15
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Bruschke S, Baumann U, Stöver T. Residual low-frequency hearing after early device activation in cochlear implantation. Eur Arch Otorhinolaryngol 2023; 280:3977-3985. [PMID: 36943438 PMCID: PMC10382339 DOI: 10.1007/s00405-023-07887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/14/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE The cochlear implant (CI) is a standard treatment for patients with severe to profound hearing loss. In recent years, early device activation of the sound processor after 2-3 days following surgery has been established. The aim of this study is to evaluate the residual hearing of CI patients with substantial preoperative low-frequency hearing after early device activation over a period of 12 months. METHODS Results were compared between an early fitted group (EF) with device activation to less than 15 days after CI surgery and a control group (CG) with device activation after 3-6 weeks. In total, 57 patients were divided into EF group (n = 32), and CG (n = 25). Low-frequency residual hearing and speech recognition in quiet and in noise were compared over an observation period of 12 months. RESULTS No significant difference (p > 0.05) in the residual low-frequency hearing PTAlow between EF and CG was found, neither preoperatively (EF 33.2 dB HL/CG 35.0 dB HL), nor postoperatively (EF 46.8 dB HL/CG 46.2 dB HL). In both groups, postoperative residual hearing decreased compared to preoperative and remained stable within the first year after CI surgery. Furthermore, both groups showed no significant differences (p > 0.05) in speech recognition in quiet and in noise within the first year. CONCLUSION Early device activation is feasible in CI patients with preoperative low-frequency residual hearing, without an additional effect on postoperative hearing preservation.
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Affiliation(s)
- Stefanie Bruschke
- Goethe University Frankfurt, University Hospital, ENT Department, Theodor-Stern-Kai 7, 60590, Frankfurt a. M, Germany.
| | - Uwe Baumann
- Goethe University Frankfurt, University Hospital, ENT Department, Theodor-Stern-Kai 7, 60590, Frankfurt a. M, Germany
| | - Timo Stöver
- Goethe University Frankfurt, University Hospital, ENT Department, Theodor-Stern-Kai 7, 60590, Frankfurt a. M, Germany
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16
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Lindquist NR, Holder JT, Patro A, Cass ND, Tawfik KO, O'Malley MR, Bennett ML, Haynes DS, Gifford RH, Perkins EL. Cochlear Implants for Single-Sided Deafness: Quality of Life, Daily Usage, and Duration of Deafness. Laryngoscope 2023; 133:2362-2370. [PMID: 36254870 DOI: 10.1002/lary.30452] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To report our experience for adults undergoing cochlear implantation (CI) for single-sided deafness (SSD). METHODS This is a retrospective case series for adults with SSD who underwent CI between January 2013 and May 2021 at our institution. CNC and AzBio speech recognition scores, Tinnitus Handicap Inventory (THI), Speech, Spatial, and Qualities of Hearing Scale (SSQ12), datalogging, and the Cochlear Implant Quality of Life (CIQOL)-10 Global measure were utilized. RESULTS Sixty-six adults underwent CI for SSD (median 51.3 years, range 20.0-74.3 years), and 57 (86.4%) remained device users at last follow-up. Compared to pre-operative performance, device users demonstrated significant improvement in speech recognition scores and achieved peak performance at six months post-activation for CNC (8.0% increased to 45.6%, p < 0.0001) and AzBio in quiet (12.2% increased to 59.5%, p < 0.0001). THI was decreased at 6 months post-implantation (58.1-14.6, p < 0.0001), with 77% of patients reporting improved or resolved tinnitus. Patients demonstrated improved SSQ12 scores as well as the disease-specific CIQOL-10 Global questionnaire. Duration of deafness was not associated with significant differences in speech recognition performance. Average daily wear time was positively associated with CNC and AzBio scores as well as post-operative CIQOL-10 scores. CONCLUSIONS Herein we present the largest cohort of adult CI recipients with SSD with data on speech recognition scores, tinnitus measures, and SSQ12. Novel insights regarding the correlation of datalogging, duration of deafness, and CI-specific quality of life (CIQOL-10) metrics are discussed. Data continue to support CI as an efficacious treatment option for SSD. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2362-2370, 2023.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nathan D Cass
