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Said NM, Telmesani LS, Telmesani LM. Effect of congenital inner ear malformations (IEMs) on electrically evoked compound action potential (ECAP) responses in cochlear implant children. Eur Arch Otorhinolaryngol 2023; 280:5193-5204. [PMID: 37606729 DOI: 10.1007/s00405-023-08196-2] [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: 06/17/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE The study was designed to assess the electrically evoked compound action potential (ECAP) responses in children with inner ear malformations compared to children with normal inner ear anatomy. METHODS The study included 235 prelingual deaf children who were implanted in cochlear implant unit in King Fahad University hospital-Imam Abdulrahman Bin Faisel University. Subjects were using either Cochlear Nucleus or Medel cochlear implant devices. We had 171 (64.5%) subjects with normal inner ear anatomy and 94 (35.5%) subjects with inner ear malformations (IEMs) and they were classified into 6 groups according to inner ear anatomy. Fourteen subjects (14.9%) subjects had enlarged vestibular aqueduct (EVA), 30 (32%) subjects had Mondini deformity, 25 (26.6%) subjects had incomplete partition type two (IPII), 9 (9.6%) subjects had incomplete partition type one (IPI) and 16 (17%) subjects had hypoplastic cochlea type III or IV. Intraoperative electrically evoked compound action potential (ECAP) responses were analyzed and compared in all subjects. RESULTS AND CONCLUSIONS Measurable ECAP responses can be elicited in patients with IEMs in most of the channels. Severe malformations can affect the prevalence of measuring ECAP and getting identifiable waveform morphology. Additionally, increased thresholds and lower slope of AGF was observed in IEMs specially in more severe malformations (e.g. IPI). IPI patients with better word recognition scores tended to show more identifiable ECAP measurements. This could suggest the presence of some correlation between ECAP responses and patients' performance after cochlear implantation.
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Affiliation(s)
- Nithreen M Said
- Audiovestibular Medicine Unit, Otorhinolaryngology Department, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
- Audio-Vestibular Medicine Unit, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Lena S Telmesani
- Otorhinolaryngology Department, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Laila M Telmesani
- Otorhinolaryngology Department, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Kim J, Hong SH, Moon IJ. Effect of inner ear malformations on intraoperative
ECAP
thresholds and postoperative auditory performance. Laryngoscope Investig Otolaryngol 2022; 7:1098-1106. [PMID: 36000038 PMCID: PMC9392413 DOI: 10.1002/lio2.836] [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: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives This study sought to characterize the influence of inner ear malformations (IEMs) on intraoperative electrically evoked compound action potential (ECAP) and auditory performance to better understand the underlying pathophysiology related to variabilities in cochlear implant (CI) outcomes that individuals with malformed cochlea may present. Methods The medical records of 222 ears implanted with Cochlear Nucleus CI were reviewed. Of the total, 64 ears had radiologic evidence of IEMs, and 158 ears were normal. Individuals with IEMs were grouped based on the severity of anomalies; 38 had mild IEMs (e.g., enlarged vestibular aqueduct, incomplete partition type II, etc.) and 26 had severe IEMs (e.g., cochlear nerve hypoplasia, common cavity, etc.). Intraoperative ECAP thresholds obtained via neural response telemetry (NRT) and the categories of auditory performance (CAP) scores measured at 12 months postoperative were compared and correlated. Results Absent ECAP responses were more apparent in the IEM group. ECAP thresholds were significantly elevated in the severe IEM group, while the mild IEM group had ECAP thresholds comparable to the normal group. The mild IEM group achieved CAP scores similar to the normal control. Patients in the severe IEM group showed significantly lower CAP scores at 12 months postoperative. Significant negative relationships existed between ECAP thresholds and CAP scores obtained from all subjects. Conclusion Measurable ECAP responses and NRT thresholds varied across groups. The inverse relationship between NRT thresholds and CAP scores may suggest that electrophysiological responses measured during surgery may potentially be indicative of postoperative performance in our CI population. Level of Evidence 2b.
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Affiliation(s)
- Jeong‐Seo Kim
- Hearing Research Laboratory Samsung Medical Center Seoul South Korea
| | - Sung Hwa Hong
- Hearing Research Laboratory Samsung Medical Center Seoul South Korea
- Department of Otolaryngology – Head and Neck Surgery Samsung Changwon Hospital, Sungkyunkwan University School of Medicine Changwon South Korea
| | - Il Joon Moon
- Hearing Research Laboratory Samsung Medical Center Seoul South Korea
- Department of Otolaryngology – Head and Neck Surgery Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul South Korea
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Ozkan HB, Cicek Cinar B, Yarali M, Sennaroglu G, Bilginer B, Sennaroglu L. Facial nerve stimulation necessitating auditory brainstem implantation: 8 years follow-up a case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2021. [DOI: 10.1080/23772484.2021.1975498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | - Mehmet Yarali
- Department of Audiology, Hacettepe University, Ankara, Turkey
| | | | - Burcak Bilginer
- Department of Neurosurgery, Hacettepe University, Ankara, Turkey
| | - Levent Sennaroglu
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
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Sharma S, Grover M, Samdani S, Gupta G, Preetam C. SMS classification of inner ear malformations: our experience with implantation in type II anomalies. Eur Arch Otorhinolaryngol 2021; 279:3847-3855. [PMID: 34671858 DOI: 10.1007/s00405-021-07124-6] [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: 04/10/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To study and analyse the radiological and surgical findings of 24 cochlear implantees with SMS type II cochleovestibular malformation and to compare their outcomes in terms of hearing and speech gains pre- and postoperatively. METHODS Retrospective analysis of cochlear implanted candidates over a period of 8 year 6 months from 3 institutions was undertaken and 24 patients suffering from prelingual profound congenital sensori-neural hearing loss along with the presence of SMS type II cochleovestibular malformation were studied. Preoperative radiology, surgical difficulties and complication, and postoperative hearing and speech outcomes up to a period of 2 years, using IT-MAIS and SIR scores were noted. Statistical comparison pre- and postimplantation was done using Wilcoxon signed rank test and a p value of < 0.05 was considered statistically significant. RESULTS In 24 cases, we encountered four cases of SMS type IIa malformation with a smaller modiolus, while the rest 20 were type SMS type IIb with partially defective modiolus. Intraoperatively, CSF leak was observed in 11 patients. Complete electrode insertion and good electrical response (NRT) was detected in all. No facial nerve anomaly was encountered. IT-MAIS and SIR scores increased from a preoperative mean of 5.6 and 1.16-34.56 and 3.88 after 2 years postsurgery, respectively and this difference was found to be statistically significant. CONCLUSION Our experience with SMS Type II malformations show promising and motivating results with less chances of complications. Proper evaluation and surgical planning preoperatively can lead to an uneventful surgery with good outcomes. A simple and uniform classification system of these anomalies is a must for appropriate prognostication and right decision making.
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Affiliation(s)
- Shivam Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan, 302004, India
| | - Mohnish Grover
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan, 302004, India. .,, Jaipur, India.
| | - Sunil Samdani
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan, 302004, India
| | - Gaurav Gupta
- Department of Otorhinolaryngology and Head Neck Surgery, S.P Medical College and Hospital, Bikaner, Rajasthan, India
| | - Chappati Preetam
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
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Karamert R, Tutar H, Altinyay Ş, Düzlü M, Yildiz M, Akdulum İ, Uğur MB, Çolak M, Cebeci S, Şahin MM, Orçan E, Bayazit YA. Cochlear Implantation in Inner Ear Malformations: Considerations Related to Surgical Complications and Communication Skills. ORL J Otorhinolaryngol Relat Spec 2021; 84:211-218. [PMID: 34500448 DOI: 10.1159/000517562] [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: 07/03/2020] [Accepted: 05/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are particular challenges in the implantation of malformed cochleae, such as in cases of facial nerve anomalies, cerebrospinal fluid (CSF) leaks, erroneous electrode insertion, or facial stimulation, and the outcomes may differ depending on the severity of the malformation. The aim of this study was to assess the impact of inner ear malformations (IEMs) on surgical complications and outcomes of cochlear implantation. METHODS In order to assess the impact of IEMs on cochlear implant (CI) outcomes, 2 groups of patients with similar epidemiological parameters were selected from among 863 patients. Both the study group (patients with an IEM) and control group (patients with a normal inner ear) included 25 patients who received a CI and completed at least 1 year of follow-up. Auditory performance, receptive and expressive language skills, and production and use of speech were evaluated preoperatively and at least 1 year after implantation. Types of surgical complications and rates of revision surgeries were determined in each group. RESULTS In the study group, the most common malformation was an isolated enlarged vestibular aqueduct (EVA) (44.8%). Overall, the patients with IEMs showed significant improvement in auditory-verbal skills. In general, the patients who had normal cochleae scored significantly better compared to patients with IEMs (p < 0.05). The complication rate was significantly lower in the control group compared to the study group (p = 0.001), but the rate of revision surgeries did not differ significantly (p = 0.637). CONCLUSION It is possible to improve communication skills with CIs in patients with IEMs despite the variations in postoperative performances. Patients with EVA, incomplete partition type 2, and cochlear hypoplasia type 2 were the best performers in terms of auditory-verbal skills. Patients with IEMs scored poorly compared to patients with normal cochleae. CSF leak (gusher or oozing) was the most common complication during surgery, which is highly likely in cases of incomplete partition type 3.
