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Yamazaki H, Moroto S, Yamazaki T, Tamaya R, Fujii N, Sasaki I, Fujiwara K, Naito Y. Intraoperative EABR Testing Predicts Strength of Cochlear Implant Stimulation Optimized After Long-Term Use in Pediatric Malformation Ears. Otol Neurotol 2024; 45:e307-e314. [PMID: 38478409 DOI: 10.1097/mao.0000000000004152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
OBJECTIVE This study focused on the intensities of cochlear implant (CI) stimulation in pediatric CI users with inner ear malformation or cochlear nerve deficiency (CND). In this population, CI programming is difficult because a large intensity of CI stimulation is required to achieve sufficient hearing, but the excess CI stimuli often induce facial nerve stimulation. We aimed to assess whether the results of intraoperative electrically evoked auditory brainstem responses (EABRs) testing predict maximum current levels of CI stimuli (cC levels) optimized by a behavioral-based method after long-term CI use. STUDY DESIGN A retrospective case review. SETTING A tertiary referral CI center. PATIENTS A total of 116 ears with malformations (malformation group) and 63 control ears (control group) from patients younger than 18 years who received CI. The malformation group comprised 23 ears with a common cavity (CC), 26 with incomplete partition type 1 (IP-1), 26 with incomplete partition type 2 (IP-2), and 41 with CND. INTERVENTIONS Diagnostic. MAIN OUTCOME MEASURES Correlation between intraoperative EABR results and cC levels determined by the behavioral-based CI programming after long-term CI use. RESULTS The CC, IP-1, and CND ears required significantly larger cC levels than the IP-2 ears and control groups. However, the cC levels increased to reach the plateau 1 year after surgery in all groups. Among the malformation group, 79 ears underwent intraoperative EABR testing. Greater than 80% of the CC, IP-1, and IP-2 ears and 54.8% of the CND ears exhibited evoked wave V (eV) and were included in the eV-positive category. Myogenic responses but no eV were observed in 18.2, 15.0, and 35.5% of the CC, IP-1, and CND ears, defined as the myogenic category. No eV or myogenic response was elicited in 9.7% of the CND ears. We focused on minimum current levels that elicited eV (eV levels) in the eV-positive category and maximum current levels that did not elicit any myogenic responses (myogenic levels) in the myogenic category. A significant relationship was detected between the eV levels and the cC levels. When analyzed in each malformation type, the eV levels significantly correlate with the cC levels in the CC and CND ears but not in the IP-1 and IP-2 ears, probably because of slight variation within the IP-1 group and the small number of the IP-2 group. The myogenic category did not show a significant relationship between the myogenic levels and cC levels, but the cC levels were similar to or smaller than the myogenic levels in most ears. CONCLUSIONS This study confirmed that intraoperative EABR testing helps predict the optimal cC levels in malformation ears. EABR-based CI programming immediately after cochlear implantation, followed by behavioral-based CI programming, may allow us to achieve early postoperative optimization of CI maps even in young children with severe malformations.
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Affiliation(s)
| | | | | | | | | | - Ichiro Sasaki
- Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe Japan
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Reimann K, Klose U, Ehrenpfordt U, Thangavelu K, Schulze M. Detection of Reduced Diameter of the Cochlear Nerve in Long-term Deaf Patients Quantified With Semiautomatic Measurement of Nerve Cross-sectional Area Using 3T MRI Data. OTOLOGY & NEUROTOLOGY OPEN 2024; 4:e047. [PMID: 38533346 PMCID: PMC10962875 DOI: 10.1097/ono.0000000000000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/22/2023] [Indexed: 03/28/2024]
Abstract
Hypothesis High-resolution parallel transmit T2 sampling perfection with application optimized contrast using different flip angle evolution sequence with improved edge discrimination and semiautomatic determination of nerve cross-sectional area (CSA) can be used to evaluate nerve degeneration in the inner auditory canal (IAC) in long-term deaf patients. Background In patients with hearing loss, temporal bone MRI is routinely acquired to evaluate the morphology of the nerves within the IAC. Earlier studies have shown that the diameter of the cochlear nerve can be used as prognostic marker for the auditory performance after cochlear implantation in postlingually deaf patients. Methods Eighty-two consecutive MRI scans were analyzed using a semiautomatic tool to measure CSA of cranial nerves in the IAC. Results were correlated with patient history and audiology testing as well as with age and gender. Results There was a significant reduced CSA of the cochlear nerve in ears with moderate-to-profound hearing loss and deafness compared with ears with normal hearing, but no significant difference in ears with mild-to-moderate hearing loss compared with normal hearing. In detail, normal hearing ears had a CSA of 1.23 ± 0.11 mm2, whereas ears with pantonal hearing loss of more than 40 dB had 1.02 ± 0.05 mm2 (P = 0.026). Maximal CSA of the facial nerve was not different among all groups (average, 1.04 mm2 ± 0.03; linear regression, P = 0.001) and stable with age. However, vestibular nerve CSA decreased significantly with age (average, 1.78 ± 0.05 mm2; linear regression, P = 0.128). Conclusions In long-term deaf patients, smaller the diameter of cochlear nerve is the more severe the hearing loss is. The new semiautomatic tool can primarily be used to assess nerve diameter and possibly determine ears with nerve degeneration.
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Affiliation(s)
- Katrin Reimann
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Uwe Klose
- Department of Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Ulrike Ehrenpfordt
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Kruthika Thangavelu
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Marburg, Germany
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Spitzer ER, Attlassy Y, Roland JT, Waltzman SB. Early cochlear implantation for children with single sided deafness. Int J Pediatr Otorhinolaryngol 2024; 177:111857. [PMID: 38244481 DOI: 10.1016/j.ijporl.2024.111857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES Single-sided deafness (SSD) can have consequences for a child's language, educational, and social development. A cochlear implant (CI) is the only device which can restore true binaural hearing, yet they are only approved for children with (SSD) over the age of five in the United States. Reports on speech perception outcomes for children implanted at a younger age are limited. The present study aims to examine the effects of age at implantation, duration of deafness, hearing loss etiology, and presence of additional disabilities on device usage and speech perception outcomes. METHODS A retrospective chart review was used to examine demographics and speech perception outcomes for 18 children implanted at age five or younger. RESULTS Speech perception results were highly variable, with some children deriving significant benefit and others demonstrating no sound awareness through the implant alone. Age at implantation and duration of deafness did not have a clear impact on outcomes. Device usage was low in many children, often those with anatomical abnormalities such as a hypoplastic cochlear nerve. There are challenges to assessing speech perception in young children with SSD, leading to a lack of standardized outcome measures. CONCLUSIONS Early CI for children with SSD may improve speech perception, but benefit is not guaranteed. Candidacy evaluation should consider both medical and audiological factors, in addition to the degree of family support and realistic expectations. Caution is especially warranted in children with significant anatomical anomalies.
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Affiliation(s)
- Emily R Spitzer
- New York University Grossman School of Medicine, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA.
| | - Younes Attlassy
- New York University Grossman School of Medicine, New York, NY, USA
| | - J Thomas Roland
- New York University Grossman School of Medicine, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - Susan B Waltzman
- New York University Grossman School of Medicine, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
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Wei X, Lu S, Chen B, Chen J, Zhang L, Li Y, Kong Y. Cochlear implantation programming characteristics and outcomes of cochlear nerve deficiency. Eur Arch Otorhinolaryngol 2023; 280:4409-4418. [PMID: 37036510 DOI: 10.1007/s00405-023-07949-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/29/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE Due to the specificity of cochlear implantation (CI) programming parameters and outcomes in cochlear nerve deficiency (CND) patients, this study aimed to investigate the correlation between programming parameters and outcomes and further compare the difference between normal and CND groups. METHODS Ninety (95 ears) CND patients (normal cochlea, 39; malformed cochlea, 56) and seventy-nine (81 ears) normal cochlea patients who underwent CI surgery with either Med-El or Cochlear devices were included. The programming parameters and outcomes evaluated by the questionnaires were collected and compared among the normal CND, malformed CND, and normal groups in the two device groups, and their correlation was analyzed. RESULTS In the CND group, a reduced stimulation rate, higher pulse width, and triphasic pulse were needed in some cases. The stimulus levels of the CND group were significantly higher than that of the normal group (p < 0.05), but the outcomes of the CND group were significantly worse than that of the normal group (p < 0.05), and the stimulus level was significantly correlated with the outcomes (p < 0.05). However, there was no difference between normal and malformed CND groups. The non-auditory response was observed in the CND group, especially the ones with malformations. CONCLUSION The CI programming parameters of some CND patients need to be adjusted, and a slower stimulation rate and higher pulse width are required sometimes. CND patients need a higher stimulus level than normal patients but their outcomes are poorer. Non-auditory response should be noticed in CND patients during programming.
