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Song B, Hwang K, Koh SM, Moon IJ, Cho YS. Clinical Portrait of Cochlear Implantation in Patients With CHARGE Syndrome. Otolaryngol Head Neck Surg 2024; 171:560-570. [PMID: 38738912 DOI: 10.1002/ohn.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To examine the clinical characteristics and auditory performance of patients with CHARGE syndrome following cochlear implantation (CI), as well as the prognostic factors affecting auditory outcomes. STUDY DESIGN Retrospective cohort. SETTING Tertiary academic center. METHODS A retrospective chart review was performed in patients with CHARGE syndrome who underwent CI from 2007 to 2022. The category of auditory performance (CAP) score was used to assess the CI outcomes, and factors that may affect the speech outcomes were also evaluated. RESULTS In 14 children with CHARGE syndrome, 22 CIs were performed, 6 unilaterally and 8 bilaterally. The mean age at CI was 25.9 months (range: 10-62). All patients had ear abnormalities and developmental delays, and cochlear nerve deficiency (CND) was present in all ears. At the last follow-up (mean: 49.6 months), the mean CAP score improved significantly compared to the preoperative measure (from 0.36 ± 0.81 to 3.21 ± 1.70, P = .001), with 6 patients (42.9%) achieving a CAP score of 4 points or higher. However, between the unilateral and bilateral CI groups, the final CAP score or change in CAP score was similar. Factors including age, coloboma, and CND did not significantly affect speech outcomes (all P > .05). CONCLUSION Even though CHARGE syndrome features challenging anomalies, CI can be conducted safely and can offer effective contribution to significant speech improvement. Patients with CHARGE syndrome should be given the opportunity to undergo CI to maximize their audiological progress.
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Affiliation(s)
- Bokhyun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyuhyeon Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Min Koh
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il Joon Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Caragli V, Monzani D, Genovese E, Palma S, Persico AM. Cochlear Implantation in Children with Additional Disabilities: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1653. [PMID: 37892316 PMCID: PMC10605071 DOI: 10.3390/children10101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
This study examines the last 10 years of medical literature on the benefits of cochlear implantation in children who are deaf or hard of hearing (DHH) with additional disabilities. The most recent literature concerning cochlear implants (CIs) in DHH children with additional disabilities was systematically explored through PubMed, Embase, Scopus, PsycINFO, and Web of Science from January 2012 to July 2023. Our two-stage search strategy selected a total of 61 articles concerning CI implantation in children with several forms of additional disabilities: autism spectrum disorder, cerebral palsy, visual impairment, motor disorders, developmental delay, genetic syndromes, and intellectual disability. Overall, many children with additional disabilities benefit from CIs by acquiring greater environmental sound awareness. This, in turn, improves non-verbal communication and adaptive skills, with greater possibilities to relate to others and to be connected with the environment. Instead, despite some improvement, expressive language tends to develop more slowly and to a lesser extent compared to children affected by hearing loss only. Further studies are needed to better appreciate the specificities of each single disability and to personalize interventions, not restricting the analysis to auditory and language skills, but rather applying or developing cross-culturally validated instruments able to reliably assess the developmental trajectory and the quality of life of DHH children with additional disabilities before and after CI.
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Affiliation(s)
- Valeria Caragli
- Otorhinolaryngology-Head and Neck Surgery, Audiology Program, Department of Diagnostic Clinical and Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Daniele Monzani
- Department of Surgery Dentistry Paediatrics and Gynaecology, University of Verona, 37100 Verona, Italy;
| | - Elisabetta Genovese
- Audiology Program, Department of Diagnostic Clinical and Public Health, University of Modena and Reggio Emilia, 41100 Modena, Italy;
| | - Silvia Palma
- Audiology, Primary Care Department, AUSL Modena, 41100 Modena, Italy;
| | - Antonio M. Persico
- Child and Adolescent Neuropsychiatry Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, 41125 Modena, Italy
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Cochlear Implant Outcomes in CHARGE Syndrome: Updated Perspectives. Otol Neurotol 2022; 43:632-637. [PMID: 35261375 DOI: 10.1097/mao.0000000000003533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate outcomes of auditory implants in children with CHARGE syndrome and describe the evolution in management of hearing loss in this complex population. METHODS A retrospective case review was performed at a tertiary referral center. Children with CHARGE syndrome who received either a cochlear implant (CI) or auditory brainstem implant (ABI) were included. Clinical records, demographic information, CHARGE features, neuroimaging, audiology, hearing rehabilitation interventions, operative notes, and outcomes were reviewed. RESULTS Thirteen children with CHARGE syndrome underwent a total of 19 cochlear implants between 2008 and 2020. Among the congenitally deafened children (n = 9), six underwent bilateral implantation (five simultaneous and one sequential). Bilateral implantation was performed even in the presence of diminutive-appearing cochlear nerves. The average age of implantation was 1.1 years, and the mean device use time was 9.4 hours per day. Patients showed improvements in subjective family assessment related to hearing. In this group, two patients use oral communication, five use total communication, and two use sign language exclusively. Among the children with progressive hearing loss, the mean age of hearing deterioration was 4.4 years of age, and the device use time on average was 9.8 hours per day. The highest performer in the cohort was a child who lost hearing in their only hearing ear at age 4 and had normal cochleovestibular anatomy on that side. One child received an auditory brainstem implant at age two after deriving no benefit from a CI and can detect environmental sounds but is currently a nonuser. Over time, we noted that implantation occurred earlier in life and that practice has shifted toward bilateral implantation. CONCLUSIONS Compared to a previous institutional cohort, children evaluated in this study were often implanted at a younger age and bilaterally with significantly improved outcomes. A CI evaluation should be considered in children with CHARGE syndrome to maximize sensory input and auditory ability.
