Factors influencing rehabilitation effect in prelingually deafened late-implanted cochlear implant users, and the construction of a nomogram.

OBJECTIVES: Our study aimed to identify potential factors that may influence rehabilitation outcomes in late-implanted adolescents and adults with prelingual deafness and to construct a user-friendly nomogram. DESIGN: This cross-sectional study included 120 subjects under 30 years of age who had received cochlear implantation at a single medical centre. The Categories of Auditory Performance (CAP) scale was used to evaluate the rehabilitation outcomes. A nomogram was constructed by using the R and EmpowerStats software. RESULTS: Univariate analysis indicated higher rates of auditory performance improvement in younger aged subjects. Residual hearing and regular implant use were more frequently seen among subjects with auditory performance improvement. Multivariate analysis identified residual hearing (Hazard Ratio, 6.11; 95% Confidence Interval, 1.83-20.41; p < .01), age group (Hazard Ratio, 0.31; 95% Confidence Interval, 0.14-0.83; p = .02) and regular CI use (Hazard Ratio, 7.79; 95% Confidence Interval, 2.50-24.20; p < .01) as independent predictors for auditory performance improvement. The nomogram's predictive performance was satisfactory as shown by the calibration curve and receiver operating characteristic (ROC) curve. CONCLUSIONS: Factors such as residual hearing, younger age and regular CI use are associated with auditory performance improvement in this cochlear implant user population. The nomogram model also demonstrates a satisfactory predictive performance.

The use of the MUSS and the SIR scale in late-implanted prelingually deafened adolescents and adults as a subjective evaluation.

Background: The SIR scale has been widely used to measure speech improvement in late-implanted prelingually deafened adolescents and adults. However the ceiling effect of the SIR scale may lead to the loss of some information.Aim/objectives: To evaluate the oral ability of late-implanted prelingually deafened adolescents and adults using the MUSS and SIR scale and to analyse the relationship between the SIR score and the MUSS score.Material and methods: Ninety-four prelingually deafened adolescents and adults who had received cochlear implants were investigated. The MUSS and SIR scale were used to evaluate oral ability.Results: The relationship between the duration of implant use and the MUSS score was significantly different. No significant differences were found among the groups for age at implantation, gender and side of cochlear implantation. The total score on the MUSS was positively correlated with the SIR score.Conclusions and significance: The MUSS and the SIR scale could be used to evaluate the oral ability of late implanted patients. The SIR scale could be used to perform a rapid assessment and the MUSS could help provide more information. The combination of the two scales could be used to evaluate vocal ability more accurately and effectively.

Interaction of tinnitus suppression and hearing ability after cochlear implantation.

OBJECTIVES: To study the postoperative impact of cochlear implants (CIs) on tinnitus, as well as the impact of tinnitus on speech recognition with CI switched on. METHODS: Fifty-two postlingual deafened CI recipients (21 males and 31 females) were assessed using an established Tinnitus Characteristics Questionnaire and Tinnitus Handicap Inventory (THI) before and after cochlear implantation. The tinnitus loudness was investigated when CI was switched on and off in CI recipients with persistent tinnitus. The relation between tinnitus loudness and recipients' satisfaction of cochlear implantation was analyzed by the visual analogue scale (VAS) score. RESULTS: With CI 'OFF', 42 CI recipients experienced tinnitus postimplant ipsilaterally and 44 contralaterally. Tinnitus was totally suppressed ipsilateral to the CI with CI 'ON' in 42.9%, partially suppressed in 42.9%, unchanged in 11.9% and aggravated in 2.4%. Tinnitus was totally suppressed contralaterally with CI 'ON' in 31.8% of CI recipients, partially suppressed in 47.7%, unchanged in 20.5%. Pearson correlation analysis showed that tinnitus loudness and the results of cochlear implant patients satisfaction was negatively correlated (r = .674, p < .001). CONCLUSION: The study suggests six-month CI activation can be effective for suppressing tinnitus. The tinnitus loudness may affect patients' satisfaction with the use of CI.

Determination of benefits of cochlear implantation in children with auditory neuropathy.

BACKGROUND: Auditory neuropathy (AN) is a recently recognized hearing disorder characterized by intact outer hair cell function, disrupted auditory nerve synchronization and poor speech perception and recognition. Cochlear implants (CIs) are currently the most promising intervention for improving hearing and speech in individuals with AN. Although previous studies have shown optimistic results, there was large variability concerning benefits of CIs among individuals with AN. The data indicate that different criteria are needed to evaluate the benefit of CIs in these children compared to those with sensorineural hearing loss. We hypothesized that a hierarchic assessment would be more appropriate to evaluate the benefits of cochlear implantation in AN individuals. METHODS: Eight prelingual children with AN who received unilateral CIs were included in this study. Hearing sensitivity and speech recognition were evaluated pre- and postoperatively within each subject. The efficacy of cochlear implantation was assessed using a stepwise hierarchic evaluation for achieving: (1) effective audibility, (2) improved speech recognition, (3) effective speech, and (4) effective communication. RESULTS: The postoperative hearing and speech performance varied among the subjects. According to the hierarchic assessment, all eight subjects approached the primary level of effective audibility, with an average implanted hearing threshold of 43.8 ± 10.2 dB HL. Five subjects (62.5%) attained the level of improved speech recognition, one (12.5%) reached the level of effective speech, and none of the subjects (0.0%) achieved effective communication. CONCLUSION: CIs benefit prelingual children with AN to varying extents. A hierarchic evaluation provides a more suitable method to determine the benefits that AN individuals will likely receive from cochlear implantation.

