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INTRODUCTION: Preoperative evaluation of cochlear morphology is important for successful cochlear implantation. This study analyzed the cochlear canal by three-dimensional reconstructions of temporal bones using computed tomography (CT). METHODS: Fifty temporal bones from 25 patients aged 42-74 years were evaluated. The inner spaces of the bony cochlea were reconstructed using a surface rendering technique on the CT images. Eight angular points (P0-P7) every 90° were selected from 0° to 630° from the center of the round window using the reconstructed cochlear canal images. The radius (R) and thickness (T) of the cochlear canal at each point were measured. The cochlear canal length (CoCL) was estimated using an equation based on the radius at each point. The cochlear width and height based on multiplanar CT images were also measured and compared with the length and volume of the cochlear canal. RESULTS: The mean CoCL from 0° to 630° was 31.5 mm, and the cochlear volume was 55.9 mm3. The CoCL to P7 was correlated with the cochlear volume (r = 0.77), coiling ratios (R4/R0, r = 0.47; R5/R1, r = 0.384), cochlear width (long) (r = 0.539), cochlear height (r = 0.385), and total thickness at each point (r = 0.475). The cochlear volume was correlated with CoCL (630°) (r = 0.77), coiling ratio (R4/R0, r = 0.367), cochlear width (long) (r = 0.616), cochlear height (r = 0.447), and total T (r = 0.566). CONCLUSION: Preoperative evaluation using three-dimensional reconstruction can elucidate the size and shape of the cochlear canal before cochlear implantation.
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Cóclea , Implante Coclear , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Humanos , Implante Coclear/métodos , Idoso , Cóclea/diagnóstico por imagem , Cóclea/cirurgia , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Osso Temporal/diagnóstico por imagem , Osso Temporal/anatomia & histologia , Osso Temporal/cirurgiaRESUMO
INTRODUCTION: The aim of this study was to examine how bimodal stimulation affects quality of life (QOL) during the postoperative period following cochlear implantation (CI). These data could potentially provide evidence to encourage more bimodal candidates to continue hearing aid (HA) use after CI. METHODS: In this prospective study, patients completed preoperative and 1-, 3-, and 6-month post-activation QOL surveys on listening effort, speech perception, sound quality/localization, and hearing handicap. Fifteen HA users who were candidates for contralateral CI completed the study (mean age 65.6 years). RESULTS: Patients used both devices at a median rate of 97%, 97%, and 98% of the time at 1, 3, and 6 months, respectively. On average, patients' hearing handicap scores decreased by 16% at 1 month, 36% at 3 months, and 30% at 6 months. Patients' listening effort scores decreased by a mean of 10.8% at 1 month, 12.6% at 3 months, and 18.7% at 6 months. Localization significantly improved by 24.3% at 1 month and remained steady. There was no significant improvement in sound quality scores. CONCLUSION: Bimodal listeners should expect QOL to improve, and listening effort and localization are generally optimized using CI and HA compared to CI alone. Some scores improved at earlier time points than others, suggesting bimodal auditory skills may develop at different rates.
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In asymmetric hearing loss (AHL), the normal pattern of contralateral hemispheric dominance for monaural stimulation is modified, with a shift towards the hemisphere ipsilateral to the better ear. The extent of this shift has been shown to relate to sound localization deficits. In this study, we examined whether cochlear implantation to treat postlingual AHL can restore the normal functional pattern of auditory cortical activity and whether this relates to improved sound localization. The auditory cortical activity was found to be lower in the AHL cochlear implanted (AHL-CI) participants. A cortical asymmetry index was calculated and showed that a normal contralateral dominance was restored in the AHL-CI patients for the nonimplanted ear, but not for the ear with the cochlear implant. It was found that the contralateral dominance for the nonimplanted ear strongly correlated with sound localization performance (rho = 0.8, P < 0.05). We conclude that the reorganization of binaural mechanisms in AHL-CI subjects reverses the abnormal lateralization pattern induced by the deafness, and that this leads to improved spatial hearing. Our results suggest that cochlear implantation enables the reconstruction of the cortical mechanisms of spatial selectivity needed for sound localization.