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Affiliation(s)
- Xingmei Wei
- Key Laboratory of Otolaryngology Head and Neck Surgery, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Simeng Lu
- Key Laboratory of Otolaryngology Head and Neck Surgery, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Biao Chen
- Key Laboratory of Otolaryngology Head and Neck Surgery, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jingyuan Chen
- Key Laboratory of Otolaryngology Head and Neck Surgery, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Lifang Zhang
- Key Laboratory of Otolaryngology Head and Neck Surgery, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yongxin Li
- Key Laboratory of Otolaryngology Head and Neck Surgery, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Ying Kong
- Key Laboratory of Otolaryngology Head and Neck Surgery, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, People's Republic of China.
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Ren C, Lin Y, Xu Z, Fan X, Zhang X, Zha D. Audiological characteristics and cochlear implant outcome in children with cochlear nerve deficiency. Front Neurol 2022; 13:1080381. [PMID: 36619922 PMCID: PMC9813738 DOI: 10.3389/fneur.2022.1080381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to examine the audiological characteristics and validity of predicting outcomes of cochlear implants (CIs) in children with cochlear nerve deficiency (CND) based on the internal auditory meatus (IAM) nerve grading system. Methods The audiological characteristics of 188 ears in 105 children diagnosed with CND were analyzed based on the IAM nerve grading system. In addition, 42 children with CND who underwent CI were also divided into four groups based on the system, and their auditory and speech performance at baseline (preoperative) and 6, 12, and 24 months after CI were analyzed and compared with those of the control group (n = 24) with a normal cochlear nerve (CN) and CI. Results The audiological test results showed no significant differences among the four CND groups in terms of elicited rates of distortion product otoacoustic emission (DPOAE) (p = 1.000), auditory brainstem response (ABR) (p = 0.611), and cochlear microphonic (CM) (p = 0.167). Hearing in the CND IV group was significantly better than that in the CND I group (p < 0.05). In children with CI, the auditory and speech performance of the control group was significantly higher than all CND groups from 6 to 24 months (p < 0.05) and 12 to 24 months (p < 0.05), respectively. Meanwhile, there were no significant differences between each pair group in the four CND groups (p > 0.05). Conclusion Children with CND, including those in whom the CN was not visualized by MRI, can benefit from CI. Additionally, the IAM nerve grading system could not predict the outcomes of CI in children with CND.
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James AL, Papsin BC. Endoscopic Repair of Round Window Cochleocele. Otol Neurotol 2022; 43:e1136-e1139. [PMID: 36156534 DOI: 10.1097/mao.0000000000003695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the novel presentation, implications, and endoscopic management of a congenital round window cochleocele. PATIENT A 16-month old girl with profound hearing loss from bilateral incomplete partition type 1 (IP1) anomaly of the cochlea plus left-sided cochlear nerve aplasia and cochleocele. INTERVENTION Anomalies were identified with computed tomographic scanning and magnetic resonance imaging during cochlear implant candidacy assessment. While under general anesthesia for right-sided cochlear implantation, the cochleocele was removed and packed with temporalis fascia using transcanal endoscopic ear surgery. The endoscope was held by an assistant while the surgeon packed the round window using a two-handed technique to counter the gush of cerebrospinal fluid. RESULTS The child made an uneventful recovery with no cerebrospinal fluid leak or meningitis. CONCLUSIONS Cochleocele can protrude through the round window of a cochlea with incomplete partition type 1 anomaly. An increased risk of meningitis secondary to acute otitis media is expected given the known risk from cochleocele arising through a stapes footplate fistula. Care should be taken to check for the presence of a cochleocele in hearing loss from congenital malformations involving the basal turn of the cochlea on imaging and also at the time of cochlear implant surgery. Repair should be considered at the first opportunity to prevent meningitis. If early cochlear implant surgery is not feasible or appropriate (as, for example, with cochlear nerve aplasia), transcanal endoscopic ear surgery provides good access for a low-morbidity approach.
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Affiliation(s)
- Adrian L James
- Department of Otolaryngology Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Chen W, Duan B, Huang Y, Wang T, Lu P, Xu Z, Wang Y. Imaging and audiological features of children with cochlear nerve deficiency. EAR, NOSE & THROAT JOURNAL 2022:1455613221096622. [PMID: 35491876 DOI: 10.1177/01455613221096622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Cochlear nerve deficiency (CND) accounts for 10-19% of hearing loss in children; this study investigated the imaging and audiological features of 25 CND children. Methods: A total of 563 children with an unpassed automatic auditory brainstem response were diagnosed with hearing loss in our department between December 2018 and December 2021, of which, the imaging and audiological features of 25 children (25/563, 4.4%) diagnosed with a CND were reviewed. Results: Twenty-one (21/25, 84.0%) CND children had unilateral deafness, and 4 cases of bilateral deafness. All deaf ears were diagnosed as severe hearing loss due to an auditory brainstem response. CM waves were recorded in 8 cases and DPOAE in 3 cases, suggesting the audiological characteristics of auditory neuropathy spectrum disorders (ANSD). MRI results indicated 23 cases had small cochlear nerves and 2 cases had absent cochlear nerves. No genetic mutations were identified in the 25 CND children. Conclusions: Most CND children had unilateral hearing loss; therefore, high-resolution MRI imaging of the internal auditory canal should be performed to detect the auditory nerve in children with severe hearing loss. Some CND children had characteristics of ANSD.
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Affiliation(s)
- Wenxia Chen
- Department of Otolaryngology-Head and Neck Surgery, 12478Children's hospital of Fudan University, Shanghai, China
| | - Bo Duan
- Department of Otolaryngology-Head and Neck Surgery, 12478Children's hospital of Fudan University, Shanghai, China
| | - Yue Huang
- Department of Otolaryngology-Head and Neck Surgery, 12478Children's hospital of Fudan University, Shanghai, China
| | - Tan Wang
- Department of Otolaryngology-Head and Neck Surgery, 12478Children's hospital of Fudan University, Shanghai, China
| | - Ping Lu
- Department of Otolaryngology-Head and Neck Surgery, 12478Children's hospital of Fudan University, Shanghai, China
| | - Zhengmin Xu
- Department of Otolaryngology-Head and Neck Surgery, 12478Children's hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's hospital of Fudan University, Shanghai, China
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Dewyer NA, Smith S, Herrmann B, Reinshagen KL, Lee DJ. Pediatric Single-Sided Deafness: A Review of Prevalence, Radiologic Findings, and Cochlear Implant Candidacy. Ann Otol Rhinol Laryngol 2021; 131:233-238. [PMID: 34036833 DOI: 10.1177/00034894211019519] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To characterize the prevalence, imaging characteristics, and cochlear implant candidacy of pediatric patients with single-sided deafness (SSD). METHODS An audiometric database of patients evaluated at a large tertiary academic medical center was retrospectively queried to identify pediatric patients (<18 years old) with SSD, defined as severe to profound sensorineural hearing loss in one ear and normal hearing in the other. Medical records of identified patients were reviewed to characterize the prevalence, etiology, and cochlear implant candidacy of pediatric patients with SSD. RESULTS We reviewed audiometric data obtained from 1993 to 2018 for 52,878 children at our institution. 191 (0.36%) had the diagnosis of SSD. Cochlear nerve deficiency (either hypoplasia or aplasia) diagnosed on MRI and/or CT was the most common etiology of SSD and was present in 22 of 88 (25%) pediatric SSD patients with available imaging data. 70 of 106 (66%) pediatric SSD patients with available imaging had anatomy amenable to cochlear implantation. CONCLUSIONS Pediatric SSD is a rare condition and the most common etiology based on radiology is cochlear nerve deficiency. High resolution imaging of the temporal bone is essential to determine cochlear nerve morphology prior to consideration of cochlear implantation.
