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Wu SS, Dunn-Johnson C, Zeitler DM, Schwartz S, Sutliff S, Appachi S, Jamis C, Petter K, Vovos R, Goldberg D, Anne S. Auditory Outcomes Following Cochlear Implantation in Children with Unilateral Hearing Loss. Otol Neurotol 2024; 45:513-520. [PMID: 38511263 PMCID: PMC11087191 DOI: 10.1097/mao.0000000000004169] [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] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Unilateral hearing loss (UHL) in children is associated with speech and language delays. Cochlear implantation (CI) is currently the only rehabilitative option that restores binaural hearing. This study aims to describe auditory outcomes in children who underwent CI for UHL and to determine the association between duration of hearing loss and auditory outcomes. STUDY DESIGN Retrospective case series. SETTING Three tertiary-level, academic institutions. PATIENTS Children <18 years with UHL who underwent CI between 2018 and 2021. INTERVENTION Cochlear implantation. MAIN OUTCOME MEASURES Speech perception and Speech, Spatial and Qualities of Hearing Scale (SSQ) were assessed postimplantation. Scores >50% on speech perception and SSQ scores >8 points were considered satisfactory. Associations between duration of UHL and implantation age and outcomes were assessed using Spearman's rank correlation. RESULTS Of the 38 children included, mean age at CI was 7.9 ± 3.2 years and mean UHL duration was 5.0 ± 2.8 years. Mean datalogging was 8.1 ± 3.1 hours/day. Mean auditory testing scores were SSQ, 7.9 ± 1.2; BABY BIO, 68.1 ± 30.2%; CNC, 38.4 ± 28.4%; WIPI, 52.5 ± 23.1%. Scores >50% on CNC testing were achieved by 40% of patients. SSQ scores >8 points were reported by 78% (7/9) of patients. There were no significant correlations between UHL duration and auditory outcomes. CONCLUSION Overall, children with UHL who undergo CI can achieve satisfactory speech perception scores and SSQ scores. There were no associations between duration of hearing loss and age at implantation with auditory outcomes. Multiple variables may impact auditory outcomes, including motivation, family support, access to technology, and consistent isolated auditory training postactivation and should be taken into consideration in addition to age at implantation and duration of UHL in determination of CI candidacy.
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Affiliation(s)
- Shannon S. Wu
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Camille Dunn-Johnson
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daniel M. Zeitler
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington
| | - Seth Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington
| | - Suzanne Sutliff
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Swathi Appachi
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carmen Jamis
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karen Petter
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rachel Vovos
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Donald Goldberg
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samantha Anne
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
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Arndt S, Findeis L, Wesarg T, Aschendorff A, Speck I, Ketterer MC, Rauch AK. Long-Term Outcome of Cochlear Implantation in Children With Congenital, Perilingual, and Postlingual Single-Sided Deafness. Ear Hear 2024; 45:316-328. [PMID: 37726884 DOI: 10.1097/aud.0000000000001426] [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: 09/21/2023]
Abstract
OBJECTIVES We investigated the long-term outcomes of children with single-sided deafness (SSD) after cochlear implant (CI) surgery, during and after rehabilitation, and compared the results of children with congenital, perilingual, and postlingual SSD. We evaluated the impact of SSD at age at onset and duration of deafness on their performance. DESIGN Thirty-six children with SSD treated with CI participated in the study: 20 had congenital, seven perilingual (defined: >0 to 4 years), and nine had postlingual deafness (defined as >4 years of age). Their outcome with CI were measured on both subjective and objective scales: duration of device use, speech intelligibility in noise and in quiet, bilateral hearing and localization ability, quality of life and hearing, presence and loudness of tinnitus, and hearing ability of the better hearing ear. RESULTS After a mean follow-up time of 4.75 years, 32 of the 36 children used their CI on a regular basis. The remaining four children were nonusers. These children had congenital SSD and were older than three years at the time of CI surgery. Overall, for congenital/perilingual and postlingual SSD, speech intelligibility in noise and the Speech, Spatial and Qualities of Hearing Scale (SSQ) speech subscore were significantly improved, as were their subjective and objective localization ability and hearing-related quality of life. Children with postlingual SSD benefited from the CI with regard to speech intelligibility, SSQ speech/spatial/total score, and localization error, and children with congenital SSD showed better results with a short duration of deafness of less than 3 years compared with those with a longer deafness period. CONCLUSIONS Cochlear implantation is a successful treatment for children with congenital/perilingual or postlingual SSD. Results largely differed with respect to the onset and duration of deafness, and better outcomes were achieved by children with postlingual SSD and with a short duration of deafness. Our data also confirmed that children with congenital SSD should be implanted with a CI within three years of age.
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Affiliation(s)
- Susan Arndt
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Park LR, Dillon MT, Buss E, Brown KD. Two-Year Outcomes of Cochlear Implant Use for Children With Unilateral Hearing Loss: Benefits and Comparison to Children With Normal Hearing. Ear Hear 2023; 44:955-968. [PMID: 36879386 PMCID: PMC10426784 DOI: 10.1097/aud.0000000000001353] [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: 04/11/2022] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Children with severe-to-profound unilateral hearing loss, including cases of single-sided deafness (SSD), lack access to binaural cues that support spatial hearing, such as recognizing speech in complex multisource environments and sound source localization. Listening in a monaural condition negatively impacts communication, learning, and quality of life for children with SSD. Cochlear implant (CI) use may restore binaural hearing abilities and improve outcomes as compared to alternative treatments or no treatment. This study investigated performance over 24 months of CI use in young children with SSD as compared to the better hearing ear alone and to children with bilateral normal hearing (NH). DESIGN Eighteen children with SSD who received a CI between the ages of 3.5 and 6.5 years as part of a prospective clinical trial completed assessments of word recognition in quiet, masked sentence recognition, and sound source localization at regular intervals out to 24-month postactivation. Eighteen peers with bilateral NH, matched by age at the group level, completed the same test battery. Performance at 24-month postactivation for the SSD group was compared to the performance of the NH group. RESULTS Children with SSD have significantly poorer speech recognition in quiet, masked sentence recognition, and localization both with and without the use of the CI than their peers with NH. The SSD group experienced significant benefits with the CI+NH versus the NH ear alone on measures of isolated word recognition, masked sentence recognition, and localization. These benefits were realized within the first 3 months of use and were maintained through the 24-month postactivation interval. CONCLUSIONS Young children with SSD who use a CI experience significant isolated word recognition and bilateral spatial hearing benefits, although their performance remains poorer than their peers with NH.
