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Meng C, Guo Q, Kong Y, Lyu J, Chen X. A Long-Term Follow-Up Study on the Auditory Performance and Speech Intelligibility of Mandarin-Speaking Prelingually Deaf Children With Isolated Large Vestibular Aqueduct Syndrome After Cochlear Implantation. Am J Audiol 2024:1-8. [PMID: 38306503 DOI: 10.1044/2023_aja-23-00145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate the auditory performance and speech perception of 104 children with isolated large vestibular aqueduct syndrome (LVAS) and 523 children with no inner ear malformation (IEM) for 5 years after cochlear implantation, in order to explore whether isolated LVAS can affect the long-term hearing and speech rehabilitation of deaf children after cochlear implantation. METHOD A cohort study was established consisting of 627 children who underwent cochlear implantation at Beijing Tongren Hospital from 1999 to 2016. The children were examined at 0, 6, 12, 24, 36, 48, and 60 months after cochlear implantation to assess their auditory performance and speech perception using the Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) questionnaires. RESULTS The CAP scores of the isolated LVAS group increased significantly during the baseline to the 24th month, after which they gradually rose until reaching the plateau during the 24th to the 60th month. The CAP scores of the non-IEM group increased significantly during the baseline to the 36th month and then increased steadily. The SIR scores went up significantly during the baseline to the 48th month, and increased in a gradual manner in other stages of isolated LVAS evaluation. In comparison, The SIR scores of non-IEM group grew remarkably from the baseline to the 60th month. There were no significant differences in the CAP or SIR scores between isolated LVAS and non-IEM groups in each stage of evaluation, with the only exception being the CAP score at baseline month after cochlear implantation. CONCLUSIONS The CAP and SIR questionnaires are helpful tools for quantifying the early hearing and speech skills of younger prelingually deafened cochlear implant recipients. This long-term follow-up study shows that the speech and hearing development of children in isolated LVAS and non-IEM groups follow similar patterns, and isolated LVAS does not affect the long-term rehabilitation of deaf children after cochlear implantation.
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Affiliation(s)
- Chao Meng
- Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology, Head and Neck Surgery (Capital Medical University), Ministry of Education, China
| | - Qianqian Guo
- Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology, Head and Neck Surgery (Capital Medical University), Ministry of Education, China
| | - Ying Kong
- Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology, Head and Neck Surgery (Capital Medical University), Ministry of Education, China
| | - Jing Lyu
- Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology, Head and Neck Surgery (Capital Medical University), Ministry of Education, China
| | - Xueqing Chen
- Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology, Head and Neck Surgery (Capital Medical University), Ministry of Education, China
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Alahmadi A, Abdelsamad Y, Salamah M, Alenzi S, Badr KM, Alghamdi S, Alsanosi A. Cochlear implantation in adults and pediatrics with enlarged vestibular aqueduct: a systematic review on the surgical findings and patients' performance. Eur Arch Otorhinolaryngol 2022; 279:5497-5509. [PMID: 35771280 DOI: 10.1007/s00405-022-07511-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/13/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Cochlear implantation (CI) has been considered a safe and effective management option for patients with severe to profound hearing loss. Patients with enlarged vestibular aqueduct (EVA) could be challenging with some variations in surgical approaches, intraoperative surgical notes, and clinical outcomes. This study aimed to review the surgical and clinical outcomes of cochlear implantation among patients with EVA. MATERIALS AND METHODS A systematic literature search was carried out in five major databases. All original studies reporting cochlear implantation in patients with EVA were included for qualitative data synthesis. The risk of bias was independently assessed through the National Intuitional of Health tool. The review protocol was registered in PROSPERO (reference number: CRD42021225900). RESULTS A total of 34 studies with 4035 subjects were included. Of them, 853 (21.14%) had EVA and underwent CI. Mondini malformation was the most frequently associated anomaly (n = 78, 11.1%). Unilateral implantation was performed in 258 cases while bilateral in 119 subjects. Postoperative complications included CSF/perilymph gusher (n = 112), CSF oozing (n = 18), and partial electrode insertion (n = 6). Closing the cochleostomy with temporalis fascia, muscle, connective tissue, or fibrin glue was the most frequently reported approach to manage CSF/perilymph gusher (n = 67, 56.7%) while packing was performed in six patients. CONCLUSION Patients with EVA demonstrated audiometric and speech performance improvement after CI. However, many patients had intra- or postoperative complications. Further research is needed as the outcomes may be affected by associated temporal bone pathology, the timing of implant, and hearing condition.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box; 245, Riyadh, 11411, Saudi Arabia.