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Implante Coclear , Implantes Cocleares , Surdez , Perda Auditiva , Localização de Som , Percepção da Fala , Humanos , Implante Coclear/métodos , Audição/fisiologia , Localização de Som/fisiologia , Tomografia por Emissão de Pósitrons , Percepção da Fala/fisiologiaRESUMO
PURPOSES: The objective of this research was to interpret and analyze the imaging, audiological features and cochlear implantation outcomes in cochlear nerve deficiency children. MATERIAL AND METHODS: Retrospective analysis. RESULTS: 25 prelingual hearing loss children diagnosed cochlear nerve deficiency (CND), the age range from 1 to 15 (mean age, 5.04), underwent cochlear implantation at Ear Nose and Throat Hospital - Ho Chi Minh City (ENT hospital - HCMC) from 2016 to 2023. All children had sensorineural hearing loss (SNHL) from severe to profound degree. Magnetic resonance imaging (MRI) showed cochlear nerve hypoplasia in 76 % and cochlear nerve aplasia in 24 % of cases. Inner ear malformations were found in 52 % of cases. The mean Categories of Auditory Performance (CAP) score at 1 year after surgery was 4.8. At 6 months and 1 year after surgery, the mean CAP score of the aplasia group was significantly lower than that of the hypoplasia group (p < 0.05). CONCLUSIONS: In cochlear nerve deficiency children, auditory perception and speech performance still improved after cochlear implantation. However, this progress was significantly limited in cochlear nerve aplasia group.
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BACKGROUND: Cochlear implantation (CI) in children with malformed ears can be challenging through the standard surgical technique. Several alternative approaches have been described. The endoscopic-assisted approach can be chosen as an effective and safe surgical technique, overcoming the drawbacks of the traditional approach. MATERIAL: We further describe a combined technique based on a limited mastoidectomy with no posterior tympanotomy and an endoscopic transmeatal approach to the round window (RW): the electrode is driven from the mastoid to the middle ear through the attic. RESULTS: The concomitant endoscopic assistance allows for improved surgical vision, reducing the risk of major complications. The main advantages of this technique are related to better visualization of the RW for safe insertion of the electrode; avoidance of damage to the facial nerve (FN), due to direct visualization, and sparing the posterior tympanotomy; avoidance of subtotal petrosectomy, if not necessary. CONCLUSION: The purpose of this article, supported with a video file, is to describe step by step this endoscopic-assisted procedure in a patient with middle ear malformation.
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Implante Coclear , Implantes Cocleares , Criança , Humanos , Implante Coclear/métodos , Orelha/cirurgia , Orelha Média/cirurgia , Audição , Janela da Cóclea/cirurgiaRESUMO
OBJECTIVE: The purpose of this study is to investigate how cognition, as measured using the Self-Administered Gerocognitive Examination Test (SAGE), and age affect speech recognition scores in older adults (age > 65) at one year and two years after cochlear implantation. STUDY DESIGN: This is a prospective study. SETTING: This study was conducted at a single institution. METHODS: Unilateral cochlear implantation was performed by two surgeons on adult patients (>65 years) with postlingual bilateral sensorineural hearing loss. There were 230 patients who underwent cochlear implantation from January 2016 to June 2023. Fifty-five of these patients completed the SAGE questionnaire before implantation, one year after implantation, and 2 years after implantation. Paired t-test analysis was used to evaluate pre- and post-operative speech recognition scores (CNC, AzBio in Quiet). RESULTS: Patients who had normal preoperative cognition on SAGE showed greater improvement in postoperative speech recognition tests at 1 year and 2 years after implantation compared with patients who showed preoperative cognitive impairment. There were no significant differences in postoperative speech outcome between age group 1 (between 65 and 80 years old) and age group 2 (over 80 years old) cochlear implant recipients. There were no changes in cognitive SAGE scores after 2 years implantation. CONCLUSION: Cognitive function, as measured by SAGE, is a more reliable predictor than age in determining speech recognition improvement after cochlear implantation. Cochlear implantation did not improve postoperative cognition.