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Affiliation(s)
- Lisa R. Park
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Margaret T. Dillon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Emily Buss
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Kevin D. Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
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Park LR, Gagnon EB, Dillon MT. Factors that influence outcomes and device use for pediatric cochlear implant recipients with unilateral hearing loss. Front Hum Neurosci 2023; 17:1141065. [PMID: 37250696 PMCID: PMC10213360 DOI: 10.3389/fnhum.2023.1141065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Candidacy criteria for cochlear implantation in the United States has expanded to include children with single-sided deafness (SSD) who are at least 5 years of age. Pediatric cochlear implant (CI) users with SSD experience improved speech recognition with increased daily device use. There are few studies that report the hearing hour percentage (HHP) or the incidence of non-use for pediatric CI recipients with SSD. The aim of this study was to investigate factors that impact outcomes in children with SSD who use CIs. A secondary aim was to identify factors that impact daily device use in this population. Methods A clinical database query revealed 97 pediatric CI recipients with SSD who underwent implantation between 2014 and 2022 and had records of datalogs. The clinical test battery included speech recognition assessment for CNC words with the CI-alone and BKB-SIN with the CI plus the normal-hearing ear (combined condition). The target and masker for the BKB-SIN were presented in collocated and spatially separated conditions to evaluate spatial release from masking (SRM). Linear mixed-effects models evaluated the influence of time since activation, duration of deafness, HHP, and age at activation on performance (CNC and SRM). A separate linear mixed-effects model evaluated the main effects of age at testing, time since activation, duration of deafness, and onset of deafness (stable, progressive, or sudden) on HHP. Results Longer time since activation, shorter duration of deafness, and higher HHP were significantly correlated with better CNC word scores. Younger age at device activation was not found to be a significant predictor of CNC outcomes. There was a significant relationship between HHP and SRM, with children who had higher HHP experiencing greater SRM. There was a significant negative correlation between time since activation and age at test with HHP. Children with sudden hearing loss had a higher HHP than children with progressive and congenital hearing losses. Conclusion The present data presented here do not support a cut-off age or duration of deafness for pediatric cochlear implantation in cases of SSD. Instead, they expand on our understanding of the benefits of CI use in this population by reviewing the factors that influence outcomes in this growing patient population. Higher HHP, or greater percentage of time spent each day using bilateral input, was associated with better outcomes in the CI-alone and in the combined condition. Younger children and those within the first months of use had higher HHP. Clinicians should discuss these factors and how they may influence CI outcomes with potential candidates with SSD and their families. Ongoing work is investigating the long-term outcomes in this patient population, including whether increasing HHP after a period of limited CI use results in improved outcomes.
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Zeitler DM, Dunn C, Schwartz SR, McCoy JL, Jamis C, Chi DH, Goldberg DM, Anne S. Health-Related Quality of Life in Children With Unilateral Sensorineural Hearing Loss Following Cochlear Implantation. Otolaryngol Head Neck Surg 2023; 168:1511-1520. [PMID: 36934432 DOI: 10.1002/ohn.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 03/20/2023]
Abstract
OBJECTIVE Evaluate health-related quality of life (HR-QOL) benefits with cochlear implantation (CI) in children with unilateral sensorineural hearing loss (USNHL) versus bilateral sensorineural hearing loss (BSNHL). STUDY DESIGN A cross-sectional survey of parents of children who underwent CI for USNHL and BSNHL. SETTING Tertiary care academic centers. METHODS The "Children with cochlear implants: parental perspectives" survey was administered. Parents rated responses on a 5-point Likert scale. Scores greater than 3.0 were considered favorable. Responses were recorded within 8 domains and groups were compared with respect to domain scores. Analysis of covariance models was used to compare groups while adjusting for age at implantation and duration of implant use. RESULTS There were 31 patients with USNHL and 27 patients with BSNHL. The average age of implantation in BSNHL patients was 1.9 and 6.7 years for USNHL. Parents of all children answered favorably in all domains. When adjusted for age at implantation and duration of implant use, parents of BSNHL children responded significantly more favorably only in 2 domains. When comparing patients with older age or prolonged duration of hearing loss in the USNHL cohort, there were favorable responses in all domains with no significant differences between groups. CONCLUSION There are HR-QOL benefits of CI in USNHL children; less pronounced favorable results were noted only in 2 domains when compared to BSNHL children. Benefits were noted with CI in USNHL children at an older age at implantation or prolonged duration of hearing loss. Therefore, these factors should not be absolute contraindications for CI in USNHL.
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Affiliation(s)
| | | | | | - Jennifer L McCoy
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - David H Chi
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Silva VAR, Pauna HF, Lavinsky J, Hyppolito MA, Vianna MF, Leal M, Massuda ET, Hamerschmidt R, Bahmad Jr F, Cal RV, Sampaio ALL, Felix F, Chone CT, Castilho AM. Task force Guideline of Brazilian Society of Otology - hearing loss in children - Part II - Treatment. Braz J Otorhinolaryngol 2022; 89:190-206. [PMID: 36528468 PMCID: PMC9874354 DOI: 10.1016/j.bjorl.2022.11.001] [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: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children. CONCLUSIONS In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil,Corresponding author.
