Cochlear implantation in children with inner ear malformation: A multicenter study on auditory performance and speech production outcomes

Variability in Receptive Language Development Following Bilateral Cochlear Implantation

OBJECTIVES

The primary aim was to investigate the variability in language development in children aged 5-7.5 years after bilateral cochlear implantation (CI) up to the age of 2 years, and any impact of the age at implantation and additional noncognitive or anatomical disorders at implantation.

DESIGN

Data of 84 congenitally deaf children that had received simultaneous bilateral CI at the age of ≤ 24 months were included in this retrospective study. The results of language comprehension acquisition were evaluated using a standardized German language acquisition test for normal hearing preschoolers and first graders. Data on speech perception of monosyllables and sentences in quiet and noise were added.

RESULTS

In a monosyllabic test, the children achieved a median performance of 75.0 ± 12.88%. In the sentence test in quiet, the median performance was 89 ± 12.69%, but dropped to 54 ± 18.92% in noise. A simple analysis showed a significant main effect of age at implantation on monosyllabic word comprehension (p < .001), but no significant effect of comorbidities that lacked cognitive effects (p = .24). Language acquisition values correspond to the normal range of children with normal hearing. Approximately 25% of the variability in the language acquisition tests is due to the outcome of the monosyllabic speech perception test.

CONCLUSIONS

Congenitally deaf children who were fitted bilaterally in the 1st year of life can develop age-appropriate language skills by the time they start school. The high variability in the data is partly due to the age of implantation, but additional factors such as cognitive factors (e.g., working memory) are likely to influence the variability.

Prognostic factors in pediatric cochlear implant: an outcome-based study

OBJECTIVE

To determine the prognostic factors in the pediatric cochlear implant (CI) outcome.

MATERIALS AND METHODS

This prospective cohort study was conducted on 289 pediatric cases with prelingual hearing loss who received cochlear implantation. Several possible salient factors have been recorded. Auditory and speech evaluations were performed before CI, as well as 6 and 12 months after surgery, using Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) tests.

RESULTS

According to univariate analysis, age at the time of surgery was a statistically significant factor. Neurological problems in the child, history of newborn infectious diseases, history of hearing aid use, proper parental cooperation, and round window approach were all significantly related to better auditory or speech outcomes. On the other hand, good parental cooperation and age (for CAP) and good parental cooperation, age, history of infectious disease, and hearing aids use (for SIR) are the significant factors in the multivariate setting.

CONCLUSION

As evidenced by the obtained results, age, background diseases, history of rehabilitation with hearing aids, and surgical details are essential factors to be taken into account in the case-selection process.

Cochlear implantation programming characteristics and outcomes of cochlear nerve deficiency

PURPOSE

Due to the specificity of cochlear implantation (CI) programming parameters and outcomes in cochlear nerve deficiency (CND) patients, this study aimed to investigate the correlation between programming parameters and outcomes and further compare the difference between normal and CND groups.

METHODS

Ninety (95 ears) CND patients (normal cochlea, 39; malformed cochlea, 56) and seventy-nine (81 ears) normal cochlea patients who underwent CI surgery with either Med-El or Cochlear devices were included. The programming parameters and outcomes evaluated by the questionnaires were collected and compared among the normal CND, malformed CND, and normal groups in the two device groups, and their correlation was analyzed.

RESULTS

In the CND group, a reduced stimulation rate, higher pulse width, and triphasic pulse were needed in some cases. The stimulus levels of the CND group were significantly higher than that of the normal group (p < 0.05), but the outcomes of the CND group were significantly worse than that of the normal group (p < 0.05), and the stimulus level was significantly correlated with the outcomes (p < 0.05). However, there was no difference between normal and malformed CND groups. The non-auditory response was observed in the CND group, especially the ones with malformations.

CONCLUSION

The CI programming parameters of some CND patients need to be adjusted, and a slower stimulation rate and higher pulse width are required sometimes. CND patients need a higher stimulus level than normal patients but their outcomes are poorer. Non-auditory response should be noticed in CND patients during programming.

The effect of cochlear implant insertion technique on post-operative neural response telemetry and impedance in paediatric patients

OBJECTIVE

This study aimed to compare neural response telemetry and impedance between the round window and cochleostomy approaches for cochlear implantation.

