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Hamed N, Alajmi N, Alkoblan FI, Alghtani YA, Abdelsamad Y, Alhussien A, Alhajress RI, Alhabib SF. The Chronological Evolution of Cochlear Implant Contraindications: A Comprehensive Review. J Clin Med 2024; 13:2337. [PMID: 38673610 PMCID: PMC11050773 DOI: 10.3390/jcm13082337] [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: 03/19/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Cochlear implantation has emerged as a transformative intervention in addressing profound hearing loss, offering a paradigm shift in auditory rehabilitation for individuals with restricted auditory function. Throughout its history, the understanding of contraindications for cochlear implant (CI) surgery has evolved significantly. This review comprehensively analyzes the chronological advancements in the understanding of CI contraindications, examining studies conducted from historical timelines to the present. Recent research has revealed significant developments in the field, prompting a reevaluation of established criteria and resulting in expanded indications for CI. The chronological evolution of contraindications underscores the transformative nature of the field, offering potential improvements in outcomes and enhancing the quality of life for individuals with profound hearing loss. In conclusion, this narrative review emphasizes the dynamic nature of the field, where the reevaluation of contraindications has created new opportunities and broader indications for CI. The emerging prospects, including improved outcomes and enhanced quality of life, hold promise for individuals with profound hearing loss.
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Affiliation(s)
- Nezar Hamed
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Norah Alajmi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Faisal Ibrahim Alkoblan
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Yazeed Abdullah Alghtani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Yassin Abdelsamad
- Research Department, MED-EL GmbH, P.O. Box 245, Riyadh 11411, Saudi Arabia;
| | - Ahmed Alhussien
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Rafeef Ibrahim Alhajress
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Salman F. Alhabib
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
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Lee SJ, Oh H, Shin KH, Park SM, Kim YK, Jung DH, Yang J, Chun Y, Kim MY, Han JH, Kim JA, Tran NT, Kim BJ, Choi BY. Early Postoperative Benefits in Receptive and Expressive Language Development After Cochlear Implantation Under 9 Months of Age in Comparison to Implantation at Later Ages. Clin Exp Otorhinolaryngol 2024; 17:46-55. [PMID: 38326998 PMCID: PMC10933813 DOI: 10.21053/ceo.2024.00011] [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: 01/12/2024] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES The recent expansion of eligibility for cochlear implantation (CI) by the U.S. Food and Drug Administration (FDA) to include infants as young as 9 months has reignited debates concerning the clinically appropriate cut-off age for pediatric CI. Our study compared the early postoperative trajectories of receptive and expressive language development in children who received CI before 9 months of age with those who received it between 9 and 12 months. This study involved a unique pediatric cohort with documented etiology, where the timing of CI was based on objective criteria and efforts were made to minimize the influence of parental socioeconomic status. METHODS A retrospective review of 98 pediatric implantees recruited at a tertiary referral center was conducted. The timing of CI was based on auditory and language criteria focused on the extent of delay corresponding to the bottom 1st percentile of language development among age-matched controls, with patients categorized into very early (CI at <9 months), early (CI at 9-12 months) and delayed (CI at 12-18 months) CI groups. Postoperative receptive/expressive language development was assessed using the Sequenced Language Scale for Infants receptive and expressive standardized scores and percentiles. RESULTS Only the very early CI group showed significant improvements in receptive language starting at 3 months post-CI, aligning with normal-hearing peers by 9 months and maintaining this level until age 2 years. During this period (<2 years), all improvements were more pronounced in receptive language than in expressive language. CONCLUSION CI before 9 months of age significantly improved receptive language development compared to later CI, with improvements sustained at least up to the age of 2. This study supports the consideration of earlier CI, beyond pediatric Food and Drug Administration labeling criteria (>9 months), in children with profound deafness who have a clear deafness etiology and language development delays (<1st percentile).