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Mariana Leal
- Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia, Recife, PE, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Rogério Hamerschmidt
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Fayez Bahmad Jr
- Universidade de Brasília (UnB), Programa de Pós-Graduação em Ciências da Saúde, Brasília, DF, Brazil,Instituto Brasiliense de Otorrinolaringologia (IBO), Brasília, DF, Brazil
| | - Renato Valério Cal
- Centro Universitário do Estado do Pará (CESUPA), Departamento de Otorrinolaringologia, Belém, PA, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Felippe Felix
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Departamento de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
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Brown KD, Dillon MT, Park LR. Benefits of Cochlear Implantation in Childhood Unilateral Hearing Loss (CUHL Trial). Laryngoscope 2021; 132 Suppl 6:S1-S18. [PMID: 34542181 PMCID: PMC9293149 DOI: 10.1002/lary.29853] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 08/22/2021] [Indexed: 11/12/2022]
Abstract
Objectives/Hypotheses Children with unilateral sensory hearing loss (UHL) struggle to understand speech in noise and locate the origin of sound and have reduced quality of hearing. This clinical trial will determine the benefits of cochlear implantation in children with UHL. Study Design Prospective clinical trial. Methods Twenty children with at least moderate to profound sensory hearing loss and poor speech perception (word score <30%) in one ear and normal hearing in the contralateral ear participated in a Food and Drug Administration‐approved clinical trial. Subjects were evaluated for speech perception in quiet, speech perception in noise, sound localization, and subjective benefits after implantation. Results CNC word score perception in quiet significantly improved (1% to 50%, P < .0001) by 12 months after activation. Speech perception in noise by BKB‐SIN significantly improved in all three noise configurations; there was a 3.6 dB advantage in head shadow (P < .0001), a 1.6 dB advantage in summation (P = .003), and a 2.5 dB advantage in squelch (P = .0001). Localization improved by 26° at 9 months (P < .0001). Speech, Spatial, and Qualities (SSQ) demonstrated significant improvements in speech (5.2 to 7.4, P = .0012), qualities of hearing (5.9 to 7.5, P = .0056), and spatial hearing (2.7 to 6.6, P < .0001). SSQ subscales associated with binaural hearing were significantly improved, as was listening effort (P = .0082). Subjects demonstrated a non‐significant improvement in fatigue. Conclusions This study demonstrates that children with UHL significantly benefit from cochlear implantation. Level of Evidence Level 3 Laryngoscope, 132:S1–S18, 2022
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Affiliation(s)
- Kevin D Brown
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Margaret T Dillon
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Lisa R Park
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
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Children With Congenital Unilateral Sensorineural Hearing Loss: Effects of Late Hearing Aid Amplification-A Pilot Study. Ear Hear 2021; 41:55-66. [PMID: 30998543 DOI: 10.1097/aud.0000000000000730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although children with unilateral hearing loss (uHL) have high risk of experiencing academic difficulties, speech-language delays, poor sound localization, and speech recognition in noise, studies on hearing aid (HA) outcomes are few. Consequently, it is unknown when and how amplification is optimally provided. The aim was to study whether children with mild-to-moderate congenital unilateral sensorineural hearing loss (uSNHL) benefit from HAs. DESIGN All 6- to 11-year-old children with nonsyndromic congenital uSNHL and at least 6 months of HA use were invited (born in Stockholm county council, n = 7). Participants were 6 children (9.7- to 10.8-years-old) with late HA fittings (>4.8 years of age). Unaided and aided hearing was studied with a comprehensive test battery in a within-subject design. Questionnaires were used to study overall hearing performance and disability. Sound localization accuracy (SLA) and speech recognition thresholds (SRTs) in competing speech were measured in sound field to study hearing under demanding listening conditions. SLA was measured by recording eye-gaze in response to auditory-visual stimuli presented from 12 loudspeaker-video display pairs arranged equidistantly within ±55° in the frontal horizontal plane. The SRTs were measured for target sentences at 0° in spatially separated (±30° and ±150°) continuous speech. Auditory brainstem responses (ABRs) were obtained in both ears separately to study auditory nerve function at the brainstem level. RESULTS The mean ± SD pure-tone average (0.5, 1, 2, and 4 kHz) was 45 ± 8 dB HL and 6 ± 4 dB HL in the impaired and normal hearing ear, respectively (n = 6). Horizontal SLA was significantly poorer in the aided compared with unaided condition. A significant relationship was found between aided SLA (quantified by an error index) and the impaired ear's ABR I to V interval, suggesting a relationship between the two. Results from questionnaires revealed aided benefit in one-to-one communication, whereas no significant benefit was found for communication in background noise or reverberation. No aided benefit was found for the SRTs in competing speech. CONCLUSIONS Children with congenital uSNHL benefit from late HA intervention in one-to-one communication but not in demanding listening situations, and there is a risk of degraded SLA. The results indicate that neural transmission time from the impaired cochlea to the upper brainstem may have an important role in unilaterally aided spatial hearing, warranting further study in children with uHL receiving early HA intervention.
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Park LR, Dillon MT, Buss E, O'Connell BP, Brown KD. Spatial Release From Masking in Pediatric Cochlear Implant Recipients With Single-Sided Deafness. Am J Audiol 2021; 30:443-451. [PMID: 33769866 PMCID: PMC9522323 DOI: 10.1044/2020_aja-20-00119] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Children with single-sided deafness (SSD) experience difficulty understanding speech in multisource listening situations. Case reports and retrospective studies have indicated that a cochlear implant (CI) may improve masked speech recognition in children with SSD. This prospective study was conducted to determine whether providing a CI to children with SSD supports spatial release from masking (SRM), an improvement in speech recognition associated with separating the target and masker sources. Method Twenty children with at least a moderate-to-profound hearing loss in one ear and normal hearing in the contralateral ear underwent cochlear implantation. The average age of implantation was 5.5 years (range: 3.5-12.7). After 12 months of CI use, subjects completed a sentence recognition task in multitalker masker with and without the CI. The target was presented from the front, and the masker was either colocated with the target (0°) or from the side (+90° or -90°). A two-way repeated-measures analysis of variance was completed to investigate SRM with and without the CI. Results Pediatric CI recipients experienced significant SRM when the masker was directed to the normal-hearing ear or to the affected ear. Conclusions The results indicate that cochlear implantation in children with SSD supports binaural skills required for speech recognition in noise. These results are consistent with improved functional communication in multisource environments, like classrooms.