| | | | - Marzouqi Salamah
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box; 245, Riyadh, 11411, Saudi Arabia
| | - Saad Alenzi
- King Fahad Specialist Hospital, MOH, Tabuk, Saudi Arabia
| | | | | | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box; 245, Riyadh, 11411, Saudi Arabia
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Cochlear Implantation in Children with Enlarged Vestibular Aqueduct: A Systematic Review of Surgical Implications and Outcomes. Ear Hear 2022; 44:440-447. [PMID: 36397213 DOI: 10.1097/aud.0000000000001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study investigated age at implantation, improvement in hearing and speech perception outcomes, as well as surgical complications in pediatric cochlear implant recipients with Pendred Syndrome (PS) or non-syndromic enlarged vestibular aqueduct (NSEVA). DESIGN A systematic review of the literature between 1984 and 2021 was performed. Two independent reviewers performed abstract and full-text screening using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The inclusion criteria were: English language, cochlear implant, age at implantation available, age <18 years, PS, Mondini malformation, and enlarged vestibular aqueduct. Full-text analysis was completed using the National Institute of Health assessment tool for case series and case-control studies. Studies were also graded according to the Oxford Centre for Evidence-Based Medicine grading system. RESULTS In total, 198 studies were identified and screened, and 55 studies were included for analysis. Audiological outcomes were available in 46 studies, and the four-frequency pure-tone audiogram average improved by 60 to 78 dB HL due to cochlear implantation. Auditory performance and speech intelligibility scores increased by 44%. The overall average implantation age was 60 months. The implantation age was 21 months lower in the studies where individuals were implanted after the year 2000 compared with those implanted before the year 2000. Perilymph gusher/oozing was the most common surgical incident reported, occurring in 187 of 1572 implantations. CONCLUSIONS In children with PS/NSEVA, cochlear implantation improves pure-tone average by 60 to 78 dB HL and capacity of auditory performance/speech intelligibility by 44%. The implantation age for these children has decreased during the last two decades but is still somewhat higher than reported for unselected pediatric cochlear implantation. Perilymph gusher/oozing is the most common surgical complication.
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Gong P, Jiao X, Yang Z. A case of Landau-Kleffner syndrome with SLC26A4-related hearing impairment. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-021-00067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Landau-Kleffner syndrome (LKS) is an acquired aphasia and electroencephalogram (EEG) abnormalities mainly in temporoparietal areas. SLC26A4 mutations can cause hearing loss associated with enlarged vestibular aqueduct (EVA).
Case presentations
We report a case of LKS in a 5-year-old boy with non-syndromic EVA due to homozygous mutations of c.919-2A>G (IVS7-2A>G) in SLC26A4. He had normal language development before 2 years old. At the age of 2.5 years, he was admitted to the hospital due to remarkable language delay, and diagnosed with hearing loss with EVA. The seizures started at 4.4 years of age and EEG recording showed electrical status epilepticus during sleep (ESES) with a posterior-temporal predominance. He received cochlear implantation in the right ear at 4.7 years of age, which improved his hearing and language skills. The nocturnal focal motor seizures recurred at 4.9 years of age. Then a remarkable inability to respond to calls and reduction in spontaneous speech were noticed. He was treated with methylprednisolone at 5 years old, which controlled the seizures, suppressed ESES, and remarkably improved the language ability. The absence of seizures maintained until the last follow-up at 5.3 years of age, with further improvements in EEG recording and language ability.
Conclusions
The co-existence of LKS and hearing loss caused by SLC26A4 mutations increases the difficulty of LKS diagnosis, especially in the presence of hearing loss and impaired language skills. EEG discharges predominantly in temporoparietal areas, the occurrence of ESES, and language improvement after antiepileptic medications are potential indicators for LKS diagnosis.