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Affiliation(s)
- Recep Karamert
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hakan Tutar
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Şenay Altinyay
- Department of Audiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Düzlü
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Merve Yildiz
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - İsmail Akdulum
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Birol Uğur
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mustafa Çolak
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Süleyman Cebeci
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Muammer Melih Şahin
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Elçin Orçan
- Department of Audiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Grover M, Sharma S, Samdani S, Gupta G, Preetam C, Gera K, Vaishnav JK, Hada MK. New SMS Classification of Cochleovestibular Anomalies: Our Experience with 25 Cases of Type I Anomaly. Indian J Otolaryngol Head Neck Surg 2021; 73:333-339. [PMID: 34471622 PMCID: PMC8364613 DOI: 10.1007/s12070-021-02442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To study and analyse the radiological and surgical findings of 25 cochlear implantees with SMS type-I cochleovestibular malformation and to compare their outcomes in terms of hearing and speech gains pre- and post-operatively. METHODS Retrospective analysis of cochlear implanted candidates over a period of 8 year from 3 institutions was undertaken and 25 patients suffering from pre-lingual profound congenital sensori-neural hearing loss along with presence of SMS type I cochleovestibular malformation were studied. Pre-operative radiology, surgical difficulties and complication, and post-operative hearing and speech outcomes upto a period of 2 years, using IT-MAIS scores were noted. Statistical comparison pre- and post-implantation was done using Wilcoxon signed rank test and a p-value of < 0.05 was considered significant. RESULTS In 25 cases, we encountered 2 posterior SCC dysplasia, 15 enlarged vestibular aqueducts (LVA), 2 dilated vestibules, 4 superior SCC dysplasia, 2 cases with both posterior and superior SCC dysplasia and of those 1 had a dilated vestibule also. Intra-operatively, CSF leak was observed in 10 patients. Complete electrode insertion and good electrical response (NRT) was detected in all. No facial nerve anomaly was encountered. IT-MAIS scores increased from a pre-operative mean of 4.32 to 34.56 two years post-operatively and this difference was found to be statistically significant. CONCLUSION Our experience with SMS Type I malformations show promising and motivating results with less chances of complications, similar to implant candidates with normal anatomy. The outcomes in this group of patients are definitely not affected by any malformations in semicircular canals, vestibule or vestibular aqueduct.
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Affiliation(s)
- Mohnish Grover
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Shivam Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Sunil Samdani
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Gaurav Gupta
- Department of Otorhinolaryngology and Head Neck Surgery, S.P Medical College and Hospital, Bikaner, Rajasthan India
| | - Chappati Preetam
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa India
| | - Kriti Gera
- S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Jairaj Kumar Vaishnav
- Department of Otorhinolaryngology and Head Neck Surgery, RVRS Medical College and Hospital, Bhilwara, Rajasthan India
| | - Mahendra Kumar Hada
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
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Lee SY, Choi BY. Potential Implications of Slim Modiolar Electrodes for Severely Malformed Cochleae: A Comparison With the Straight Array With Circumferential Electrodes. Clin Exp Otorhinolaryngol 2021; 14:287-294. [PMID: 34098628 PMCID: PMC8373838 DOI: 10.21053/ceo.2021.00752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Malformations of the inner ear account for approximately 20% of cases of congenital deafness. In current practice, straight arrays with circumferential electrodes (i.e., full-banded electrodes) are widely used in severely malformed cochleae. However, the unpredictability of the location of residual spiral ganglion neurons in such malformations argues against obligatorily using full-banded electrodes in all cases. Here, we present our experience of electrically evoked compound action potential (ECAP) and radiography-based selection of an appropriate electrode for severely malformed cochleae. Methods Three patients with severely malformed cochleae, showing cochlear hypoplasia type II (CH-II), incomplete partition type I (IP-I), and cochlear aplasia with a dilated vestibule (CADV), respectively, were included, and the cochlear nerve deficiency (CND) was evaluated. A full-banded electrode (CI24RE(ST)) and slim modiolar electrode (CI632) were alternately inserted to compare ECAP responses and electrode position. Results In patient 1 (CH-II with CND), who had initially undergone cochlear implantation (CI) using a lateral wall electrode (CI422), revision CI was performed due to incomplete insertion of CI422 and resultant unsatisfactory performance by explanting the CI422 and re-inserting the CI24RE(ST) and CI632 sequentially. Although both electrodes elicited reliable ECAP responses with correct positioning, CI24RE(ST) showed overall lower ECAP thresholds compared to CI632; thus, CI24RE(ST) was selected. In patient 2 (IP-I with CND), CI632 elicited superior ECAP responses relative to CI24RE(ST), with correct positioning of the electrode; CI632 was chosen. In patient 3 (CADV), CI632 did not elicit an ECAP response, while meaningful ECAP responses were obtained with the CI24RE(ST) array once correct positioning was achieved. All patients’ auditory performance markedly improved postoperatively. Conclusion The ECAP and radiography-based strategy to identify an appropriate electrode may be useful for severely malformed cochleae, leading to enhanced functional outcomes. The practice of sticking to full-banded straight electrodes may not always be optimal for IP-I and CH-II.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Audiologic Outcomes of Cochlear Implantation in Cochlear Malformations: A Comparative Analysis of Lateral Wall and Perimodiolar Electrode Arrays. Otol Neurotol 2021; 41:e1201-e1206. [PMID: 33433084 DOI: 10.1097/mao.0000000000002833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cochlear implantation in children with inner ear malformations has been shown to be beneficial. The aims of this study are to evaluate open set word recognition outcomes among children with cochlear implants who have cochlear malformations, and to further assess if either the lateral wall (LW) or perimodiolar (PM) electrode arrays confer any performance outcome advantages. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS Pediatric cochlear implant recipients with cochlear malformations who were implanted at our institution within the last 10 years and had speech perception scores were eligible for inclusion in the study. Potential participants were excluded if they had less than 1 year of listening experience with the cochlear implant or suspected cochlear nerve deficiency. INTERVENTION None. MAIN OUTCOME MEASURE Most recent consonant-nucleus-consonant word score. RESULTS ANOVA analysis demonstrated that the type of cochlear malformation was significantly associated with speech perception outcome (p = 0.006). Those with IP2 malformations had significantly better word recognition outcomes than the remaining cochlear malformations. Array type (LW or PM) was not associated with better word recognition outcomes in long-term follow-up of patients with IP2 malformations (p = 0.13). CONCLUSIONS In children who have cochlear malformations, cochlear implantation results in varying word recognition outcomes based on the type of malformation. While the participants in this study demonstrated postoperative open set word recognition skills, those with IP2 malformations demonstrated the most benefit. Electrode type was not found to significantly impact outcomes in this cohort.
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Othman IA, Abdullah A, See GB, Umat C, Tyler RS. Auditory Performance in Early Implanted Children with Cochleovestibular Malformation and Cochlear Nerve Deficiency. J Int Adv Otol 2020; 16:297-302. [PMID: 33136006 DOI: 10.5152/iao.2020.8563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study aimed to report the auditory performance in children with cochleovestibular malformation (CVM)/cochlear nerve deficiency (CND) who were implanted early at the Universiti Kebangsaan Malaysia Medical Centre, using Categorical Auditory Performance (CAP)-II score and Speech Intelligibility Rating (SIR) scales, and to compare the outcome of their matched counterparts. MATERIALS AND METHODS A total of 14 children with CVM/CND with unilateral cochlear implant (CI) implanted before the age of 4 years old were matched and compared with 14 children with normal inner ear structures. Their improvement in auditory performance was evaluated twice using CAP-II score and SIR scales at 6-month intervals, with the baseline evaluation done at least 6 months after implantation. RESULTS The average age of implantation was 31±8 and 33±7 months for the control group and the case (CVM/CND) group, respectively. Overall, there were no significant differences in outcome when comparing the entire cohort of case subjects and their matched control subjects in this study. However, the improvement in CAP-II scores and SIR scales among the case subjects in between the first and second evaluations was statistically significant (p=0.040 and p=0.034, respectively). With longer duration of CI usage, children with CVM/CND showed significant speech perception outcome evident by their SIR scales (p=0.011). CONCLUSION Children with radiographically malformed inner ear structures who were implanted before the age of 4 years have comparable performance to their matched counterparts, evident by their similar improvement of CAP-II scores and SIR scales over time. Hence, this group of children benefited from cochlear implantation.