[Effect of cochlear implantation on bilateral perceived tinnitus of postlingually deafened patients].

OBJECTIVE: The aim of the study was to evaluate the effects of cochlear implantation on bilateral perceived tinnitus of postlingually deafened patients. METHOD: Total of 32 postlingually deafened cochlear implant recipients (13 males, 19 females; 31 unilateral,1 bilateral cochlear implantation) with bilateral tinnitus were assessed by Tinnitus Handicap Inventory (THI) before and after implantation. Furthermore, characteristics information of tinnitus were recorded to analyze the variety of tinnitus. Intensity of tinnitus in ispilateral and contralateral ears was investigated when cochlear implant was switched on and off. Statistical analysis was performed by SPSS 18.0. RESULTS: Twenty-two patients (71.0%) got a decreased THI score of more than 20 points after the operation. The average THI score of pre-operation was 56.4±18.1, and post-operation score was 24.7±22.7. A paired-samples t test analysis showed a significant difference of the THI total scores (t=8.037, P<0.05). Tinnitus in the ipsilateral ear improved in 81.9% (27/33) patients and 18.2% (6/33) unchanged. Tinnitus in the contralateral ear improved in 71.0% (22/31) patients, 16.1% (5/31) unchanged and 12.9% (4/31) worsen. Tinnitus of ipsilateral ears improved or abolished in 97.0% (32/33) patients, while 83.9% (26/31) of contralateral ear got reduction or absence of loudness when cochlear implant was switched on. CONCLUSIONS: As an electrical stimulation treatment method, cochlear implant has the inhibitory effect on tinnitus. However, cases of tinnitus aggravation were found, further data is still necessary before considering CI as a treatment of tinnitus.

One-stage coclear implantation via a facial recess approach in children with otitis media with effusion.

OBJECTIVE: To investigate surgical indications, operative techniques, complications and auditory and speech rehabilitation for cochlear implant (CI) in children with otitis media with effusion (OME). MATERIAL AND METHODS: This is a retrospective review of records of 24children with bilateral profound sensorineural hearing loss and OME who were implanted during January 2011 to November 2014 in the Department of Otorhinolaryngology and Head and Neck Surgery at the PLA Hospital, using one-stage implantation via the facial recess approach and round window insertion. The incus was removed in 8 cases during the implantation procedure. Local infiltration of dexamethasone and adrenaline in the middle ear was also performed. Postoperative complications were examined. Preoperative and postoperative questionnaires including Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and the Meaningful Auditory Integration Scale (MAIS) were collected. RESULTS: All electrodes were implanted successfully without any immediate or delayed complications. Inflammatory changes of middle ear mucosa with effusion were noted in all implanted ears. The scores of post-implant CAP and SIR increased significantly in all 24 cases (t = -25.95 and -14.09, respectively for CAP and SIR, p < 0.05). CONCLUSIONS: One-stage CI via the facial recess approach with round window insertion is safe and effective in cochlear implant candidates with OME, as seen in the 24 children in our study who achieved improved auditory performance and speech intelligibility after CI.

Vibrant Soundbridge implantation via the third window in two Chinese patients with severe bilateral congenital aural atresia.

CONCLUSION: In patients with undeveloped vestibular/oval windows and inaccessible round windows, Vibrant Soundbridge (VSB) implantation performed by placing the transducer into a reconstructed window on the inner tympanum wall demonstrated significant improvement in hearing and verbal communication ability. OBJECTIVE: To report our surgical experience with new placement of the VSB in pediatric patients with undeveloped vestibular windows, inaccessible round windows, and severe bilateral congenital aural atresia (CAA). METHODS: In two patients with bilateral CAA selected for middle ear implantation, CT scans revealed severe middle ear malformation including inaccessible round windows, absence of vestibular/oval windows, and abnormal facial nerve anatomy. The transducer of the VSB was implanted into a 'window' drilled at the inner tympanum wall in both patients. RESULTS: The surgery was successful. Pure-tone air conduction thresholds across the frequencies of 0.25-8 Hz were improved by 35 dB (preoperation, 69.2 dB; postactivation, 34 dB) in patient 1 and 46.6 dB (preoperation, 75.8 dB; postactivation, 24.2 dB) in patient 2. Normal hearing thresholds were achieved in the range of 1-8 kHz in both patients. A sentence recognition rate of up to 100% (65 dB SPL in a quiet room) was attained by both patients after surgery and VSB activation at 3 months postoperatively.

NRT test in auditory neuropathy patients with cochlear implants.

CONCLUSION: In patients with auditory neuropathy (AN), waveforms of neural response telemetry (NRT) could be present, showing characteristics of low incidence, low differentiation, and large variation. OBJECTIVE: To study the characteristics of NRT in AN patients who had received cochlear implants (CIs). METHODS: NRT data for seven AN patients who had received Nucleus CIs were retrospectively analyzed. Twenty-one CI implantees with sensorineural hearing loss (SNHL) were included as the control group. The incidence of electrically evoked compound action potentials (ECAPs), threshold of wave N1, and amplitude of N1-P2 in the AN group were analyzed and compared between groups. RESULTS: The intraoperative incidence of valid ECAPs in the AN group was 42.9%, and the postoperative incidence was 66.7%, both of which were lower than those in the SNHL group, which were 95.2% and 100%, respectively. NRT in the AN group showed larger variation and lower differentiation than in the SNHL group. Wilcoxon's non-parametric test results indicated no significant difference between AN and SNHL groups in either the threshold of ECAP or N1-P2 amplitude.