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Affiliation(s)
- Nicholas A Dewyer
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Sullivan Smith
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Barbara Herrmann
- Department of Audiology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Katherine L Reinshagen
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear/Massachusetts General Hospital, Boston, MA, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
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Audiologic Outcome of Cochlear Implantation in Children With Cochlear Nerve Deficiency. Otol Neurotol 2020; 42:38-46. [DOI: 10.1097/mao.0000000000002849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arumugam SV, Nair G, Paramasivan VK, Goyal S, Murali S, Kameswaran M. A Study of Outcome of Pediatric Cochlear Implantation in Patients with Cochleovestibular Nerve Deficiency. J Int Adv Otol 2020; 16:147-152. [PMID: 32784150 DOI: 10.5152/iao.2020.8466] [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 A cochleovestibular nerve deficiency (CVND) could compromise stimulation of nerve by electrical pulses delivered from a cochlear implant, thereby hindering activity along auditory pathway. The evaluation of children with congenital hearing loss with a high-resolution magnetic resonance imaging is presently the investigative modality of choice to diagnose CVND. The aim of this study was to determine the outcomes in pediatric cochlear implant recipients with a diagnosis of CVND. The objectives included (1) to study the prevalence of CVND among children with prelingual congenital severe to profound hearing loss; (2) to assess post cochlear implantation (CI) outcomes in children with CVND using categories of auditory performance (CAP), speech intelligibility rating (SIR), and cortical auditory evoked potentials (CAEPs); and (3) to propose a management protocol for these children. MATERIALS AND METHODS All CI procedures performed during the study period in children 5 years or younger were included in study. All patients who were older than 5 years or had syndromic associations, multiple disabilities, second side or revision CI were excluded from the study. Children with unilateral cochleovestibular nerve aplasia and all other cases of CVND (type IIa and IIb) were advised to undergo CI on side with more radiologically robust nerve and/or cochlea anatomy. Children with bilateral CVND were included in group A, and age-matched cochlear implant candidates with normal cochleovestibular nerve anatomy were included in group B for statistical comparison of outcomes. RESULTS In group A, post CI CAP and SIR, CAEP amplitude and latency at 12 months showed statistically significant difference (p<0.05) compared with preoperative values. However, mean score of CAEP latency and amplitude and SIR score was worse for group A compared with group B at 12 months, which was statistically significant (p<0.05). CONCLUSION This study supports the fact that CI is a viable option to be offered in children with CVND (type IIa and IIb) for the development of auditory perception and speech.
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Affiliation(s)
| | - Geetha Nair
- Department of ENT, Government Medical College, Kerela, India
| | | | - Sunil Goyal
- Department of ENT-HNS, Army Hospital (R-R), Delhi, India
| | - Sathiya Murali
- Madras ENT Research Foundation (Pvt) Ltd, Chennai, India
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The limitation of risk factors as a means of prognostication in auditory neuropathy spectrum disorder of perinatal onset. Int J Pediatr Otorhinolaryngol 2020; 135:110112. [PMID: 32502912 DOI: 10.1016/j.ijporl.2020.110112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The management of hearing loss due to auditory neuropathy spectrum disorder (ANSD) in neonates and infants is challenging because speech and language development prognosis cannot be directly inferred from early audiometric hearing thresholds. Consequently, appropriate intervention with hearing aids or cochlear implantation (CI) can be delayed. Our objective was to determine whether any features of patient history could be used to identify CI candidates with ANSD at an earlier age. METHOD A database was maintained over 11 years to monitor cases of perinatal onset ANSD. Risk factors associated with the perinatal time period considered pertinent to hearing outcomes were assessed, including prematurity, birth weight, APGAR score, ototoxic drugs, and hyperbilirubinemia. Children with cochlear nerve aplasia and genetic mutations were excluded. Hearing outcome was determined according to mode of auditory rehabilitation beyond 30 months of age: A) no hearing device; B) hearing aid; C) CI. RESULTS Of twenty-eight children with ANSD, nine (32%) had behavioural thresholds and language development sufficient to require no assistive device, 9 (32%) were fitted with hearing aids and 10 (36%) had CIs. The average age at CI (3.45 ± 2.07 years) was significantly older than the age at CI of other children in our program with prelingual hearing loss (2.05 ± 1.14 years; p = 0.01 Mann-Witney U Test). None of the putative risk factors for hearing loss reliably predicted the need for subsequent CI. CONCLUSION The small sample size in this study is sufficient to confirm that clinical history alone does not reliably predict which young children with perinatal-onset ANSD will require CI. Consequently, timing for CI remains delayed in these children, potentially affecting speech and language outcome. The pathogenesis of perinatal-onset ANSD remains undetermined and novel means of assessment are required for prognostication in affected infants.
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Purcell PL, Cushing SL, Papsin BC, Gordon KA. Unilateral Hearing Loss and Single-Sided Deafness in Children: an Update on Diagnosis and Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00293-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Sharma SD, Cushing SL, Papsin BC, Gordon KA. Hearing and speech benefits of cochlear implantation in children: A review of the literature. Int J Pediatr Otorhinolaryngol 2020; 133:109984. [PMID: 32203759 DOI: 10.1016/j.ijporl.2020.109984] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
Cochlear implantation is a safe and reliable treatment for children with severe to profound hearing loss. The primary benefit of these medical devices in children is the acquisition of hearing, which promotes development of spoken language. The present paper reviews published literature demonstrating predictive effects of a number of factors on acquisition of hearing development and speech recognition. Of the many variables that contribute to an individual child's development after implantation, age at implantation, the presence of medical comorbidities, social determinants of health, and the provision of bilateral versus unilateral hearing are those that can vary widely and have consistently shown clear impacts. Specifically, age of implantation is crucial to reduce effects of deafness on the developing auditory system and capture the remarkable plasticity of early development. Language development after cochlear implantation requires therapy emphasizing hearing and oral communication, education, and other support which can be influenced by known social determinants of health; specifically, outcomes in children decline with reductions in socioeconomic status and levels of parental education. Medical co-morbidities also slow rates of progress after cochlear implantation. On the other hand, benefits of implantation increase in children who are provided with access to hearing from both ears. In sum, cochlear implants promote development of hearing in children and the best outcomes are achieved by providing early access to sound in both ears. These benefits can be limited by known social determinants of health which restrict access to needed support and medical comorbidities which add further complexity in care and outcome.