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Affiliation(s)
- Iylia Ajmal Othman
- Department of Otorhinolaryngology Head and Neck Surgery, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia;Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Asma Abdullah
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Goh Bee See
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Cila Umat
- Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Richard S Tyler
- Department of Otolaryngology Head and Neck Surgery, Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, USA
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Ozkan HB, Cicek Cinar B, Yucel E, Sennaroglu G, Sennaroglu L. Audiological Performance in Children with Inner Ear Malformations Before and After Cochlear Implantation: A Cohort Study of 274 Patients. Clin Otolaryngol 2020; 46:154-160. [PMID: 32749771 DOI: 10.1111/coa.13625] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Inner ear malformations (IEMs) are common in children with hearing loss. The different types of IEMs form a unique subgroup of cochlear implant (CI) candidates. We aimed to evaluate the auditory perception outcomes of CI in children with different types of IEMs and compare them with CI users without IEMs. METHODS The study included 274 CI users with and without IEMs as two groups (n = 137, each). Both groups' chronological age at implantation and duration of CI usage was matched (± 8 months). All subjects were evaluated pre-operatively and post-operatively by the Ling's sound test and the auditory perception test battery, which includes the Meaningful Auditory Integration Scale (MAIS), closed-set Pattern Perception Test (PPT) and open-set Sentence Recognition Test (SRT). Besides, children with IEMs were assessed for language development. RESULTS Progress in the IEMs' group differed according to the type of ear anomaly. CI users with enlarged vestibular aqueduct had the highest scores, while users with common cavity had the lowest. Children with IEMs performed well on the closed-set test while having difficulty with the open-set test. CONCLUSION Cochlear implantation outcomes are favourable in IEMs' patients with a cochlear nerve visible on magnetic resonance imaging. Our results indicate that it is critical to take the anatomical differences into account during follow-up and rehabilitation programmes. Each CI user should be evaluated according to his or her individual needs.
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Affiliation(s)
- Hilal Burcu Ozkan
- Faculty of Health Sciences, Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Betul Cicek Cinar
- Faculty of Health Sciences, Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Esra Yucel
- Faculty of Health Sciences, Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Gonca Sennaroglu
- Faculty of Health Sciences, Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Levent Sennaroglu
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
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Chen B, Li Y, Lu S, Chen J, Shi Y, Cui D, Zhang L, Xie J. Cochlear implant surgery through oval window: A novel approach in a child with facial nerve aberration. Int J Pediatr Otorhinolaryngol 2020; 135:110110. [PMID: 32446042 DOI: 10.1016/j.ijporl.2020.110110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
Cochlear implantation is safe for simple case presentations. However, facial nerve (FN) aberrations may impede insertion of the electrode through a round window and increase the risk of iatrogenic FN injury. We developed a novel method of cochlear implantation, a present the case of a child with FN aberrations. Inferior displacement of a horizontal segment of FN lay on the surface of th e promontory, obscuring the round window. The oval window was used and the electrode successfully inserted. No postoperative complications occurred, and significant improvement in speech perception was achieved. This novel approach is suitable for patients with FN aberrations.
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Affiliation(s)
- Biao Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, PR China
| | - Yongxin Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, PR China.
| | - Simeng Lu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, PR China
| | - Jingyuan Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, PR China
| | - Ying Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, PR China
| | - Danmo Cui
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, PR China
| | - Lifang Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, PR China
| | - Jing Xie
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, PR China
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Application of the new SMS system of cochleovestibular anomalies: our experience with nine cases of type III anomaly. Eur Arch Otorhinolaryngol 2020; 278:659-664. [DOI: 10.1007/s00405-020-06114-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
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Daneshi A, Farhadi M, Ajalloueyan M, Rajati M, Hashemi SB, Ghasemi MM, Emamdjomeh H, Asghari A, Mohseni M, Mohebbi S, Hosseinzadeh F, Mirsalehi M. Cochlear implantation in children with inner ear malformation: A multicenter study on auditory performance and speech production outcomes. Int J Pediatr Otorhinolaryngol 2020; 132:109901. [PMID: 32006863 DOI: 10.1016/j.ijporl.2020.109901] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This multicenter study evaluated the auditory performance and speech production outcomes of cochlear implantation in children with inner ear anomaly and compared the outcomes of patients with different kinds of malformation. METHODS Cochlear implantation was performed in 107 children with inner ear malformation at four tertiary academic centers. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated preoperatively and one year and two years postoperatively. RESULTS Types of inner ear malformation and their frequencies were: incomplete partition type-I, 19 (17.8%) patients; incomplete partition type-II, 31 (29%), common cavity, 17 (15.9%), cochlear hypoplasia, 17 (15.9%), and isolated enlarged vestibular aqueduct (isolated EVA), 23 (21.5%) patients. EVA was the coexisting anomaly in 27(25.2%) subjects. The median CAP and SIR scores improved significantly during the first two years after cochlear implantation in all groups (p-values <0.001 and < 0.001, respectively). No significant difference was seen in CAP and SIR scores of children with different inner ear malformations (p-value = 0.147 and 0.570, respectively) or in patients with isolated EVA compared to coexisting EVA (p-value = 0.538 and 0.075, respectively). CONCLUSION The median CAP and SIR scores two years after surgery were 5 (Understanding of common phrases without lip-reading) IQR: 4-6, and 3 (Connected speech is intelligible to a listener who concentrates and lip-reads within a known context) IQR: 3-4, respectively. Auditory performance and speech production were significantly improved in all inner ear malformation patient groups, and no significant difference was observed between the scores of patients with different types of anomaly.
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Affiliation(s)
- Ahmad Daneshi
- ENT and Head & Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Farhadi
- ENT and Head & Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ajalloueyan
- Department of Otorhinolaryngology, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Mohsen Rajati
- Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Seyed Basir Hashemi
- Department of Otorhinolaryngology, Khalili Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Mahdi Ghasemi
- Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hesamaldin Emamdjomeh
- ENT and Head & Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Alimohamad Asghari
- Skull Base Research Center, The Five Sense Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Mohseni
- ENT and Head & Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Saleh Mohebbi
- ENT and Head & Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Farideh Hosseinzadeh
- ENT and Head & Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Marjan Mirsalehi
- ENT and Head & Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.
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Jahn KN, Bergan MD, Arenberg JG. Auditory Detection Thresholds and Cochlear Resistivity Differ Between Pediatric Cochlear Implant Listeners With Enlarged Vestibular Aqueduct and Those With Connexin-26 Mutations. Am J Audiol 2020; 29:23-34. [PMID: 31934787 DOI: 10.1044/2019_aja-19-00054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose The goal of this study was to evaluate differences in the electrode-neuron interface as a function of hearing loss etiology in pediatric cochlear implant (CI) listeners with enlarged vestibular aqueduct (EVA) syndrome and in those with autosomal recessive connexin-26 mutations (DFNB1). Method Fifteen implanted ears (9 participants, 5 ears with EVA, 10 ears with DFNB1) were assessed. Single-channel auditory detection thresholds were measured using broad and spatially focused electrode configurations (steered quadrupolar; focusing coefficients = 0 and 0.9). Cochlear resistivity estimates were obtained via electrode impedances and electrical field imaging. Between-group differences were evaluated using linear mixed-effects models. Results Children with EVA had significantly higher auditory detection thresholds than children with DFNB1, irrespective of electrode configuration. Between-group differences in thresholds were more pronounced on apical electrodes than on basal electrodes. In the apex, electrode impedances and electrical field imaging values were higher for children with EVA than for those with DFNB1. Conclusions The electrode-neuron interface differs between pediatric CI listeners with DFNB1 and those with EVA. It is possible that optimal clinical interventions may depend, in part, on hearing loss etiology. Future investigations with large samples should investigate individualized CI programming strategies for listeners with EVA and DFNB1.
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Affiliation(s)
- Kelly N. Jahn
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, MA
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston
| | - Molly D. Bergan
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Julie G. Arenberg
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, MA
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston
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Sennaroğlu L, Tahir E. A Novel Classification: Anomalous Routes of the Facial Nerve in Relation to Inner Ear Malformations. Laryngoscope 2020; 130:E696-E703. [PMID: 32134124 DOI: 10.1002/lary.28596] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/29/2020] [Accepted: 02/10/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this study was to classify anomalous facial nerve (FN) routes and to determine their association with inner ear malformations (IEMs). STUDY DESIGN Retrospective cross sectional study. METHODS The computed tomography images of 519 patients (796 ears) with IEMs were retrospectively evaluated, and the abnormal routes of the FN were classified as: Meatal segment: type 1, normal internal auditory canal (IAC); type 2, narrow IAC; type 3, facial canal (FC) only; type 4: separate FC/duplicated IAC. Labyrinthine segment (LS): type 1, normal; type 2a/b/c, mild/moderate/severe anterior displacement; type 3, superior displacement; type 4: straight LS. Tympanic segment (TS): type 1, normal; type 2, superiorly displaced TS; type 3, TS at the oval window; type 4: TS inferior to the oval window; type 5: unclassified. Mastoid segment: type 1, normal facial recess (FR)/normal mastoid segment; type 2: narrow FR; type 3, unclassified. RESULTS In meatal segment classification, a narrow IAC was common in ears with cochlear hypoplasia (CH) (76.1%), and only FC was common in ears with severe IEMs (62.7%) such as Michel deformity, common cavity, and cochlear aplasia. Incomplete partition-III has its unique superiorly displaced LS (100%). CH-IV also has its unique mild anterosuperior displacement. Ears with a superiorly displaced TS usually (93.1%) had aplastic or hypoplastic semicircular canals. The FR is likely to be narrow in CH and severe IEMs. CONCLUSIONS The FN route is affected in IEMs, which must be kept in mind when operating on ears with IEMs. Especially in CH cases, all segments of the FN can be abnormal. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E696-E703, 2020.