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Implante Coclear , Implantes Cocleares , Percepção da Fala , Humanos , Idoso , Lactente , Estudos Prospectivos , Fala , Resultado do Tratamento , CogniçãoRESUMO
OBJECTIVE: To describe an AI model to facilitate adult cochlear implant candidacy prediction based on basic demographical data and standard behavioral audiometry. METHODS: A machine-learning approach using retrospective demographic and audiometric data to predict candidacy CNC word scores and AzBio sentence in quiet scores was performed at a tertiary academic center. Data for the model were derived from adults completing cochlear implant candidacy testing between January 2011 and March 2023. Comparison of the prediction model to other published prediction tools and benchmarks was performed. RESULTS: The final dataset included 770 adults, encompassing 1045 AzBio entries, and 1373 CNC entries. Isophoneme scores and word recognition scores exhibited strongest importance to both the CNC and AzBio prediction models, followed by standard pure tone average and low-frequency pure tone average. The mean absolute difference between the predicted and actual score was 15 percentage points for AzBio sentences in quiet and 13 percentage points for CNC word scores, approximating anticipated test-retest constraints inherent to the variables incorporated into the model. Our final combined model achieved an accuracy of 87 % (sensitivity: 90 %; precision: 80 %). CONCLUSION: We present an adaptive AI model that predicts adult cochlear implant candidacy based on routine behavioral audiometric and basic demographical data. Implementation efforts include a public-facing online prediction tool and accompanying smartphone program, an embedded notification flag in the electronic medical record to alert providers of potential candidates, and a program to retrospectively engage past patients who may be eligible for cochlear implantation based on audiogram results.
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Implante Coclear , Implantes Cocleares , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Adulto , Estudos Retrospectivos , Implante Coclear/métodos , Idoso , Audiometria/métodos , Aprendizado de Máquina , Seleção de Pacientes , Adulto Jovem , Idoso de 80 Anos ou maisRESUMO
PURPOSE: To investigate the benefits of cochlear implantation in adults with single-sided deafness (SSD) and asymmetric hearing loss (AHL). STUDY DESIGN: Prospective within-subjects repeated-measures. SETTING: Two tertiary cochlear implant centers. PATIENTS: Fourteen adults with severe-to-profound sensorineural hearing loss in the worse hearing ear and up to moderate SNHL in the better hearing ear. INTERVENTION: Cochlear implantation in the worse hearing ear. MAIN OUTCOME MEASURES: Consonant-nucleus-consonant (CNC) test, AzBio sentence test in noise, and lateralization testing were conducted preoperatively and at 3-, 6-, and 12-months post-activation. Patient-related outcomes were measured using the Speech, Spatial, and Qualities of Hearing Scale and Glasgow Benefit Inventory. Tinnitus Handicap Inventory was administered to subjects with tinnitus. RESULTS: Mean length of hearing loss in the worse hearing ear was 3.5 years. The mean CNC change scores from baseline were 54.8, 55.9, and 58.9 percentage points at 3-, 6-, and 12-months (p < 0.001). AzBio sentence test in noise demonstrated improved scores in all spatial configurations, although statistically significant in S0N0 (speech front, noise front) only. Lateralization testing showed significant improvement of 22.9, 24.5, and 24.0 percentage points at 3-, 6-, and 12 months post-activation (p = 0.002). All patient-related outcome measures revealed significant improvement. CONCLUSION: This study demonstrates improved speech perception in noise, sound lateralization, quality of life, and reduction in tinnitus perception in adults with SSD/AHL who undergo cochlear implantation. Our results add to the growing body of evidence that cochlear implant should be offered to this population.
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Implante Coclear , Implantes Cocleares , Perda Auditiva Unilateral , Perda Auditiva , Percepção da Fala , Zumbido , Adulto , Humanos , Implante Coclear/métodos , Zumbido/cirurgia , Qualidade de Vida , Estudos Prospectivos , Resultado do Tratamento , Perda Auditiva/cirurgia , Percepção da Fala/fisiologia , Perda Auditiva Unilateral/cirurgia , Perda Auditiva Unilateral/reabilitaçãoRESUMO
INTRODUCTION: Robot-assisted cochlear implant surgery (RACIS) as defined by the HEARO®-procedure performs minimal invasive cochlear implant (CI) surgery by directly drilling a keyhole trajectory towards the inner ear. Hitherto, an entirely robotic automation including electrode insertion has not been described yet. The feasability of using a newly developed, dedicated motorised device for automated electrode insertion in the first clinical case of entirely robotic cochlear implant surgery was investigated. AIM: The aim is to report the first experience of entirely robotic cochlear implantation surgery. INTERVENTION: RACIS with a straight flexible lateral wall electrode. PRIMARY OUTCOME MEASUREMENTS: Electrode cochlear insertion depth. SECONDARY OUTCOME MEASUREMENTS: The audiological outcome in terms of mean hearing thresholds. CONCLUSION: Here, we report on a cochlear implant robot that performs the most complex surgical steps to place a cochlear implant array successfully in the inner ear and render similar audiological results as in conventional surgery. Robots can execute tasks beyond human dexterity and will probably pave the way to standardize residual hearing preservation and broadening the indication for electric-acoustic stimulation in the same ear with hybrid implants.