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Affiliation(s)
- Sunil D Sharma
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Sharon L Cushing
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Blake C Papsin
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Karen A Gordon
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
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Ropers FG, Pham ENB, Kant SG, Rotteveel LJC, Rings EHHM, Verbist BM, Dekkers OM. Assessment of the Clinical Benefit of Imaging in Children With Unilateral Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2020; 145:431-443. [PMID: 30946449 DOI: 10.1001/jamaoto.2019.0121] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Imaging used to determine the cause of unilateral sensorineural hearing loss (USNHL) in children is often justified by the high likelihood of detecting abnormalities, which implies that these abnormalities are associated with hearing loss and that imaging has a positive contribution to patient outcome or well-being by providing information on the prognosis, hereditary factors, or cause of hearing loss. Objectives To evaluate the diagnostic yield of computed tomography (CT) and magnetic resonance imaging (MRI) in children with isolated unexplained USNHL and investigate the clinical relevance of these findings. Evidence Review Cochrane Library, Embase, PubMed, and Web of Science databases were searched for articles published from 1978 to 2017 on studies of children with USNHL who underwent CT and/or MRI of the temporal bone. Two authors (F.G.R. and E.N.B.P.) independently extracted information on population characteristics, imaging modality, and the prevalence of abnormalities and assessed the studies for risk of bias. Eligibility criteria included studies with 20 or more patients with USNHL who had CT and/or MRI scans, a population younger than 18 years, and those published in English. Main Outcomes and Measures The pooled prevalence with 95% CI of inner ear abnormalities grouped according to finding and imaging modality. Findings Of 1562 studies, 18 were included with a total of 1504 participants included in the analysis. Fifteen studies were consecutive case studies and 3 were retrospective cohort studies. The pooled diagnostic yield for pathophysiologic relevant findings in patients with unexplained USNHL was 37% for CT (95% CI, 25%-48%) and 35% for MRI (95% CI, 22%-49%). Cochleovestibular abnormalities were found with a pooled frequency of 19% for CT (95% CI, 14%-25%) and 16% for MRI (95% CI, 7%-25%). Cochlear nerve deficiency and associated cochlear aperture stenosis had a pooled frequency of 16% for MRI (95% CI, 3%-29%) and 44% for CT (95% CI, 36%-53%), respectively. Enlarged vestibular aqueduct (EVA) was detected with a pooled frequency of 7% for CT and 12% for MRI in children with USNHL. Conclusions and Relevance Imaging provided insight into the cause of hearing loss in a pooled frequency of about 35% to 37% in children with isolated unexplained USNHL. However, none of these findings had therapeutic consequences, and imaging provided information on prognosis and hereditary factors only in a small proportion of children, namely those with EVA. Thus, there is currently no convincing evidence supporting a strong recommendation for imaging in children who present with USNHL. The advantages of imaging should be carefully balanced against the drawbacks during shared decision making.
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Affiliation(s)
- Fabienne G Ropers
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Eveline N B Pham
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Sarina G Kant
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Edmond H H M Rings
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands.,Department of Pediatrics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Medicine, Section Endocrinology, Leiden University Medical Center, Leiden, Netherlands
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15
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Jang JH, Kim H, Mun HA, Choo OS, Park HY, Ha EJ, Choung YH. Can radiological measurements of cochlear nerve parameters predict cochlear implant outcome? Our experience in 87 ears. Clin Otolaryngol 2019; 44:1142-1146. [PMID: 31442002 DOI: 10.1111/coa.13419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/30/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jeong Hun Jang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hantai Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hyung Ah Mun
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Oak Sung Choo
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hun Yi Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea.,Bk21 Plus Research Center for Biomedical Sciences, Ajou University Graduate School of Medicine Suwon, Suwon, Korea
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16
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Amin N, Sethukumar P, Pai I, Rajput K, Nash R. Systematic review of cochlear implantation in CHARGE syndrome. Cochlear Implants Int 2019; 20:266-280. [DOI: 10.1080/14670100.2019.1634857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nikul Amin
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - Priya Sethukumar
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - Irumee Pai
- Hearing Implant Team, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Kaukab Rajput
- Cochlear Implant Department, Great Ormond Street Hospital, London, UK
| | - Robert Nash
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
- Cochlear Implant Department, Great Ormond Street Hospital, London, UK
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17
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Responsiveness of the Electrically Stimulated Cochlear Nerve in Children With Cochlear Nerve Deficiency. Ear Hear 2019; 39:238-250. [PMID: 28678078 DOI: 10.1097/aud.0000000000000467] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES This study aimed to (1) investigate the responsiveness of the cochlear nerve (CN) to a single biphasic-electrical pulse in implanted children with cochlear nerve deficiency (CND) and (2) compare their results with those measured in implanted children with normal-size CNs. DESIGN Participants included 23 children with CND (CND1 to CND23) and 18 children with normal-size CNs (S1 to S18). All subjects except for CND1 used Cochlear Nucleus cochlear implants with contour electrode arrays in their test ears. CND1 was implanted with a Cochlear Nucleus Freedom cochlear implant with a straight electrode array in the test ear. For each subject, the CN input/output (I/O) function and the refractory recovery function were measured using electrophysiological measures of the electrically evoked compound action potential (eCAP) at multiple electrode sites across the electrode array. Dependent variables included eCAP threshold, the maximum eCAP amplitude, slope of the I/O function, and time-constants of the refractory recovery function. Slopes of I/O functions were estimated using statistical modeling with a sigmoidal function. Recovery time-constants, including measures of the absolute refractory period and the relative refractory period, were estimated using statistical modeling with an exponential decay function. Generalized linear mixed-effect models were used to evaluate the effects of electrode site on the dependent variables measured in children with CND and to compare results of these dependent variables between subject groups. RESULTS The eCAP was recorded at all test electrodes in children with normal-size CNs. In contrast, the eCAP could not be recorded at any electrode site in 4 children with CND. For all other children with CND, the percentage of electrodes with measurable eCAPs decreased as the stimulating site moved in a basal-to-apical direction. For children with CND, the stimulating site had a significant effect on the slope of the I/O functions and the relative refractory period but showed no significant effect on eCAP threshold and the maximum eCAP amplitude. Children with CND had significantly higher eCAP thresholds, smaller maximum eCAP amplitudes, flatter slopes of I/O functions, and longer absolute refractory periods than children with normal-size CNs. There was no significant difference in the relative refractory period measured in these two subject groups. CONCLUSIONS In children with CND, the functional status of the CN varied along the length of the cochlea. Compared with children with normal-size CNs, children with CND showed reduced CN responsiveness to electrical stimuli. The prolonged CN absolute refractory period in children with CND might account for, at least partially, the observed benefit of using relatively slow pulse rate in these patients.
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18
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Siu JM, Blaser SI, Gordon KA, Papsin BC, Cushing SL. Efficacy of a selective imaging paradigm prior to pediatric cochlear implantation. Laryngoscope 2019; 129:2627-2633. [PMID: 30613974 DOI: 10.1002/lary.27666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/27/2018] [Accepted: 10/12/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS There is no consensus on the necessary preoperative imaging in children being evaluated for cochlear implantation (CI). Dual-imaging protocols that implement both magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) create diagnostic redundancy in the face of potentially unnecessary radiation and anaesthetic exposure. The objectives of the current study were to examine the efficacy of an MRI-predominant with selective HRCT imaging protocol. STUDY DESIGN Retrospective review. METHODS The protocol was implemented over a 4-year period, during which HRCT was obtained in addition to MRI only if specific risk factors on clinical assessment were identified or if imaging findings in need of further evaluation were detected on initial MRI evaluation. Retrospective review of operative reports and prospective review of imaging were performed; anesthetic exposure and costing information were also obtained. RESULTS Of the 240 patients who underwent assessment, seven (2.9%) had combined HRCT and MRI performed concurrently based on initial clinical assessment, 15 (6.3%) underwent HRCT based on imaging anomalies found on MRI, and MRI alone was ordered for the remaining 218 (90.1%). All patients were implanted without complication. Overall, radiation exposure, general anesthesia (GA), and healthcare costs were reduced. CONCLUSIONS MRI alone can be used in the vast majority of cases for preoperative evaluation of pediatric CI candidates resulting in a significant reduction in healthcare costs, radiation, and GA exposure in children. The additional need for HRCT occurs in a small proportion and can be predicted up front on clinical assessment or on initial MRI. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2627-2633, 2019.