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Affiliation(s)
- Levent Sennaroğlu
- Department of Otolaryngology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Emel Tahir
- Department of Otolaryngology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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A Ten-Year Review of Audiological Performance in Children with Inner Ear Abnormalities after Cochlear Implantation in Singapore. Int J Otolaryngol 2019; 2019:6483714. [PMID: 31885597 PMCID: PMC6915011 DOI: 10.1155/2019/6483714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/26/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives To evaluate children with inner ear malformations following cochlear implantation (CI) in a tertiary pediatric hospital in Singapore to identify factors influencing outcomes after CI. Methods This is a retrospective cohort study of children aged 0 to 18 years, who had CI between 2000 and 2013. Demographic information, data on risk factors, type of inner ear malformation (IEM), age at implantation, speech pre- and postimplantation, and duration of follow-up were collected from clinical records. Operative details and audiological outcomes were also analyzed. Results A total of 70 children underwent 83 CI surgeries. The mean age of the patients was 4.05 ± 3.17 years (range 1–18 years). Twenty patients (28.57%) had abnormal CT scan findings. CSF gusher occurred in 15 out of 26 CI (57.69%) in the group with IEM. Nine out of twenty patients (45.00%) had poor IT-MAIS scores prior to implantation. The average preoperative IT-MAIS score for children with anomalous inner ear anatomy was 14.1. The older CI patients, 3/20 (15.00%), mean age 8.33 years (range 7–10 years), were mostly referred for persistently unclear speech following hearing aids. Eleven patients (55.00%) had good speech and aided hearing threshold within speech limits after CI and were eligible for reintegration into mainstream schools. Five patients (25.00%) had improvement in speech but continued to receive education in special schools. Four patients (20.00%) had poor progress after surgery. Conclusion The presence of absent cochlear nerve, electrode folding, and underlying neurological disorders seemed to be associated with poorer outcomes.
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Hu HC, Chen WKH, Huang MJ, Lin CC, Chen JKC. Rounded Insertion Technique for Cochlear Implantation Surgery to Treat Cystic Inner Ear Malformation. Laryngoscope 2019; 130:2229-2233. [PMID: 31800101 DOI: 10.1002/lary.28425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/29/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This article outlines the advantages and applicability of the rounded insertion technique of cochlear implants in patients with cystic inner ear malformation. This technique enables the insertion of the maximum number of electrodes and prevents the unwanted entry of electrodes into the internal auditory canal. METHODS We conducted a retrospective chart review of consecutive patients with cochlear hypoplasia (CH) and/or common cavity (CC) who underwent CI (cochlear implantation) via rounded insertion technique. The position of the electrode array in each patient was confirmed postoperatively via X-ray, and the number of functional electrodes was confirmed during the mapping process. RESULTS This study included five male and two female patients (median age: 3 years; age range: 2-7 years). Among the seven patients, four received a cochlear implant on the right side, one on the left side, and two bilaterally. Of the nine ears, six were cases of CH, and three were CC. All cochlear implant surgeries via rounded insertion technique were completed without complications. The maximum number of electrode contacts with fair function in the cystic cochlea was confirmed via postoperative X-ray and the subsequent mapping process. CONCLUSION This consecutive series of patients demonstrated the safety and reliability of rounded insertion technique for CI in patients with CH and/or CC. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2229-2233, 2020.
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Affiliation(s)
- Hao-Chun Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan, New Taipei City, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - William Kuan-Hua Chen
- Auditory Implantation Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Jui Huang
- Auditory Implantation Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Ching Lin
- Auditory Implantation Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Joshua Kuang-Chao Chen
- Auditory Implantation Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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18
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Speech development in young children with Mondini dysplasia who had undergone cochlear implantation. Int J Pediatr Otorhinolaryngol 2019; 116:118-124. [PMID: 30554681 DOI: 10.1016/j.ijporl.2018.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the development of speech skills in young children with Mondini dysplasia and age-matched deaf children with radiologically normal inner ears over a period of 5 years after cochlear implantation (CI). METHODS In total, 700 congenitally severely to profoundly deaf children (281 girls and 419 boys) participated in this study. All of the participants had undergone unilateral CI surgery before 36 months of age. The participants were categorized into two groups based on the absence or presence of Mondini dysplasia in the implanted ear, as assessed via high-resolution, thin-slice computerized tomography or magnetic resonance imaging: group A comprised 592 children with radiologically normal inner ears and group B comprised 108 children with Mondini dysplasia. The Meaningful Use of Speech Scale (MUSS) and Speech Intelligibility Rating (SIR) were used to evaluate the speech performance of all young children at various time points: pre-surgery and at 1, 3, 6, 12, 24, 36, 48, and 60 months after switch-on programming. RESULTS The mean scores of SIR and MUSS in children from both group A and group B showed significant improvements over time. No significant differences were found in the mean scores of SIR between the two groups at any time interval during the 5-year follow-up. The mean score of MUSS was significantly different between group A and group B at 12, 24, and 36 months after implantation, whereas no obvious differences were noted pre-surgery, and at 1, 3, 6, 48, and 60 months post-operation. CONCLUSIONS Young children with Mondini dysplasia develop their speech skills at a fast rate and achieve similar speech acquisition compared to age-matched children with radiologically normal inner ears 5 years post-operation. Therefore, CI is an effective intervention method for young children with Mondini dysplasia.
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Fisher LM, Martinez AS, Richmond FJ, Krieger MD, Wilkinson EP, Eisenberg LS. Assessing the Benefit-Risk Profile for Pediatric Implantable Auditory Prostheses. Ther Innov Regul Sci 2018; 52:669-679. [PMID: 29714549 PMCID: PMC5943182 DOI: 10.1177/2168479017741111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/25/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIMS Children with congenital cochleovestibular abnormalities associated with profound hearing loss have few treatment options if cochlear implantation does not yield benefit. An alternative is the auditory brainstem implant (ABI). Regulatory authority device approvals currently include a structured benefit-risk assessment. Such an assessment, for regulatory purposes or to guide clinical decision making, has not been published, to our knowledge, for the ABI and may lead to the design of a research program that incorporates regulatory authority, family, and professional input. METHODS Much structured benefit-risk research has been conducted in the context of drug trials; here we apply this approach to device studies. A qualitative framework organized benefit (speech recognition, parent self-report measures) and risk (surgery- and device-related) information to guide the selection of candidates thought to have potential benefit from ABI. RESULTS Children with cochleovestibular anatomical abnormalities are challenging for appropriate assessment of candidacy for a cochlear implant or an ABI. While the research is still preliminary, children with an ABI appear to slowly obtain benefit over time. A team of professionals, including audiological, occupational, and educational therapy, affords maximum opportunity for benefit. CONCLUSIONS Pediatric patients who have abnormal anatomy and are candidates for an implantable auditory prosthetic require an individualized, multisystems review. The qualitative benefit-risk assessment used here to characterize the condition, the medical need, potential benefits, risks, and risk management strategies has revealed the complex factors involved. After implantation, continued team support for the family during extensive postimplant therapy is needed to develop maximum auditory skill benefit.
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Affiliation(s)
- Laurel M. Fisher
- Rick and Tina Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of University of Southern California, 1540 Alcazar Street, Suite 204, Los Angeles, CA 90033
| | - Amy S. Martinez
- Rick and Tina Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of University of Southern California, 1540 Alcazar Street, Suite 204, Los Angeles, CA 90033
| | - Frances J. Richmond
- USC School of Pharmacy, Department of Regulatory Science, Keck School of Medicine of University of Southern California, 1540 Alcazar Street, CHP 140 Los Angeles, CA 90033
| | - Mark D. Krieger
- Billy and Audrey L. Wilder Endowed Chair in Neurosurgery, Professor of Clinical Neurological Surgery, USC Keck School of Medicine, 4650 Sunset Blvd, Los Angeles, CA 90027
| | - Eric P. Wilkinson
- Huntington Medical Research Institute, 99 N. El Molino Ave, Pasadena, CA 91101
| | - Laurie S. Eisenberg
- Rick and Tina Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of University of Southern California, 1540 Alcazar Street, Suite 204, Los Angeles, CA 90033
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20
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Melo AS, Martins J, Silva J, Quadros J, Paiva A. Cochlear implantation in children with anomalous cochleovestibular anatomy. Auris Nasus Larynx 2017; 44:509-516. [DOI: 10.1016/j.anl.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 01/11/2017] [Accepted: 02/03/2017] [Indexed: 11/15/2022]
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Incerti PV, Ching TYC, Hou S, Van Buynder P, Flynn C, Cowan R. Programming characteristics of cochlear implants in children: effects of aetiology and age at implantation. Int J Audiol 2017; 57:S27-S40. [PMID: 28885072 DOI: 10.1080/14992027.2017.1370139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We investigated effects of aetiology and age at implantation on changes in threshold (T) levels, comfortable (C) levels and dynamic range (DR) for cochlear implants (CIs) in children over the first five years of life. DESIGN Information was collected at 6 months post-activation of CIs, and at 3 and 5 years of age. STUDY SAMPLE One hundred and sixty-one children participating in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. RESULTS Children with neural and structural cochlear lesions had higher T-levels and C-levels as compared to those without these conditions. Parameter settings varied from manufacturer's defaults more often in the former than in the latter group. Investigation of the effect of age at implantation for children without neural and structural cochlear lesions showed that those implanted at ≤12 months of age had higher T-levels and narrower DR at 6 months post-activation, as compared to the later-implanted group. For both early- and later-implanted groups, the C-levels at 6 months post-activation were lower than those at age 3 and 5 years. There were no significant differences in T-levels, C-levels, or DR between age 3 and 5 years. CONCLUSIONS Aetiology and age at implantation had significant effects on T-levels and C-levels.