METHODS

In this case-control study, 64 patients aged less than 3.5 years underwent cochlear implantation via the round window or cochleostomy approach. Post-operative neural response telemetry and impedance were measured.

RESULTS

The impedance measurements at electrodes 1, 11 and 22 showed no significant differences between the two groups three months after implantation (p = 0.90, p = 0.08 and p = 0.37, respectively). Similar results were observed six months after implantation (p = 0.71, p = 0.65 and p = 0.70, respectively). There was no significant difference in neural response telemetry between the two groups after three months. The neural response telemetry of electrode 1 in the cochleostomy group (171.26 ± 19.81 μV) was significantly higher in comparison with that of electrode 1 in the round window group (161.97 ± 12.71 μV) after six months (p = 0.03). The neural response telemetry values for electrodes 11 and 22 did not show any significant difference after six months (p = 0.14 and p = 0.48, respectively).

CONCLUSION

Both approaches provide equal stimulation of the cochlear nerve and impedance.

Cochlear Implantation Outcomes in Pediatrics with Inner Ear Malformations in a Tertiary Care Hospital in Ahvaz

Cochlear implantation (CI) has been successful in individuals with sensorineural hearing loss (SNHL) over the last few years. This study assessed the auditory and speech performance results of pediatrics with inner ear malformations (IEMs) following cochlear implantation at the Ahvaz cochlear implantation center and compared the outcomes of various malformations. All pediatrics with IEMs undergoing CI were included in the study. This retrospective study was performed on pediatrics with congenital IEMs who underwent cochlear implantation in Ahvaz cochlear implantation center between 2014 and 2019. The Category of Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) scores are two of the most frequently administered tests. The CAP with ranging from 0 (displays no awareness of environmental sounds) to 7 (can use the telephone with a familiar talker), was used to measure the speech perception performance of the implanted children. Furthermore, SIR consists of five performance categories ranging from "prerecognizable words in spoken language" to "connected speech is intelligible to all listeners". Finally, the study included 22 patients. The evaluation of the CT-Scan revealed three types of inner ear malformation: Incomplete Partition (IP)-I in 2 (9.1%), IP-II in 12 (54.5%), and common cavity in 8 (36.4%) individuals. The results were shown that the median CAP score preoperative was 0.5 (interquartile range (IQR): 0-2) and postoperative was 3.5 (IQR: 3-7). There were statistically significant differences in CAP scores between preoperative and second-year follow-up postoperative (p value = 0.036). The results were shown that the median SIR score preoperative was 1 (IQR: 1-5) and postoperative was 2 (IQR: 1-5). There were statistically significant differences in SIR scores between preoperative and second-year follow-up postoperative (p value = 0.001). Following a thorough preoperative screening, patients with specific IEMs can be candidates for CI and not a contraindication. There were statistically significant differences in CAP and SIR scores between preoperative and second-year follow-up postoperative in the common cavity and IP-II groups.

Cochlear implantation in children with congenital inner ear malformations - Our experience

OBJECTIVE

To share our experience of the surgical challenges faced in cochlear implanted patients with inner ear malformation and to assess the auditory and speech perception outcomes.

MATERIAL AND METHOD

Clinical records of 502 cochlear implant procedures were reviewed and data of 122 patients who had inner ear malformations were enrolled in the study. Their auditory and speech performances were evaluated post implantation for 3 years.

RESULT

Cerebrospinal fluid gusher was encountered during opening of cochlea in 42 patients (34.4%) and one patient was re-explored within 24 h. In 30.3% of cases facial anomaly was found. Significant improvement in average performance was seen in all malformation types except in cochlear hypoplasia at 12 months postoperatively.

CONCLUSION

Surgical challenges can be overcome with expertise and giving special attention to preoperative imaging. Our experience suggests that outcomes are favourable in patients with inner ear malformations too.

Complications and outcomes of cochlear implantation in children younger than 12 months: A multicenter study

OBJECTIVES

Evidence suggests that Cochlear Implantation (CI) is a beneficial approach for auditory and speech skills improvement in children with severe to profound hearing loss. However, it remains controversial if implantation in children <12 months is safe and effective compared to older children. The present study aimed to determine whether children's ages affect surgical complications and auditory and speech development.