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Affiliation(s)
- Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Diagnostic Imaging-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Appropriate Imaging Modality for the Etiologic Diagnosis of Congenital Single-Sided Deafness in Children. J Clin Med 2018; 7:jcm7120515. [PMID: 30518098 PMCID: PMC6306910 DOI: 10.3390/jcm7120515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/16/2018] [Accepted: 11/29/2018] [Indexed: 12/13/2022] Open
Abstract
We aimed to compare the diagnostic yield between temporal bone computed tomography (TBCT) and internal auditory canal MRI (IAC MRI) for the etiologic diagnosis of children with congenital single-sided deafness (SSD) and the evaluation of cochlear implant (CI) candidacy. In the original cohort, 24 subjects with congenital SSD were enrolled and underwent both TBCT and IAC MRI. We recruited an additional 22 consecutive infants with congenital SSD (the supplementary cohort) and evaluated in particular the cochlear nerve (CN) integrity using IAC MRI. Cochlear nerve deficiency (CND) was classified as ‘absent’, ‘small’, and ‘indeterminate’ via mutual comparison between optical and parameters based on the MRI results. The most common etiologies were CND in the original cohort (19 out of 24). Notably, accurate evaluations of CN status (‘small CN’ = 2, ‘indeterminate CN’ = 2), inner ear malformations, and brain abnormalities were possible only with MRI. The ‘indeterminate CN’ tended to be more frequently detected in SSD ears than in unaffected ears. MRI appeared to be more accurate than TBCT in a meticulous differentiation of CN, which is crucial for the selection of appropriate CI candidacy among congenital SSD children. Additionally, we introduced the novel concept of ‘indeterminate CN’, of which the causal relationship with SSD awaits confirmation.
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20
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Vilchez-Madrigal LD, Blaser SI, Wolter NE, James AL, Papsin BC, Gordon KA, Cushing SL, Propst EJ. Children with unilateral cochlear nerve canal stenosis have bilateral cochleovestibular anomalies. Laryngoscope 2018; 129:2403-2408. [PMID: 30353559 DOI: 10.1002/lary.27559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 07/18/2018] [Accepted: 08/16/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the cochleovestibular apparatus bilaterally in children with isolated unilateral bony cochlear nerve canal (bCNC) stenosis. STUDY DESIGN Retrospective review. METHODS Imaging studies of children with unilateral bCNC stenosis (<1.0 mm) on computed tomography imaging (N = 36) were compared with controls imaged due to trauma without temporal bone injury (N = 32). Twenty-six measurements were obtained in each ear, assessing the bony internal auditory canal (IAC), cochlea, and vestibular end-organs, and were analyzed using one-way analysis of variance for intersubject comparisons and paired t tests for intrasubject comparisons with a Bonferroni adjustment for multiple comparisons (P = .0006). RESULTS Patients with bCNC stenosis had a smaller IAC (P < .000) and cochlea (P < .000) on the stenotic side as compared with controls. Although the vestibular end-organ was also smaller in bCNC ears, this difference was not significant. The contralateral ear also had a smaller bCNC (P < .000) and cochlea (P < .000) as compared with controls, although to a lesser degree than the stenotic side. CONCLUSIONS Children with unilateral bCNC stenosis have abnormal biometry of both the cochlea and the vestibular end-organ in the affected and the normal contralateral ear as compared with controls. LEVEL OF EVIDENCE 3b Laryngoscope, 129:2403-2408, 2019.
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Affiliation(s)
- Luis D Vilchez-Madrigal
- Department of Otolaryngology-Head and Neck Surgery, National Children's Hospital, San Jose, Costa Rica
| | - Susan I Blaser
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, Division of Neuroradiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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21
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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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22
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Ehrmann-Müller D, Kühn H, Matthies C, Hagen R, Shehata-Dieler W. Outcomes after cochlear implant provision in children with cochlear nerve hypoplasia or aplasia. Int J Pediatr Otorhinolaryngol 2018; 112:132-140. [PMID: 30055722 DOI: 10.1016/j.ijporl.2018.06.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cochlear nerve aplasia or hypoplasia is found in up to a half of patients with unilateral or bilateral hearing loss. There is an ongoing discussion regarding the indication of cochlear implants for hearing rehabilitation in cases with radiologically-defined aplasia or hypoplasia of the cochlear nerve in those patients, especially in children. At present there is conflicting evidence whether the audiological outcomes of those children with a CI are comparable to those of children with a CI and a radiologically-normal cochlear nerve. The primary aim of this study was to assess the audiological abilities before and after CI provision in children with cochlear nerve hypoplasia or aplasia. Additionally, we aimed to determine if audiological outcomes differed in children with aplasia from those with hypoplasia. Such data should be helpful in determining if CI provision is appropriate for such children. METHODS This retrospective study presents 7 children who were diagnosed with cochlear nerve aplasia or hypoplasia and received a CI. The pre- and postoperative audiological performance and the hearing and speech development of the children were examined. RESULTS 4 children were unilateral CI users and 3 were bilateral CI users. Hearing reactions could be detected in all children. Already at first fitting, prompt responses and reactions to songs were observed. The aided thresholds in free field in children with hypoplasia were between 30 and 60 dB. Even in children with aplasia, the results in free field with CI averaged between 30 and 70 dB. Therefore the aided thresholds in children with hypoplasia and in children with aplasia of the CN are similar. It could be demonstrated that hearing reactions improve with the long term use of the implant. Improvement in general development could be observed in all children despite the very heterogeneous conditions and the accompanying handicaps. CONCLUSION The results of this study support the hypothesis that children with radiologically-defined CN hypoplasia or aplasia and detectable responses to electrical or acoustical stimuli can improve their sound detection thresholds and their awareness of sound when provided with a CI.
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Affiliation(s)
- Désirée Ehrmann-Müller
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany.
| | - Heike Kühn
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
| | - Wafaa Shehata-Dieler
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
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Progression of Unilateral Hearing Loss in Children With and Without Ipsilateral Cochlear Nerve Canal Stenosis: A Hazard Analysis. Otol Neurotol 2018; 38:e138-e144. [PMID: 28538470 DOI: 10.1097/mao.0000000000001452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the risk of hearing loss progression in each ear among children with unilateral hearing loss associated with ipsilateral bony cochlear nerve canal (BCNC) stenosis. SETTING Tertiary pediatric referral center. PATIENTS Children diagnosed with unilateral hearing loss who had undergone temporal bone computed tomography imaging and had at least 6 months of follow-up audiometric testing were identified from a prospective audiological database. INTERVENTIONS Two pediatric radiologists blinded to affected ear evaluated imaging for temporal bone anomalies and measured bony cochlear canal width independently. All available audiograms were reviewed, and air conduction thresholds were documented. MAIN OUTCOME MEASURE Progression of hearing loss was defined by a 10 dB increase in air conduction pure-tone average. RESULTS One hundred twenty eight children met inclusion criteria. Of these, 54 (42%) had a temporal bone anomaly, and 22 (17%) had ipsilateral BCNC stenosis. At 12 months, rates of progression in the ipsilateral ear were as follows: 12% among those without a temporal bone anomaly, 13% among those with a temporal bone anomaly, and 17% among those with BCNC stenosis. Children with BCNC stenosis had a significantly greater risk of progression in their ipsilateral ear compared with children with no stenosis: hazard ratio (HR) 2.17, 95% confidence interval (CI) (1.01, 4.66), p value 0.046. When we compared children with BCNC stenosis to those with normal temporal bone imaging, we found that the children with stenosis had nearly two times greater risk estimate for progression, but this difference did not reach significance, HR 1.9, CI (0.8, 4.3), p = 0.1. No children with BCNC stenosis developed hearing loss in their contralateral year by 12 months of follow-up. CONCLUSION Children with bony cochlear nerve canal stenosis may be at increased risk for progression in their ipsilateral ear. Audiometric and medical follow-up for these children should be considered.