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Affiliation(s)
- Paola V Incerti
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
| | - Teresa Y C Ching
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Sanna Hou
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Patricia Van Buynder
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Christopher Flynn
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia
| | - Robert Cowan
- b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
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Telmesani Radiological Classification of the Location of the Vertical Segment of the Facial Nerve: Impact on Surgical Approach in Cochlear Implant Surgery. Otol Neurotol 2017; 38:e335-e338. [PMID: 28820756 DOI: 10.1097/mao.0000000000001547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was conducted to establish a radiological classification of the location of the vertical segment of the facial nerve (VSFN) and to see if this has implications on the surgical technique needed to access the round window niche (RWN) in cochlear implant (CI) surgery. STUDY DESIGN Observational case series study. SETTING Tertiary referral center. PATIENTS One hundred twenty seven patients underwent CI surgery, and high resolution computed tomography (HRCT) of 140 temporal bones was studied. The data that were collected consisted of the patient's age, sex, radiological inner ear malformations (IEM), and the surgical technique used to access the RWN. MAIN OUTCOME MEASURES The radiologic location of the VSFN in relation to the lateral semicircular canal in the coronal plane of HRCT and its implication on the surgical approach used to access the RWN in CI surgery. RESULTS A statistically significant association is present between the radiological location of the VSFN and the surgical approach used (p < 0.001).There was insignificant correlation between the locations of the VSFN and the patient's age, sex, and IEM as the p > 0.05. CONCLUSIONS On HRCT (0.6 mm) in the coronal plane, the position of the VSFN in relation to the lateral semicircular canal is correlated with the alternative approaches that must be taken during CI surgery.
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Farhood Z, Nguyen SA, Miller SC, Holcomb MA, Meyer TA, Rizk AHG. Cochlear Implantation in Inner Ear Malformations: Systematic Review of Speech Perception Outcomes and Intraoperative Findings. Otolaryngol Head Neck Surg 2017; 156:783-793. [DOI: 10.1177/0194599817696502] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective (1) To analyze reported speech perception outcomes in patients with inner ear malformations who undergo cochlear implantation, (2) to review the surgical complications and findings, and (3) to compare the 2 classification systems of Jackler and Sennaroglu. Data Sources PubMed, Scopus (including Embase), Medline, and CINAHL Plus. Review Methods Fifty-nine articles were included that contained speech perception and/or intraoperative data. Cases were differentiated depending on whether the Jackler or Sennaroglu malformation classification was used. A meta-analysis of proportions examined incidences of complete insertion, gusher, and facial nerve aberrancy. For speech perception data, weighted means and standard deviations were calculated for all malformations for short-, medium-, and long-term follow-up. Speech tests were grouped into 3 categories—closed-set words, open-set words, and open-set sentences—and then compared through a comparison-of-means t test. Results Complete insertion was seen in 81.8% of all inner ear malformations (95% CI: 72.6-89.5); gusher was reported in 39.1% of cases (95% CI: 30.3-48.2); and facial nerve anomalies were encountered in 34.4% (95% CI: 20.1-50.3). Significant improvements in average performance were seen for closed- and open-set tests across all malformation types at 12 months postoperatively. Conclusions Cochlear implantation outcomes are favorable for those with inner ear malformations from a surgical and speech outcome standpoint. Accurate classification of anatomic malformations, as well as standardization of postimplantation speech outcomes, is necessary to improve understanding of the impact of implantation in this difficult patient population.
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Affiliation(s)
- Zachary Farhood
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University, St Louis, Missouri, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephen C. Miller
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Meredith A. Holcomb
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A. Meyer
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - and Habib G. Rizk
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Kimura Y, Masuda T, Tomizawa A, Sakata H, Kaga K. A child with severe inner ear malformations with favorable hearing utilization and balance functions after wearing hearing aids. J Otol 2017; 12:41-46. [PMID: 29937836 PMCID: PMC6011802 DOI: 10.1016/j.joto.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 11/07/2022] Open
Abstract
Infants with congenital deafness caused by severe bilateral inner ear malformations frequently suffer from severe hearing loss and poor balance. Unfortunately, the use of hearing aids is usually ineffective in recovering hearing, necessitating cochlear implants. We report a case of a 6-year-old boy with congenital deafness and bilateral inner ear malformations (right side, incomplete partition type I [IP-I]; left side, common cavity deformity). Hearing aids had a remarkable effect in this patient, enabling sufficient and favorable hearing recovery such as to allow the patient to engage in daily conversations. Per-rotatory nystagmus was recorded on an electronystagmogram for both right and left rotations in a damped rotational chair test. It is rare for deaf children with severe bilateral inner ear malformation to demonstrate favorable development in hearing and good equilibrium function. Our findings suggest that auditory–vestibular hair cells in this patient may have been partially preserved despite IP-I in the right ear and common cavity deformity of the left ear.
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Affiliation(s)
- Yusuke Kimura
- National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Masuda
- National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Akifumi Tomizawa
- Department of Speech, Language and Hearing Therapy, Mejiro University, Saitama, Japan
| | - Hideaki Sakata
- Department of Speech, Language and Hearing Therapy, Mejiro University, Saitama, Japan.,Kawagoe Otology Institute, Saitama, Japan
| | - Kimitaka Kaga
- National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
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25
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Isaiah A, Lee D, Lenes-Voit F, Sweeney M, Kutz W, Isaacson B, Roland P, Lee KH. Clinical outcomes following cochlear implantation in children with inner ear anomalies. Int J Pediatr Otorhinolaryngol 2017; 93:1-6. [PMID: 28109477 DOI: 10.1016/j.ijporl.2016.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE A significant proportion of children with congenital hearing loss who are candidates for cochlear implants (CIs) may have inner ear malformations (IEMs). Surgical and speech outcomes following CI in these children have not been widely reported. METHODS The charts of children who were evaluated for a CI between 1/1/1986 and 12/31/2014 at a university-based tertiary level pediatric cochlear implant center were reviewed. Principal inclusion criteria included (i) age 1-18 years, (ii) history of bilateral severe to profound sensorineural hearing loss, and (iii) limited benefit from binaural amplification. Exclusion criteria included (i) underlying diagnosis of neurodevelopmental disorder and (ii) lack of follow up for speech assessment if a CI was performed. The following outcome measures were reviewed: (i) imaging findings with magnetic resonance imaging or high resolution computed tomography, (ii) intraoperative complications, and (iii) speech perception categorized as the ability to perceive closed set, open set, or none. RESULTS The prevalence of IEMs was 27% (102 of 381), of which 79% were bilateral. Cochlear dysplasia accounted for 30% (40 of 136) of the anomalies. Seventy-eight of the 102 patients received a CI (78%). Surgery was noted to be challenging in 24% (19 of 78), with a perilymphatic gusher being the most common intraoperative finding. Cochlear dysplasia, vestibular dysplasia and cochlear nerve hypoplasia were associated with poor speech perception (open OR closed set speech recognition scores, 0-23%), although the outcomes in children with enlarged vestibular aqueduct were similar to those of children with normal inner ear anatomy (65%). CONCLUSIONS Cochlear implantation is safe in children with IEMs. However, the speech perception outcomes are notably below those of patients with normal anatomy, with the exception of when an enlarged vestibular aqueduct is present.
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Affiliation(s)
- Amal Isaiah
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Felicity Lenes-Voit
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melissa Sweeney
- UT Dallas Callier Center for Communication Disorders, Dallas, TX, USA
| | - Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Roland
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kenneth H Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Facial nerve anomalies in paediatric cochlear implant candidates: radiological evaluation. The Journal of Laryngology & Otology 2016; 131:26-31. [DOI: 10.1017/s0022215116009555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Pre-operative radiological identification of facial nerve anomalies can help prevent intra-operative facial nerve injury during cochlear implantation. This study aimed to evaluate the incidence and configuration of facial nerve anomalies and their concurrence with inner-ear anomalies in cochlear implant candidates.Methods:Inner-ear and concomitant facial nerve anomalies were evaluated by magnetic resonance imaging and temporal high-resolution computed tomography in 48 children with congenital sensorineural hearing loss who were cochlear implant candidates.Results:Inner-ear anomalies were present in 11 out of 48 patients (23 per cent) and concomitant facial nerve anomalies were present on 7 sides in 4 patients (7 per cent of the total). Facial nerve anomalies were accompanied by cochlear or vestibular malformation.Conclusion:Potential facial nerve abnormalities should always be considered in patients with inner-ear anomalies. Pre-operative facial nerve imaging can increase the surgeon's confidence to plan and perform cochlear implantation. Magnetic resonance imaging should be used to detect inner-ear anomalies; if these are identified, temporal high-resolution computed tomography should be used to evaluate the facial nerve.
