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1.
JASA Express Lett ; 4(5)2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38717468

RESUMEN

This study evaluated whether adaptive training with time-compressed speech produces an age-dependent improvement in speech recognition in 14 adult cochlear-implant users. The protocol consisted of a pretest, 5 h of training, and a posttest using time-compressed speech and an adaptive procedure. There were significant improvements in time-compressed speech recognition at the posttest session following training (>5% in the average time-compressed speech recognition threshold) but no effects of age. These results are promising for the use of adaptive training in aural rehabilitation strategies for cochlear-implant users across the adult lifespan and possibly using speech signals, such as time-compressed speech, to train temporal processing.


Asunto(s)
Implantes Cocleares , Percepción del Habla , Humanos , Percepción del Habla/fisiología , Anciano , Masculino , Persona de Mediana Edad , Femenino , Adulto , Anciano de 80 o más Años , Implantación Coclear/métodos , Factores de Tiempo
2.
J Acoust Soc Am ; 155(5): 3101-3117, 2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38722101

RESUMEN

Cochlear implant (CI) users often report being unsatisfied by music listening through their hearing device. Vibrotactile stimulation could help alleviate those challenges. Previous research has shown that musical stimuli was given higher preference ratings by normal-hearing listeners when concurrent vibrotactile stimulation was congruent in intensity and timing with the corresponding auditory signal compared to incongruent. However, it is not known whether this is also the case for CI users. Therefore, in this experiment, we presented 18 CI users and 24 normal-hearing listeners with five melodies and five different audio-to-tactile maps. Each map varied the congruence between the audio and tactile signals related to intensity, fundamental frequency, and timing. Participants were asked to rate the maps from zero to 100, based on preference. It was shown that almost all normal-hearing listeners, as well as a subset of the CI users, preferred tactile stimulation, which was congruent with the audio in intensity and timing. However, many CI users had no difference in preference between timing aligned and timing unaligned stimuli. The results provide evidence that vibrotactile music enjoyment enhancement could be a solution for some CI users; however, more research is needed to understand which CI users can benefit from it most.


Asunto(s)
Estimulación Acústica , Percepción Auditiva , Implantes Cocleares , Música , Humanos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Anciano , Percepción Auditiva/fisiología , Adulto Joven , Prioridad del Paciente , Implantación Coclear/instrumentación , Percepción del Tacto/fisiología , Vibración , Tacto
3.
JASA Express Lett ; 4(5)2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38727569

RESUMEN

Bimodal stimulation, a cochlear implant (CI) in one ear and a hearing aid (HA) in the other, provides highly asymmetrical inputs. To understand how asymmetry affects perception and memory, forward and backward digit spans were measured in nine bimodal listeners. Spans were unchanged from monotic to diotic presentation; there was an average two-digit decrease for dichotic presentation with some extreme cases of decreases to zero spans. Interaurally asymmetrical decreases were not predicted based on the device or better-functioning ear. Therefore, bimodal listeners can demonstrate a strong ear dominance, diminishing memory recall dichotically even when perception was intact monaurally.


Asunto(s)
Implantes Cocleares , Humanos , Persona de Mediana Edad , Anciano , Masculino , Femenino , Pruebas de Audición Dicótica , Adulto , Percepción Auditiva/fisiología , Audífonos
5.
J Clin Ethics ; 35(2): 101-106, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38728696

RESUMEN

AbstractCochlear implants can restore hearing in people with severe hearing loss and have a significant impact on communication, social integration, self-esteem, and quality of life. However, whether and how much clinical benefit is derived from cochlear implants varies significantly by patient and is influenced by the etiology and extent of hearing loss, medical comorbidities, and preexisting behavioral and psychosocial issues. In patients with underlying psychosis, concerns have been raised that the introduction of auditory stimuli could trigger hallucinations, worsen existing delusions, or exacerbate erratic behavior. This concern has made psychosis a relative contraindication to cochlear implant surgery. This is problematic because there is a lack of data describing this phenomenon and because the psychosocial benefits derived from improvement in auditory function may be a critical intervention for treating psychosis in some patients. The objective of this report is to provide an ethical framework for guiding clinical decision-making on cochlear implant surgery in the hearing impaired with psychosis.