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - René H Gifford
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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DeFreese AJ, Lindquist NR, Shi L, Holder JT, Berg KA, Haynes DS, Gifford RH. The Impact of Daily Processor Use on Adult Cochlear Implant Outcomes: Reexamining the Roles of Duration of Deafness and Age at Implantation. Otol Neurotol 2023; 44:672-678. [PMID: 37367733 PMCID: PMC10524754 DOI: 10.1097/mao.0000000000003920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To quantify the roles and relationships between age at implantation, duration of deafness (DoD), and daily processor use via data logging on speech recognition outcomes for postlingually deafened adults with cochlear implants. STUDY DESIGN Retrospective case review. SETTING Cochlear implant (CI) program at a tertiary medical center. PATIENTS Six-hundred fourteen postlingually deafened adult ears with CIs (mean age, 63 yr; 44% female) were included. MAIN OUTCOME MEASURES A stepwise multiple regression analysis was completed to investigate the combined effects of age, DoD, and daily processor use on CI-aided speech recognition (Consonant-Nucleus-Consonant monosyllables and AzBio sentences). RESULTS Results indicated that only daily processor use was significantly related to Consonant-Nucleus-Consonant word scores ( R2 = 0.194, p < 0.001) and AzBio in quiet scores ( R2 = 0.198, p < 0.001), whereas neither age nor DoD was significantly related. In addition, there was no significant relationship between daily processor use, age at implantation, or DoD and AzBio sentences in noise ( R2 = 0.026, p = 0.005). CONCLUSIONS Considering the clinical factors of age at implantation, DoD, and daily processor use, only daily processor use significantly predicted the ~20% of variance in postoperative outcomes (CI-aided speech recognition) accounted for by these clinical factors.
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Affiliation(s)
- Andrea J DeFreese
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linjie Shi
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katelyn A Berg
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
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Thomas JP, Klein H, Haubitz I, Dazert S, Völter C. Intra- and Interrater Reliability of CT- versus MRI-Based Cochlear Duct Length Measurement in Pediatric Cochlear Implant Candidates and Its Impact on Personalized Electrode Array Selection. J Pers Med 2023; 13:jpm13040633. [PMID: 37109019 PMCID: PMC10142378 DOI: 10.3390/jpm13040633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023] Open
Abstract
Background: Radiological high-resolution computed tomography-based evaluation of cochlear implant candidates’ cochlear duct length (CDL) has become the method of choice for electrode array selection. The aim of the present study was to evaluate if MRI-based data match CT-based data and if this impacts on electrode array choice. Methods: Participants were 39 children. CDL, length at two turns, diameters, and height of the cochlea were determined via CT and MRI by three raters using tablet-based otosurgical planning software. Personalized electrode array length, angular insertion depth (AID), intra- and interrater differences, and reliability were calculated. Results: Mean intrarater difference of CT- versus MRI-based CDL was 0.528 ± 0.483 mm without significant differences. Individual length at two turns differed between 28.0 mm and 36.6 mm. Intrarater reliability between CT versus MRI measurements was high (intra-class correlation coefficient (ICC): 0.929–0.938). Selection of the optimal electrode array based on CT and MRI matched in 90.1% of cases. Mean AID was 629.5° based on the CT and 634.6° based on the MRI; this is not a significant difference. ICC of the mean interrater reliability was 0.887 for the CT-based evaluation and 0.82 for the MRI-based evaluation. Conclusion: MRI-based CDL measurement shows a low intrarater difference and a high interrater reliability and is therefore suitable for personalized electrode array selection.