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Kim LS, Jeong SW, Huh MJ, Park YD. Cochlear Implantation in Children with Inner Ear Malformations. Ann Otol Rhinol Laryngol 2016; 115:205-14. [PMID: 16572611 DOI: 10.1177/000348940611500309] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study was to assess the outcomes of cochlear implantation in children with inner ear malformations (IEMs). Methods: A retrospective review of 212 children who received implants from September 1994 to May 2004 was performed. Forty-six of them had radiologic evidence of IEMs. The preoperative evaluations, intraoperative findings, postoperative complications, and performance outcomes were analyzed. For the comparative analysis of performance outcomes, the children with IEMs were matched and compared with children with a normal inner ear who had received implants. Statistical analysis was performed with a repeated-measures analysis of variance. Results: All of the children were studied with computed tomography and magnetic resonance imaging. Three-dimensional volume rendering of magnetic resonance images was performed in cases that were difficult to interpret because of structural complexity. The operative findings included aberrant facial nerves in 2 children and cerebrospinal fluid gushers in 22 children. Intraoperative fluoroscopic examination was performed to evaluate electrode placement. There were no serious postoperative complications. All children with IEMs achieved open-set speech perception abilities, except for the children with a narrow internal auditory canal (IAC), and showed progressive improvement of their speech perception abilities over time. There were no statistically significant differences in performance measured by the Common Phrases test between the 2 groups. Although the repeated-measures analysis of variance indicated that children with IEMs performed more poorly than those with a normal inner ear on the Phonetically Balanced Kindergarten test for phonemes, statistical significance was not found at 2 years after implantation. The children with a narrow IAC benefited from the implantation and used the device every day, although their speech perception abilities were limited. Conclusions: The results of the present study show that cochlear implantation can be performed relatively safely in deaf children with IEMs and that they receive considerable benefit from their implants. Substantial benefit can be expected from implantation in children with most kinds of IEMs, except for a narrow IAC, which is often associated with limited results.
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Affiliation(s)
- Lee-Suk Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Korea
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Wasson JD, Briggs RJS. Contemporary surgical issues in paediatric cochlear implantation. Int J Audiol 2016; 55 Suppl 2:S77-87. [DOI: 10.1080/14992027.2016.1184765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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CSF Gusher in Cochlear Implant Surgery–does it affect surgical outcomes? Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133 Suppl 1:S21-4. [DOI: 10.1016/j.anorl.2016.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/17/2016] [Accepted: 04/28/2016] [Indexed: 11/17/2022]
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Saeed H, Powell HRF, Saeed SR. Cochlear implantation in X-linked deafness - How to manage the surgical challenges. Cochlear Implants Int 2016; 17:178-183. [PMID: 27142359 DOI: 10.1080/14670100.2016.1180018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE AND IMPORTANCE In children with X-linked deafness, cochlear malformations challenge the implant surgeon to avoid electrode insertion into the internal auditory meatus and prevent a continuous cerebrospinal fluid (CSF) leak. We describe our experience of cochlear implantation (CI) in two children with profound hearing loss secondary to X-linked deafness, highlighting safer operative techniques to avoid potential complications. CLINICAL PRESENTATION Descriptive cases of two children with X-linked deafness (patient 1 and patient 2) undergoing CI. Peri-operative imaging and work-up to surgery are discussed. Specific operative considerations, post-operative complications and subsequent audiological performance are highlighted. TECHNIQUE In each case, intra-operative fluoroscopic imaging ensured intra-cochlear insertion of electrodes. Expected CSF gusher was seen in each case which was initially controlled by packing around the cochleostomy and array with temporalis muscle and fascia. Patient 1 developed post-operative meningitis secondary to continuous CSF leak. We avoided further significant CSF leak by planning staged procedures for patient 2, with obliteration of the middle ear cleft and external ear canal (EAC) at the time of implantation. In both patients, bilateral implantation successfully provided hearing thresholds of less than 35 dB in both ears at routine follow up. CONCLUSIONS When planning for CI in children with radiological features of X-linked deafness, intra-operative imaging should be utilized to ensure correct electrode positioning. Traditional methods of stopping a CSF gusher may not suffice. We therefore encourage additional surgical obliteration of the middle ear space and EAC to avoid persistent CSF leak and its associated complications.
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Affiliation(s)
- Haroon Saeed
- a Department of Ear Nose and Throat Surgery , Tameside General Hospital , Fountain Street, Ashton-under-Lyne OL6 9RW , UK
| | - Harry R F Powell
- b Royal National Throat, Nose and Ear Hospital, University College London Hospitals , UK
| | - Shakeel R Saeed
- b Royal National Throat, Nose and Ear Hospital, University College London Hospitals , UK
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le Roux T, Vinck B, Butler I, Cass N, Louw L, Nauta L, Schlesinger D, Soer M, Tshifularo M, Swanepoel DW. Predictors of pediatric cochlear implantation outcomes in South Africa. Int J Pediatr Otorhinolaryngol 2016; 84:61-70. [PMID: 27063755 DOI: 10.1016/j.ijporl.2016.02.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/27/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify and describe predictors of pediatric cochlear implantation outcomes in a South African population. METHODS A retrospective study of 301 pediatric cochlear implant (CI) recipients from five CI programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including demographical, CI, risk and family factors. Multiple regression analyses were performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement. RESULTS Although implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education. CONCLUSION An extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counseling.
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Affiliation(s)
- Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.
| | - Bart Vinck
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa; Speech-Language Audiology Department, Ghent University, Belgium
| | - Iain Butler
- Department of Otorhinolaryngology, University of the Free State, Bloemfontein, South Africa
| | | | - Liebie Louw
- Department of Statistics, University of Pretoria, South Africa
| | - Leone Nauta
- Johannesburg Cochlear Implant Program, South Africa
| | - Dani Schlesinger
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Maggi Soer
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Mashudu Tshifularo
- Department of Otorhinolaryngology, Steve Biko Academic Hospital, University of Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa; Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia; Ear Science Institute Australia, Subiaco, Australia
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Marchioni D, Soloperto D, Bianconi L, Guarnaccia MC, Genovese E, Presutti L. Endoscopic approach for cochlear implantation in advanced otosclerosis: A case report. Auris Nasus Larynx 2016; 43:584-90. [PMID: 27106776 DOI: 10.1016/j.anl.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 03/05/2016] [Accepted: 03/13/2016] [Indexed: 12/20/2022]
Abstract
HYPOTHESIS Ossification of the cochlea was once considered to be a contraindication for cochlear implantation. Advances in cochlear implant technology and coding strategies have led to developments in different surgical procedures to manage cochlear ossification. The endoscopic technique allows a direct approach to the round window and the cochlea, especially in remodeled labyrinth, allowing a better vision of scala tympani. BACKGROUND Tertiary referral ENT center. METHODS Between January 2011 and February 2015 three patients with far advanced otosclerosis with partial obliteration of the cochlea were selected and underwent endoscopic-assisted cochlear implantation. RESULTS In far advanced otosclerosis, endoscopy allowed a magnification of the anatomy of the round window, permitting the surrounding anatomical structures forming the anatomy of the niche to be identified, and avoiding a blind dissection. No postoperative complications were noted, in particular, no surgical site infection, no vertigo, and no facial nerve injuries. Implant activation was routinely performed 1 month after surgery. All monitoring till date has indicated that the external auditory ducts are well ventilated and there are no signs of extrusion. CONCLUSIONS Ossification may occur as a consequence of the pathology of meningitis, chronic otitis media, severe otosclerosis, autoimmune inner ear diseases, temporal bone traumas, and other diseases. Advances in cochlear implant technology and coding strategies have led to developments in different surgical procedures to manage cochlear ossification. Supported by a number of years of experience in the field of otoendoscopic surgery, we propose a technique for cochlear implantation under unfavorable conditions using endoscopic-assisted surgery, especially in advanced otosclerosis. This technique permits us to extend the indication for cochlear implantation, and in our opinion will reduce the morbidity associated with this surgical procedure.
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Affiliation(s)
- Daniele Marchioni
- Otolaryngology Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Davide Soloperto
- Otolaryngology Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Luca Bianconi
- Otolaryngology Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy.
| | - Maria C Guarnaccia
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Elisabetta Genovese
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Livio Presutti
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
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Leigh JR, Moran M, Hollow R, Dowell RC. Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults. Int J Audiol 2016; 55 Suppl 2:S3-8. [DOI: 10.3109/14992027.2016.1146415] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tan L, Holland SK, Deshpande AK, Chen Y, Choo DI, Lu LJ. A semi-supervised Support Vector Machine model for predicting the language outcomes following cochlear implantation based on pre-implant brain fMRI imaging. Brain Behav 2015; 5:e00391. [PMID: 26807332 PMCID: PMC4714644 DOI: 10.1002/brb3.391] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/23/2015] [Accepted: 08/09/2015] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION We developed a machine learning model to predict whether or not a cochlear implant (CI) candidate will develop effective language skills within 2 years after the CI surgery by using the pre-implant brain fMRI data from the candidate. METHODS The language performance was measured 2 years after the CI surgery by the Clinical Evaluation of Language Fundamentals-Preschool, Second Edition (CELF-P2). Based on the CELF-P2 scores, the CI recipients were designated as either effective or ineffective CI users. For feature extraction from the fMRI data, we constructed contrast maps using the general linear model, and then utilized the Bag-of-Words (BoW) approach that we previously published to convert the contrast maps into feature vectors. We trained both supervised models and semi-supervised models to classify CI users as effective or ineffective. RESULTS Compared with the conventional feature extraction approach, which used each single voxel as a feature, our BoW approach gave rise to much better performance for the classification of effective versus ineffective CI users. The semi-supervised model with the feature set extracted by the BoW approach from the contrast of speech versus silence achieved a leave-one-out cross-validation AUC as high as 0.97. Recursive feature elimination unexpectedly revealed that two features were sufficient to provide highly accurate classification of effective versus ineffective CI users based on our current dataset. CONCLUSION We have validated the hypothesis that pre-implant cortical activation patterns revealed by fMRI during infancy correlate with language performance 2 years after cochlear implantation. The two brain regions highlighted by our classifier are potential biomarkers for the prediction of CI outcomes. Our study also demonstrated the superiority of the semi-supervised model over the supervised model. It is always worthwhile to try a semi-supervised model when unlabeled data are available.