METHODS

The current multicenter study enrolled 86 children who underwent CI surgery at <12 months of age (group A) and 362 children who underwent implantation between 12 and 24 months of age (group B). The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were determined pre-impanation, and "one-year" and "two-year" post-implantation.

RESULTS

All children had full insertions of the electrode array. Four complications (overall rate: 4.65%; three minor) occurred in group A and 12 complications (overall rate: 4.41%; nine minor) occurred in group B. We found no statistically significant difference in the complication rates between the groups (p > 0.05). The mean SIR and CAP scores improved over time following CI activation in both groups. However, we did not find significant differences in CAP and SIR scores between the groups across different time points.

CONCLUSION

Cochlear implantation in children younger than 12 months is a safe and efficient procedure, providing substantial auditory and speech benefits. Furthermore, rates and nature of minor and major complications in infants are similar to those of children undergoing the CI at an older age.

Speech Perception and Sound Localization Skills in Inner Ear Malformations: Children With Incomplete Partition Type-II

OBJECTIVE

The present study aimed to evaluate binaural auditory skills in bimodal and bilateral pediatric cochlear implant (CI) users with incomplete partition type-II (IP-II) and to reveal the effect of IP-II on performance by comparing the results to pediatric CI users with normal cochlear morphology.

STUDY DESIGN

Cross-sectional study.

SETTING

Tertiary referral center.

METHODS

Forty-one CI users (mean age 8.8 ± 1.9) were grouped as bimodal (BIM-IP) and bilateral (BIL-IP) users with IP-II; bimodal (BIM-N) and bilateral (BIL-N) users with normal cochlear anatomy. Speech perception in noise and sound localization skills were compared under 2 conditions; binaural (bilateral or bimodal) and monaural (first CI alone).

RESULTS

BIM-IP and BIL-IP showed no performance difference in binaural tasks. The BIM-N group showed remarkably poor performance in comparison to the groups of BIL-IP (p = .007), BIM-IP (p < .001), and BIL-N (p = .004) in terms of speech-in-noise skills. In sound localization abilities, similar significant differences were found between the group of BIM-N and the groups of BIL-IP (p = .001), BIM-IP (p < .001), and BIL-N (p = .004). All groups showed statistically significant improvements in binaural condition on both tasks (p < .05).

CONCLUSION

We revealed that bilateral and bimodal pediatric CI users with IP-II benefitted from implantation as much as bilateral users with normal anatomy. Differences in residual hearing between groups may explain the poor performance of bimodal users with normal cochlear morphology. To the best of our knowledge, it is the first study to unveil binaural performance characteristics in children diagnosed with a specific inner ear malformation subgroup.

A 3-Year Follow-Up and Radiological Analysis of Cochlear Implantation Patients with Cochlear Nerve Deficiency and Modiolar Deficiency-Type Malformations

OBJECTIVE

Cochlear nerve deficiency (CND) is often combined with modiolar deficiency-type inner ear malformations, which cause variable cochlear implantation (CI) outcomes. We aimed to assess the postoperative development of auditory and speech perception in CND patients with modiolar deficiency-type malformations after 3 years of follow-up to determine the factors correlated with CI outcomes.

METHODS

Sixty-seven CND patients with modiolar deficiency-type malformations who underwent CI surgery were retrospectively reviewed. Modiolar deficiency-type malformations included common cavity (CC), cochlear hypoplasia (CH) (including CH-I and CH-II) and incomplete partition-I (IP-I). Categorical auditory performance (CAP) and the infant-toddler meaningful auditory integration scale (MAIS) were used to assess auditory ability. The speech intelligibility rating (SIR) and meaningful use of speech scale (MUSS) were used to assess the speech intelligibility of these CI patients. The CI outcomes were evaluated at 0, 12, 24 and 36 months after implant activation.

