Remote programming of cochlear implants in users of all ages.

BACKGROUND: Remote programming for adult cochlear implant (CI) users is feasible, safe, and effective. Limited evidence, however, exists on if remote CI programming can also be productively done with paediatric CI users. AIMS/OBJECTIVES: To assess the safety and feasibility of remote CI programming in CI users for all ages. MATERIALS AND METHODS: Forty-six (25 children, 21 adults) experienced CI users were fit locally and remotely. The results of these two fitting sessions were compared in terms of safety, Impedance Field Telemetry (IFT), Maximum Comfortable Levels (MCL), Threshold Levels (THR), audiometry, fitting duration, and speech understanding. RESULTS: The subjects' safety was not compromised during any of the fitting procedures. No significant difference was found for IFT, MCL, THR, audiometry, or speech understanding for either remote or local fitting. Remote fittings took slightly longer than local fittings when only the fitting time itself was measured. CONCLUSIONS AND SIGNIFICANCE: Remote follow-up fitting is as safe, feasible, and effective as local fitting for CI users of all ages. A more extensive adoption of remote fitting may allow many CI users greater access to clinics and therefore increased benefit from CI use.

Effects of a dexamethasone-releasing implant on cochleae: A functional, morphological and pharmacokinetic study.

AIM: This study evaluated the impact of a dexamethasone-releasing silicone implant on hearing function preservation, cochlear morphology and perilymph pharmacokinetics after cochlear implantation. METHODS: Guinea pigs were implanted unilaterally with silicone rods containing either 2% dexamethasone (DEXA group, n = 18) or no dexamethasone (control group, n = 17). Auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs) were measured preoperatively and over 6 months postoperatively. Cochlear histology using standard hematoxylin and eosin (H&E) staining and tumor necrosis factor (TNF)-alpha staining was performed 1 month postoperatively. Twenty-two guinea pigs were involved in the pharmacokinetic study, and real-time drug concentrations in perilymph were investigated using high-performance liquid chromatography (HPLC). The Mann-Whitney U test (1-tailed) was used for statistical analyses. RESULTS: ABR and DPOAE testing demonstrated decreased hearing function immediately postoperatively followed by a progressive hearing loss within the first day postoperatively. There was almost no observable hearing improvement in the control group from 1 week to 6 months postoperatively, but hearing levels in the DEXA group improved gradually from 1 week to 12 weeks. Hearing loss in the DEXA and control group was 5.0 ± 3.4 dB and 21.7 ± 5.3 dB, respectively at a 16-kHz stimulus frequency 6 months postoperatively. The difference in threshold shifts was present throughout all measured frequencies, and it was significant at 4-24 kHz. The morphological study revealed new fibrosis formation in the scala tympani, which encapsulated the implanted electrode. TNF-alpha positive staining in the cochleae of the DEXA group was less evident than the control group. The pharmacokinetic study revealed a peak perilymph concentration 30 min postoperatively and sustained dexamethasone release at least 1 week postoperatively. CONCLUSION: Cochlear implants that incorporate dexamethasone can release drug chronically in the inner ear and induce significant long-term recovery and preservation of auditory function after implantation.