Cochlear implantation: a review of current clinical practice

Parental Competence as a Teacher in the Auditory Development of Children with Cochlear Implants

The number of children with partial or total hearing loss is increasing every day, and most of them are undergoing cochlear implant surgery. The paper aims to assess the teaching competence of parents of children with cochlear implants. The study took one year (2022) in 1 [Almaty, Kazakhstan] kindergarten and 1 specialized school. Twenty-four parents of children (mean age 3.5 ± 0.5 years) and 20 parents of children of primary school age (10.0 ± 0.5 years) who underwent surgery at the age of 1-2 and 6-9 years were included in the study. A minimal number of parents had a high level of competence; sufficient competence was noticed among the two times larger number of parents; however, most of the parents had insufficient competence. The indicators of children were as follows: 3 children had a high level of listening perception; twice as many of them had a sufficient level; the same number had an insufficient level. There were more children with a low level, 3 times more than with a high level. A high level of pedagogical competence of parents correlated with a high level of children's auditory verbal abilities (on the scale of auditory ability integration). There was also a direct relationship with the level of speech development (on the scale of speech use) for children who had the surgery a year earlier. The obtained data can apply to the educational process for children with cochlear implants to improve their auditory and speech skills as quickly as possible. The involvement of parents in the education and rehabilitation of children with cochlear implants is crucial for the successful adaptation and development of the child. Parents can become irreplaceable partners of specialists and educational institutions, providing their children with optimal support and assistance on their way to the development of auditory and communication skills. To enhance parental competence in the area of auditory development of children with cochlear implants, it is recommended to participate in specialized educational programs designed for parents, offered by professionals and organizations. Additionally, actively engaging with educational resources, online materials, and informational communities is beneficial for acquiring up-to-date knowledge and receiving support from other parents, specialists, and experts.

Insertion Guidance Based on Impedance Measurements of a Cochlear Electrode Array

The cochlear implantable neuromodulator provides substantial auditory perception to those with severe or profound impaired hearing. Correct electrode array positioning in the cochlea is one of the important factors for quality hearing, and misplacement may lead to additional injury to the cochlea. Visual inspection of the progress of electrode insertion is limited and mainly relies on the surgeon's tactile skills, and there is a need to detect in real-time the electrode array position in the cochlea during insertion. The available clinical measurement presently provides very limited information. Impedance measurement may be used to assist with the insertion of the electrode array. Using computational modeling of the cochlea, and its local tissue layers merging with the associated neuromodulator electrode array parameters, the impedance variations at different insertion depths and the proximities to the cochlea walls have been analyzed. In this study, an anatomical computational model of the temporal region of a patient is used to derive the relationship between impedance variations and the electrode proximity to the cochlea wall and electrode insertion depth. The aim was to examine whether the use of electrode impedance variations can be an effective marker of electrode proximity and electrode insertion depth. The proposed anatomical model simulates the quasi-static electrode impedance variations at different selected points but at considerable computation cost. A much less computationally intensive geometric model (~1/30) provided comparative impedance measurements with differences of <2%. Both use finite element analysis over the entire cross-section area of the scala tympani. It is shown that the magnitude of the impedance varies with both electrode insertion depth and electrode proximity to the adjacent anatomical layers (e.g., cochlea wall). In particular, there is a 1,400% increase when the electrode array is moved very close to the cochlea wall. This may help the surgeon to find the optimal electrode position within the scala tympani by observation of such impedance characteristics. The misplacement of the electrode array within the scala tympani may be eliminated by using the impedance variation metric during electrode array insertion if the results are validated with an experimental study.

Intrinsic properties of primary hippocampal neurons contribute to PIP2 depletion during nsEP-induced physiological response

High-energy, short-duration electric pulses (EPs) are known to be effective in neuromodulation, but the biological mechanisms underlying this effect remain unclear. Recently, we discovered that nanosecond electric pulses (nsEPs) could initiate the phosphatidylinositol_4,5-bisphosphate (PIP₂) depletion in non-excitable cells identical to agonist-induced activation of the G_q11 coupled receptors. PIP₂ is the precursor for multiple intracellular second messengers critically involved in the regulation of intracellular Ca²⁺ homeostasis and plasma membrane (PM) ion channels responsible for the control of neuronal excitability. In this paper we demonstrate a novel finding that five day in vitro (DIV5) primary hippocampal neurons (PHNs) undergo significantly higher PIP₂ depletion after 7.5 kV/cm 600 ns EP exposure than DIV1 PHNs and day 1-5 (D1-D5) non-excitable Chinese hamster ovarian cells with muscarinic receptor 1 (CHO-hM₁). Despite the age of development, the stronger 15 kV/cm 600 ns or longer 7.5 kV/cm 12 µs EP initiated profound PIP₂ depletion in all cells studied, outlining damage of the cellular PM and electroporation. Therefore, the intrinsic properties of PHNs in concert with nanoporation explain the stronger neuronal response to nsEP at lower intensity exposures. PIP₂ reduction in neurons could be a primary biological mechanism responsible for the stimulation or inhibition of neuronal tissues.

Social competence in children with cochlear implants: is it possible to catch up with their peers?

PURPOSE

The objective of this study is to compare social competence skills in children with CI and their normal hearing peers.

METHODS

Forty-six children with normal hearing and 46 children with CI between the ages of 42 and 72 months were included in the control group and study group, respectively. Preschool teachers rated children's social competence in the classroom using the Social Competence and Behavior Evaluation-Preschool Edition. Three subscales constitute the structure of the SCBE-30 scale: anger-aggression, social competence, and anxiety-withdrawal.

RESULTS

The analyses showed that there were statistically significant differences between social competence scores of the study group and the control group. However, there was no statistically significant difference between anger-aggression scores and anxiety-withdrawal scores of the study group and the control group. There was a significant correlation found between anger-aggression score and the age of starting rehabilitation.

CONCLUSION

Anger-aggression scores and anxiety-withdrawal scores were similar between children using cochlear implant and normal hearing peers, whereas children with CI show lower social competence abilities than normal hearing peers. Earlier beginning to the rehabilitation programs coincide with lower anger-aggression scores. To the best of our knowledge, this is the first study to reflect these findings more objectively, from the view of teachers.