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Affiliation(s)
- Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Johannes Hospital, Cath. St. Paulus Society, Academic Teaching Hospital of the University of Münster, Johannesstr. 9-17, 44137 Dortmund, Germany
| | - Hannah Klein
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787 Bochum, Germany
| | - Imme Haubitz
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787 Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787 Bochum, Germany
| | - Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787 Bochum, Germany
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19
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Totten DJ, Saltagi A, Libich K, Pisoni DB, Nelson RF. Cochlear Implantation in US Military Veterans: A Single Institution Study. OTO Open 2023; 7:e53. [PMID: 37187572 PMCID: PMC10181857 DOI: 10.1002/oto2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Objective Military veterans have high rates of noise-induced hearing loss (NIHL) which is associated with more significant spiral ganglion neuronal loss. This study explores the relationship between NIHL and cochlear implant (CI) outcomes in veterans. Study Design Retrospective case series of veterans who underwent CI between 2019 and 2021. Setting Veterans Health Administration hospital. Methods AzBio Sentence Test, Consonant-Nucleus-Consonant (CNC) scores, and Speech, Spatial, and Qualities of Hearing Scale (SSQ) were measured pre- and postoperatively. Linear regression assessed relationships between outcomes and noise exposure history, etiology of hearing loss, duration of hearing loss, and Self-Administered Gerocognitive Exam (SAGE) scores. Results Fifty-two male veterans were implanted at an average (standard deviation) age of 75.0 (9.2) years without major complications. The average duration of hearing loss was 36.0 (18.4) years. The average time of hearing aid use was 21.2 (15.4) years. Noise exposure was reported in 51.3% of patients. Objectively, AzBio and CNC scores 6 months postoperatively showed significant improvement of 48% and 39%, respectively. Subjectively, average 6-month SSQ scores showed significant improvement by 34 points (p < .0001). Younger age, SAGE score ≥17, and shorter duration of amplification were associated with higher postoperative AzBio scores. Greater improvement in AzBio and CNC scores was associated with lower preoperative scores. Noise exposure was not associated with any difference in CI performance. Conclusion Despite high levels of noise exposure and advanced age, veterans derive substantial benefits from cochlear implantation. SAGE score ≥17 may be predictive of overall CI outcomes. Noise exposure does not impact CI outcomes. Level of Evidence Level 4.
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Affiliation(s)
- Douglas J. Totten
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Abdul Saltagi
- College of Medicine, Indiana University School of MedicineIndianapolisIndianaUSA
| | - Karen Libich
- Department of AudiologyRoudebush Veterans' Administration Medical CenterIndianapolisIndianaUSA
| | - David B. Pisoni
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Psychological and Brain SciencesIndiana UniversityBloomingtonIndianaUSA
| | - Rick F. Nelson
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Neurological SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
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20
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Nijmeijer HGB, Groenewoud HMM, Mylanus EAM, Goedegebure A, Huinck WJ, van der Wilt GJ. Impact of Expanding Eligibility Criteria for Cochlear Implantation - Dynamic Modeling Study. Laryngoscope 2023; 133:924-932. [PMID: 35792007 DOI: 10.1002/lary.30270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Eligibility criteria for cochlear implantation (CI) are shifting due to technological and surgical improvements. The aim of this study was to explore the impact of further expanding unilateral CI criteria in those with severe hearing loss (HL) (61-80 dBHL) in terms of number of CI recipients, costs, quality of life, and cost-effectiveness. METHODS A dynamic population-based Markov model was constructed mimicking the Dutch population in three age categories over a period of 20 years. Health states included severe HL (61-80 dBHL), profound HL (>81 dBHL), CI recipients, and no-CI recipients. Model parameters were based on published literature, (national) databases, expert opinion, and model calibration. RESULTS If persons with severe HL would qualify and opt for CI similar to those with profound HL now, this would lead to a 6-7 times increase of new CI recipients and an associated increase in costs (€550 million) and QALYs (54.000) over a 20-year period (incremental cost utility ratio: 10.771 euros/QALY [2.5-97.5 percentiles: 1.252-23.171]). One-way-sensitivity analysis indicated that model outcomes were most sensitive to regaining employment, utility associated with having a CI, and costs of surgery and testing. CONCLUSION Our findings suggest that expanding eligibility for CI to persons with severe HL could be a cost-effective use of resources. Clearly, however, it would require a significant increase in diagnostic, operative, and rehabilitative capacity. Our quantitative estimates can serve as a basis for a wider societal deliberation on the question whether such an increase can and should be pursued. LEVEL OF EVIDENCE NA Laryngoscope, 133:924-932, 2023.