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Affiliation(s)
- Lisa R. Park
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Margaret T. Dillon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Emily Buss
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Brendan P. O'Connell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Kevin D. Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
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Donato M, Santos R, Correia F, Escada P. Single-sided deafness: Bone conduction devices or cochlear implantation? A systematic review with meta-analysis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The cochlear implant (CI) as a treatment option for single-sided deafness (SSD) started with a clinical study looking in to the influence of cochlear implantation with a MED-EL device on incapacitating unilateral tinnitus in SSD. The study began in 2003 and was conducted by P. Van de Heyning and his team in Antwerp, Belgium. The first CI in SSD without tinnitus in Germany was implanted by J. Mueller and R. Jacob in Koblenz in 2005. Translational research activities took place since then to evaluate the CI as a treatment option for SSD not only in adults but also in children. They assessed the hearing performance of SSD patients implanted with CI, importance of long electrode arrays in SSD patients, degree of acceptance of CI by SSD children, importance of early CI implantation in SSD children in developing language skills, music enjoyment by hearing with two ears and evidence on spiral ganglion cell body distribution. In 2013, MED-EL was the first CI manufacturer to receive the CE mark for the indication of SSD and asymmetric hearing loss (AHL) in adults and children. In 2019, MED-EL was the first CI manufacturer to get its CI device approved for patients over the age of five with SSD and AHL, by the FDA in the USA. This article covers the milestones of translational research from the first concept to the widespread clinical use of CI in SSD.
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Affiliation(s)
| | - Ingeborg Hochmair
- MED-EL Elektromedizinische Geraete Gesellschaft m.b.H., Innsbruck, Austria
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Liu J, Zhou M, He X, Wang N. Single-sided deafness and unilateral auditory deprivation in children: current challenge of improving sound localization ability. J Int Med Res 2020; 48:300060519896912. [PMID: 31948312 PMCID: PMC7113713 DOI: 10.1177/0300060519896912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Interaural time difference and interaural level difference signals are insufficient in patients with single-sided deafness (SSD). This insufficiency leads to an absence of sound localization abilities and a decrease in speech intelligibility in noisy environments. SSD occurring in children further affects their language learning and cognitive abilities and their academic performance because they lack spatial abilities and binaural hearing. The early stages of central auditory system development are critical for auditory function development and morphological refinement. SSD occurring in the critical period can cause significant lateralization in the bilateral auditory pathway. This may increase the risk that affected individuals cannot re-establish binaural benefits after rehabilitation of hearing loss in the post-sensitive period. For otorhinolaryngologists, there is the concern that children with congenital SSD cannot benefit from cochlear implantation. Only a few studies have investigated auditory rehabilitation in children with congenital SSD with cochlear implantation and their results were inconsistent. The present review aims to clarify the main problems and challenges of clinical rehabilitation of congenital SSD, particularly focusing on the effect of CI on sound localization ability in children with congenital SSD.
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Affiliation(s)
- Jinfeng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Mo Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Xiaolin He
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Ningyu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China
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Donato M, Santos R, Correia F, Escada P. Single-sided deafness: Bone conduction devices or cochlear implantation? A systematic review with meta-analysis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:101-108. [PMID: 33160618 DOI: 10.1016/j.otorri.2020.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/25/2020] [Accepted: 02/25/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To perform a systematic review with meta-analysis of the studies published on the efficacy of bone conduction devices and cochlear implantation in single-sided deafness, through the evaluation of speech discrimination in noise, sound localization and tinnitus suppression. As a secondary outcome, patient satisfaction is also assessed. DESIGN A systematic search in PubMed, Embase and CENTRAL was conducted, including all articles written in English and published in the last 10 years. The outcomes selected were speech perception in noise, sound localization, tinnitus intensity and, secondarily, quality of life assessment. Studies that met prospectively defined criteria were subjected to random effects meta-analyses. The review protocol is registered on PROSPERO with number CRD42019121444. RESULTS Nineteen articles reporting a total of 210 patients (95 patients with bone conduction devices and 115 in the cochlear implantation group) were included. The meta-analysis identifies statistically significant benefits in cochlear implantation for sound localization, tinnitus suppression, in global quality of life assessment and in 2 of the 3 subscales of quality of life assessment (ease of communication and reverberation). Bone conduction devices are better regarding speech discrimination in noise and background noise quality of life assessment. CONCLUSION Cochlear implants effectively offer better results in 2 of the 3 evaluated parameters, being a very valid option. Bone conduction devices should continue to be considered in the treatment of these patients because, in addition to allowing better discrimination in noise, patient satisfaction is greater in environments with background noise.
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Affiliation(s)
- Mariana Donato
- Otorhinolaryngology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
| | - Ricardo Santos
- Otorhinolaryngology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Filipe Correia
- Otorhinolaryngology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Escada
- Otorhinolaryngology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
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Rauch AK, Arndt S, Aschendorff A, Beck R, Speck I, Ketterer MC, Jakob TF, Hassepass F. Long-term results of cochlear implantation in children with congenital single-sided deafness. Eur Arch Otorhinolaryngol 2020; 278:3245-3255. [PMID: 33079248 PMCID: PMC8328851 DOI: 10.1007/s00405-020-06409-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this retrospective study was to investigate the outcome and critical age of cochlear implantation in congenital single-sided deafness (SSD). Methods 11 children with congenital SSD were implanted with a cochlear implant (CI). Auditory performance was measured through the results of speech discrimination, subjective assessment by the Categories of auditory performance (CAP) score, the Speech, Spatial and Qualities scale questionnaire (SSQ) and the German version of the IOI-HA [Internationales Inventar zur Evaluation von Hörgeräten (IIEH, version for CI)]. Results Long-term follow-up [median: 3 years and 5 months (3;5 years)] revealed that nine children use their CI (> 8 h/day) and two became nonusers. In children aged below 3;2 years at surgery, there was a substantial long-term increase in speech discrimination and subjective benefit. Children over 4;4 years of age at CI surgery improved partially in audiological/subjective measurements. Among children above 5 years, the SSQ score did not improve despite further slight improvement in speech discrimination long-term. Conclusion Our data suggest a critical age for CI surgery below 3 years in children with congenital SSD for successful hearing rehabilitation. It is mandatory to identify children with SSD as early as bilaterally deaf children.