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Affiliation(s)
- Seung Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Heonjeong Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Ha Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Min Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Kyeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Hyun Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jiyeon Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yejun Chun
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Ang Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ngoc-Trinh Tran
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bong Jik Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea
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Cottrell J, Spitzer E, Friedmann D, Jethanamest D, McMenomey S, Thomas Roland J, Waltzman S. Cochlear Implantation in Children Under 9 Months of Age: Safety and Efficacy. Otol Neurotol 2024; 45:121-127. [PMID: 38082466 DOI: 10.1097/mao.0000000000004071] [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: 01/12/2024]
Abstract
OBJECTIVE To assess the safety of cochlear implants (CIs) in children under 9 months of age to better understand expected postoperative complication rates, and to provide a preliminary look at efficacy. STUDY DESIGN Single-center retrospective review. SETTING Tertiary referral center. PATIENTS Children 5 to 8 months of age who received a CI between 2011 and 2021. INTERVENTIONS Therapeutic-CI. MAIN OUTCOME MEASURES The primary outcome was 6-month postoperative complication rate. Secondary outcomes included length of stay, device explantation/reimplantation, rehabilitation supports, and hearing and language outcomes. Complications of children implanted under than 9 months of age was compared with a cohort of children implanted 9 to 18 months of age between the years 2011 and 2016 using a chi-squared test ( p < 0.05). RESULTS One hundred six children under 9 months of age were implanted (204 CIs) at a mean age of 6.6 months (range: 5-8). Postoperative complications occurred in 28 patients (26%) and were often minor. There were no mortalities. There was no statistically significant difference in complications, including reimplantation rates, between patients implanted under 9 months of age and those implanted 9 to 18 months of age. Speech discrimination outcomes were excellent, and mean spoken language outcomes were near normative for typically developing children. CONCLUSIONS Cochlear implantation can be a safe and effective treatment option for children 5 to 8 months of age. Early hearing screening and referral for infants to receive appropriate intervention will continue to play a critical role in optimizing speech and language outcomes.
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Affiliation(s)
- Justin Cottrell
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone, New York, NY
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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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Castellanos I, Houston DM. Temperament in Toddlers With and Without Prelingual Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:232-243. [PMID: 37992410 PMCID: PMC11000787 DOI: 10.1044/2023_jslhr-23-00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/22/2023] [Accepted: 09/24/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE The purpose of this study is to examine parent-reported ratings of temperament in toddlers with and without prelingual hearing loss. METHOD The parent-completed Early Childhood Behavior Questionnaire (ECBQ) was used to assess temperament in toddlers aged 18-36 months. Three dimensions of temperament were examined: surgency, negative affectivity, and effortful control. Analyses were conducted to (a) examine differences in temperament across toddlers with and without prelingual hearing loss; (b) examine possible associations between temperament, demographic, and communication factors; and (c) determine if the ECBQ is sensitive to differences in hearing, communication, and listening skills among toddlers with prelingual hearing loss. RESULTS The parent-completed ECBQ revealed that toddlers with prelingual hearing loss differed from their hearing peers on some but not all dimensions of temperament. Specifically, children with prelingual hearing loss were rated as displaying higher levels of surgency and lower levels of effortful control but comparable levels of negative affectivity when compared to their hearing peers. Regression analyses revealed that chronological age and communication strategy predicted scores of effortful control in toddlers with prelingual hearing loss, whereas chronological age alone predicted scores of effortful control in toddlers with hearing. Finally, the ECBQ appears to contain "listening" items that skew (lower) levels of effortful control in toddlers with prelingual hearing loss, such that only the group effect of higher levels of surgency remained after removing these "listening" items. Correlations between the original and our modified ECBQ (removing the "listening" items) revealed strong associations, reflective of high construct validity. CONCLUSIONS This was the first study to measure temperament in toddlers with prelingual hearing loss using the ECBQ. Our results revealed differences between children with and without prelingual hearing loss centering on the dimension of surgency. Examining differences in temperament during the toddler period of development may be particularly important and useful for predicting functional outcomes following prelingual hearing loss.
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Affiliation(s)
- Irina Castellanos
- Department of Otolaryngology – Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Derek M. Houston
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs
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Honigman T, Cushing SL, Papsin BC, Waltzman S, Woodard J, Neumann S, Fitzgerald MB, Gordon KA. Safety and Early Outcomes of Cochlear Implantation of Nucleus Devices in Infants: A Multi-Centre Study. Trends Hear 2024; 28:23312165241261480. [PMID: 38887094 PMCID: PMC11185016 DOI: 10.1177/23312165241261480] [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: 01/04/2024] [Revised: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024] Open
Abstract
This multi-center study examined the safety and effectiveness of cochlear implantation of children between 9 and 11 months of age. The intended impact was to support practice regarding candidacy assessment and prognostic counseling of pediatric cochlear implant candidates. Data in the clinical chart of children implanted at 9-11 months of age with Cochlear Ltd devices at five cochlear implant centers in the United States and Canada were included in analyses. The study included data from two cohorts implanted with one or two Nucleus devices during the periods of January 1, 2012-December 31, 2017 (Cohort 1, n = 83) or between January 1, 2018 and May 15, 2020 (Cohort 2, n = 50). Major adverse events (requiring another procedure/hospitalization) and minor adverse events (managed with medication alone or underwent an expected course of treatment that did not require surgery or hospitalization) out to 2 years post-implant were monitored and outcomes measured by audiometric thresholds and parent-reports on the IT-MAIS and LittlEARS questionnaires were collected. Results revealed 60 adverse events in 41 children and 227 ears implanted (26%) of which 14 major events occurred in 11 children; all were transitory and resolved. Improved hearing with cochlear implant use was shown in all outcome measures. Findings reveal that the procedure is safe for infants and that they show clear benefits of cochlear implantation including increased audibility and hearing development.