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Affiliation(s)
- Hugo G B Nijmeijer
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Hans M M Groenewoud
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emmanuel A M Mylanus
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wendy J Huinck
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Schoo DP, Ayiotis AI, Brillet CF, Chow MR, Lane KE, Ward BK, Carey JP, Santina CCD. Vestibular Implantation Can Work Even After More Than 20 Years of Bilateral Vestibular Hypofunction. Otol Neurotol 2023; 44:168-171. [PMID: 36624598 PMCID: PMC9851668 DOI: 10.1097/mao.0000000000003768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine whether prosthetic stimulation delivered via a vestibular implant can elicit artificial sensation of head movement despite long (23-yr) duration adult-onset ototoxic bilateral vestibular hypofunction (BVH). STUDY DESIGN Case report. SETTING Tertiary care center as part of a first-in-human clinical trial. PATIENTS One. INTERVENTIONS Unilateral vestibular implantation with an investigational multichannel vestibular implant in a 55-year-old man with a well-documented 23-year history of aminoglycoside-induced BVH. MAIN OUTCOME MEASURES Electrically evoked vestibulo-ocular reflexes (eeVOR). RESULTS Vestibular implant stimulation can drive stimulus-aligned eeVOR and elicit a vestibular percept 23 years after the onset of bilateral vestibulopathy. Prosthetic stimulation targeting individual semicircular canals elicited eye movements that approximately aligned with each targeted canal's axis. The magnitude of the eeVOR response increased with increasing stimulus current amplitude. Response alignment and magnitude were similar to those observed for implant recipients who underwent vestibular implantation less than 10 years after BVH onset. Responses were approximately stable for 18 months of continuous device use (24 h/d except during sleep). CONCLUSIONS Vestibular implantation and prosthetic electrical stimulation of semicircular canal afferent nerves can drive canal-specific eye movement responses more than 20 years after the onset of ototoxic vestibular hypofunction.
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Affiliation(s)
- Desi P. Schoo
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery
| | - Andrianna I. Ayiotis
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering
| | | | - Margaret R. Chow
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering
- Labyrinth Devices, LLC, Baltimore, Maryland, USA
| | - Kelly E. Lane
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering
| | - Bryan K. Ward
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery
| | - John P. Carey
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery
| | - Charles C. Della Santina
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering
- Labyrinth Devices, LLC, Baltimore, Maryland, USA
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22
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Heine K, Timm ME, Gärtner L, Lenarz T, Lesinski-Schiedat A. Auditory rehabilitation after temporal bone fracture with cochlear implants - a case control study. Cochlear Implants Int 2023:1-10. [PMID: 36617461 DOI: 10.1080/14670100.2022.2148351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Temporal bone fracture can cause posttraumatic deafness. Sequelae like ossification or obliteration of the cochlea can impact the outcome of cochlear implantation. This study highlights the effect of localisation of the fracture to morphologic, electric and functional criteria. METHODS The study group consists of patients suffering from hearing loss caused by temporal bone fracture (n = 61 ears). Patients were divided into otic capsule sparing (OCS) and otic capsule involving (OCI) fractures. The OCI group was additionally divided into subgroups with or without signs of ossification inside the cochlea. Postoperative imaging, hearing tests and electrode impedances were analysed. RESULTS The results of postoperative hearing rehabilitation showed lower speech understanding scores for the OCI group, especially for the ossification group. OCI fractures with signs of ossification showed increased impedances. Patients in the OCI group suffered more frequently from facial nerve stimulation (FNS). FNS was most frequently observed within the ossification group. CONCLUSION Cochlear implantation in patients with temporal bone fracture is adequate therapy for the treatment of fracture-induced deafness. In long-term observation, these patients show comparable results with regular cochlear implant (CI) patients. Implantation should be performed as soon as possible after hearing loss, before obstructing obliteration or ossification of the cochlea start.