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Affiliation(s)
- Ann-Kathrin Rauch
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany.
| | - Susan Arndt
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Antje Aschendorff
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Rainer Beck
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Iva Speck
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Manuel Christoph Ketterer
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Till Fabian Jakob
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Frederike Hassepass
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
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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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Snapp HA, Ausili SA. Hearing with One Ear: Consequences and Treatments for Profound Unilateral Hearing Loss. J Clin Med 2020; 9:jcm9041010. [PMID: 32260087 PMCID: PMC7230949 DOI: 10.3390/jcm9041010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/28/2020] [Accepted: 03/31/2020] [Indexed: 12/02/2022] Open
Abstract
There is an increasing global recognition of the negative impact of hearing loss, and its association to many chronic health conditions. The deficits and disabilities associated with profound unilateral hearing loss, however, continue to be under-recognized and lack public awareness. Profound unilateral hearing loss significantly impairs spatial hearing abilities, which is reliant on the complex interaction of monaural and binaural hearing cues. Unilaterally deafened listeners lose access to critical binaural hearing cues. Consequently, this leads to a reduced ability to understand speech in competing noise and to localize sounds. The functional deficits of profound unilateral hearing loss have a substantial impact on socialization, learning and work productivity. In recognition of this, rehabilitative solutions such as the rerouting of signal and hearing implants are on the rise. This review focuses on the latest insights into the deficits of profound unilateral hearing impairment, and current treatment approaches.
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Ehrmann-Mueller D, Kurz A, Kuehn H, Rak K, Mlynski R, Hagen R, Shehata-Dieler W. Usefulness of cochlear implantation in children with single sided deafness. Int J Pediatr Otorhinolaryngol 2020; 130:109808. [PMID: 31809969 DOI: 10.1016/j.ijporl.2019.109808] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Children with single sided deafness (SSD) show a poorer performance at school, which is attributable to reduced speech discrimination in noise, to reduced localization ability, and to a decreased power of concentration due to faster hearing exhaustion. Therefore, it is important to provide children with SSD with adequate hearing amplification to restore binaural hearing. This can only be achieved by provision with a cochlear implant (CI). But these treatment option in children with SSD is still under discussion. The aim of the present study is to evaluate audiological and clinical results in children with SSD following cochlear implantation. A special focus was placed on the duration of deafness before implantation and on the frequency of CI-use in everyday life. METHODS Seven children with SSD of different etiologies who were provided with a CI between 3 and 16 years of age were evaluated. Every child underwent multiple audiological tests before and after cochlear implantation. After cochlear implantation speech recognition tests in noise using the HSM (Hochmair, Schulz and Moser 1997) test and localization tests were performed. Furthermore, the frequency of implant use was evaluated. RESULTS Speech recognition in noise with CI compared to the unaided condition significantly improved in all children in different settings. Improvement of the localization ability measured by the root mean square error (RMSE) was shown in all children. All children are very satisfied with the decision to have undergone cochlear implantation and are all full-time users. CONCLUSIONS Cochlear implantation benefits speech recognition in noise and sound localization ability in children with SSD at different ages. All implanted children are full-time users regardless of age or duration of deafness before implantation.
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Affiliation(s)
- Désirée Ehrmann-Mueller
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany.
| | - Anja Kurz
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany
| | - Heike Kuehn
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany
| | - Kristen Rak
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, "Otto-Koerner", University of Rostock, Doberaner Strasse 137-139, 18057, Rostock, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany
| | - Wafaa Shehata-Dieler
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany
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Deep NL, Gordon SA, Shapiro WH, Waltzman SB, Roland JT, Friedmann DR. Cochlear Implantation in Children with Single-Sided Deafness. Laryngoscope 2020; 131:E271-E277. [PMID: 32065422 DOI: 10.1002/lary.28561] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/01/2020] [Accepted: 01/21/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe our experience with children undergoing unilateral cochlear implantation (CI) for treatment of single-sided deafness (SSD). STUDY DESIGN Retrospective case series. METHODS A retrospective case review from a tertiary referral center involving 14 pediatric patients (<18 years) with SSD who underwent unilateral CI. Speech perception testing in quiet and noise in the CI-only and bimodal conditions with at least 1 year of device use and device usage from data logs represent the main outcome measures. RESULTS The mean age at CI was 5.0 years (median 4.4, range 1.0-11.8 years). The mean duration of deafness was 3.0 years (median 2.4, range 0.6-7.0 years). Mean follow-up was 3.4 years. Speech perception testing with a minimum of 1 year post-CI was available in eight patients. The mean word recognition scores (WRS) in the CI-only condition was 56%; a significant improvement from baseline. Testing in background noise with spatially separated speech and noise revealed that patients scored as well or better with the CI-on versus CI-off in all conditions and in no cases was interference from the CI noted. Data logs were reviewed for device usage which revealed an average use of 6.5 hr/d. CONCLUSION Cochlear implantation is a viable treatment option for pediatric SSD in this self-selected cohort. Open-set speech and improvement in background noise can be achieved. Careful patient selection and thorough counseling on expectations is paramount to achieving successful outcomes. LEVEL OF EVIDENCE IV Laryngoscope, 131:E271-E277, 2021.