RESULTS

All patients demonstrated improvements in auditory ability and speech intelligibility after CI. There were no significant differences in CI outcomes at any time point according to the malformation type. The number of nerve bundles within the internal auditory canal (IAC) showed significant differences at 12, 24 and 36 months after CI ( p < 0.05). Patients with one nerve bundle had relatively poor CI outcomes.

CONCLUSIONS

CND patients with modiolar deficiency-type malformations showed continuous improvement in auditory and speech abilities after CI. Compared with malformations, the number of nerve bundles should be given more attention when selecting the side for CI.

Cochlear implantation in adults and pediatrics with enlarged vestibular aqueduct: a systematic review on the surgical findings and patients' performance

PURPOSE

Cochlear implantation (CI) has been considered a safe and effective management option for patients with severe to profound hearing loss. Patients with enlarged vestibular aqueduct (EVA) could be challenging with some variations in surgical approaches, intraoperative surgical notes, and clinical outcomes. This study aimed to  review the surgical and clinical outcomes of cochlear implantation among patients with EVA.

MATERIALS AND METHODS

A systematic literature search was carried out in five major databases. All original studies reporting cochlear implantation in patients with EVA were included for qualitative data synthesis. The risk of bias was independently assessed through the National Intuitional of Health tool. The review protocol was registered in PROSPERO (reference number: CRD42021225900).

RESULTS

A total of 34 studies with 4035 subjects were included. Of them, 853 (21.14%) had EVA and underwent CI. Mondini malformation was the most frequently associated anomaly (n = 78, 11.1%). Unilateral implantation was performed in 258 cases while bilateral in 119 subjects. Postoperative complications included CSF/perilymph gusher (n = 112), CSF oozing (n = 18), and partial electrode insertion (n = 6). Closing the cochleostomy with temporalis fascia, muscle, connective tissue, or fibrin glue was the most frequently reported approach to manage CSF/perilymph gusher (n = 67, 56.7%) while packing was performed in six patients.

CONCLUSION

Patients with EVA demonstrated audiometric and speech performance improvement after CI. However, many patients had intra- or postoperative complications. Further research is needed as the outcomes may be affected by associated temporal bone pathology, the timing of implant, and hearing condition.

Outcomes of Acoustic and Linguistic Performances Following Cochlear Implantation in Large Vestibular Aqueduct Syndrome (LVAS)

AIM

This study aims to collate the outcomes in acoustic and linguistic performances after cochlear implantation in LVAS.

METHODS

In a hospital-based prospective interventional study, seven prelingual children with bilateral profound sensorineural hearing loss (SNHL) with LVAS were recruited. They underwent unilateral cochlear implantation between December 2013 and December 2015 in the Department of Otorhinolaryngology and Head Neck Surgery at a tertiary care center. Outcomes of auditory and speech performances were assessed in the form of revised categories of auditory perception (CAP), infant toddler meaningful auditory integration scale (IT-MAIS) and speech intelligibility rating (SIR) scores preoperatively, at one and two years follow up.

RESULTS

The mean age of implantation was 4 years. The median revised CAP, IT-MAIS, and SIR scores after one and two years of follow-up were 6, 27, 3, and 11, 36, 5 respectively. The mean follow-up duration was 21.3 months.

CONCLUSION

Pre op median revised CAP, IT-MAIS, and SIR scores of 0, 1, 1 showed improvement to 11, 36, 5 at two years follow up which was statistically significant. Hence, we conclude that good functional outcomes post-operatively advocate the significance of cochlear implantation in LVAS.

The effects of cochlear implantation on middle ear function: A prospective study

OBJECTIVES

Although sound conduction mechanisms may influence by cochlear implantation (CI), it is not very clear whether, how, and to what extent these mechanisms may be influenced the pediatric population. Wideband tympanometry (WBT) is a sensitive tool to evaluate alternations in the middle ear mechanics in a wide frequency range. The current study aimed to explore CI's impacts on sound conduction across the middle ear cavity using WBT in pediatrics.

METHODS

In a prospective design, 35 unilaterally implanted children (<24 months of age) with normal temporal bone anatomy were included in this study. Traditional tympanometry (226-Hz) and WBT measures were compared for each child in the implanted and non-implanted ears preoperatively and three months postoperatively.