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Affiliation(s)
- Katharina Heine
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Max Eike Timm
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence, Hearing4all, Hannover Medical School, Hannover, Germany
| | - Lutz Gärtner
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
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23
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Chen YS, Cabrera E, Tucker BJ, Shin TJ, Moawad JV, Totten DJ, Booth KT, Nelson RF. TMPRSS3 expression is limited in spiral ganglion neurons: implication for successful cochlear implantation. J Med Genet 2022; 59:1219-1226. [PMID: 35961784 DOI: 10.1136/jmg-2022-108654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND It is well established that biallelic mutations in transmembrane protease, serine 3 (TMPRSS3) cause hearing loss. Currently, there is controversy regarding the audiological outcomes after cochlear implantation (CI) for TMPRSS3-associated hearing loss. This controversy creates confusion among healthcare providers regarding the best treatment options for individuals with TMPRSS3-related hearing loss. METHODS A literature review was performed to identify all published cases of patients with TMPRSS3-associated hearing loss who received a CI. CI outcomes of this cohort were compared with published adult CI cohorts using postoperative consonant-nucleus-consonant (CNC) word performance. TMPRSS3 expression in mouse cochlea and human auditory nerves (HAN) was determined by using hybridisation chain reaction and single-cell RNA-sequencing analysis. RESULTS In aggregate, 27 patients (30 total CI ears) with TMPRSS3-associated hearing loss treated with CI, and 85% of patients reported favourable outcomes. Postoperative CNC word scores in patients with TMPRSS3-associated hearing loss were not significantly different than those seen in adult CI cohorts (8 studies). Robust Tmprss3 expression occurs throughout the mouse organ of Corti, the spindle and root cells of the lateral wall and faint staining within <5% of the HAN, representing type II spiral ganglion neurons. Adult HAN express negligible levels of TMPRSS3. CONCLUSION The clinical features after CI and physiological expression of TMPRSS3 suggest against a major role of TMPRSS3 in auditory neurons.
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Affiliation(s)
- Yuan-Siao Chen
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ernesto Cabrera
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brady J Tucker
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Timothy J Shin
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jasmine V Moawad
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas J Totten
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kevin T Booth
- Neurobiology, Harvard Medical School, Boston, Massachusetts, USA
- Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rick F Nelson
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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24
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Effect of Electrode Insertion Angle on Cochlear Implantation Outcomes in Adult and Children Patients with Sensorineural Hearing Loss. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9914716. [PMID: 36052159 PMCID: PMC9427248 DOI: 10.1155/2022/9914716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
Purpose To determine the role played by electrode insertion angle in cochlear implantation (CI) outcomes in adult and children patients with sensorineural hearing loss (SNHL). Methods Adults (n = 10) and children (n = 19) with SNHL undergoing CI in a tertiary specialized hospital were retrospectively enrolled. The measurements were evaluated before and after CI surgery using sound field audiometry and speech recognition tests. Questionnaires were used to assess subjective benefits. Electrode insertion angles were determined using postoperative X-rays. Results Both adult and children patients showed significant improvements in hearing, speech performance, and audiology and speech-related quality of life after CI. The angular insertion depths of adult and children group were 323.70 ± 43.57° and 341.53 ± 57.07°, respectively, showing no significant difference. In the adult group, deeper insertion depths were found to be strongly linked to lower postoperative pure tone thresholds at 12 months and higher postoperative disyllabic Word Recognition and Sentence Recognition Scores at 6 months (all P < 0.05). In the children group, deeper insertion depth had a positive correlation with postoperative monosyllabic Word Recognition Scores 6 and 12 months after CI surgery (both P < 0.05). Multiple linear regression models were constructed to predict disyllabic Word Recognition Scores at 6 and 12 months postoperatively in the children group, in which insertion angle, duration of hearing loss, and preoperative questionnaire result were identified as dependent variables. Conclusions Greater angular insertion depths resulted in improved hearing and speech performances after CI. The benefits of greater angular insertion depths can be found in both adult and children patients and last for at least 12 months. Clinicians are expected to determine the optimal implantation direction during CI and ensure the insertion depth to improve the speech rehabilitation of patients.
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25
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Wimmer W, Soldati FO, Weder S, Vischer M, Mantokoudis G, Caversaccio M, Anschuetz L. Cochlear base length as predictor for angular insertion depth in incomplete partition type 2 malformations. Int J Pediatr Otorhinolaryngol 2022; 159:111204. [PMID: 35696773 DOI: 10.1016/j.ijporl.2022.111204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The preoperative determination of suitable electrode array lengths for cochlear implantation in inner ear malformations is a matter of debate. The choice is usually based on individual experience and the use of intraoperative probe electrodes. The purpose of this case series was to evaluate the applicability and precision of an angular insertion depth (AID) prediction method, based on a single measurement of the cochlear base length (CBL). METHODS We retrospectively measured the CBL in preoperative computed tomography (CT) images in 10 ears (8 patients) with incomplete partition type 2 malformation. With the known electrode length (linear insertion depth, LID) the AID at full insertion was retrospectively predicted for each ear with a heuristic equation derived from non-malformed cochleae. Using the intra- or post-implantation cone beam CT images, the actual AID was assessed and compared. The deviations of the predicted from the actual insertion angles were quantified (clinical prediction error) to assess the precision of this single-measure estimation. RESULTS Electrode arrays with 15 mm (n = 3), 19 mm (n = 2), 24 mm (n = 3), and 26 mm (n = 2) length were implanted. Postoperative AIDs ranged from 211° to 625°. Clinical AID prediction errors from -64° to 62° were observed with a mean of 0° (SD of 44°). In two ears with partial insertion of the electrode, the predicted AID was overestimated. The probe electrode was intraoperatively used in 9/10 cases. CONCLUSION The analyzed method provides good predictions of the AID based on LID and CBL. It does not account for incomplete insertions, which lead to an overestimation of the AID. The probe electrode is useful and well established in clinical practice. The investigated method could be used for patient-specific electrode length selection in future patients.