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Sokolov M, Cushing SL, Polonenko M, Blaser SI, Papsin BC, Gordon KA. Clinical Characteristics of Children With Single-Sided Deafness Presenting for Candidacy Assessment for Unilateral Cochlear Implantation. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0173-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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Peng KA, Kuan EC, Hagan S, Wilkinson EP, Miller ME. Cochlear Nerve Aplasia and Hypoplasia: Predictors of Cochlear Implant Success. Otolaryngol Head Neck Surg 2017; 157:392-400. [DOI: 10.1177/0194599817718798] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To identify factors predicting performance outcomes following cochlear implantation in patients with cochlear nerve aplasia or hypoplasia. Data Sources Individual patient data extracted from published case series and reports. Review Methods The MEDLINE database, Cochrane Library, Embase, Web of Science, and Google Scholar were queried for “cochlear implant” in conjunction with “aplasia” or “hypoplasia” between 1985 and 2015. Eighteen studies were included describing 97 subjects with individual postimplant auditory data. Postimplant performance was categorized as follows: level 1, nonstimulation/minimal detection; level 2, improved detection; level 3, closed-set speech perception; or level 4, open-set speech perception. The subjects achieving speech perception (levels 3 and 4) were descriptively compared with those who did not. Results Subjects with a hypoplastic cochlear nerve on magnetic resonance imaging had higher reported rates of achieving speech perception than those with an aplastic nerve. Subjects with syndromic medical comorbidities had higher reported rates of nonstimulation than nonsyndromic subjects. The data showed that some children with an aplastic cochlear nerve or those with partial electrode insertion could obtain levels of speech discrimination. Reporting of patient characteristics and auditory outcomes was extremely variable across studies. Conclusion As previously shown, cochlear implant in patients with cochlear nerve aplasia or hypoplasia can provide meaningful hearing for select patients. The current study suggests that presence of a cochlear nerve on magnetic resonance imaging and lack of comorbid medical syndrome are associated with better auditory outcomes in such patients. Future efforts to report individual data in a consistent manner may allow better determination of predictive factors.
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Affiliation(s)
| | - Edward C. Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
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Cinar BC, Yarali M, Atay G, Bajin MD, Sennaroglu G, Sennaroglu L. The role of eABR with intracochlear test electrode in decision making between cochlear and brainstem implants: preliminary results. Eur Arch Otorhinolaryngol 2017. [DOI: 10.1007/s00405-017-4643-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Predicting Auditory Outcomes From Radiological Imaging in Cochlear Implant Patients With Cochlear Nerve Deficiency. Otol Neurotol 2017; 38:685-693. [DOI: 10.1097/mao.0000000000001382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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A Prospective Longitudinal Study of U.S. Children Unable to Achieve Open-Set Speech Recognition 5 Years After Cochlear Implantation. Otol Neurotol 2016; 36:985-92. [PMID: 25700015 DOI: 10.1097/mao.0000000000000723] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify characteristics associated with the inability to progress to open-set speech recognition in children 5 years after cochlear implantation. STUDY DESIGN Prospective, longitudinal, and multidimensional assessment of auditory development for 5 years. SETTING Six tertiary cochlear implant (CI) referral centers in the United States. PATIENTS Children with severe-to-profound hearing loss who underwent implantation before age 5 years enrolled in the Childhood Development after Cochlear Implantation study, categorized by level of speech recognition ability. INTERVENTION(S) Cochlear implantation before 5 years of age and annual assessment of emergent speech recognition skills. MAIN OUTCOME MEASURE(S) Progression to open-set speech recognition by 5 years after implantation. RESULTS Less functional hearing before implantation, older age at onset of amplification, lower maternal sensitivity to communication needs, minority status, and complicated perinatal history were associated with the inability to obtain open-set speech recognition by 5 years. CONCLUSION Characteristics of a subpopulation of children with CIs associated with an inability to achieve open-set speech recognition after 5 years of CI experience were investigated. These data distinguish pediatric CI recipients at risk for poor auditory development and highlight areas for future interventions to enhance support of early implantation.
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Harrison RV, Gordon KA, Papsin BC, Negandhi J, James AL. Auditory neuropathy spectrum disorder (ANSD) and cochlear implantation. Int J Pediatr Otorhinolaryngol 2015; 79:1980-7. [PMID: 26545793 DOI: 10.1016/j.ijporl.2015.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
We discuss issues related to cochlear implantation in children with auditory neuropathy spectrum disorder (ANSD). We describe the varied nature of this disease category including the numerous potential causes of auditory neuropathy. The most prevalent etiology for infants with ANSD is associated with prolonged neonatal intensive care unit (NICU) stay. We discuss the potential contribution of cochlear hypoxia to this etiology. The second part of this review describes in detail our own experience at the Hospital for Sick Children in Toronto, with cochlear implantation of children diagnosed with ANSD. We outline the detection, diagnosis, and referral routes for our patients. We provide an overview of our "standard operation procedures" regarding candidacy, and discuss some of the special considerations that need to be applied to children with ANSD. This includes decisions to implant children with better audiometric thresholds that are standard in non-ANSD patients, concerns about the possibility of spontaneous remission and the appropriate timing of implantation. Finally we review an extensive published literature in outcomes after cochlear implantation (CI) in ANSD. This is not a systematic review but rather an exercise to distill out some important reoccurring themes and the general consensus of opinion to date. Our conclusion is that the hearing loss category ANSD, together with its numerous co-morbidities, is far too heterogeneous to make definitive statements about prognosis with CI.
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Affiliation(s)
- Robert V Harrison
- Department of Otolaryngology - HNS, Program in Neuroscience and Mental Health, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8; Department of Otolaryngology - Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Toronto, Ontario, Canada MG5 2N2.
