ABSTRACT
OBJECTIVES: To review a patient series of 16 cochlear implantations performed under local anaesthetic (LA), including a description of the centre's technique for this procedure. We also describe the application of a method for calculation of the potential morbidity/mortality avoided by using this technique. METHODS: Chart review of 16 patients' pre-operative medical and anaesthetic notes and calculation of predicted individual P-POSSUM Scores for operative morbidity/mortality. RESULTS: All 16 patients were implanted successfully with no significant complications. Age range was 26-92 years, with an average of 68 years. The patients' average predicted mortality score associated with a general anaesthetic (GA) was 8.6% and morbidity score was 58%. CONCLUSIONS: Our experience shows LA cochlear implantation to be a safe and effective procedure. It has the benefit of avoiding the operative mortality risk predicted by P-POSSUM Scores. Cochlear implantation is known to significantly improve quality of life for users. Our findings suggest a potential group of cochlear implant recipients considered 'unfit' for GA may be being denied access to this intervention or being exposed to additional risk.
Subject(s)
Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Cochlear Implantation/methods , Hearing Loss, Sensorineural/surgery , Patient Safety , Adult , Aged , Aged, 80 and over , Cochlear Implantation/mortality , Cochlear Implants , Cohort Studies , Female , Follow-Up Studies , Hearing Loss, Sensorineural/mortality , Humans , Male , Middle Aged , Preoperative Care/methods , Retrospective Studies , Risk Assessment , Survival Rate , Treatment OutcomeABSTRACT
HYPOTHESIS: Auditory perception and speech discrimination among pediatric cochlear implantees may vary because of underlying deafness etiology, including connexin 26 (GJB2) gene-related deafness. BACKGROUND: Preliminary data suggest pathologic changes due to GJB2 mutations do not affect the spiral ganglion cells, which are stimulated by the cochlear implant. The survival of the spiral ganglion cells is believed to be an important determinant of outcome after surgery. Patients with GJB2-related deafness may therefore have enhanced prospects for good speech discrimination after implantation. METHODS: In an observational cohort study, GJB2 mutation analysis was performed using polymerase chain reaction amplification and direct sequencing on 31 prelingually deaf pediatric cochlear implantees, of which there were 30 with nonsyndromic deafness of unknown etiology, and one with keratitis-ichthyosis-deafness syndrome. Speech discrmination was assessed prospectively when they had reached postoperative year 3 using the IOWA Matrix Level B Sentences test and Glendonald Auditory Screening Procedure (GASP), with both patients and assessors blind to GJB2 status. RESULTS: Eleven patients had GJB2-related deafness and 20 patients had GJB2-unrelated deafness. IOWA Matrix scores were higher in patients with GJB2-related deafness but did not reach statistical significance. However, GASP scores were statistically significantly higher in patients with GJB2-related deafness (median word score, 92%; median sentence score, 80%), compared with those of patients with GJB2-unrelated deafness (median word score, 63%; median sentence score, 45%; word score, p = 0.037; sentence score, p = 0.045). Ordinal logistic regression analysis on IOWA Matrix and GASP sentence scores found better statistically significant scores in patients with GJB2-related deafness (p < 0.05) after adjustment for confounding variables. CONCLUSION: Pediatric cochlear implantees with GJB2-related deafness appear to have equal or better speech discrimination compared with a group of prelingually deaf children with deafness of unknown etiology.
Subject(s)
Auditory Perception , Cochlear Implantation , Connexins/genetics , Deafness/genetics , Deafness/therapy , Speech Perception , Child , Child, Preschool , Cohort Studies , Connexin 26 , Humans , Logistic Models , Mutation/genetics , Treatment OutcomeABSTRACT
HYPOTHESIS: Speech intelligibility in children after cochlear implantation may depend on their deafness cause, including connexin 26 (GJB2) gene-related deafness. BACKGROUND: There is significant variability in the degree of intelligibility, or clarity, of children's speech after cochlear implantation. GJB2 gene-related deafness may be a factor, as preliminary data suggest that pathologic changes do not affect the spiral ganglion cells, which are the neural elements stimulated by the implant, thus favoring better results. METHODS: In an observational retrospective cohort study of pediatric cochlear implantees, 38 patients with nonsyndromic deafness of unknown cause and 1 with keratitisichthyosis-deafness syndrome underwent GJB2 mutation analysis using polymerase chain reaction amplification and direct sequencing. The primary outcome measure assessed was Speech Intelligibility Rating score from postoperative Year 1 (n = 39) to Year 5 (n = 17). Educational setting was considered as a secondary outcome measure. Statistical analysis was double-blinded, with patients and assessors of outcome unaware of GJB2 status. RESULTS: Fourteen patients had GJB2-related deafness and 25 had GJB2-unrelated deafness. Comparisons at Year 3 (n = 31) revealed intelligible speech achieved by 9 of 11 with GJB2-related deafness, compared with only 6 of 20 with GJB2-unrelated deafness (p = 0.017). Ordinal logistic regression analysis on Speech Intelligibility Rating scores found statistically significantly better scores in children with GJB2-related deafness (p < 0.05) both before and after adjustment for confounding variables. A larger proportion with GJB2-related deafness also attended mainstream school (p = 0.01). CONCLUSION: In pediatric cochlear implantees, GJB2-related deafness is a predictor of good speech intelligibility.