Asunto(s)
Implantación Coclear , Trastornos Psicóticos , Humanos , Trastornos Psicóticos/complicaciones , Pérdida Auditiva/cirugía , Implantes Cocleares , Calidad de Vida , Comorbilidad , Toma de Decisiones/ética , Toma de Decisiones Clínicas/ética , Ética Médica
6.
Trends Hear ; 28: 23312165241252240, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38715410

RESUMEN

In recent years, tools for early detection of irreversible trauma to the basilar membrane during hearing preservation cochlear implant (CI) surgery were established in several clinics. A link with the degree of postoperative hearing preservation in patients was investigated, but patient populations were usually small. Therefore, this study's aim was to analyze data from intraoperative extracochlear electrocochleography (ECochG) recordings for a larger group.During hearing preservation CI surgery, extracochlear recordings were made before, during, and after CI electrode insertion using a cotton wick electrode placed at the promontory. Before and after insertion, amplitudes and stimulus response thresholds were recorded at 250, 500, and 1000 Hz. During insertion, response amplitudes were recorded at one frequency and one stimulus level. Data from 121 patient ears were analyzed.The key benefit of extracochlear recordings is that they can be performed before, during, and after CI electrode insertion. However, extracochlear ECochG threshold changes before and after CI insertion were relatively small and did not independently correlate well with hearing preservation, although at 250 Hz they added some significant information. Some tendencies-although no significant relationships-were detected between amplitude behavior and hearing preservation. Rising amplitudes seem favorable and falling amplitudes disadvantageous, but constant amplitudes do not appear to allow stringent predictions.Extracochlear ECochG measurements seem to only partially realize expected benefits. The questions now are: do gains justify the effort, and do other procedures or possible combinations lead to greater benefits for patients?


Asunto(s)
Audiometría de Respuesta Evocada , Umbral Auditivo , Cóclea , Implantación Coclear , Implantes Cocleares , Audición , Humanos , Audiometría de Respuesta Evocada/métodos , Estudios Retrospectivos , Implantación Coclear/instrumentación , Femenino , Persona de Mediana Edad , Masculino , Anciano , Adulto , Audición/fisiología , Cóclea/cirugía , Cóclea/fisiopatología , Resultado del Tratamiento , Adolescente , Valor Predictivo de las Pruebas , Adulto Joven , Niño , Audiometría de Tonos Puros , Anciano de 80 o más Años , Preescolar , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/fisiopatología , Pérdida Auditiva/cirugía , Pérdida Auditiva/rehabilitación
7.
Trends Hear ; 28: 23312165241248973, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38717441

RESUMEN

To preserve residual hearing during cochlear implant (CI) surgery it is desirable to use intraoperative monitoring of inner ear function (cochlear monitoring). A promising method is electrocochleography (ECochG). Within this project the relations between intracochlear ECochG recordings, position of the recording contact in the cochlea with respect to anatomy and frequency and preservation of residual hearing were investigated. The aim was to better understand the changes in ECochG signals and whether these are due to the electrode position in the cochlea or to trauma generated during insertion. During and after insertion of hearing preservation electrodes, intraoperative ECochG recordings were performed using the CI electrode (MED-EL). During insertion, the recordings were performed at discrete insertion steps on electrode contact 1. After insertion as well as postoperatively the recordings were performed at different electrode contacts. The electrode location in the cochlea during insertion was estimated by mathematical models using preoperative clinical imaging, the postoperative location was measured using postoperative clinical imaging. The recordings were analyzed from six adult CI recipients. In the four patients with good residual hearing in the low frequencies the signal amplitude rose with largest amplitudes being recorded closest to the generators of the stimulation frequency, while in both cases with severe pantonal hearing losses the amplitude initially rose and then dropped. This might be due to various reasons as discussed in the following. Our results indicate that this approach can provide valuable information for the interpretation of intracochlearly recorded ECochG signals.