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Affiliation(s)
- Lirong Tan
- Division of Biomedical Informatics Cincinnati Children's Hospital Research Foundation 3333 Burnet Avenue Cincinnati Ohio 45229; Department of Electrical Engineering and Computing System University of Cincinnati 812 Rhodes Hall Cincinnati Ohio 45221-0030
| | - Scott K Holland
- Pediatric Neuroimaging Research Consortium Cincinnati Children's Hospital Medical Center Cincinnati Ohio 45221
| | - Aniruddha K Deshpande
- Department of Speech-Language-Hearing-Sciences, 106A Davison Hall 110 Hofstra University, Hempstead New York 11549
| | - Ye Chen
- Division of Biomedical Informatics Cincinnati Children's Hospital Research Foundation 3333 Burnet Avenue Cincinnati Ohio 45229; Department of Electrical Engineering and Computing System University of Cincinnati 812 Rhodes Hall Cincinnati Ohio 45221-0030
| | - Daniel I Choo
- Department of Otolaryngology College of Medicine University of Cincinnati Medical Sciences Building 231 Albert Sabin Way Cincinnati Ohio 45267
| | - Long J Lu
- Division of Biomedical Informatics Cincinnati Children's Hospital Research Foundation 3333 Burnet Avenue Cincinnati Ohio 45229; Department of Electrical Engineering and Computing System University of Cincinnati 812 Rhodes Hall Cincinnati Ohio 45221-0030; Department of Environmental Health College of Medicine University of Cincinnati 231 Albert Sabin Way Cincinnati Ohio 45267
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Cochlear Implant Outcomes and Genetic Mutations in Children with Ear and Brain Anomalies. BIOMED RESEARCH INTERNATIONAL 2015; 2015:696281. [PMID: 26236732 PMCID: PMC4506828 DOI: 10.1155/2015/696281] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/06/2015] [Indexed: 11/24/2022]
Abstract
Background. Specific clinical conditions could compromise cochlear implantation outcomes and drastically reduce the chance of an acceptable development of perceptual and linguistic capabilities. These conditions should certainly include the presence of inner ear malformations or brain abnormalities. The aims of this work were to study the diagnostic value of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in children with sensorineural hearing loss who were candidates for cochlear implants and to analyse the anatomic abnormalities of the ear and brain in patients who underwent cochlear implantation. We also analysed the effects of ear malformations and brain anomalies on the CI outcomes, speculating on their potential role in the management of language developmental disorders. Methods. The present study is a retrospective observational review of cochlear implant outcomes among hearing-impaired children who presented ear and/or brain anomalies at neuroimaging investigations with MRI and HRCT. Furthermore, genetic results from molecular genetic investigations (GJB2/GJB6 and, additionally, in selected cases, SLC26A4 or mitochondrial-DNA mutations) on this study group were herein described. Longitudinal and cross-sectional analysis was conducted using statistical tests. Results. Between January 1, 1996 and April 1, 2012, at the ENT-Audiology Department of the University Hospital of Ferrara, 620 cochlear implantations were performed. There were 426 implanted children at the time of the present study (who were <18 years). Among these, 143 patients (64 females and 79 males) presented ear and/or brain anomalies/lesions/malformations at neuroimaging investigations with MRI and HRCT. The age of the main study group (143 implanted children) ranged from 9 months and 16 years (average = 4.4; median = 3.0). Conclusions. Good outcomes with cochlear implants are possible in patients who present with inner ear or brain abnormalities, even if central nervous system anomalies represent a negative prognostic factor that is made worse by the concomitant presence of cochlear malformations. Common cavity and stenosis of the internal auditory canal (less than 2 mm) are negative prognostic factors even if brain lesions are absent.
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Jeong SW, Kim LS. A New Classification of Cochleovestibular Malformations and Implications for Predicting Speech Perception Ability after Cochlear Implantation. Audiol Neurootol 2015; 20:90-101. [DOI: 10.1159/000365584] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/30/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives: The aims of this study were to introduce a new classification of cochleovestibular malformation (CVM) and to investigate how well this classification can predict speech perception ability after cochlear implantation in children with CVM. Methods: Fifty-nine children with CVM who had used a cochlear implant for more than 3 years were included. CVM was classified into 4 subtypes based on the morphology of the cochlea and the modiolus on temporal bone computed tomography (TBCT): normal cochlea and normal modiolus (type A, n = 16), malformed cochlea and partial modiolus (type B, n = 31), malformed cochlea and no modiolus (type C, n = 6), and no cochlea and no modiolus (type D, n = 6). Speech perception test scores were compared between the subtypes of CVM using analysis of covariance with post hoc Bonferroni test. Univariate and multivariate regression analyses were used to identify the significant predictors of the speech perception test scores. Results: The speech perception test scores after implantation were significantly better in children with CVM type A or type B than in children with CVM type C or type D. The test scores did not differ significantly between the implanted children with CVM type A or type B and those without CVM. In univariate regression analysis, the type of CVM was a significant predictor of the speech perception test scores in implanted children with CVM. Multivariate regression analysis revealed that the age at cochlear implantation, cochlear nerve size and preimplantation speech perception test scores were significant predictors of the postimplantation speech perception test scores. The chance of cochlear nerve deficiency increased progressively from CVM type A to type D. Conclusion: The new classification of CVM based on the morphology of the cochlea and the modiolus is simple and easy to use, and correlated well with postimplantation speech perception ability and cochlear nerve status. This simple classification of CVM using TBCT with cochlear nerve assessment by magnetic resonance imaging is helpful in the preoperative evaluation of children with CVM.
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Surgical Outcomes After Cochlear Implantation in Children With Incomplete Partition Type I. Otol Neurotol 2015; 36:e11-7. [DOI: 10.1097/mao.0000000000000606] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Catli T, Uckan B, Olgun L. Speech and language development after cochlear implantation in children with bony labyrinth malformations: long-term results. Eur Arch Otorhinolaryngol 2014; 272:3131-6. [DOI: 10.1007/s00405-014-3319-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
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Rachovitsas D, Psillas G, Triaridis S, Vital V, Constantinidis J. Outcome of cochlear implantation in children with cochlear malformation [corrected]. Eur Arch Otorhinolaryngol 2014; 271:2845. [PMID: 24756618 DOI: 10.1007/s00405-014-3059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 04/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Dimitrios Rachovitsas
- First Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, 1, Stilponos Kyriakidi St, 546 36, Thessaloniki, Greece
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Abstract
OBJECTIVES To share our experience of cerebrospinal fluid (CSF) gusher in cochlear implantation. METHODS Demographic, radiological, and surgical results of patients with CSF gusher in 523 consecutive cochlear implant recipients including children and adults as well as our management technique were evaluated and a review of the literature has been included. RESULTS Fifteen (2.87%) cases had CSF gusher. Two patients (13.3%) were adults with post-lingual hearing loss and the rest 12 (86.7%) were children with congenital hearing loss. Twelve patients (80%) had various types of inner ear malformation. Three patients (20%) had no predictable risk of CSF gusher from history or pre-operative imaging. In all patients, CSF gushers were controlled with our technique of packing the electrode entrance site with no additional measures. CONCLUSION CSF gusher may occur with post-lingual hearing loss and in children with apparently unremarkable imaging and history. Thus, surgeons should always be ready to manage it. Management of CSF gusher can be mainly performed during the initial surgery by precise tight packing of the electrode entrance site. Furthermore, non-surgical or surgical measures are rarely required to stop a persistent leak. Our results show that our management technique may be recommended as well.