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Affiliation(s)
- Tal Honigman
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon L. Cushing
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Blake C. Papsin
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Susan Waltzman
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer Woodard
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Matthew B. Fitzgerald
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Karen A. Gordon
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Communication Disorders, The Hospital for Sick Children, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
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Hardman G, Herman R, Kyle FE, Ebbels S, Morgan G. Identifying Developmental Language Disorder in Deaf Children with Cochlear Implants: A Case Study of Three Children. J Clin Med 2023; 12:5755. [PMID: 37685824 PMCID: PMC10488728 DOI: 10.3390/jcm12175755] [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: 07/05/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: While spoken language learning delays are assumed for deaf and hard of hearing (DHH) children after cochlear implant (CI), many catch up with their hearing peers. Some DHH children with CIs, however, show persistent delays in language, despite protective factors being in place. This suggests a developmental language disorder (DLD). However, at present there is little consensus on how to diagnose DLD in DHH children. (2) Methods: Given the lack of consensus in this area, a set of case studies provides an appropriate first step. The goal of this paper is to show the plausibility of a DLD diagnosis, following careful analysis of protective and risk factors. A retrospective case study review was conducted for three children. Their long-term language outcomes up to four years after CI were considered in the context of access to sound, speech sound discrimination, social skills and non-verbal cognition. (3) Results: It was possible to posit DLD in one child who had experienced good access to sound, alongside good speech discrimination abilities and social development, and normal non-verbal cognition, but who presented with severe language learning difficulties. (4) Conclusions: Finding markers for DLD in DHH children is important for diagnosis and intervention. The implications for clinical practice are discussed.
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Affiliation(s)
- Gemma Hardman
- Department of Language and Communication Science, City, University of London, London EC1V 0HB, UK; (G.H.); (R.H.)
| | - Rosalind Herman
- Department of Language and Communication Science, City, University of London, London EC1V 0HB, UK; (G.H.); (R.H.)
| | - Fiona Elizabeth Kyle
- Deafness, Cognition and Language Research Centre (DCAL), University College London, London WC1E 6BT, UK
| | - Susan Ebbels
- Moor House Research and Training Institute, Moor House School & College, Oxted RH8 9AQ, UK;
- Language and Cognition, Psychology and Language, University College London, London WC1E 6BT, UK
| | - Gary Morgan
- Psychology and Education Department, University Oberta Catalunya, 08035 Barcelona, Spain;
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Spitzer ER, Waltzman SB. Cochlear implants: the effects of age on outcomes. Expert Rev Med Devices 2023; 20:1131-1141. [PMID: 37969071 DOI: 10.1080/17434440.2023.2283619] [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: 07/13/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Cochlear implants (CIs) provide access to sound for children and adults who do not receive adequate benefit from hearing aids. Age at implantation is known to affect outcomes across the lifespan. AREAS COVERED The effects of age on CI outcomes are examined for infants, children, adolescents, and older adults. A variety of outcome measures are considered, including speech perception, language, cognition, and quality of life measures. EXPERT OPINION/COMMENTARY For those meeting candidacy criteria, CIs are beneficial at any age. In general, younger age is related to greater benefit when considering pre-lingual deafness. Other factors such as additional disabilities, may mitigate this effect. Post-lingually deafened adults demonstrate similar benefit regardless of age, though the oldest individuals (80+) may see smaller degrees of improvement from preoperative scores. Benefit can be measured in many ways, and the areas of greatest benefit may vary based on age: young children appear to see the greatest effects of age at implantation on language measures, whereas scores on cognitive measures appear to be most impacted for the oldest population. Future research should consider implantation at extreme ages (5-9 months or > 90 years), unconventional measures of CI benefit including qualitative assessments, and longitudinal designs.