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Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - Steven A Gordon
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - William H Shapiro
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - Susan B Waltzman
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - J Thomas Roland
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - David R Friedmann
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
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Wedekind A, Rajan G, Van Dun B, Távora-Vieira D. Restoration of cortical symmetry and binaural function: Cortical auditory evoked responses in adult cochlear implant users with single sided deafness. PLoS One 2020; 15:e0227371. [PMID: 31935234 PMCID: PMC6959557 DOI: 10.1371/journal.pone.0227371] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background Cochlear implantation for single-sided deafness (SSD) is the only treatment option with the potential to restore binaural hearing cues. Significant binaural benefit has been measured in adults by speech in noise and localisation tests, who receive a cochlear implant for SSD, however, little is known on the cortical changes that help provide this benefit. In the present study, detection of sound in the auditory cortex, speech testing and localisation was used to investigate the ability of a cochlear implant (CI) to restore auditory cortical latencies and improve binaural benefit in the adult SSD population. Methods Twenty-nine adults with acquired single-sided deafness who received a CI in adulthood were studied. Speech perception in noise was tested using the Bamford-Kowal-Bench speech-in-noise test, localisation ability was measured using the auditory speech sounds evaluation (AδE) localisation test and cortical auditory evoked responses, comparing N1-P2 latencies recorded from the normal hearing ear and cochlear implant were used to investigate the synchrony of the cortical pathway from the CI and normal hearing ear (NHe) with binaural hearing function. Results There was a significant improvement in speech perception in noise in all spatial configurations S0/N0 (Z = -3.066, p<0.002), S0/NHE (Z = -4.031, p<0.001), SCI/NHE (Z = -3.851, p<0.001). Localization significantly improved when tested with the cochlear implant on (p<0.001) with a shorter duration of deafness correlating to a greater improvement in localisation ability F(1:18) = 6.854; p = 0.017). There was no significant difference in N1-P2 latency recorded from the normal hearing ear and the CI. Conclusion Cortical auditory evoked response latencies recorded from the CI and NHe showed no significant difference, indicating that the detection of sound in the auditory cortex occurred simultaneously, providing the cortex with auditory information for binaural hearing.
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Affiliation(s)
- Andre Wedekind
- Otolaryngology, Head and Neck Surgery, School of Surgery, University of Western Australia, Perth, Australia
- Fiona Stanley Hospital, Perth, Australia
- * E-mail:
| | - Gunesh Rajan
- Otolaryngology, Head and Neck Surgery, School of Surgery, University of Western Australia, Perth, Australia
- Department of Otolaryngology, Head & Neck Surgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Bram Van Dun
- The National Acoustic Laboratories, Sydney, Australia
| | - Dayse Távora-Vieira
- Otolaryngology, Head and Neck Surgery, School of Surgery, University of Western Australia, Perth, Australia
- Fiona Stanley Hospital, Perth, Australia
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Park SK, Lee SY, Kim DH, Lee MY, Oh SH. Auditory Cortical Plasticity and Reorganization in Rats With Single-Sided Deafness During Early Developmental Period. Ann Otol Rhinol Laryngol 2019; 128:16S-25S. [PMID: 31092025 DOI: 10.1177/0003489419837687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to examine the serial change of sound-specific auditory cortical activation patterns in age-matched normal hearing (NH) and young single-sided deafness (YSSD) rats to understand the critical period that influences a benefit of a binaural hearing. METHOD Experiments were performed on the age-matched 64 Sprague-Dawley rats; NH group = 45 rats, and YSSD group = 19 rats. NH rats were evaluated the multi-unit neural activities from the age of post-14 days (P14ds) to P73ds by week interval. For YSSD group, left-side cochlear ablations were done at the age of P10ds, and multineural recordings were implemented at the post-deafening (PD) 2 weeks (W), PD4W, PD6W, and PD8W, with age matching. After craniotomy, tungsten wire-based 16-channel microelectrode array was inserted to the surface of the auditory cortex. Gaussian white sound stimulation was introduced to the right ear every 500 ms, and analyses were performed of the Peri-stimulus time histogram. The parameters, including peak latency, peak amplitude, total responsive area, and index of contralaterality, were evaluated. RESULTS In NH group, larger peak amplitude and total responsive area and shorter peak latency of the contralateral hemisphere to sound stimulation were observed in all ages. Interestingly, YSSD group demonstrated that total reactive area in the contralateral side was significantly smaller than that in the ipsilateral side at PD2W and PD4W, indicating the disappearance of contralateral dominance within PD4W. Subsequently, monaural stimulation from the hearing ear exclusively activated the contralateral hemisphere at PD6W and PD8W. CONCLUSION Early onset of unilateral deafening leads to the alternation of contralateral dominance in the early period, replaced by faster and massive reorganization toward the ipsilateral cortex. But, gradual adaptation in the contralateral side was exclusively observed. Given the short critical period in the young SSD model, early intervention may be crucial for the development of binaural hearing if SSD occurs early in life.
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Affiliation(s)
- Su-Kyoung Park
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Kangnam Secred Heart Hospital, Seoul, Korea
| | - Sang-Yeon Lee
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hee Kim
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Young Lee
- 3 Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Seung-Ha Oh
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
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Cortical auditory evoked responses in cochlear implant users with early-onset single-sided deafness: indicators of the development of bilateral auditory pathways. Neuroreport 2019; 29:408-416. [PMID: 29489587 DOI: 10.1097/wnr.0000000000000984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cochlear implantation (CI) for early-onset single-sided deafness (SSD) provides a unique insight into the development and cortical reorganization of binaural pathways. This case series aimed to investigate the impact of duration of deafness on CI outcomes as measured by cortical evoked auditory potentials (CAEPs). Four adults with early-onset SSD were studied after CI. The adults had a duration of deafness of 22, 24, 42, and 38 years before implantation. CAEPs and speech perception in noise were used to investigate binaural cortical pathways and function. Our four patients lost their hearing at the ages of 3, 6, 5, and 6 (S1, S2, S3, and S4, respectively). CAEPs were present bilaterally in S2, S3, and S4. S1's, who had the least experience with a CI, cortical responses at 1 month after CI activation showed cortical responses from the CI ipsilateral pathway, but no responses from the CI contralateral pathway. At 3 and 6 months, S1 showed significant cortical responses from the CI contralateral pathway for two speech tokens. An improvement in speech perception in noise testing was observed in all four participants. This case series indicates that long duration of deafness for early-onset SSD is not a contraindication for CI and may not impact the long-term outcomes in this population. The electrical stimulation from the CI integrates with the normal-hearing ear to produce bilateral cortical projections and functional improvement in speech perception in noise. These early data provide surprisingly positive results and call for larger scale research to be carried out.