| | - Karen A Gordon
- Department of Otolaryngology - HNS, Program in Neuroscience and Mental Health, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8; Department of Otolaryngology - Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Toronto, Ontario, Canada MG5 2N2
| | - Blake C Papsin
- Department of Otolaryngology - HNS, Program in Neuroscience and Mental Health, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8; Department of Otolaryngology - Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Toronto, Ontario, Canada MG5 2N2
| | - Jaina Negandhi
- Department of Otolaryngology - HNS, Program in Neuroscience and Mental Health, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8
| | - Adrian L James
- Department of Otolaryngology - HNS, Program in Neuroscience and Mental Health, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8; Department of Otolaryngology - Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Toronto, Ontario, Canada MG5 2N2
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Iseli C, Buchman CA. Management of Children with Severe, Severe-profound, and Profound Sensorineural Hearing Loss. Otolaryngol Clin North Am 2015; 48:995-1010. [DOI: 10.1016/j.otc.2015.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ishikawa M, Ohnishi H, Skerleva D, Sakamoto T, Yamamoto N, Hotta A, Ito J, Nakagawa T. Transplantation of neurons derived from human iPS cells cultured on collagen matrix into guinea-pig cochleae. J Tissue Eng Regen Med 2015. [PMID: 26205474 DOI: 10.1002/term.2072] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The present study examined the efficacy of a neural induction method for human induced pluripotent stem (iPS) cells to eliminate undifferentiated cells and to determine the feasibility of transplanting neurally induced cells into guinea-pig cochleae for replacement of spiral ganglion neurons (SGNs). A stepwise method for differentiation of human iPS cells into neurons was used. First, a neural induction method was established on Matrigel-coated plates; characteristics of cell populations at each differentiation step were assessed. Second, neural stem cells were differentiated into neurons on a three-dimensional (3D) collagen matrix, using the same protocol of culture on Matrigel-coated plates; neuron subtypes in differentiated cells on a 3D collagen matrix were examined. Then, human iPS cell-derived neurons cultured on a 3D collagen matrix were transplanted into intact guinea-pig cochleae, followed by histological analysis. In vitro analyses revealed successful induction of neural stem cells from human iPS cells, with no retention of undifferentiated cells expressing OCT3/4. After the neural differentiation of neural stem cells, approximately 70% of cells expressed a neuronal marker, 90% of which were positive for vesicular glutamate transporter 1 (VGLUT1). The expression pattern of neuron subtypes in differentiated cells on a 3D collagen matrix was identical to that of the differentiated cells on Matrigel-coated plates. In addition, the survival of transplant-derived neurons was achieved when inflammatory responses were appropriately controlled. Our preparation method for human iPS cell-derived neurons efficiently eliminated undifferentiated cells and contributed to the settlement of transplant-derived neurons expressing VGLUT1 in guinea-pig cochleae. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Masaaki Ishikawa
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Hiroe Ohnishi
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Desislava Skerleva
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Tatsunori Sakamoto
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Norio Yamamoto
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Akitsu Hotta
- Centre for iPS Cell Research and Application, Kyoto University, Japan
| | - Juichi Ito
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Takayuki Nakagawa
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
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Usefulness of MRI and EABR Testing for Predicting CI Outcomes Immediately After Cochlear Implantation in Cases With Cochlear Nerve Deficiency. Otol Neurotol 2015; 36:977-84. [DOI: 10.1097/mao.0000000000000721] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arndt S, Prosse S, Laszig R, Wesarg T, Aschendorff A, Hassepass F. Cochlear implantation in children with single-sided deafness: does aetiology and duration of deafness matter? Audiol Neurootol 2015; 20 Suppl 1:21-30. [PMID: 25999052 DOI: 10.1159/000380744] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
For adult patients with single-sided deafness (SSD), treatment with a cochlear implant (CI) is well established as an acceptable and beneficial hearing rehabilitation method administered routinely in clinical practice. In contrast, for children with SSD, CI has been applied less often to date, with the rationale to decide either on a case-by-case basis or under the realm of clinical research. The aim of our clinical study was to evaluate the longitudinal benefits of CI for a group of children diagnosed with SSD and to compare their outcomes with respect to patient characteristics. Evaluating a pool of paediatric SSD patients presenting for possible CI surgery revealed that the primary aetiology of deafness was congenital cochlear nerve deficiency. A subgroup of children meeting the CI candidacy criteria for the affected ear (the majority with acquired hearing loss) were enrolled in the study. Preliminary group results suggest substantial improvements in speech comprehension in noise and in the ability to localise sound, which was demonstrated through objective and subjective assessments after CI treatment for the group, with results varying from patient to patient. Our study shows a trend towards superior outcomes for children with acquired hearing loss and a shorter duration of hearing loss compared to congenitally deafened children who had a longer duration of SSD. This indicates an interactive influence of the age at onset, aetiology and duration of deafness upon the restoration of binaural integration and the overall benefits of sound stimulation to two ears after CI treatment. Continued longitudinal investigation of these children and further studies in larger groups may provide more guidance on the optimal timing of treatment for paediatric patients with acquired and congenital SSD.
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Affiliation(s)
- Susan Arndt
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Freiburg, Freiburg, Germany
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Zong L, Guan J, Ealy M, Zhang Q, Wang D, Wang H, Zhao Y, Shen Z, Campbell CA, Wang F, Yang J, Sun W, Lan L, Ding D, Xie L, Qi Y, Lou X, Huang X, Shi Q, Chang S, Xiong W, Yin Z, Yu N, Zhao H, Wang J, Wang J, Salvi RJ, Petit C, Smith RJH, Wang Q. Mutations in apoptosis-inducing factor cause X-linked recessive auditory neuropathy spectrum disorder. J Med Genet 2015; 52:523-31. [PMID: 25986071 PMCID: PMC4518735 DOI: 10.1136/jmedgenet-2014-102961] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/21/2015] [Indexed: 01/09/2023]
Abstract
Background Auditory neuropathy spectrum disorder (ANSD) is a form of hearing loss in which auditory signal transmission from the inner ear to the auditory nerve and brain stem is distorted, giving rise to speech perception difficulties beyond that expected for the observed degree of hearing loss. For many cases of ANSD, the underlying molecular pathology and the site of lesion remain unclear. The X-linked form of the condition, AUNX1, has been mapped to Xq23-q27.3, although the causative gene has yet to be identified. Methods We performed whole-exome sequencing on DNA samples from the AUNX1 family and another small phenotypically similar but unrelated ANSD family. Results We identified two missense mutations in AIFM1 in these families: c.1352G>A (p.R451Q) in the AUNX1 family and c.1030C>T (p.L344F) in the second ANSD family. Mutation screening in a large cohort of 3 additional unrelated families and 93 sporadic cases with ANSD identified 9 more missense mutations in AIFM1. Bioinformatics analysis and expression studies support this gene as being causative of ANSD. Conclusions Variants in AIFM1 gene are a common cause of familial and sporadic ANSD and provide insight into the expanded spectrum of AIFM1-associated diseases. The finding of cochlear nerve hypoplasia in some patients was AIFM1-related ANSD implies that MRI may be of value in localising the site of lesion and suggests that cochlea implantation in these patients may have limited success.
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Affiliation(s)
- Liang Zong
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Jing Guan
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Megan Ealy
- Molecular Otolaryngology and Renal Research Laboratories and the Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Qiujing Zhang
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Dayong Wang
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Hongyang Wang
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Yali Zhao
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China Beijing Institute of Otorhinolaryngology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhirong Shen
- National Institute of Biological Sciences, Beijing, China
| | - Colleen A Campbell
- Molecular Otolaryngology and Renal Research Laboratories and the Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Fengchao Wang
- National Institute of Biological Sciences, Beijing, China
| | - Ju Yang
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Wei Sun
- Department of Communicative Disorders & Sciences, Center for Hearing and Deafness, University at Buffalo, Buffalo, New York, USA
| | - Lan Lan
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Dalian Ding
- Department of Communicative Disorders & Sciences, Center for Hearing and Deafness, University at Buffalo, Buffalo, New York, USA
| | - Linyi Xie
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Yue Qi
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Xusheng Huang
- Department of Neurology, PLA General Hospital, Beijing, China
| | - Qiang Shi
- Department of Neurology, PLA General Hospital, Beijing, China
| | - Suhua Chang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Wenping Xiong
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Zifang Yin
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Ning Yu
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | - Hui Zhao
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
| | | | - Jing Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Richard J Salvi
- Department of Communicative Disorders & Sciences, Center for Hearing and Deafness, University at Buffalo, Buffalo, New York, USA
| | - Christine Petit
- Unité de Génétique et Physiologie de l'Audition, Institut Pasteur, Collège de France, Paris, France
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories and the Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Qiuju Wang
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, PLA General Hospital, Beijing, China
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Kaplan AB, Kozin ED, Puram SV, Owoc MS, Shah PV, Hight AE, Sethi RK, Remenschneider AK, Lee DJ. Auditory brainstem implant candidacy in the United States in children 0-17 years old. Int J Pediatr Otorhinolaryngol 2015; 79:310-315. [PMID: 25577282 PMCID: PMC4477282 DOI: 10.1016/j.ijporl.2014.11.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The auditory brainstem implant (ABI) is an option for hearing rehabilitation in profoundly deaf patients ineligible for cochlear implantation. Over the past decade, surgeons have begun implanting ABIs in pediatric patients who are unable to receive cochlear implants due to congenital or acquired malformations of the inner ear. No study has examined the potential population-level demand for ABIs in the United States (US). Herein, we aim to quantify the potential need for pediatric ABIs. METHODS A systematic literature review was conducted to identify studies detailing the rates of congenital cochlear and/or cochlear nerve (CN) anomalies. Absolute indications for ABI include bilateral cochlea or CN aplasia (Group A), and relative indications for ABI include bilateral cochlea or CN hypoplasia (Group B). Data was subsequently correlated to the US Census Bureau, the National Health Interview Survey, and the Gallaudet Research Institute to provide an estimation of pediatric ABI candidates. RESULTS Eleven studies documented rates of bilateral findings. Bilateral cochlea aplasia was identified in 0-8.7% of patients and bilateral CN aplasia in 0-4.8% of patients (Group A). Bilateral cochlea hypoplasia was identified in 0-8.7% of patients and bilateral CN hypoplasia in 0-5.4% of patients (Group B). Using population-level sensorineural hearing loss data, we roughly estimate 2.1% of potential implant candidates meet absolute indications for an ABI in the United States. CONCLUSION Congenital cochlear and cochlear nerve anomalies are exceedingly rare. This study provides the first preliminary estimate of cochlea and CN aplasia/hypoplasia at the population level albeit with limitations based on available data. These data suggest the need for dedicated ABI centers to focus expertise and management.