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Biggs K, Lovett A, Metcalfe C, Muzaffar J, Monksfield P, Bance M. Outcomes of Cochlear Implantation in Patients with Pendred syndrome: A Systematic Review and Narrative Synthesis. J Int Adv Otol 2021; 16:432-442. [PMID: 33136026 DOI: 10.5152/iao.2020.9039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Establish outcomes following cochlear implantation (CI) in patients with Pendred syndrome. Systematic review and narrative synthesis. Databases searched: Medline, Pubmed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Review conducted in accordance with the PRISMA statement. Searches identified 251 abstracts and 242 full texts. Of these, 22 studies met inclusion criteria reporting outcomes in 231 patients with at least 234 implants. Hearing outcomes were generally good with patients experiencing useful functional improvement. A total of 46 minor complications were reported in 78 cases. The methodological quality of included studies was modest, predominantly consisting of case reports and non-controlled case series with small numbers of patients. All studies were OCEBM grade III-IV. Hearing outcomes following CI in Pendred syndrome are generally good with useful functional improvement. However, outcomes reported in published studies lack long term follow up.
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Affiliation(s)
- Kirsty Biggs
- Royal Stoke University Hospital, Stoke on Trent, UK
| | - Amy Lovett
- Royal Stoke University Hospital, Stoke on Trent, UK
| | - Chris Metcalfe
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Bigmingham, UK
| | - Jameel Muzaffar
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Bigmingham, UK
| | - Peter Monksfield
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Bigmingham, UK
| | - Manohar Bance
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Benchetrit L, Jabbour N, Appachi S, Liu YC, Cohen MS, Anne S. Cochlear Implantation in Pediatric Patients With Enlarged Vestibular Aqueduct: A Systematic Review. Laryngoscope 2021; 132:1459-1472. [PMID: 34233033 DOI: 10.1002/lary.29742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE(S) To describe cochlear implantation (CI) outcomes, with speech perception, auditory, language, and parent-reported auditory and speech behaviors, in children with an enlarged vestibular aqueduct (EVA) and incomplete partition type 2 (IP-II) and compare to control children without inner ear malformations (IEMs) and to determine cerebrospinal fluid gusher rates and effect on outcomes. STUDY DESIGN Systematic review and meta-analysis. METHODS MEDLINE, Embase, Cochrane, and CINAHL databases were searched from inception to February 2020. Studies reporting relevant outcomes in children with EVA or EVA + IP-II and controls without IEMs undergoing CI were included. Mean differences in speech perception, auditory, and language scores between cases and controls were meta-analyzed. Gusher rates were determined by proportion meta-analyses. RESULTS Of 214 identified articles, 42 met inclusion criteria, evaluating 775 cases and 2,191 controls. Of -cases, 578 (74.6%) had EVA and 197 (25.4%) had EVA + IP-II. Cases showed a significant improvement in speech perception, auditory and language performance, comparable to controls. Parent-reported auditory and speech production behaviors outcomes were positive among cases and comparable to controls. Pooled gusher proportions in EVA and EVA + IP-II cases were 27.7% (95% CI: 17.6-39.1) and 48.6% (95% CI: 28.6-69.0), respectively, with a proportion difference of 20.9% (95% CI: 11.0-30.1). Gusher occurrence did not impact speech perception or language outcomes. CONCLUSION Outcomes in children with EVA or EVA + IP-II undergoing CI are favorable and largely comparable to outcomes in children with hearing loss undergoing CI without IEMs. Intraoperative gusher is more prevalent among children with EVA + IP-II as compared to iEVA. Gusher does not influence speech perception and language development outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Liliya Benchetrit
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, U.S.A
| | | | - Swathi Appachi
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, U.S.A
| | - Yi-Chun Liu
- Texas Children's Hospital, Division of Pediatric Otolaryngology, Houston, Texas, U.S.A
| | - Michael S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Samantha Anne
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, U.S.A
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Li Y, Yang Y, Zhang W, Sun J, Liu B, Chen M, Liu W, Liu S, Wang X, Li S, Zhang J, Ni X. Developmental performance between pediatric cochlear implantation candidates with and without large vestibular aqueduct syndrome. Acta Otolaryngol 2021; 141:250-255. [PMID: 33502272 DOI: 10.1080/00016489.2020.1862909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND We are inclined to pay special care and attention to children with large vestibular aqueduct syndrome (LVAS). However, it is not clear whether children with LVAS have more developmental delays than children without LVAS. OBJECTIVES To compare the developmental performance between pediatric cochlear implantation (CI) candidates with and without LVAS. MATERIALS AND METHODS Medical records of pediatric CI candidates were reviewed. Through propensity score matching analysis, 70 children with LVAS and 70 gender-, age-, and auditory-matched children were recruited as the LVAS and non-LVAS group, respectively. Developmental performances were compared between the two groups. RESULTS Compared with normal developmental metrics, both LVAS and non-LVAS groups had developmental delay in multiple domains (both p < .001). Although some differences in motor developments between children with LVAS and without LVAS, they demonstrated overall equal developmental levels in both verbal and nonverbal aspects (all p > .05). Age of intervention was the primary risk factor for developmental performance of LVAS children (β < 0, p < .05) with an obvious delay starting at 1 year of age. CONCLUSION Pediatric CI candidates with LVAS had both verbal and nonverbal developmental delays. However, they exhibited similar overall developmental performances to those without LVAS.