Asunto(s)
Audiometría de Respuesta Evocada , Cóclea , Implantación Coclear , Implantes Cocleares , Humanos , Cóclea/cirugía , Cóclea/fisiología , Cóclea/fisiopatología , Implantación Coclear/instrumentación , Implantación Coclear/métodos , Audiometría de Respuesta Evocada/métodos , Persona de Mediana Edad , Anciano , Masculino , Femenino , Audición/fisiología , Adulto , Resultado del Tratamiento , Valor Predictivo de las Pruebas , Estimulación Eléctrica , Personas con Deficiencia Auditiva/rehabilitación , Personas con Deficiencia Auditiva/psicología , Umbral Auditivo/fisiología
8.
Hear Res ; 447: 109011, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38692015

RESUMEN

This study introduces and evaluates the PHAST+ model, part of a computational framework designed to simulate the behavior of auditory nerve fibers in response to the electrical stimulation from a cochlear implant. PHAST+ incorporates a highly efficient method for calculating accommodation and adaptation, making it particularly suited for simulations over extended stimulus durations. The proposed method uses a leaky integrator inspired by classic biophysical nerve models. Through evaluation against single-fiber animal data, our findings demonstrate the model's effectiveness across various stimuli, including short pulse trains with variable amplitudes and rates. Notably, the PHAST+ model performs better than its predecessor, PHAST (a phenomenological model by van Gendt et al.), particularly in simulations of prolonged neural responses. While PHAST+ is optimized primarily on spike rate decay, it shows good behavior on several other neural measures, such as vector strength and degree of adaptation. The future implications of this research are promising. PHAST+ drastically reduces the computational burden to allow the real-time simulation of neural behavior over extended periods, opening the door to future simulations of psychophysical experiments and multi-electrode stimuli for evaluating novel speech-coding strategies for cochlear implants.


Asunto(s)
Potenciales de Acción , Adaptación Fisiológica , Implantes Cocleares , Nervio Coclear , Simulación por Computador , Estimulación Eléctrica , Modelos Neurológicos , Nervio Coclear/fisiología , Animales , Humanos , Factores de Tiempo , Implantación Coclear/instrumentación , Biofisica , Estimulación Acústica
9.
Hear Res ; 447: 109027, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38723386

RESUMEN

Despite that fact that the cochlear implant (CI) is one of the most successful neuro-prosthetic devices which allows hearing restoration, several aspects still need to be improved. Interactions between stimulating electrodes through current spread occurring within the cochlea drastically limit the number of discriminable frequency channels and thus can ultimately result in poor speech perception. One potential solution relies on the use of new pulse shapes, such as asymmetric pulses, which can potentially reduce the current spread within the cochlea. The present study characterized the impact of changing electrical pulse shapes from the standard biphasic symmetric to the asymmetrical shape by quantifying the evoked firing rate and the spatial activation in the guinea pig primary auditory cortex (A1). At a fixed charge, the firing rate and the spatial activation in A1 decreased by 15 to 25 % when asymmetric pulses were used to activate the auditory nerve fibers, suggesting a potential reduction of the spread of excitation inside the cochlea. A strong "polarity-order" effect was found as the reduction was more pronounced when the first phase of the pulse was cathodic with high amplitude. These results suggest that the use of asymmetrical pulse shapes in clinical settings can potentially reduce the channel interactions in CI users.


Asunto(s)
Corteza Auditiva , Implantes Cocleares , Estimulación Eléctrica , Animales , Cobayas , Corteza Auditiva/fisiología , Potenciales Evocados Auditivos , Nervio Coclear/fisiopatología , Estimulación Acústica , Cóclea/cirugía , Implantación Coclear/instrumentación , Potenciales de Acción , Femenino
10.
Hear Res ; 447: 109023, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38733710

RESUMEN

Limited auditory input, whether caused by hearing loss or by electrical stimulation through a cochlear implant (CI), can be compensated by the remaining senses. Specifically for CI users, previous studies reported not only improved visual skills, but also altered cortical processing of unisensory visual and auditory stimuli. However, in multisensory scenarios, it is still unclear how auditory deprivation (before implantation) and electrical hearing experience (after implantation) affect cortical audiovisual speech processing. Here, we present a prospective longitudinal electroencephalography (EEG) study which systematically examined the deprivation- and CI-induced alterations of cortical processing of audiovisual words by comparing event-related potentials (ERPs) in postlingually deafened CI users before and after implantation (five weeks and six months of CI use). A group of matched normal-hearing (NH) listeners served as controls. The participants performed a word-identification task with congruent and incongruent audiovisual words, focusing their attention on either the visual (lip movement) or the auditory speech signal. This allowed us to study the (top-down) attention effect on the (bottom-up) sensory cortical processing of audiovisual speech. When compared to the NH listeners, the CI candidates (before implantation) and the CI users (after implantation) exhibited enhanced lipreading abilities and an altered cortical response at the N1 latency range (90-150 ms) that was characterized by a decreased theta oscillation power (4-8 Hz) and a smaller amplitude in the auditory cortex. After implantation, however, the auditory-cortex response gradually increased and developed a stronger intra-modal connectivity. Nevertheless, task efficiency and activation in the visual cortex was significantly modulated in both groups by focusing attention on the visual as compared to the auditory speech signal, with the NH listeners additionally showing an attention-dependent decrease in beta oscillation power (13-30 Hz). In sum, these results suggest remarkable deprivation effects on audiovisual speech processing in the auditory cortex, which partially reverse after implantation. Although even experienced CI users still show distinct audiovisual speech processing compared to NH listeners, pronounced effects of (top-down) direction of attention on (bottom-up) audiovisual processing can be observed in both groups. However, NH listeners but not CI users appear to show enhanced allocation of cognitive resources in visually as compared to auditory attended audiovisual speech conditions, which supports our behavioural observations of poorer lipreading abilities and reduced visual influence on audition in NH listeners as compared to CI users.