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Zeitler DM, Sladen DP, DeJong MD, Torres JH, Dorman MF, Carlson ML. Cochlear implantation for single-sided deafness in children and adolescents. Int J Pediatr Otorhinolaryngol 2019; 118:128-133. [PMID: 30623849 DOI: 10.1016/j.ijporl.2018.12.037] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/28/2018] [Accepted: 12/30/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate outcomes in pediatric and adolescent patients with single-sided deafness (SSD) undergoing cochlear implantation. METHODS A retrospective cohort design at two tertiary level academic cochlear implant centers. The subjects included nine children ages 1.5 to 15 years-old with single-sided deafness (SSD) who had undergone cochlear implantation in the affected ear. Objective outcome measures included were speech reception testing in quiet and noise, bimodal speech reception threshold testing in noise, tinnitus suppression, and device usage. RESULTS Nine pediatric and adolescent patients with SSD were implanted between 2011 and 2017. The median age at implantation was 8.9 years (range, 1.5-15.1) and the children had a median duration of deafness 2.9 years (range, 0.8-9.5). There was variability in testing measures due to patient age. Median pre-operative aided word recognition scores on the affected side were <30% regardless of the testing paradigm used. Six patients had pre-operative word testing (4 CNC, median score 25%; 2 MLNT, 8% and 17%). Four patients had pre-operative sentence testing (3 AzBio, median score 44%; 1 HINT-C, 57%). Median post-implantation follow-up interval was 12.3 months (range, 3-27.6 months). Six subjects had post-operative word recognition testing (CNC median, 70%; MLNT 50%, 92%) with a median improvement of 45.5% points. Five subjects had post-operative sentence testing (AzBio, median 82%; HINT, median 76%), with a median improvement of 40.5% points. Eight patients are full time users of their device. Tinnitus and bimodal speech reception thresholds in noise were improved. CONCLUSION Pediatric subjects with SSD benefit substantially from cochlear implantation. Objective speech outcome measures are improved in both quiet and noise, and bimodal speech reception thresholds in noise are greatly improved. There is a low rate of device non-use.
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Affiliation(s)
- Daniel M Zeitler
- Listen for Life Center, Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA, 98101, USA.
| | - Douglas P Sladen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Melissa D DeJong
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jennifer H Torres
- Denver Ear Associates, 401 W. Hampden Place #240, Englewood, CO, 80110, USA
| | - Michael F Dorman
- Department of Speech and Hearing Science, Arizona State University, PO Box 870102, Tempe, AZ, 85287, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Jakob TF, Illing RB, Rosskothen-Kuhl N. Monaural Neonatal Deafness Induces Inhibition among Bilateral Auditory Networks under Binaural Activation. Neuroscience 2019; 400:1-16. [DOI: 10.1016/j.neuroscience.2018.12.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 11/15/2022]
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van Wieringen A, Boudewyns A, Sangen A, Wouters J, Desloovere C. Unilateral congenital hearing loss in children: Challenges and potentials. Hear Res 2019; 372:29-41. [PMID: 29395617 DOI: 10.1016/j.heares.2018.01.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/17/2017] [Accepted: 01/21/2018] [Indexed: 11/16/2022]
Abstract
The estimated incidence of sensorineural hearing impairment (>40 dB HL) at birth is 1.86 per 1000 newborns in developed countries and 30-40% of these are unilateral. Profound sensorineural unilateral hearing impairment or single sided deafness (SSD) can be treated with a cochlear implant. However, this treatment is costly and invasive and unnecessary in the eyes of many. Very young children with SSD often do not exhibit language and cognitive delays and it is hard to imagine that neurocognitive skills will present difficulties with one good ear. In the current paper we review the most recent evidence on the consequences of unilateral hearing impairment for auditory and neurocognitive factors. While data of both adults and children are discussed, we focus on developmental factors, congenital deafness and a window of opportunity for intervention. We discuss which etiologies qualify for a cochlear implant and present our multi-center prospective study on cochlear implants in infants with one deaf ear. The large, state-of-the art body of research allows for evidence-based decisions regarding management of unilateral hearing loss in children.
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Affiliation(s)
- Astrid van Wieringen
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental ORL, Herestraat 49, 3000 Leuven, Belgium.
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Anouk Sangen
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental ORL, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Wouters
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental ORL, Herestraat 49, 3000 Leuven, Belgium
| | - Christian Desloovere
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental ORL, Herestraat 49, 3000 Leuven, Belgium; University Hospital Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
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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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Simon F, Hempel JM. [Extended applications for cochlear implantation]. MMW Fortschr Med 2018; 160:51-53. [PMID: 29721870 DOI: 10.1007/s15006-018-0485-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Florian Simon
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland.
| | - John-Martin Hempel
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland
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Cochlear Implantation in Children With Congenital Unilateral Deafness: A Case Series. Otol Neurotol 2017; 38:e570-e576. [DOI: 10.1097/mao.0000000000001597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Functional Result After Cochlear Implantation in Children and Adults With Single-sided Deafness. Otol Neurotol 2017; 37:e332-40. [PMID: 27631656 DOI: 10.1097/mao.0000000000000971] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with single-sided deafness (SSD) suffer from reduced binaural hearing (i.e., sound localization and speech in noise discrimination). Cochlear implantation has recently been introduced for patients with SSD, as an alternative to hearing devices that employ contralateral routing of the signal. Application to children has also been started. METHODS We retrospectively analyze a case series of 4 children and 17 adults with SSD, treated with cochlear implantation. The outcome of adult patients was compared with a control group of 27 patients with bilateral profound hearing loss using a cochlear implant. RESULTS During 12 months, the mean speech recognition score increased from 30 to 41% for monosyllabic words in adults, and from 58 to 89% for multisyllabic numbers. The cochlear implant (CI) improved hearing in noise in all SSD patients, as was demonstrated by a significant improvement of the speech reception threshold in different speech and noise configurations. Sound localization-correlated angle detection error improved with CI use at every time point. The maximum word recognition score for monosyllabic words in quiet correlated with the logarithm of the duration of deafness; improvement of the speech reception threshold and RMS angle detection error by the CI did not. CONCLUSION All SSD patients benefitted from the CI in different hearing situations. Patients with SSD for a long period can improve after cochlear implantation.