RESULTS

No significant changes in the "static acoustic admittance" and "peak pressure" parameters were observed between the pre-CI and post-CI conditions in the implanted and non-implanted ears in the 226-Hz tympanometry test. Wideband absorbance recordings before CI surgery exhibited a double-peaked pattern over a frequency range of 250 to 8000 Hz. The pre- and postoperative acoustic energy absorbance comparisons indicated a significantly reduced mid-frequency (1260 to 3175 Hz) and high-frequency (5040 to 8000 Hz) absorbance in the implanted ears. However, our results indicated no significant differences in sound absorbance between the pre- and postoperative conditions in non-implanted ears.

CONCLUSION

Our findings suggested that WBT is a more sensitive method than traditional tympanometry for monitoring the mechanical status of the middle ear after cochlear implantation in pediatrics. Cochlear implantation in young children can significantly reduce mid- and high-frequency acoustic absorbance measured by WBT.

A systematic review of studies on connected speech processing: Trends, key findings, and implications

Connected speech processing (CSP) is of great significance to individuals’ language and cognitive development. It is particularly crucial not only for clinical detection and treatment of developmental disorders, but also for the Foreign/second language teaching instructions. However, given the importance of this field, there is a clear lack of systematic reviews that summarize the key findings of previous studies. To this end, through searching in the scientific databases PsycInfo, Scopus, PubMed, ERIC, Taylor and Francis, and Web of Science, the present study identified 128 core CSP articles with high reference values according to PRISMA guidance and the following results were obtained through quantitative analysis and qualitative comparative synthesis: (1) The number of studies on CSP published per year showed an upward trend; however, most focused on English language, whereas the studies on other languages were comparatively rare; (2) CSP was found to be affected by multiple factors, among which speech speed, semantics, word frequency, and phonological awareness were most frequently investigated; (3) the deficit in CSP capacity was widely recognized as a significant predictor and indicator of developmental disorders; (4) more studies were carried out on connected speech production than on perception; and (5) almost no longitudinal studies have ever been conducted among either native or non-native speakers. Therefore, future research is needed to explore the developmental trajectory of CSP skills of typically developing language learners and speakers with cognitive disorders over different periods of time. It is also necessary to deepen the understanding of the processing mechanism beyond their performance and the role played by phonological awareness and lexical representations in CSP.

Systematic review of cochlear implantation in patients with inner ear malformations

OBJECTIVES

To evaluate the outcomes of cochlear implantation in patients with severe to profound sensorineural hearing loss due to inner ear malformations (IEMs) when compared to patients without IEMs. We discussed audiological outcomes such as open-set testing, closed-set testing, CAP score, and SIR score as well as postoperative outcomes such as cerebrospinal fluid gusher and incomplete insertion rate associated with cochlear implantation in individuals with IEMs.

DATA SOURCES

PubMed, Science Direct, Web of Science, Scopus, and EMBASE databases.

REVIEW METHODS

After screening a total of 222 studies, twelve eligible original articles were included in the review to analyze the speech and hearing outcomes of implanted patients with IEMs. Five reviewers independently screened, selected, and extracted data. The "Tool to Assess Risk of Bias in Cohort Studies" published by the CLARITY group was used to perform quality assessment on eligible studies. Systematic review registration number: CRD42021237489.

RESULTS

IEMs are more likely to be associated with abnormal position of the facial nerve, raising the risk of intraoperative complications. These patients may benefit from cochlear implantation, but audiological outcomes may also be less favorable than in individuals without IEMs. Furthermore, due to the risk of cerebrospinal fluid gusher, incomplete insertion of electrodes, and postoperative facial nerve stimulation, surgeons can employ precautionary measures such as preoperative imaging and proper counseling. Postoperative imaging is suggested to be beneficial in ensuring proper electrode placement.

CONCLUSIONS

Cochlear implants (CIs) have the potential to provide auditory rehabilitation to individuals with IEMs. Precise classification of the malformation, preoperative imaging and anatomical mapping, appropriate electrode selection, intra-operative techniques, and postoperative imaging are recommended in this population.