Asunto(s)
Estimulación Acústica , Atención , Implantación Coclear , Implantes Cocleares , Sordera , Electroencefalografía , Personas con Deficiencia Auditiva , Estimulación Luminosa , Percepción del Habla , Humanos , Masculino , Femenino , Persona de Mediana Edad , Implantación Coclear/instrumentación , Adulto , Estudios Prospectivos , Estudios Longitudinales , Personas con Deficiencia Auditiva/psicología , Personas con Deficiencia Auditiva/rehabilitación , Sordera/fisiopatología , Sordera/rehabilitación , Sordera/psicología , Estudios de Casos y Controles , Anciano , Percepción Visual , Lectura de los Labios , Factores de Tiempo , Audición , Potenciales Evocados Auditivos , Corteza Auditiva/fisiopatología , Potenciales Evocados
11.
Hear Res ; 447: 109024, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38735179

RESUMEN

Delayed loss of residual acoustic hearing after cochlear implantation is a common but poorly understood phenomenon due to the scarcity of relevant temporal bone tissues. Prior histopathological analysis of one case of post-implantation hearing loss suggested there were no interaural differences in hair cell or neural degeneration to explain the profound loss of low-frequency hearing on the implanted side (Quesnel et al., 2016) and attributed the threshold elevation to neo-ossification and fibrosis around the implant. Here we re-evaluated the histopathology in this case, applying immunostaining and improved microscopic techniques for differentiating surviving hair cells from supporting cells. The new analysis revealed dramatic interaural differences, with a > 80 % loss of inner hair cells in the cochlear apex on the implanted side, which can account for the post-implantation loss of residual hearing. Apical degeneration of the stria further contributed to threshold elevation on the implanted side. In contrast, spiral ganglion cell survival was reduced in the region of the electrode on the implanted side, but apical counts in the two ears were similar to that seen in age-matched unimplanted control ears. Almost none of the surviving auditory neurons retained peripheral axons throughout the basal half of the cochlea. Relevance to cochlear implant performance is discussed.


Asunto(s)
Umbral Auditivo , Implantación Coclear , Implantes Cocleares , Ganglio Espiral de la Cóclea , Implantación Coclear/instrumentación , Implantación Coclear/efectos adversos , Humanos , Ganglio Espiral de la Cóclea/patología , Ganglio Espiral de la Cóclea/fisiopatología , Células Ciliadas Auditivas Internas/patología , Factores de Tiempo , Supervivencia Celular , Masculino , Audición , Pérdida Auditiva/fisiopatología , Pérdida Auditiva/patología , Pérdida Auditiva/cirugía , Pérdida Auditiva/etiología , Femenino , Células Ciliadas Auditivas/patología , Anciano , Degeneración Nerviosa , Persona de Mediana Edad , Hueso Temporal/patología , Hueso Temporal/cirugía
12.
Otol Neurotol ; 45(5): 529-535, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38693093