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PURPOSE: We investigate the clinical manifestations, mechanisms, and methods of preventing electrode migration in Cochlear Implantation (CI) patients, based on our practical experience with this problem. STUDY DESIGN: This is a retrospective study in a single center. METHODS: We retrospectively reviewed electrode migration in 4 (0.75%) of 532 patients who underwent CI at our tertiary institution from January 2002 to December 2022. Pre- and post-operative pure-tone audiometry, word recognition score, aided functional gain test, and sound field speech intelligibility test were evaluated. RESULTS: All four patients underwent CIs with the straight electrode type. The following events or symptoms were observed in the patients before confirming electrode migration: an increase in high-frequency thresholds during the post-operative aided functional gain test and a decline in scores on the sound field speech intelligibility test. Electrode migration was confirmed through transocular view X-ray or temporal bone computer tomography. Two patients showed coiled electrodes within the mastoid cavity; while in the others, the electrodes were observed to be floating inside the cavity. To prevent migration of electrodes due to these issues, we mixed bone paste collected during the drilling of the mastoid cavity with glue and used it to secure the electrodes in place. CONCLUSION: Electrode migration can result in a decrease in hearing ability and may necessitate a revision surgery to adjust the electrode placement. The main factors affecting electrode placement include the position of electrode within the mastoid cavity and the elasticity of straight electrodes. It is important for surgeons to recognize the factors that increase the risk of electrode migration and to take preventative measures to reduce this risk.
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Implante Coclear , Implantes Cocleares , Percepção da Fala , Humanos , Implantes Cocleares/efeitos adversos , Implante Coclear/efeitos adversos , Implante Coclear/métodos , Estudos Retrospectivos , Audição , Audiometria de Tons PurosRESUMO
INTRODUCTION: In this study we investigated the effect of cochlear implantation on tinnitus in patients with post lingual bilateral profound hearing loss. METHODS: In this retrospective study, 66 post-lingual deaf patients over 18 years old who referred for cochlear implantation and complained of tinnitus were included. Patients were divided into two groups with residual hearing (in frequency 250-500 Hz) and without residual hearing. All data including age, gender, type of implants, type of surgery, cause of the disease, and information on the THI score before cochlear implantation, one month after cochlear implantation and one year after cochlear implantation was recorded and analyzed. RESULTS: Nine patients had residual hearing, while 57 patients did not. After one month and one year, in both groups, the mean THI score has decreased significantly (p-value = 0.001), but there was no significant difference in the mean THI score before surgery and one month and one year after surgery between two groups with and without residual hearing. There was no significant difference in tinnitus severity according to THI-grade between two groups. Also there was no significant difference in THI score and the cause of the hearing loss, type and insertion method of implantation, one month and one year after the surgery between two groups. CONCLUSION: According to our results, the was no significant correlation between residual hearing and tinnitus score before surgery, one month and one year after the surgery.