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Affiliation(s)
- Yanhong Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
| | - Yang Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
| | - Wanxia Zhang
- Department of Health Care, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
| | - Jihang Sun
- Department of Radiology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Bing Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
| | - Min Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
| | - Wei Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
| | - Shanshan Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
| | - Xiaoxu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
| | - Shilan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
| | - Jie Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
| | - Xin Ni
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, National Center for Children′s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, China
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Mohammad Azmi HH, Goh BS, Abdullah A, Umat C. The outcomes of bilateral cochlear implant users in Universiti Kebangsaan Malaysia. Acta Otolaryngol 2020; 140:838-844. [PMID: 32564640 DOI: 10.1080/00016489.2020.1775887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Bilateral cochlear implants are seen to improve hearing capabilities. OBJECTIVE To assess the auditory outcome of paediatric bilateral cochlear implant in Universiti Kebangsaan Malaysia. MATERIALS AND METHODS This was a cross-sectional and descriptive study single centre analysis. Categories of Auditory Performance (CAP-II) scale and Speech, Spatial and Qualities (SSQ) of Hearing questionnaire were used. RESULTS Forty-six patients were recruited. Majority of the children (30.4%) rated 7 and 23.9% scored perfectly (9) based on the CAP-II Scale. The least performing children were rated 5 (average). Children that were implanted sequentially within 24 months showed median CAP-II scale of 7. No significant correlation seen between CAP-II and the duration interval, use and age of 1st CI (p > .05). The speech domain of SSQ-P scale showed median value of 8 indicating good speech understanding. The spatial hearing domain had median value of 7, quality of hearing domain had median of 8. Significant correlation seen in hearing in noise with the duration of use of CI (p < .05). DISCUSSION Bilateral CI have shown benefits in auditory performance even though majority were performed sequentially. Promising outcome was better with prolonged usage of the device. CONCLUSION Hearing in noise is significantly better in bilateral CI.
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Affiliation(s)
- Haziq Hakimi Mohammad Azmi
- Department of Otorhinolaryngology-Head & Neck Surgery, University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| | - Bee See Goh
- Department of Otorhinolaryngology-Head & Neck Surgery, University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| | - Asma Abdullah
- Department of Otorhinolaryngology-Head & Neck Surgery, University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| | - Cila Umat
- Centre for Rehabilitation & Special Needs, of Audiology & Speech Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Hura N, Stewart M, Walsh J. Progression of hearing loss and cochlear implantation in large vestibular aqueduct syndrome. Int J Pediatr Otorhinolaryngol 2020; 135:110133. [PMID: 32480135 DOI: 10.1016/j.ijporl.2020.110133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Large vestibular aqueduct syndrome (LVAS) is a congenital inner ear malformation that commonly results in progressive sensorineural hearing loss (SNHL) and cochlear implantation (CI). Though LVAS accounts for approximately 15% of pediatric SNHL, little is known regarding the rate and severity of SNHL in these patients. We sought to characterize the timing of SNHL progression to CI in patients with LVAS. METHODS We performed a retrospective chart review at our institution from 2000 to 2018 using ICD-10 "large vestibular aqueduct syndrome," and through identifying patients with CI who had LVAS. Demographic, surgical, and audiometric data were collected. Theoretical CI candidacy was approximated using a pure tone average (PTA) HL threshold of 70 dB. RESULTS Of 103 patients, 96 had bilateral LVAS, and 7 had unilateral LVAS. Forty-one patients had bilateral implants, 52 had unilateral implants, and 10 were not implanted. The mean age at first implant was 8.62 years old [95%CI = 6.75,10.49], the mean age at second implant was 12.24 years old [95%CI = 8.33,16.15], and the mean time between implants was 4.37 years [95%CI = 3.02,5.73]. LVAS patients reached HL threshold of 70 dB at a mean age of 5.16 years old (SD = 3.04) for the "worse ear" and 9.08 years old (SD = 4.96) for the "better ear." CONCLUSIONS LVAS patients are a heterogenous population of patients, in which some may undergo progression of HL and some may not. Further, there may be a discrepancy in the timing between patients' theoretical CI candidacy and when they undergo CI. In order to optimize timing of CI, individual monitoring and close observation of LVAS patients is recommended.