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Affiliation(s)
- Wilhelm Wimmer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland; Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3008, Bern, Switzerland.
| | - Fabio O Soldati
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3008, Bern, Switzerland
| | - Stefan Weder
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland; Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3008, Bern, Switzerland
| | - Mattheus Vischer
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3008, Bern, Switzerland
| | - Georgios Mantokoudis
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland; Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3008, Bern, Switzerland
| | - Marco Caversaccio
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland; Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3008, Bern, Switzerland
| | - Lukas Anschuetz
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland; Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3008, Bern, Switzerland
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26
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Völter C, Oberländer K, Haubitz I, Carroll R, Dazert S, Thomas JP. Poor Performer: A Distinct Entity in Cochlear Implant Users? Audiol Neurootol 2022; 27:356-367. [PMID: 35533653 PMCID: PMC9533457 DOI: 10.1159/000524107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Several factors are known to influence speech perception in cochlear implant (CI) users. To date, the underlying mechanisms have not yet been fully clarified. Although many CI users achieve a high level of speech perception, a small percentage of patients does not or only slightly benefit from the CI (poor performer, PP). In a previous study, PP showed significantly poorer results on nonauditory-based cognitive and linguistic tests than CI users with a very high level of speech understanding (star performer, SP). We now investigate if PP also differs from the CI user with an average performance (average performer, AP) in cognitive and linguistic performance. METHODS Seventeen adult postlingually deafened CI users with speech perception scores in quiet of 55 (9.32) % (AP) on the German Freiburg monosyllabic speech test at 65 dB underwent neurocognitive (attention, working memory, short- and long-term memory, verbal fluency, inhibition) and linguistic testing (word retrieval, lexical decision, phonological input lexicon). The results were compared to the performance of 15 PP (speech perception score of 15 [11.80] %) and 19 SP (speech perception score of 80 [4.85] %). For statistical analysis, U-Test and discrimination analysis have been done. RESULTS Significant differences between PP and AP were observed on linguistic tests, in Rapid Automatized Naming (RAN: p = 0.0026), lexical decision (LexDec: p = 0.026), phonological input lexicon (LEMO: p = 0.0085), and understanding of incomplete words (TRT: p = 0.0024). AP also had significantly better neurocognitive results than PP in the domains of attention (M3: p = 0.009) and working memory (OSPAN: p = 0.041; RST: p = 0.015) but not in delayed recall (delayed recall: p = 0.22), verbal fluency (verbal fluency: p = 0.084), and inhibition (Flanker: p = 0.35). In contrast, no differences were found hereby between AP and SP. Based on the TRT and the RAN, AP and PP could be separated in 100%. DISCUSSION The results indicate that PP constitute a distinct entity of CI users that differs even in nonauditory abilities from CI users with an average speech perception, especially with regard to rapid word retrieval either due to reduced phonological abilities or limited storage. Further studies should investigate if improved word retrieval by increased phonological and semantic training results in better speech perception in these CI users.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Cochlear Implant Center Ruhrgebiet, St Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Kirsten Oberländer
- Department of Otorhinolaryngology, Head and Neck Surgery, Cochlear Implant Center Ruhrgebiet, St Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany,
| | - Imme Haubitz
- Department of Otorhinolaryngology, Head and Neck Surgery, Cochlear Implant Center Ruhrgebiet, St Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Rebecca Carroll
- Institute of English and American Studies, Technical University Braunschweig, Braunschweig, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Cochlear Implant Center Ruhrgebiet, St Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, St-Johannes-Hospital, Dortmund, Germany
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