The Outcome of Cochlear Implantations in Deaf-Blind Patients: A Multicenter Observational Study

OBJECTIVE

This multicenter study aimed to evaluate the auditory and speech outcomes of cochlear implantation (CI) in deaf-blind patients compared with deaf-only patients.

STUDY DESIGN

Retrospective cohort study.

SETTING

Multiple cochlear implant centers.

PATIENTS

The current study was conducted on 17 prelingual deaf-blind children and 12 postlingual deaf-blind adults who underwent CI surgery. As a control group, 17 prelingual deaf children and 12 postlingual deaf adults were selected.

INTERVENTION

Cochlear implantation.

MAIN OUTCOME MEASURES

Auditory and linguistic performances in children were assessed using the categories of auditory performance (CAP) and Speech Intelligibility Rating (SIR) scales, respectively. The word recognition score (WRS) was also used to measure speech perception ability in adults. The mean CAP, SIR, and WRS cores were compared between the deaf-only and deaf-blind groups before CI surgery and at "12 months" and "24 months" after device activation. Cohen's d was used for effect size estimation.

RESULTS

We found no significant differences in the mean CAP and SIR scores between the deaf-blind and deaf-only children before the CI surgery. For both groups, SIR and CAP scores improved with increasing time after the device activation. The mean CAP scores in the deaf-only children were either equivalent or slightly higher than those of the deaf-blind children at "12 months post-CI" (3.94 ± 0.74 vs 3.24 ± 1.25; mean difference score, 0.706) and "24 months post-CI" (6.01 ± 0.79 vs 5.47 ± 1.06; mean difference score, 0.529) time intervals, but these differences were not statistically significant. The SIR scores in deaf-only implanted children were, on average, 0.870 scores greater than the deaf-blind children at "12 months post-CI" (2.94 ± 0.55 vs 2.07 ± 1.4; p = 0.01, d = 0.97) and, on average, 1.067 scores greater than deaf-blind children at "24 months post-CI" (4.35 ± 0.49 vs 3.29 ± 1.20; p = 0.002; d = 1.15) time intervals. We also found an improvement in WRS scores from the "preimplantation" to the "12-month post-CI" and "24-month post-CI" time intervals in both groups. Pairwise comparisons indicated that the mean WRS in the deaf-only adults was, on average, 10.61% better than deaf-blind implanted adults at "12 months post-CI" (62.33 ± 9.09% vs 51.71 ± 10.73%, p = 0.034, d = 1.06) and, on average, 15.81% better than deaf-blind adults at "24-months post-CI" (72.67 ± 8.66% vs 56.8 ± 9.78%, p = 0.002, d = 1.61) follow-ups.

CONCLUSION

Cochlear implantation is a beneficial method for the rehabilitation of deaf-blind patients. Both deaf-blind and deaf-only implanted children revealed similar auditory performances. However, speech perception ability in deaf-blind patients was slightly lower than the deaf-only patients in both children and adults.

Comprehensive Etiologic Analyses in Pediatric Cochlear Implantees and the Clinical Implications

Cochlear implantation is the treatment of choice for children with profound sensorineural hearing impairment (SNHI), yet the outcomes of cochlear implants (CI) vary significantly across individuals. To investigate the CI outcomes in pediatric patients with SNHI due to various etiologies, we prospectively recruited children who underwent CI surgery at two tertiary referral CI centers from 2010 to 2021. All patients underwent comprehensive history taking, next generation sequencing (NGS)-based genetic examinations, and imaging studies. The CI outcomes were evaluated using Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores. Of the 160 pediatric cochlear implantees (76 females and 84 males) included in this study, comprehensive etiological work-up helped achieve clinical diagnoses in 83.1% (133/160) of the patients, with genetic factors being the leading cause (61.3%). Imaging studies identified certain findings in 31 additional patients (19.3%). Four patients (2.5%) were identified with congenital cytomegalovirus infection (cCMV), and 27 patients (16.9%) remained with unknown etiologies. Pathogenic variants in the four predominant non-syndromic SNHI genes (i.e., SLC26A4, GJB2, MYO15A, and OTOF) were associated with favorable CI outcomes (Chi-square test, p = 0.023), whereas cochlear nerve deficiency (CND) on imaging studies was associated with unfavorable CI outcomes (Chi-square test, p < 0.001). Our results demonstrated a clear correlation between the etiologies and CI outcomes, underscoring the importance of thorough etiological work-up preoperatively in pediatric CI candidates.