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Affiliation(s)
- Nanki Hura
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., 6th Floor, 21287, Baltimore, MD, USA.
| | - Matthew Stewart
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., 6th Floor, 21287, Baltimore, MD, USA.
| | - Jonathan Walsh
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., 6th Floor, 21287, Baltimore, MD, USA.
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Cochlear Implant Outcomes in Large Vestibular Aqueduct Syndrome-Should We Provide Cochlear Implants Earlier? Otol Neurotol 2020; 40:e769-e773. [PMID: 31348128 DOI: 10.1097/mao.0000000000002314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Examine postoperative speech perception outcomes in a large vestibular aqueduct syndrome (LVAS) patients at a major cochlear implantation center. STUDY DESIGN Retrospective analysis of the Sydney Cochlear Implant Centre (SCIC) database and medical records from January 1994 to December 2015 was performed. SETTING Tertiary referral center. PATIENTS Patients with a diagnosis of LVAS who received a cochlear implant (CI). Only those with speech perception outcomes recorded at least 12 months post implant were included in our analysis. INTERVENTION(S) Therapeutic. MAIN OUTCOME MEASURE(S) Postoperative speech perception scores. RESULTS Between 1994 and 2015, 176 adult and pediatric patients with a diagnosis of LVAS underwent cochlear implantation at SCIC. Postoperative Bamford-Kowal Bench (BKB) sentence test scores were obtained for 97 patients. The postoperative median BKB score was 93% with a lower quartile score of 85% and an upper quartile score of 98%. Smaller numbers were available for post-CI City University of New York (CUNY) and Consonant-Nucleus-Consonant (CNC) word scores yet similar excellent results were seen. CONCLUSIONS Our study results suggest the CI should be considered when BKB scores have dropped to 85%. We suggest that rather than LVAS cases representing a challenge to cochlear implantation, they are amongst the best candidates for surgery, and should receive a CI at an earlier stage in hearing loss, when they have better speech perception. This allows stable hearing to be established earlier along with excellent speech perception outcomes.
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Li Y, Kong Y, Xu T, Dong R, Lv J, Qi B, Wang S, Yan F, Li Y, Long M, Chen X. Speech development after cochlear implantation in infants with isolated large vestibular aqueduct syndrome. Acta Otolaryngol 2019; 139:990-997. [PMID: 31550964 DOI: 10.1080/00016489.2019.1630755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Few studies on speech performance of children after cochlear implantation (CI) described isolated large vestibular aqueduct syndrome (LVAS). Objective: To investigate speech developmental trajectories of infants with LVAS after CI, and to compare with those who have structurally normal inner ears. Materials and methods: 1112 infants with congenital severe to profound hearing loss participated in this study. 150 infants in group A were diagnosed with LVAS, 962 infants in group B with structurally normal inner ear. The speech performance was assessed via the Meaningful Use of Speech Scale (MUSS). The evaluations were performed pre-implant, 1, 3, 6, 9, 12, 24, 36, 48 and 60 months after CI. Results: The mean scores of the MUSS improved over a 5-year period after implantation in both groups A and B. The LVAS group presented similar speech developmental trajectory to the non-LVAS group at each assessment interval, except pre-operation. There were significant differences in mean scores between vocalizing behavior and oral communication skills, clarification skills of infants in both two groups. Conclusions and significance: Speech performance of infants with LVAS developed rapidly after CI and was similar to infants with structurally normal inner ear. For infants with isolated LVAS, CI had a significant effect and should be recommended as a therapeutic option.