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Cañete OM, Purdy SC, Neeff M, Brown CRS, Thorne PR. Cortical auditory evoked potential (CAEP) and behavioural measures of auditory function in a child with a single-sided deafness. Cochlear Implants Int 2017; 18:335-346. [DOI: 10.1080/14670100.2017.1373499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Oscar M. Cañete
- Speech Science, School of Psychology, The University of Auckland, New Zealand
- Eisdell Moore Centre for Research in Hearing and Balance, Auckland, New Zealand
| | - Suzanne C. Purdy
- Speech Science, School of Psychology, The University of Auckland, New Zealand
- Eisdell Moore Centre for Research in Hearing and Balance, Auckland, New Zealand
| | - Michel Neeff
- Starship Children’s Hospital, Auckland, New Zealand
| | | | - Peter R. Thorne
- Section of Audiology, The University of Auckland, New Zealand
- Eisdell Moore Centre for Research in Hearing and Balance, Auckland, New Zealand
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Greaver L, Eskridge H, Teagle HFB. Considerations for Pediatric Cochlear Implant Recipients With Unilateral or Asymmetric Hearing Loss: Assessment, Device Fitting, and Habilitation. Am J Audiol 2017; 26:91-98. [PMID: 28291986 DOI: 10.1044/2016_aja-16-0051] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/16/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this clinical report is to present case studies of children who are nontraditional candidates for cochlear implantation because they have significant residual hearing in 1 ear and to describe outcomes and considerations for their audiological management and habilitation. METHOD Case information is presented for 5 children with profound hearing loss in 1 ear and normal or mild-to-moderate hearing loss in the opposite ear and who have undergone unilateral cochlear implantation. Pre- and postoperative assessments were performed per typical clinic routines with modifications described. Postimplant habilitation was customized for each recipient using a combination of traditional methods, newer technologies, and commercial materials. RESULTS The 5 children included in this report are consistent users of their cochlear implants and demonstrate speech recognition in the implanted ear when isolated from the better hearing ear. CONCLUSIONS Candidacy criteria for cochlear implantation are evolving. Children with single-sided deafness or asymmetric hearing loss who have traditionally not been considered candidates for cochlear implantation should be evaluated on a case-by-case basis. Audiological management of these recipients is not vastly different compared with children who are traditional cochlear implant recipients. Assessment and habilitation techniques must be modified to isolate the implanted ear to obtain accurate results and to provide meaningful therapeutic intervention.
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Sangen A, Royackers L, Desloovere C, Wouters J, van Wieringen A. Single-sided deafness affects language and auditory development - a case-control study. Clin Otolaryngol 2017; 42:979-987. [DOI: 10.1111/coa.12826] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
Affiliation(s)
- A. Sangen
- Department of Neurosciences; Research Group Experimental Oto-rhino-laryngology (ExpORL), KU Leuven; University of Leuven; Leuven Belgium
| | - L. Royackers
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
| | - C. Desloovere
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
| | - J. Wouters
- Department of Neurosciences; Research Group Experimental Oto-rhino-laryngology (ExpORL), KU Leuven; University of Leuven; Leuven Belgium
| | - A. van Wieringen
- Department of Neurosciences; Research Group Experimental Oto-rhino-laryngology (ExpORL), KU Leuven; University of Leuven; Leuven Belgium
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Távora-Vieira D, Rajan G. Cochlear implantation in children with congenital unilateral deafness: Mid-term follow-up outcomes. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133 Suppl 1:S12-4. [DOI: 10.1016/j.anorl.2016.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/01/2016] [Accepted: 04/28/2016] [Indexed: 11/26/2022]
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Peters JPM, Ramakers GGJ, Smit AL, Grolman W. Cochlear implantation in children with unilateral hearing loss: A systematic review. Laryngoscope 2015; 126:713-21. [PMID: 26343240 DOI: 10.1002/lary.25568] [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] [Accepted: 07/20/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To systematically review the literature on cochlear implantation (CI) for children with unilateral hearing loss (UHL). DATA SOURCES PubMed, Cochrane, CINAHL, and Embase databases were searched for articles up to June 29, 2015 for UHL, children and CI, and all of their synonyms. METHODS After screening of titles, abstracts, and full texts for eligible articles, directness of evidence (DoE) and risk of bias (RoB) were assessed for the included articles. Study characteristics and data on our outcomes of interest (speech perception in noise, sound localization, quality of life, and speech and language development) were extracted. RESULTS In total, 296 unique articles were retrieved, of which five articles satisfied the eligibility criteria. All of these articles were case series or case reports and had a low to moderate DoE and a high RoB. In these studies, heterogeneous findings were reported in small patient samples. Speech perception in noise and localization ability improved in most patients. Although only measured in one study each, quality of life and speech and language development improved. Most of these results were not statistically significant. CONCLUSIONS No firm conclusions can be drawn on the effectiveness of CI in children with UHL, due to heterogeneous findings, small sample sizes, and the lack of high Level of Evidence studies. Based on the findings of this systematic review, cochlear implantation may be an effective treatment option in children with UHL. Laryngoscope, 126:713-721, 2016.
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Affiliation(s)
- Jeroen P M Peters
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geerte G J Ramakers
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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Cabral Junior F, Pinna MH, Alves RD, Malerbi AFDS, Bento RF. Cochlear Implantation and Single-sided Deafness: A Systematic Review of the Literature. Int Arch Otorhinolaryngol 2015; 20:69-75. [PMID: 26722349 PMCID: PMC4687988 DOI: 10.1055/s-0035-1559586] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/02/2015] [Indexed: 11/08/2022] Open
Abstract
Introduction Current data show that binaural hearing is superior to unilateral hearing, specifically in the understanding of speech in noisy environments. Furthermore, unilateral hearing reduce onés ability to localize sound. Objectives This study provides a systematic review of recent studies to evaluate the outcomes of cochlear implantation in patients with single-sided deafness (SSD) with regards to speech discrimination, sound localization and tinnitus suppression. Data Synthesis We performed a search in the PubMed, Cochrane Library and Lilacs databases to assess studies related to cochlear implantation in patients with unilateral deafness. After critical appraisal, eleven studies were selected for data extraction and analysis of demographic, study design and outcome data. Conclusion Although some studies have shown encouraging results on cochlear implantation and SSD, all fail to provide a high level of evidence. Larger studies are necessary to define the tangible benefits of cochlear implantation in patients with SSD.
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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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