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Affiliation(s)
- Emily R Spitzer
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Susan B Waltzman
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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Nassiri AM, Marinelli JP, Lohse CM, Carlson ML. Age and Incidence of Cochlear Implantation in the Pediatric Population With Congenital Bilateral Profound Hearing Loss. Otol Neurotol 2023; Publish Ahead of Print:00129492-990000000-00319. [PMID: 37367698 DOI: 10.1097/mao.0000000000003932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVES The current study characterizes age and incidence of cochlear implantation among qualifying children with congenital bilateral profound hearing loss in the U.S. STUDY DESIGN Deidentified cochlear implantation data were acquired from prospectively collected patient registries from two cochlear implant (CI) manufacturers (Cochlear Americas and Advanced Bionics). Children <36 months old were assumed to have congenital bilateral profound sensorineural hearing loss. SETTING U.S. CI centers. PATIENTS Children <36 months old who received CIs. INTERVENTIONS Cochlear implantation. MAIN OUTCOME MEASURES Age at implantation and incidence. RESULTS A total of 4,236 children <36 months old underwent cochlear implantation from 2015 to 2019. The median age at implantation was 16 months (interquartile range, 12-24 mo) and did not change significantly during the 5-year study period (p = 0.09). Patients residing closer to CI centers (p = 0.03) and treated at higher-volume centers (p = 0.008) underwent implantation at a younger age. Bilateral simultaneous implantation increased from 38% to 53% of CI surgeries in 2015 and 2019, respectively. Children who received bilateral simultaneous CIs were younger compared with those receiving unilateral or bilateral sequential CIs (median, 14 versus 18 mo; p < 0.001). The incidence of cochlear implantation increased from 7,648 per 100,000 person-years in 2015 to 9,344 in 2019 (p < 0.001). CONCLUSION Although the incidence of pediatric CI recipients and the frequency of bilateral simultaneous implantation increased over the study period, age at implantation did not change significantly and far exceeded current Food and Drug Administration (9 mo) and American Academy of Otolaryngology and Head and Neck Surgery position statement (6-12 mo) guidelines.
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Affiliation(s)
- Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO
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Park LR, Gagnon EB, Dillon MT. Factors that influence outcomes and device use for pediatric cochlear implant recipients with unilateral hearing loss. Front Hum Neurosci 2023; 17:1141065. [PMID: 37250696 PMCID: PMC10213360 DOI: 10.3389/fnhum.2023.1141065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Candidacy criteria for cochlear implantation in the United States has expanded to include children with single-sided deafness (SSD) who are at least 5 years of age. Pediatric cochlear implant (CI) users with SSD experience improved speech recognition with increased daily device use. There are few studies that report the hearing hour percentage (HHP) or the incidence of non-use for pediatric CI recipients with SSD. The aim of this study was to investigate factors that impact outcomes in children with SSD who use CIs. A secondary aim was to identify factors that impact daily device use in this population. Methods A clinical database query revealed 97 pediatric CI recipients with SSD who underwent implantation between 2014 and 2022 and had records of datalogs. The clinical test battery included speech recognition assessment for CNC words with the CI-alone and BKB-SIN with the CI plus the normal-hearing ear (combined condition). The target and masker for the BKB-SIN were presented in collocated and spatially separated conditions to evaluate spatial release from masking (SRM). Linear mixed-effects models evaluated the influence of time since activation, duration of deafness, HHP, and age at activation on performance (CNC and SRM). A separate linear mixed-effects model evaluated the main effects of age at testing, time since activation, duration of deafness, and onset of deafness (stable, progressive, or sudden) on HHP. Results Longer time since activation, shorter duration of deafness, and higher HHP were significantly correlated with better CNC word scores. Younger age at device activation was not found to be a significant predictor of CNC outcomes. There was a significant relationship between HHP and SRM, with children who had higher HHP experiencing greater SRM. There was a significant negative correlation between time since activation and age at test with HHP. Children with sudden hearing loss had a higher HHP than children with progressive and congenital hearing losses. Conclusion The present data presented here do not support a cut-off age or duration of deafness for pediatric cochlear implantation in cases of SSD. Instead, they expand on our understanding of the benefits of CI use in this population by reviewing the factors that influence outcomes in this growing patient population. Higher HHP, or greater percentage of time spent each day using bilateral input, was associated with better outcomes in the CI-alone and in the combined condition. Younger children and those within the first months of use had higher HHP. Clinicians should discuss these factors and how they may influence CI outcomes with potential candidates with SSD and their families. Ongoing work is investigating the long-term outcomes in this patient population, including whether increasing HHP after a period of limited CI use results in improved outcomes.
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