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Affiliation(s)
- Yang Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Beijing Institute of Otolaryngology, Beijing, China
| | - Ying Kong
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Beijing Institute of Otolaryngology, Beijing, China
| | - Tianqiu Xu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Beijing Institute of Otolaryngology, Beijing, China
| | - Ruijuan Dong
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Beijing Institute of Otolaryngology, Beijing, China
| | - Jing Lv
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Beijing Institute of Otolaryngology, Beijing, China
| | - Beier Qi
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Beijing Institute of Otolaryngology, Beijing, China
| | - Shuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Beijing Institute of Otolaryngology, Beijing, China
| | - Fei Yan
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yongxin Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Beijing Institute of Otolaryngology, Beijing, China
| | - Mo Long
- China Rehabilitation Research Center for Hearing and Speech Impairment, Beijing, China
| | - Xueqing Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Beijing Institute of Otolaryngology, Beijing, China
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Enlarged Vestibular Aqueduct and Cochlear Implants: The Effect of Early Counseling on the Length of Time Between Candidacy and Implantation. Otol Neurotol 2019; 39:e90-e95. [PMID: 29315182 DOI: 10.1097/mao.0000000000001663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if discussing cochlear implantation (CI) with patients with enlarged vestibular aqueducts (EVA) and their families before reaching audiological criteria for CI candidacy effects the length of time between reaching audiological candidacy and CI surgery, and to describe the universal newborn hearing screening (UNHS) results and communication modality in this sample. PATIENTS Forty-two patients (25 females) with confirmed EVA and cochlear implants. INTERVENTION(S) Diagnostic CI visit. MAIN OUTCOME MEASURES The primary outcome measure is the difference in length of time between reaching audiological candidacy for CI and surgical implantation between those who had preliminary discussions regarding CI with their medical and healthcare providers before reaching audiological candidacy versus who had discussions after reaching candidacy. The secondary outcome measure is the result of the UNHS and primary mode of communication used by each patient. RESULTS Discussing CI before reaching audiological candidacy was associated with a significantly shorter duration between reaching audiological candidacy and receiving CI (median = 3.1 mo; interquartile range [IQR] = 1.7-5.4) as compared with discussing CI after reaching candidacy (median = 5.8 mo; IQR = 3.2-11.2; p = 0.012). Participants born after the implementation of the UNHS, 16 of 24 patients referred on one or both ears. Communication modalities were evenly divided between utilizing sign-support English and oral/aural communicators only. CONCLUSIONS Discussion of CI in patients with EVA before reaching audiological candidacy reduces the amount of time the child is without adequate auditory access and contributes to a constructive and interactive preparatory experience.
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Liu H, Zhou K, Zhang X, Peng KA. Fluctuating Sensorineural Hearing Loss. Audiol Neurootol 2019; 24:109-116. [PMID: 31315108 DOI: 10.1159/000500658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several otologic conditions can present with fluctuating sensorineural hearing loss, including Ménière's disease, autoimmune inner ear disease, and enlarged vestibular aqueduct. Although these 3 etiologies vary greatly, distinguishing between these conditions at initial presentation can be challenging. Furthermore, initial treatment of these conditions is often similar. In this review, we discuss historical and current perspectives on diagnosis and treatment of these conditions. SUMMARY A literature search was performed regarding fluctuating hearing loss, and current treatment of these etiologies of fluctuating hearing loss was summarized. Immediate measures at the onset of acute hearing loss include corticosteroid therapy, while preventative and chronic therapies, which can limit disease severity and frequency, vary based on the specific condition treated. Key Messages: Fluctuating hearing loss can represent a range of pathologies, but the precise etiology may not be clear at initial presentation. Timely treatment and long-term follow-up, along with appropriate diagnostics, are necessary to optimize long-term hearing.