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Sennaroglu L. Cochlear Implantation in Inner Ear Malformations — A Review Article. Cochlear Implants Int 2013; 11:4-41. [DOI: 10.1002/cii.416] [Citation(s) in RCA: 237] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Black J, Hickson L, Black B, Khan A. Paediatric cochlear implantation: Adverse prognostic factors and trends from a review of 174 cases. Cochlear Implants Int 2013; 15:62-77. [DOI: 10.1179/1754762813y.0000000045] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Beltrame MA, Birman CS, Cervera Escario J, Kassouma J, Manolidis S, Pringle MB, Robinson P, Sainz Quevedo M, Shanks M, Suckfüll M, Tomás Barberán M. Common cavity and custom-made electrodes: speech perception and audiological performance of children with common cavity implanted with a custom-made MED-EL electrode. Int J Pediatr Otorhinolaryngol 2013; 77:1237-43. [PMID: 23759335 DOI: 10.1016/j.ijporl.2013.04.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Few studies exist on children with common cavity, fewer still on their long-term audiological development after having received a cochlear implant. Our goal was to observe and report the long-term audiological progress of children with common cavity who were implanted with a custom-made electrode. METHODS In this longitudinal, multi-center study, 19 children were implanted with a MED-EL custom-made electrode via either single slit cochleostomy or double posterior labyrinthotomy. We observed their audiological development with a test battery consisting of Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and Ling 6-Sounds tests. We tested the children 1 month prior to the surgery; at first fitting; at 1, 3, 6, 12, and 18 months post first-fitting; at 2 years after first-fitting; and, whenever possible, at 3, 4, and 5 years after first-fitting. RESULTS Children with common cavity tend to steadily and significantly improve their audiological skills over time. This development may, however, be highly individual; probably in part due to relatively high levels of additional needs. Parents should be counseled to establish realistic post-implantation expectations. Surgically, contrary to our expectations, we cannot confirm that double posterior labyrinthotomy reduces intracochlear electrode movement or that the MED-EL custom electrode leads to fewer incidences of intra- or post-implantation complications. CONCLUSIONS Cochlear implantation is a safe and effective treatment option in children with common cavity. The majority of children with CC derive significant audiological benefit from implantation. Intra- and post-surgical complications, while serious, and be dealt with effectively in most cases.
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Black J, Hickson L, Black B, Perry C. Prognostic indicators in paediatric cochlear implant surgery: a systematic literature review. Cochlear Implants Int 2013; 12:67-93. [PMID: 21756501 DOI: 10.1179/146701010x486417] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Jane Black
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane, Australia.
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Hongjian L, Guangke W, Song M, Xiaoli D, Daoxing Z. The prediction of CSF gusher in cochlear implants with inner ear abnormality. Acta Otolaryngol 2012; 132:1271-4. [PMID: 22831706 DOI: 10.3109/00016489.2012.701328] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONCLUSION The incidence rate of the cerebrospinal fluid (CSF) gusher in cochlear implant with inner ear abnormality is 30%. Bony defect in the fundus of the internal acoustic meatus is most often responsible for the occurrence of CSF gusher. This feature of the CT scan can be used to predict the occurrence of a CSF gusher. OBJECTIVE To predict the occurrence of CSF gusher in cochlear implants with inner ear abnormality. METHODS This was a retrospective analysis of 442 patients with inner ear abnormality who underwent cochlear implantation from February 1998 to July 2011. The patients were reviewed for the findings on temporal high resolution computed tomography (HRCT) scans and the complication of CSF gusher in cochlear implantation. RESULTS Among the 422 cases, 134 (30%) suffered from the complication of CSF gusher during the operation. They were all found to have a bony defect in the fundus of the internal acoustic meatus on the CT scans.
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Affiliation(s)
- Liu Hongjian
- Department of Otolaryngology, Henan Province People's Hospital, Zhengzhou University, Zhengzhou, Henan, China
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Abstract
CONCLUSION Children with cochlear aplasia can achieve favorable speech perception abilities from cochlear implantation (CI) by inserting an electrode array into the vestibule if an audiological response is reliably demonstrated before surgery by behavioral audiometry and objective measures. OBJECTIVES The purpose of this study was to evaluate the surgical outcome of CI in children with cochlear aplasia. METHODS The medical records of 454 children who underwent CI at the Dong-A University Hospital between January 1994 and September 2011 were reviewed. The prevalence of cochlear aplasia and the preoperative evaluations, operative findings, and postoperative speech perception abilities of implanted children with cochlear aplasia were evaluated. RESULTS The implanted children with cochlear aplasia accounted for 2% of those with inner ear malformations and 0.4% of all pediatric cochlear implantees. They showed audiological responses in preoperative electrophysiologic tests, and the eighth nerve was present in magnetic resonance imaging. The electrode array was inserted into the vestibule through an oval window after removing the stapes or through a transmastoid labyrinthotomy site. Electrical compound action potential and electrical auditory brainstem response tests showed clear neural responses after implantation. The hearing thresholds of the implanted ear improved to 25 dB HL and the children achieved significant open set speech perception abilities.
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Affiliation(s)
- Sung-Wook Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Korea
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Rachovitsas D, Psillas G, Chatzigiannakidou V, Triaridis S, Constantinidis J, Vital V. Speech perception and production in children with inner ear malformations after cochlear implantation. Int J Pediatr Otorhinolaryngol 2012; 76:1370-4. [PMID: 22776809 DOI: 10.1016/j.ijporl.2012.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess the speech perception and speech intelligibility outcome after cochlear implantation in children with malformed inner ear and to compare them with a group of congenitally deaf children implantees without inner ear malformation. METHODS Six deaf children (five boys and one girl) with inner ear malformations who were implanted and followed in our clinic were included. These children were matched with six implanted children with normal cochlea for age at implantation and duration of cochlear implant use. All subjects were tested with the internationally used battery tests of listening progress profile (LiP), capacity of auditory performance (CAP), and speech intelligibility rating (SIR). A closed and open set word perception test adapted to the Modern Greek language was also used. In the dysplastic group, two children suffered from CHARGE syndrome, another two from mental retardation, and two children grew up in bilingual homes. RESULTS At least two years after switch-on, the dysplastic group scored mean LiP 62%, CAP 3.8, SIR 2.1, closed-set 61%, and open-set 49%. The children without inner ear dysplasia achieved significantly better scores, except for CAP which this difference was marginally statistically significant (p=0.009 for LiP, p=0.080 for CAP, p=0.041 for SIR, p=0.011 for closed-set, and p=0.006 for open-set tests). CONCLUSION All of the implanted children with malformed inner ear showed benefit of auditory perception and speech production. However, the children with inner ear malformation performed less well compared with the children without inner ear dysplasia. This was possibly due to the high proportion of disabilities detected in the dysplastic group, such as CHARGE syndrome and mental retardation. Bilingualism could also be considered as a factor which possibly affects the outcome of implanted children. Therefore, children with malformed inner ear should be preoperatively evaluated for cognitive and developmental delay. In this case, counseling for the parents is mandatory in order to explain the possible impact of the diagnosed disabilities on performance and habilitation.
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Affiliation(s)
- Dimitrios Rachovitsas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, 1, Stilponos Kyriakidi St., GR 546 36 Thessaloniki, Greece
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Cochlear implantation in a patient with severe cochlear hypoplasia. The Journal of Laryngology & Otology 2012; 126:1172-5. [DOI: 10.1017/s0022215112001727] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:We report the case of a successful cochlear implantation in a patient with severe cochlear hypoplasia.Case report:The outcome of cochlear implantation is generally less favourable for patients with cochlear hypoplasia than for those with a normal cochlear structure. In the reported patient, part of the electrode array was inserted into the internal auditory canal. Nevertheless, the benefits following cochlear implantation seemed to outweigh the risks for this patient.Conclusion:Cochlear hypoplasia is not necessarily a contraindication for cochlear implantation.
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Pakdaman MN, Herrmann BS, Curtin HD, Van Beek-King J, Lee DJ. Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy. Otolaryngol Head Neck Surg 2011; 146:180-90. [DOI: 10.1177/0194599811429244] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To determine the influence of inner ear dysplasia on both surgical and audiologic outcomes following pediatric cochlear implant (CI) surgery. Data Sources. MEDLINE (1982-2009) and data from Massachusetts Eye and Ear Infirmary. Review Methods. A systematic review of the literature was performed. Variables assessed included age at implantation, duration of CI use, radiologic and operative findings, and speech perception outcome data. Results. The initial search yielded 1326 articles. Including data from our own study, twenty-two fulfilled criteria for inclusion, representing 311 patients. Data for bilateral implants were recorded only for the first implant. Data on simultaneous bilateral implants were not recorded. The most common anomaly seen was large vestibular aqueduct (89/311 or 29%). When comparing patients with mild-moderate or severe dysplasia, rates of cerebrospinal fluid gusher were 31% versus 35% (odds ratio [OR] = 0.50), anomalous facial nerve anatomy was seen in 11% versus 51% (OR = 0.15), and postoperative speech perception abilities were found in 84% versus 54% (OR = 1.93), respectively. A large heterogeneity was found among studies regarding all outcome measures. Conclusion. Although we found that severe inner ear dysplasia was associated with increased surgical difficulty and lower speech perception, the lack of uniformity in published clinical data limited the strength of these results. Standardization of surgical and radiologic reporting as well as more consistent speech perception testing is needed to better determine the association between anomalous cochleovestibular anatomy and clinical outcomes.
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Affiliation(s)
- Michael N. Pakdaman
- Department of Otorhinolaryngology, University of Texas Medical School, Houston, Texas, USA
| | - Barbara S. Herrmann
- Department of Audiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Hugh D. Curtin
- Department of Radiology, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Van Beek-King
- Department of Otolaryngology–Head and Neck Surgery, Georgia Health Sciences University, Augusta, Georgia, USA
| | - Daniel J. Lee
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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