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PURPOSE: The aim of this study was to compare the outcomes of different mapping procedures based on anatomic or default frequency distribution in postlingual deafness adults who underwent cochlear implantation (CI). METHODS: Forty-eight adults with postlingual deafness who underwent CI (MED-EL) from January 2021 to May 2022 in our hospital were prospectively recruited. The participants were randomly assigned to two groups (the anatomic group and the default group). Postoperative computerized tomography (CT) scans were evaluated with Otoplan® to determine the angular insertion depth (AID) and the specific locations of the intracochlear electrodes. Anatomic maps were imported into MAESTRO 9.0 software (MED-EL) for anatomy-based fitting for anatomic group, while default mapping program was set up for the default group. Hearing thresholds, Speech Recognition Scores (SRS), and subjects' auditory and musical abilities were evaluated 1 year after using the CI. Differences were determined in two groups using Stata statistical software, with significance defined as p < 0.05. RESULTS: SRS under noisy conditions was significantly greater for anatomic group than the default group (p = 0.02). Under quiet conditions, however, mean hearing thresholds (0.5, 1, 2, and 4 kHz) and SRS did not differ significantly between the two groups (p = 0.07). Modified questionnaires showed that auditory (p = 0.02) and musical (p = 0.01) quality were significantly better following the anatomic mapping than the default procedure. CONCLUSION: CI program based on the anatomic distribution may bring better SRS under noise conditions as well as better auditory and musical qualities than based on the default frequency distribution.
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Implante Coclear , Implantes Cocleares , Surdez , Percepção da Fala , Adulto , Humanos , Implante Coclear/métodos , Surdez/cirurgia , Resultado do Tratamento , AudiçãoRESUMO
INTRODUCTION: Real-time visualization of intraoperative electrocochleography (ECochG) potentials via a digital microscope during cochlear implantation can provide direct feedback during electrode insertion. The aim of this prospective, randomized study of 50 patients was to obtain long-term data with a focus on residual hearing preservation and speech understanding. MATERIAL AND METHODS: Cochlear implantations were performed in 50 patients (26 female, 24 male) with residual hearing using a digital microscope. Patients were randomized into two groups. Intraoperative ECochG potentials were either displayed directly in the surgeon's field of view (picture-in-picture display, PiP) or not directly in the field of view (without picture-in-picture display, without PiP). Residual hearing preservation and speech comprehension were recorded within a 1-year follow-up period, compared between groups (PiP versus without PiP) and to a control group of 26 patients implanted without ECochG. RESULTS: Mean insertion time was significantly longer in the picture-in-picture group (p = 0.025). Residual hearing preservation after 6 weeks at 250 Hz was significantly better in the picture-in-picture group (p = 0.017). After one year, 76% of patients showed residual hearing in the picture-in-picture group (62% without picture-in-picture technique, p = n.s.). Use of the picture-in-picture technique resulted in better long-term pure tone residual hearing preservation at 250, 500, and 1000 Hz. Speech intelligibility improved by 46% in the picture-in-picture group (38% without picture-in-picture). DISCUSSION: This study is the first to describe long-term results in a large cohort of cochlear implant patients in whom digital visualization of intraoperative ECochG was used. Our results show that visualization of intraoperative ECochG has a positive effect on residual hearing preservation.
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Implante Coclear , Implantes Cocleares , Humanos , Masculino , Feminino , Implante Coclear/métodos , Cóclea/cirurgia , Audiometria de Resposta Evocada/métodos , Inteligibilidade da FalaRESUMO
OBJECTIVE: The aim of this study was to conduct a bibliometric and visualization analysis of research on cochlear implantation (CI) for inner ear malformations (IEMs) from 1986 to 2024. METHODS: A comprehensive literature search was performed using the Web of Science Core Collection Database, resulting in the identification of 431 relevant publications. Various data analysis and visualization tools, including VOSviewer, CiteSpace, and Bibliometrix, were utilized to analyze annual publication outputs, countries/regions and institutions, authors, journals and studies, keywords, and theme evolution. RESULTS: The study revealed an overall increasing trend in research output on CI for IEMs, with significant contributions from countries such as the United States, China, Turkey, Germany, and Italy. The analysis also identified key authors, research teams, journals, and studies that have made substantial contributions to the field. Furthermore, the study highlighted important research hotspots and trends, such as the classification of IEMs, outcomes of CI for IEMs, and the management of pediatric patients with IEMs. CONCLUSION: The findings of this study provide a comprehensive overview of the research landscape surrounding CI for IEMs. The results serve as a basis for future research topic selection and emphasize the need for enhanced international collaboration and the publication of high-impact research to further advance this field.