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Jenks CM, Hoff SR, Haney J, Tournis E, Thomas D, Young NM. Cochlear Implantation Can Improve Auditory Skills, Language and Social Engagement of Children With Autism Spectrum Disorder. Otol Neurotol 2022; 43:313-319. [PMID: 34935761 PMCID: PMC8843363 DOI: 10.1097/mao.0000000000003463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review outcomes of cochlear implantation (CI) in children diagnosed with autism spectrum disorder (ASD). STUDY DESIGN Retrospective case review and parent survey. SETTING Tertiary care children's hospital. PATIENTS Thirty children with ASD who underwent CI between 1991 and 2018. Mean age at CI = 3.5 years (0.8-11.8), mean age at diagnosis of ASD = 5.1 years (2.0-15.0) (22/30 diagnosed after CI), mean follow-up = 10.5 years (1.4-21.6). Parents of 7 children returned a survey. INTERVENTION Unilateral or bilateral cochlear implantation. MAIN OUTCOME MEASURES Speech perception; expressive communication mode; educational placement; social engagement; consistency of CI use; parent survey of child behavior change. RESULTS Thirty-three percent of all and 45% of the 22 consistent device users developed measurable open-set speech perception by an average of 4.5 years of device use. Educational placement at last follow-up included 13% mainstreamed without interpreter, 50% Special Education programs, 10% therapeutic residential or day programs, 23% total communication programs, and one home schooled. Spoken language alone was used by 31% and spoken plus sign by 14%, with the remainder using sign alone, augmentative communication devices or no mode of communication. By parent report, 86% showed improvement in social engagement compared to pre-CI. Survey results showed the behaviors most frequently ranked as most affected by CI were communication and attention, while awareness of environment had the lowest (most affected) mean ranking. CONCLUSIONS Findings support a growing body of literature that cochlear implantation has the potential to improve auditory skills, language, and enhance social engagement in some deaf children with autism spectrum disorder.
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Affiliation(s)
- Carolyn M. Jenks
- Department Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine, Northwestern University Feinberg School of Medicine
- Division of Otolaryngology – Head and Neck Surgery, Section of Otology and Ann & Robert H Lurie Children's Hospital of Chicago
| | - Stephen R. Hoff
- Department Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine, Northwestern University Feinberg School of Medicine
- Division of Otolaryngology – Head and Neck Surgery, Section of Otology and Ann & Robert H Lurie Children's Hospital of Chicago
| | - Jennifer Haney
- Department of Children's Services, Ann & Robert H Lurie Children's Hospital of Chicago
| | - Elizabeth Tournis
- Department of Audiology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Denise Thomas
- Department of Audiology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nancy M. Young
- Department Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine, Northwestern University Feinberg School of Medicine
- Division of Otolaryngology – Head and Neck Surgery, Section of Otology and Ann & Robert H Lurie Children's Hospital of Chicago
- Knowles Hearing Center, Northwestern University School of Communication, Evanston, Illinois
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Relationships Between Daily Device Use and Early Communication Outcomes in Young Children With Cochlear Implants. Ear Hear 2021; 42:1042-1053. [PMID: 33974791 DOI: 10.1097/aud.0000000000000999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Children with significant hearing loss can gain access to sound via a cochlear implant (CI), but they must wear the device to reap the communication benefits of the device. That is, poor daily device use may result in underdeveloped perceptual and language skills in children and adolescents using CIs. This retrospective study focuses on the relationship between daily CI use and communication performance (auditory skills, speech recognition, expressive and receptive language) in young children, with the hypothesis that greater daily device use coincides with better communication outcomes. DESIGN The authors conducted a clinical chart review of patients with CIs younger than 5 years old who used at least 1 CI speech processor with datalogging technology. Participants (n = 65) had a mean chronologic age of 3.5 years, mean implantation age of 1.9 years, and mean device experience of 1.6 years. Approximately one quarter of participants had additional disabilities. Daily device use (i.e., datalogging information), child characteristics (e.g., age at CI), and assessments of communication skills (i.e., parent questionnaires, speech recognition tests, standardized language assessments) were obtained from each child's records. The investigators performed correlational analyses to examine relationships between communication outcomes and daily device use, and they employed group comparisons and correlations to identify child characteristics that were significantly associated with daily device use (p < 0.05, corrections for family-wise error). RESULTS Young children with CIs used their