Transcutaneous Bone Conduction Implants in Patients With Single-Sided Deafness: Objective and Subjective Evaluation

OBJECTIVES

This study aimed to investigate the audiological outcomes and subjective benefits of transcutaneous bone conduction implants (BCIs) in patients with single-sided deafness (SSD).

METHODS

This retrospective study was conducted on 11 patients with SSD implantations between 2015 and 2018 at a tertiary center. Pure-tone audiometry, speech reception threshold (SRT), and speech-in-noise (SPIN) tests were performed. Preoperative and postoperative performances were compared. Subjective satisfaction level was assessed using validated questionnaires. A PubMed search was conducted to identify the relevant studies published to date.

RESULTS

All patients demonstrated significant audiological improvements compared with their preoperative condition. The mean SRT improved significantly (p = 0.001) from 109 dB to 23 dB after implantation. The mean SPIN score improved significantly after implantation. The questionnaires showed an overall positive benefit of transcutaneous bone conduction devices (BCDs). A literature search revealed 21 articles, of which 14 reported the use of BCIs in patients with SSD. Our results agree with the published evidence showing the overall benefit of BCI in patients with SSD.

CONCLUSIONS

Transcutaneous BCDs could be considered as an alternative treatment option for patients with SSD, it could show good audiological outcomes and high satisfaction levels. Further studies should be conducted on patients with SSD to determine the most appropriate hearing solutions.

Cochlear Implants for Patients With Common Cavity Deformities and the Impact of Electrode Positioning

Objectives

Common cavity deformity is a rare congenital bony labyrinth malformation associated with profound hearing loss. Cochlear implants are widely used for hearing rehabilitation for common cavity deformities; however, the reported prognosis is poor. Due to the deformed anatomical structure, it is important to consider the position of the electrodes to maximize the performance of the cochlear implant. The present study discusses the impact of electrode placement on hearing outcomes.

Methods

A retrospective medical chart review of eight common cavity deformity patients (10 cochlear implants) who received cochlear implants was performed at a single university hospital. In all eight patients, implant surgery was performed using single-slit labyrinthotomy. Electrodes wer e manually bent before insertion to prevent misplacement and to reduce physical damage to the neuroepithelium.

Results

Four of the 10 electrodes were misplaced, with their tips placed in the anterior semicircular canal or internal auditory canal. However, after implant surgery, all patients—including those with misplaced electrodes—gained auditory perception and improved hearing function. One patient who had electrodes that did not contact the inner wall of the cavity showed limited activity of the electrodes (27%) compared to others (64%–100%).

Conclusion

Proper contact of the electrode with the inner wall was more likely to be important for cochlear implant success in cases of common cavity deformity than appropriate placement of the electrode tip.

Characteristics of electrically evoked auditory brainstem response in children with large vestibular aqueduct syndrome after cochlear implantation

BACKGROUND

The vestibular aqueduct (VA) width may affect the auditory conduction pathway of large vestibular aqueduct syndrome (LVAS) children.

OBJECTIVE

Analyzing the electrically evoked auditory brainstem response (EABR) after cochlear implantation (CI) in severe to profound sensorineural hearing loss (SNHL) children with LVAS.

MATERIALS AND METHODS

Fifty-four children with SNHL who received CI were selected, including 21 children with LVAS and 33 children without inner ear malformations (IEMs). The VA width was measured in LVAS children. The post-operative EABRs were recorded in all children.

RESULTS

For the LVAS group, the VA width was positively correlated with wave III (eIII) latency of EABR at the No. 2 electrode (E2), E5, E8, and E11, the VA width was positively correlated with wave V (eV) latency of EABR at E2, E5, E8, and E11. Only the eV latency of E2 showed a significant difference between the two groups.

CONCLUSION AND SIGNIFICANCE

SNHL children with LVAS and no IEMs have similar conduction of the auditory pathway. In the LVAS group, the conduction of the auditory pathway becomes better with the decrease of VA width. Rational use of post-operative EABRs and the measurement of anatomical parameters can effectively assess the development of part auditory pathways in LVAS children, which may be helpful in predicting post-operative speech and hearing recovery.