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PURPOSE: This study aimed to investigate the etiology of hearing loss, including genetic variants, in individuals who underwent cochlear implantation (CI) in their teens to thirties. It also sought to analyze post-CI speech performance and identify prognostic factors affecting CI outcomes in this age group. METHODS: We conducted a retrospective review of 421 cochlear implant patients at Seoul National University Bundang Hospital, focusing on 63 subjects aged 10-39 years who underwent their first CI by a single surgeon between July 2018 and June 2022. The study included audiologic evaluation, molecular genetic testing, and analysis of speech performance post-CI. Statistical analyses were performed using SPSS 25 and GraphPad Prism 7. RESULTS: Among 63 participants (M:F, 24:39), nine underwent CI in their teens, 24 in their 20 s, and 30 in their 30 s. Most of them (40, 63.5%) had postlingual deafness. The study found that 65.2% (40/63) of subjects received a genetic diagnosis, with DFNB4 being the most common etiology (37.5%, 15/40). Post-CI speech evaluation showed an average sentence score of 80% across all subjects. Factors such as the onset of hearing loss, duration of deafness (DoD), and preoperative Speech Intelligibility Rating (SIR) significantly influenced CI outcomes. Notably, longer DoD was associated with poorer CI outcomes, but this did not affect individuals with postlingual hearing loss as much. CONCLUSION: The study concludes that in individuals aged 10-39 undergoing CI, the onset of hearing loss and preoperative SIR are critical predictors of postoperative outcomes. CI is recommended for those with postlingual hearing loss in this age group, irrespective of the DoD. The study highlights the importance of genetic factors especially DFNB4 in hearing loss etiology and underscores the value of the relatively easy-to-evaluate factor, preoperative SIR in predicting CI outcomes.
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OBJECTIVES: This study aimed to explore the diagnostic sensitivity of 3D heavily weighted T2-weighted MRI (T2MRI) and high-resolution computed tomography (HRCT) in patients with cochlear fibrosis associated with Streptococcus suis (S. suis) meningitis and the practicality of Cochlear implantation (CI) treatments. METHODS: Between January 2020 and December 2022, we enrolled four patients with rare cochlear S. suis meningitis with associated hearing loss despite aggressive or non-aggressive follow-up antibiotic treatment. Clinical imaging data, surgical performances and post-surgical-electrode impedance were evaluated. RESULTS: Combined with HRCT and T2MRI, the cochlea had varying degrees of fibrosis and ossification in different cases. However, the electrodes were successfully and wholly inserted after intraoperative removal of the ossified and fibrotic foci. Post-surgical electrode impedance values of MP1 + 2 mode were normal in all 4 cases at initial activation. CONCLUSION: In patients with S. suis meningitis and associated cochlear fibrosis, T2MRI examination of the inner ear was more sensitive than HRCT. This research highlights the feasibility of CI treatment in S. suis meningitis patients with severe cochlear fibrosis.
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PURPOSE: The study explores the potential of real-time electrocochleographic potentials (ECochG) visualization during electrode insertion using digital microscopes such as RoboticScope (BHS®). Collaborative software development of the MAESTRO Software (MED-EL®) offers continuous ECochG monitoring during implantation and postoperative hearing evaluation, addressing previous time constraints. The study aims to assess software applicability and the impact of real-time visualization on long-term residual hearing preservation. METHODS: Eight patients with residual hearing underwent cochlear implantation with Flex26 or Flex28 electrode according to the Otoplan evaluation. ECochG responses were measured and visualized during electrode insertion, with insertion times recorded. Two randomized display methods (graph and arrows) tracked ECochG potentials. Postoperative behavioral thresholds determined hearing preservation. Successful real-time intraoperative ECochG visualization was achieved in all cases, enabling surgeon adaptation. Mean electrode insertion time was 114 s, with postoperative thresholds comparable to preoperative values. Visualization did not affect surgeon workload. ECochG amplitudes differed between patients with and without residual hearing. CONCLUSION: The study demonstrates effective implementation of advanced ECochG software combined with real-time visualization, enabling residual hearing preservation during CI. Visualization had no apparent effect on surgeon performance or workload. Future investigation involving a larger population will assess the long-term impact of ECochG on hearing threshold and structure preservation.