device, on average, 6.7 hr/d, with 63% below full-time use (<8 hr/d). Children without additional disabilities who wore their CI more hours per day had significantly better auditory, speech recognition, and language skills. A significant correlation also emerged between daily device use and early auditory skills in young CI users with additional disabilities, though relationships were more complicated for this subsample. Longer daily device use significantly correlated with younger age at CI and longer device experience. Differences in device use occurred in regards to absence versus presence of additional disabilities, bilateral versus unilateral device configuration, sign versus spoken language, and private versus government-assisted insurance. CONCLUSIONS The strong relationship between daily device use and early communication suggests clinicians and parents should focus on increasing the number of hours per day young children wear their CIs to enhance auditory and language outcomes. However, intervention strategies must consider barriers to consistent device use and goals of the family to efficiently and effectively support families of young children with CIs who struggle with inconsistent device use.
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Chen JX, Nourmahnad A, O'Malley J, Reinshagen K, Nadol JB, Quesnel AM. Otopathology in CHARGE syndrome. Laryngoscope Investig Otolaryngol 2020; 5:157-162. [PMID: 32128443 PMCID: PMC7042646 DOI: 10.1002/lio2.347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 11/18/2022] Open
Abstract
Postmortem temporal bone computed tomography (CT) and histopathologic findings in an infant with CHARGE syndrome revealed bilateral cochleovestibular hypoplasia, including cochlear pathology relevant to cochlear implant candidacy. Both ears had absence of the superior semicircular canals (SCCs), severely hypoplastic posterior SCCs, and hypoplastic (right ear) or absent (left ear) lateral SCCs seen on CT and histopathology. Histopathology further revealed the absence of all SCC ampullae except the right lateral SCC ampulla and atrophic vestibular neuroepithelium in the saccule and utricle bilaterally. The right cochlea consisted of a basal turn with patent round window, and malformed middle turn (type IV cochlear hypoplasia), with a small internal auditory canal (IAC) but near normal cochlear nerve aperture (fossette). Quantification of spiral ganglion neurons (SGNs) on histologic sections revealed a reduced SGN population (35% of normal for age), but this ear would still have likely achieved benefit from a cochlear implant based on this population. The left cochlea consisted of only a basal turn with patent round window (type III cochlear hypoplasia) with a small IAC and very small cochlear nerve aperture. Notably, histology revealed that there were no SGNs in the cochlea, and therefore, this ear would not have been a good candidate for cochlear implantation. Level of evidence: IV.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology Harvard Medical School Boston Massachusetts
| | - Anahita Nourmahnad
- Department of Otolaryngology Harvard Medical School Boston Massachusetts
| | - Jennifer O'Malley
- Department of Otolaryngology Harvard Medical School Boston Massachusetts
| | | | - Joseph B Nadol
- Department of Otolaryngology Harvard Medical School Boston Massachusetts
- Otopathology Laboratory Massachusetts Eye and Ear Boston Massachusetts
| | - Alicia M Quesnel
- Department of Otolaryngology Harvard Medical School Boston Massachusetts
- Otopathology Laboratory Massachusetts Eye and Ear Boston Massachusetts
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Aragón-Ramos P, Pedrero-Escalas MF, Gavilán J, Pérez-Mora R, Herrán-Martin B, Lassaletta L. Auditory Skills following Cochlear Implantation in Children with the Charge Syndrome. Audiol Neurootol 2019; 24:139-146. [PMID: 31291620 DOI: 10.1159/000500659] [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] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the auditory outcomes and skills of pediatric cochlear implant (CI) users with the CHARGE syndrome. To determine the influence of inner ear malformations on the surgical procedure and speech understanding outcomes in this population. STUDY DESIGN Observational, retrospective study. MATERIALS AND METHODS Imaging, auditory testing, intraoperative findings, complications, and postoperative auditory skills and outcomes of pediatric CI users with CHARGE syndrome were recorded. RESULTS 6 children (8 ears) were included, 5 of whom had prelingual deafness. Their mean age at implantation was 37 months. Six of the 8 ears presented cochlear malformation; the most frequent was hypoplasia type III. Intraoperatively, the transmastoid facial recess approach was used in 5 ears, and abnormalities of facial nerve anatomy were found in 5 ears. All electrode insertions were complete. All children were, to a varying degree, able to detect and identify sound. Verbalization skills were developed by 2 children, 1 of whom used oral language as his primary mode of communication. CONCLUSIONS Cochlear implantation performed by an experienced surgeon in patients with the CHARGE syndrome is a safe procedure with adequate treatment planning. All children had improved auditory skills although the improvement was variable.