Cochlear Implantation in Pediatric Patients With Enlarged Vestibular Aqueduct: A Systematic Review

OBJECTIVE(S)

To describe cochlear implantation (CI) outcomes, with speech perception, auditory, language, and parent-reported auditory and speech behaviors, in children with an enlarged vestibular aqueduct (EVA) and incomplete partition type 2 (IP-II) and compare to control children without inner ear malformations (IEMs) and to determine cerebrospinal fluid gusher rates and effect on outcomes.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

MEDLINE, Embase, Cochrane, and CINAHL databases were searched from inception to February 2020. Studies reporting relevant outcomes in children with EVA or EVA + IP-II and controls without IEMs undergoing CI were included. Mean differences in speech perception, auditory, and language scores between cases and controls were meta-analyzed. Gusher rates were determined by proportion meta-analyses.

RESULTS

Of 214 identified articles, 42 met inclusion criteria, evaluating 775 cases and 2,191 controls. Of -cases, 578 (74.6%) had EVA and 197 (25.4%) had EVA + IP-II. Cases showed a significant improvement in speech perception, auditory and language performance, comparable to controls. Parent-reported auditory and speech production behaviors outcomes were positive among cases and comparable to controls. Pooled gusher proportions in EVA and EVA + IP-II cases were 27.7% (95% CI: 17.6-39.1) and 48.6% (95% CI: 28.6-69.0), respectively, with a proportion difference of 20.9% (95% CI: 11.0-30.1). Gusher occurrence did not impact speech perception or language outcomes.

CONCLUSION

Outcomes in children with EVA or EVA + IP-II undergoing CI are favorable and largely comparable to outcomes in children with hearing loss undergoing CI without IEMs. Intraoperative gusher is more prevalent among children with EVA + IP-II as compared to iEVA. Gusher does not influence speech perception and language development outcomes.

LEVEL OF EVIDENCE

NA Laryngoscope, 2021.

Cochlear implantation in common cavity deformity: a systematic review

PURPOSE

Cochlear implantation became a valid hearing rehabilitation option in common cavity deformity. This study aimed to assess the audiological and speech outcomes of cochlear implantation in common cavity deformity patients and to address the surgical aspect used in this population.

METHODS

A comprehensive systematic literature review based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline from database inception through April 2020. Eighteen published articles including 138 patients with common cavity deformity met the inclusion criteria. These articles studied the surgical techniques and the audiological outcomes of cochlear implantation in patients with common cavity deformity in English language.

RESULTS

Trans-mastoid labyrinthotomy was the common surgical approach in these patients. The average speech intelligibility rating and categories of auditory performance scores in common cavity deformity were lower than in normal cochlea subjects (p < 0.05), and non-significant (p > 0.05) compared with other types of inner ear malformations.

CONCLUSION

Patients with common cavity deformity who underwent cochlear implantation showed a beneficial audiological and speech outcome. However, their performance is highly variable. Therefore, pre-operative counseling of the parents is necessary. The surgical approaches should be individualized according to clinical, radiological, and surgical findings.

How Transmembrane Inner Ear (TMIE) plays role in the auditory system: A mystery to us

Different cellular mechanisms contribute to the hearing sense, so it is obvious that any disruption in such processes leads to hearing impairment that greatly influences the global economy and quality of life of the patients and their relatives. In the past two decades, transmembrane inner ear (TMIE) protein has received a great deal of research interest because its impairments cause hereditary deafness in humans. This evolutionarily conserved membrane protein contributes to a fundamental complex that plays role in the maintenance and function of the sensory hair cells. Although the critical roles of the TMIE in mechanoelectrical transduction or hearing procedures have been discussed, there are little to no review papers summarizing the roles of the TMIE in the auditory system. In order to fill this gap, herein, we discuss the important roles of this protein in the auditory system including its role in mechanotransduction, olivocochlear synapse, morphology and different signalling pathways; we also review the genotype-phenotype correlation that can per se show the possible roles of this protein in the auditory system.