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Evaluation of internal auditory canal structures in tinnitus of unknown origin. Clin Exp Otorhinolaryngol 2014; 7:160-4. [PMID: 25177429 PMCID: PMC4135149 DOI: 10.3342/ceo.2014.7.3.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/11/2013] [Accepted: 04/22/2013] [Indexed: 11/16/2022] Open
Abstract
Objectives The aim of the present study was to evaluate the internal auditory canal (IAC) and the nerves inside it to define possible structural differences in cases with subjective tinnitus of unknown origin. Methods Cases applying to the ear, nose and throat department with the complaint of tinnitus with unknown origin and having normal physical examination and test results were included in the study (n=78). Patients admitted to the radiology clinic for routine cranial magnetic resonance imaging (MRI) and whose MRI findings revealed no pathologies were enrolled as the control group (n=79). Data for the control group were obtained from the radiology department and informed consent was obtained from all the patients. Diameters of the IAC and the nerves inside it were measured through enhanced images obtained by routine temporal bone MRIs in all cases. Statistical evaluations were performed using Student t-test and statistical significance was defined as P<0.05. Results Measurements of IAC diameters revealed statistically significant differences between the controls and the tinnitus group (P<0.05). Regarding the diameters of the cochlear nerve, facial nerve, inferior vestibular nerve, superior vestibular nerve, and total vestibular nerve, no statistically significant difference was found between the controls and the tinnitus group. Conclusion Narrowed IAC has to be assessed as an etiological factor in cases with subjective tinnitus of unknown origin.
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Freeman SR, Stivaros SM, Ramsden RT, O'Driscoll MP, Nichani JR, Bruce IA, Green KM, Henderson LA, Rutherford SA, King AT, Lloyd SK. The management of cochlear nerve deficiency. Cochlear Implants Int 2013; 14 Suppl 4:S27-31. [DOI: 10.1179/1467010013z.000000000129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
OBJECTIVE To report the results of cochlear implant-elicited cortical auditory evoked potentials (eCAEP) in children with cochlear nerve deficiency (CND). STUDY DESIGN Case control series. SETTING Tertiary academic referral center. PATIENTS Seven children with CND that have a cochlear implant in their affected ear. Four children without CND served as controls. INTERVENTION(S) eCAEPs were elicited by activation of individual cochlear implant electrodes. MAIN OUTCOME MEASURE(S) Onset responses (P1-N1-P2 complex). RESULTS Three of 7 CND children demonstrated eCAEP responses across a broad range of electrodes despite having limited or no open set speech perception abilities using their implants. Two of these children had eCAEPs that were characterized by substantial variability in latency, amplitude, and number of electrodes with identifiable responses. The remaining 4 ears with CND and poor speech perception had multiphasic responses that are inconsistent with eCAEPs. Non-CND ears with excellent speech perception abilities demonstrated robust responses on all electrodes stimulated. CONCLUSION Abent eCAEP responses were indicative of poor open-set speech perception skills in all cases. However, eCAEP onset responses were measurable in some children with imaging evidence of CND, indicating probable cochlear nerve hypoplasia rather than aplasia. That some children with CND and poor speech perception had robust eCAEPs in some instances makes this particular measure of limited use for predicting good speech perception outcomes after cochlear implantation in these children. The origin of multiphasic responses remains to be determined but may be of somatosensory origin in some instances.
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Taiji H, Morimoto N, Matsunaga T. Unilateral cochlear nerve hypoplasia in children with mild to moderate hearing loss. Acta Otolaryngol 2012; 132:1160-7. [PMID: 22830941 DOI: 10.3109/00016489.2012.696781] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Even if hearing loss is mild to moderate, the presence of cochlear nerve (CN) hypoplasia associated with retrocochlear disorders should be considered. OBJECTIVES CN hypoplasia is a term that refers to an absent cochlear nerve on high-resolution magnetic resonance imaging (MRI). Most cases of CN hypoplasia are associated with profound hearing loss. The present study reports six pediatric cases of unilateral CN hypoplasia with mild to moderate hearing loss. METHODS Between May 2008 and April 2011, pure-tone hearing tests were performed in 17 patients who were diagnosed with CN hypoplasia on high resolution for evaluation of unilateral sensorineural hearing loss at the National Center for Child Health and Development. Of these, six patients had average hearing levels in the affected ears of < 60 dB and were therefore included in this study. RESULTS All six ears with CN hypoplasia were associated with CN canal stenosis. DPOAEs were present in one (17%) of the six affected ears. The ABR thresholds of the ears with CN hypoplasia were significantly elevated compared with 1-4 kHz pure-tone hearing levels in one of three cases. In two of five cases, the maximum word recognition scores of the affected ears were poor compared with pure-tone hearing levels.
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Affiliation(s)
- Hidenobu Taiji
- Department of Otorhinolaryngology, National Center for Child Health and Development, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan.
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Levi J, Ames J, Bacik K, Drake C, Morlet T, O'Reilly RC. Clinical characteristics of children with cochlear nerve dysplasias. Laryngoscope 2012; 123:752-6. [DOI: 10.1002/lary.23636] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/18/2012] [Accepted: 07/10/2012] [Indexed: 11/10/2022]
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Kang WS, Hyun SM, Lim HK, Shim BS, Cho JH, Lee KS. Normative diameters and effects of aging on the cochlear and facial nerves in normal-hearing Korean ears using 3.0-tesla magnetic resonance imaging. Laryngoscope 2012; 122:1109-14. [PMID: 22374919 DOI: 10.1002/lary.23184] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 11/19/2011] [Accepted: 12/05/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the normative size of the cochlear nerve (CN) and facial nerve (FN) in normal-hearing ears and to determine whether nerve size varies with age. STUDY DESIGN Cross-sectional. METHODS We included 169 ears with normal hearing between 2005 and 2010. The height, width, and cross-sectional area (CSA) of the CN and FN in the middle of the internal auditory canal were measured on oblique sagittal images of 3.0-T magnetic resonance imaging. Results were compared by age. Young subjects were divided into three age groups, 0-5, 6-10, and 11-15 years. Subjects over age 40 years were divided into groups at 10-year intervals. RESULTS Mean age was 32.6 years (range, 0.75-79 years). We found that the CN had significantly greater vertical (1.10 ± 0.21 mm vs. 0.95 ± 0.21 mm) and horizontal (1.11 ± 0.20 mm vs. 1.03 ± 0.22 mm) diameters than the FN. The CSA of the CN was larger than that of the FN (0.98 ± 0.33 mm(2) vs. 0.79 ± 0.31 mm(2) ). Except for the CN vertical diameter, there were no significant differences between right and left ears. Sex did not affect the nerve size. Although the CN was not affected by age, the FN vertical diameter and CSA of children <5 years were significantly smaller than those of children aged >5 years. The size of the two nerves did not differ among groups over age 40 years. CONCLUSIONS The CN is not affected by age in normal-hearing ears. The FN vertical diameter and CSA of children <5 years are smaller than those of older children.
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Affiliation(s)
- Woo Seok Kang
- Department of Otolaryngology, Gangneung Asan Hospital, Gangneung, Gangwon, South Korea
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