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Affiliation(s)
- Hui Liu
- First Hospital of Shijiazhuang City, Shijiazhuang City, China,
| | - Kunpeng Zhou
- First Hospital of Shijiazhuang City, Shijiazhuang City, China
| | - Xuemei Zhang
- First Hospital of Shijiazhuang City, Shijiazhuang City, China
| | - Kevin A Peng
- House Clinic and House Ear Institute, Los Angeles, California, USA
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Morphometric Study of the Vestibular Aqueduct in Patients With Enlarged Vestibular Aqueduct. J Comput Assist Tomogr 2017; 41:467-471. [DOI: 10.1097/rct.0000000000000524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Comparisons of Auditory Performance and Speech Intelligibility after Cochlear Implant Reimplantation in Mandarin-Speaking Users. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8962180. [PMID: 27413753 PMCID: PMC4927948 DOI: 10.1155/2016/8962180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/08/2016] [Accepted: 05/25/2016] [Indexed: 11/25/2022]
Abstract
Objectives. We evaluated the causes, hearing, and speech performance before and after cochlear implant reimplantation in Mandarin-speaking users. Methods. In total, 589 patients who underwent cochlear implantation in our medical center between 1999 and 2014 were reviewed retrospectively. Data related to demographics, etiologies, implant-related information, complications, and hearing and speech performance were collected. Results. In total, 22 (3.74%) cases were found to have major complications. Infection (n = 12) and hard failure of the device (n = 8) were the most common major complications. Among them, 13 were reimplanted in our hospital. The mean scores of the Categorical Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) obtained before and after reimplantation were 5.5 versus 5.8 and 3.7 versus 4.3, respectively. The SIR score after reimplantation was significantly better than preoperation. Conclusions. Cochlear implantation is a safe procedure with low rates of postsurgical revisions and device failures. The Mandarin-speaking patients in this study who received reimplantation had restored auditory performance and speech intelligibility after surgery. Device soft failure was rare in our series, calling attention to Mandarin-speaking CI users requiring revision of their implants due to undesirable symptoms or decreasing performance of uncertain cause.
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Wu CM, Ko HC, Tsou YT, Lin YH, Lin JL, Chen CK, Chen PL, Wu CC. Long-Term Cochlear Implant Outcomes in Children with GJB2 and SLC26A4 Mutations. PLoS One 2015; 10:e0138575. [PMID: 26397989 PMCID: PMC4580418 DOI: 10.1371/journal.pone.0138575] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives To investigate speech and language outcomes in children with cochlear implants (CIs) who had mutations in common deafness genes and to compare their performances with those without mutations. Study Design Prospective study. Methods Patients who received CIs before 18 years of age and had used CIs for more than 3 years were enrolled in this study. All patients underwent mutation screening of three common deafness genes: GJB2, SLC26A4 and the mitochondrial 12S rRNA gene. The outcomes with CIs were assessed at post-implant years 3 and 5 using the Categories of Auditory Performance (CAP) scale, Speech Intelligibility Rating (SIR) scale, speech perception tests and language skill tests. Results Forty-eight patients were found to have confirmative mutations in GJB2 or SLC26A4, and 123 without detected mutations were ascertained for comparison. Among children who received CIs before 3.5 years of age, patients with GJB2 or SLC26A4 mutations showed significantly higher CAP/SIR scores than those without mutations at post-implant year 3 (p = 0.001 for CAP; p = 0.004 for SIR) and year 5 (p = 0.035 for CAP; p = 0.038 for SIR). By contrast, among children who received CIs after age 3.5, no significant differences were noted in post-implant outcomes between patients with and without mutations (all p > 0.05). Conclusion GJB2 and SLC26A4 mutations are associated with good post-implant outcomes. However, their effects on CI outcomes may be modulated by the age at implantation: the association between mutations and CI outcomes is observed in young recipients who received CIs before age 3.5 years but not in older recipients.
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Affiliation(s)
- Che-Ming Wu
- Department of Otolaryngology—Head and Neck Surgery, Chang-Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- * E-mail: (CMW); (CCW)
| | - Hui-Chen Ko
- Department of Otolaryngology—Head and Neck Surgery, Chang-Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Yung-Ting Tsou
- Department of Otolaryngology—Head and Neck Surgery, Chang-Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Yin-Hung Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ju-Li Lin
- Division of Genetics and Endocrinology, Department of Pediatrics, Chang-Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chin-Kuo Chen
- Department of Otolaryngology—Head and Neck Surgery, Chang-Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Pei-Lung Chen
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Chi Wu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (CMW); (CCW)
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