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Affiliation(s)
- Paula Aragón-Ramos
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain,
| | | | - Javier Gavilán
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
| | - Rosa Pérez-Mora
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
| | - Belén Herrán-Martin
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
| | - Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
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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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Bilateral duplication of the internal auditory canals and bilateral cochlear implant outcomes and review. Int J Pediatr Otorhinolaryngol 2019; 119:41-46. [PMID: 30665175 DOI: 10.1016/j.ijporl.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Bilateral duplication of the internal auditory canal (IAC) is rare and is associated with profound sensorineural hearing loss. The present study aims to review our experience with bilateral cochlear implantation (CI) in children with a duplication of the IAC and to review the literature. METHODS The Sydney Cochlear Implant Centre database was searched for children with duplication of the internal auditory canal. Data was collected regarding clinical history, MRI and CT findings, auditory brainstem responses (ABR), tympanometry and otoacoustic emissions (OAE), visually reinforced orientation audiometry, auditory brainstem response, electrocochleography (ECochG), transtympanic electrical auditory brainstem response (ABR), aided cortical evoked potentials (CAEP) and intraoperative neural response telemetry (NRT) and CI evoked electrical auditory brainstem testing. RESULTS two children with bilateral duplication of the IAC were identified who successfully underwent bilateral cochlear implantation. Audiological development was monitored for 2 and 3 years respectively, both children could spontaneously verbalise and displayed Categories of Auditory Performance (CAP) score of 5 and 6 respectively. CONCLUSION Children with duplication of the IAC, with accompanying cochlear nerve dysplasia (CND) can benefit from CI surgery, and verbal receptive and expressive language is possible.
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Jethanamest D, Choudhury B. Special Populations in Implantable Auditory Devices. Otolaryngol Clin North Am 2019; 52:341-347. [DOI: 10.1016/j.otc.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Yao W, Zhong J, Duan M. Three-dimensional finite-element analysis of the cochlear hypoplasia. Acta Otolaryngol 2018; 138:961-965. [PMID: 30758241 DOI: 10.1080/00016489.2018.1497304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Based on CT scan images of healthy human ear, the effects of cochlear hypoplasia on auditory functions was studied. METHODS Three-dimensional nonlinear finite-element numerical model was developed and used to predict frequency responses of hypoplastic cochleae. The numerical model was validated by comparing the modeling results to reported experimental data. RESULTS The cochlear hypoplasia compromises sound conduction of middle ear and results in significant decrease of vibration displacement amplitude of stapes foot-plate at frequencies 100 ∼ 1200 Hz with a maximal decrease of 9.1 dB at ∼1000 Hz. Consequently, the displacement ratio of basement membrane vibration at the longitudinal location ∼12 mm from the apex to the stapes vibration decreases at 100 ∼ 4000 Hz with the biggest decrease of 15.2 dB at ∼ 4000 Hz. CONCLUSIONS Numerical modeling was used to demonstrate the effect of cochlear hypoplasia on sound conduction and cochlear sensitivity. Cochlear hypoplysia causes changes in biomechanics of middle ear and inner ear, which lead to hearing loss. The current modeling results suggest that the frequency-dependent decrease of the stapes vibration can be used in clinics for diagnosing cochlear hypoplasia. This is particularly important because the middle ear function measurement can be used to diagnose unmeasurable inner ear disorders.
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Affiliation(s)
- Wenjuan Yao
- Shanghai Institute of Applied Mathematics and Mechanics, Shanghai University, Shanghai, China
| | - Jicheng Zhong
- Department of Civil Engineering, Shanghai University, Shanghai, China
| | - Maoli Duan
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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