Cochlear implants in young children

The role of computed tomography and magnetic resonance imaging for preoperative pediatric cochlear implantation work-up in academic institutions

OBJECTIVE

The goal of the study is to investigate the association of pertinent preoperative temporal bone computed tomography (CT) and brain magnetic resonance imaging (MRI) results and intraoperative surgical findings and complications of pediatric cochlear implantation reported in academic settings.

METHODS

This is a retrospective review of cochlear implant patients who received a pre-operative temporal bone CT and MRI of the brain between 2005 and 2012 at academic pediatric otolaryngology practices within children's hospitals in the United States and France. Scans were reviewed in a double-blind fashion and compared to intraoperative findings.

RESULTS

91 children were analyzed (mean age 5.54 +/- 0.58 years). A small facial recess identified on CT was associated with difficult insertion of electrodes (P = 0.0003). A prominent sigmoid sinus noted on CT was associated of difficult insertion of electrodes (P = 0.01), iatrogenic tegmen dehiscence (P = 0.005), as well as difficult round window access (P = 0.025). No specific CT finding was found to be associated with external auditory canal injury, perilymphatic gusher, or iatrogenic facial nerve injury. MRI brain and internal auditory canal findings were not predictive of surgical outcomes.

CONCLUSIONS

Preoperative CT and MRI remain an important planning tool for pediatric cochlear implantation, particularly in academic institutions. The findings of our study demonstrate that a detailed assessment of both preoperative CT and MRI are valuable for teaching and surgical planning.

New criteria of indication and selection of patients to cochlear implant

Numerous changes continue to occur in cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound unilateral hearing loss rather then the prior requirement of a bilateral profound loss. Furthermore, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low-frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. This paper will review the new concepts in the candidacy of cochlear implant. Medline data base was used to search articles dealing with the following topics: cochlear implant in younger children, cochlear implant and hearing preservation, cochlear implant for unilateral deafness and tinnitus, genetic hearing loss and cochlear implant, bilateral cochlear implant, neuropathy and cochlear implant and neural plasticity, and the selection of patients for cochlear implant.

Hearing-Impaired Children in the United Kingdom, III: Cochlear Implantation and the Economic Costs Incurred by Families

OBJECTIVES

This article addresses two questions. First, are there differences in the economic costs incurred by families of hearing-impaired children depending on whether or not children have cochlear implants? Second, are these differences important when assessed from the perspective of society?

METHODS

In a cross-sectional survey, parents of a representative sample of hearing-impaired children provided data about annual resources used by the family because of their child's hearing impairment. The data yielded estimates of two variables: out-of-pocket expenditure and time away from normal activities by parents. The economic cost of the two variables was estimated in euros at 2001/2 price levels, and summed to estimate the overall economic cost incurred by the family. Linear regression was used to estimate the association between costs and implantation, while controlling for average (unaided, preoperative) hearing level, age at onset of hearing impairment, age, gender, the number of additional disabilities, parental occupational skill level, ethnicity, and parental hearing status. The cumulative economic cost incurred by the families of implanted children, between implantation and age 16 yr, was calculated from estimates of the overall economic cost associated with implantation and compared with estimates of the incremental health-sector cost of implantation.

RESULTS

Data were provided by the families of 2858 children, 468 of whom had received a cochlear implant. Compared with the families of nonimplanted children, out-of-pocket expenditure was estimated to be significantly higher for families when children were implanted before the age of 5 yr and had used their implant for less than 2 yr, as was lost productivity when children had used their implants for less than 2 yr. Overall economic cost was estimated to be significantly higher for the families of implanted children who had used their implants for less than 2 yr. The cumulative economic cost was estimated to be 3355 euros for a family whose child was implanted at age 3 yr and 949 euros for a child implanted at age 6 yr. These costs correspond, at most, to 3% of the incremental health-sector costs of implantation.

CONCLUSIONS

Compared with families of nonimplanted children, families of implanted children incur additional costs in the 2 yr after implantation. These costs are small in relation to the health-sector costs of providing implantation.

Sensorineural hearing loss in children

During the past three to four decades, the incidence of acquired sensorineural hearing loss (SNHL) in children living in more developed countries has fallen, as a result of improved neonatal care and the widespread implementation of immunisation programmes. The overall decrease has been accompanied by a relative increase in the proportion of inherited forms of SNHL. The contribution made by one gene in particular, GJB2, to the genetic load of SNHL has strongly affected the assessment and care of children with hearing loss. These changes in the incidence of SNHL have not been seen in children living in less developed countries, where the prevalence of consanguinity is high in many areas, and both genetic and acquired forms of SNHL are more common, particularly among children who live in poverty. Focused genetic counselling and health education might lead to a decrease in the prevalence of inherited SNHL in these countries. Establishment of vaccination programmes for several vaccine-preventable infectious diseases would reduce rates of acquired SNHL. Although the primary purpose of such programmes is the prevention of serious and in many cases fatal infections, a secondary benefit would be a reduction in disease-related complications such as SNHL that cause permanent disability in survivors.