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Audiometria de Resposta Evocada , Implante Coclear , Estudos de Viabilidade , Software , Humanos , Implante Coclear/métodos , Audiometria de Resposta Evocada/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Implantes CoclearesRESUMO
PURPOSE: Despite the recent trend of cochlear implantation (CI) at the age of six or even four months is prevalent in many centers around the world, clinicians should be cautious because perinatal risk factors of auditory neuropathy and/or delayed maturation carry the possibility of reversible hearing loss, yielding better auditory performance at the age of one year. The purpose of this study is to raise awareness that early CI may not be universal for all patients. In addition, we specify the factors to be considered in the pre-operative evaluation of CI in infants younger than one year. METHODS AND RESULTS: This study describes four cases provisionally diagnosed with severe to profound sensorineural hearing loss that were presented to the CI clinic to determine candidacy for implantation. Two cases had histories of prematurity, one had Down syndrome, and one had a family history of hearing loss. None of the study cases were candidates for CI, as they had varying degrees of hearing improvement. CONCLUSION: Although early CI may yield better auditory performance, the final diagnosis should be made only after repeated subjective and objective measurements as well as family feedback on the child's auditory performance, especially in preterm children. Early auditory brainstem response (ABR) prior to the age of one year in children with cognitive, neurologic, or developmental comorbidities should be interpreted with caution, as ABR "alone" could not accurately represent the child's true hearing ability in this patient population.
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Implante Coclear , Implantes Cocleares , Surdez , Perda Auditiva Neurossensorial , Perda Auditiva , Criança , Lactente , Recém-Nascido , Humanos , Perda Auditiva/diagnóstico , Perda Auditiva/cirurgia , Surdez/cirurgia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/cirurgiaRESUMO
PURPOSE: Cochlear implantation is a standard approach to hearing rehabilitation and encompasses three main stages: appropriate patient selection, a challenging surgical procedure, which should be as atraumatic as possible and preserve cochlear structures, and lifelong postoperative follow-up. Computed tomography (CT) is performed to assess postoperative implant position. The Siemens Advanced Radar Target Identification System (ARTIS) Pheno provides fluoroscopic imaging during surgery and has so far been mainly used by cardiologists, neurosurgeons and trauma surgeons. METHODS: Six patients with difficult anatomy or a challenging medical history were selected for a surgical procedure, during which we planned to use the ARTIS Pheno to accurately position and assess implant position under fluoroscopy during and immediately after surgery. In all six cases, the ARTIS Pheno was used directly in the surgical setting. The procedures were performed in cooperation with the neuroradiology department in an interdisciplinary manner. RESULTS: In all six patients, fluoroscopy was used to visualise the procedure at different stages of surgery. In five patients, the procedure was successfully completed. This approach allowed us to finally assess implant position and confirm the correct and complete insertion of the electrode while the patient was still under anaesthesia. CONCLUSION: These cases showed positive surgical outcomes. Although the procedure is more complex than a standard approach, patients can be managed in a safe, effective and appropriate manner. The assessment of implant position in real time during surgery leads to greater patient and surgeon satisfaction. The approach presented here ensures a high quality of cochlear implant surgery even in difficult surgical situations and meets the requirements of modern surgery.
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Implante Coclear , Tomografia Computadorizada por Raios X , Humanos , Implante Coclear/métodos , Masculino , Feminino , Fluoroscopia/métodos , Pessoa de Meia-Idade , Idoso , Implantes Cocleares , Adulto , Cirurgia Assistida por Computador/métodosRESUMO
PURPOSE: The analysis of different language domains and exploration of variables that affect the outcomes of cochlear implantation would help to document the efficacy of cochlear implantation and intervention programs. The aim of this work was to examine the language profile of children with Cochlear Implants (CI) and to assess the effect of age at the time of cochlear implantation and the impact of duration of rehabilitation on the development of linguistic abilities for cochlear implanted children. METHODS: The study was conducted on 46 Arabic speaking children using unilateral CI who are receiving regular post-cochlear auditory and language rehabilitation in the phoniatrics unit, Kasr Alaini hospital. A Proficient Preschooler Language Evaluation (APPEL TOOL) was applied for the assessment of different language domains. RESULTS: Children who received post implant rehabilitation for ≥ 2 years showed significant improvement in all subtests' scores of APPEL tool than children who received same rehabilitation for ≤ 1 year. There was no significant difference of language scores between children who have received CI before age of 3 years and those who have been implanted after age of 3 years. CONCLUSION: This study showed that the language profile of CI children was beneficially affected by the longer duration of therapy post implantation.