RESUMEN

OBJECTIVE: We assessed three cochlear implant (CI) suppliers: Advanced Bionics, Cochlear Limited, and MED-EL, for implant revision requiring reoperation after CI placement. STUDY DESIGN: Retrospective cohort study of integrated-health-system database between 2010 and 2021. Separate models were created for pediatric (age <18) and adult (age ≥18) cohorts. PATIENTS: Pediatric (age <18) and adult (age ≥18) patients undergoing cochlear implantation within our integrated healthcare system. MAIN OUTCOME MEASURE: Revision after CI placement. Cox proportional hazard regression was used to evaluate revision risk and adjust for confounding factors. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented. RESULTS: A total of 2,347 patients underwent a primary CI placement, and Cochlear Limited was most implanted (51.5%), followed by Advanced Bionics (35.2%) and MED-EL (13.3%). In the pediatric cohort, the 7-year crude revision rate was 10.9% for Advanced Bionics and 4.8% for Cochlear Limited, whereas MED-EL had insufficient cases. In adults, the rates were 9.1%, 4.5%, and 3.3% for Advanced Bionics, MED-EL, and Cochlear Limited, respectively. After 2 years of postoperative follow-up, Advanced Bionics had a significantly higher revision risk (HR = 8.25, 95% CI = 2.91-23.46); MED-EL had no difference (HR = 2.07, 95% CI = 0.46-9.25). CONCLUSION: We found an increased revision risk after 2 years of follow-up for adults with Advanced Bionics CI devices. Although we found no statistical difference between manufacturers in the pediatric cohort, after 2 years of follow-up, there were increasing trends in the revision probability for Advanced Bionics. Further research may determine whether patients are better suited for some CI devices.


Asunto(s)
Implantación Coclear , Implantes Cocleares , Prestación Integrada de Atención de Salud , Reoperación , Humanos , Implantes Cocleares/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Femenino , Niño , Adulto , Implantación Coclear/estadística & datos numéricos , Implantación Coclear/tendencias , Adolescente , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Persona de Mediana Edad , Preescolar , Adulto Joven , Anciano , Lactante , Estudios de Cohortes
14.
Int J Pediatr Otorhinolaryngol ; 180: 111968, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38714045

RESUMEN

AIM & OBJECTIVES: The study aimed to compare P1 latency and P1-N1 amplitude with receptive and expressive language ages in children using cochlear implant (CI) in one ear and a hearing aid (HA) in non-implanted ear. METHODS: The study included 30 children, consisting of 18 males and 12 females, aged between 48 and 96 months. The age at which the children received CI ranged from 42 to 69 months. A within-subject research design was utilized and participants were selected through purposive sampling. Auditory late latency responses (ALLR) were assessed using the Intelligent hearing system to measure P1 latency and P1-N1 amplitude. The assessment checklist for speech-language skills (ACSLS) was employed to evaluate receptive and expressive language age. Both assessments were conducted after cochlear implantation. RESULTS: A total of 30 children participated in the study, with a mean implant age of 20.03 months (SD: 8.14 months). The mean P1 latency and P1-N1 amplitude was 129.50 ms (SD: 15.05 ms) and 6.93 µV (SD: 2.24 µV) respectively. Correlation analysis revealed no significant association between ALLR measures and receptive or expressive language ages. However, there was significant negative correlation between the P1 latency and implant age (Spearman's rho = -0.371, p = 0.043). CONCLUSIONS: The study suggests that P1 latency which is an indicative of auditory maturation, may not be a reliable marker for predicting language outcomes. It can be concluded that language development is likely to be influenced by other factors beyond auditory maturation alone.


Asunto(s)
Implantes Cocleares , Desarrollo del Lenguaje , Humanos , Masculino , Femenino , Preescolar , Niño , Implantación Coclear/métodos , Tiempo de Reacción/fisiología , Sordera/cirugía , Sordera/rehabilitación , Potenciales Evocados Auditivos/fisiología , Factores de Edad , Percepción del Habla/fisiología
15.
Otol Neurotol ; 45(5): e393-e399, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38573598

RESUMEN

HYPOTHESIS: Preimplantation word scores cannot reliably predict postimplantation outcomes. BACKGROUND: To date, there is no model based on preoperative data that can reliably predict the postoperative outcomes of cochlear implantation in the postlingually deafened adult patient. METHODS: In a group of 228 patients who received a cochlear implant between 2002 and 2021, we tested the predictive power of nine variables (age, etiology, sex, laterality of implantation, preimplantation thresholds and word scores, as well as the design, insertion approach, and angular insertion depth of the electrode array) on postimplantation outcomes. Results of multivariable linear regression analyses were then interpreted in light of data obtained from histopathological analyses of human temporal bones. RESULTS: Age and etiology were the only significant predictors of postimplantation outcomes. In agreement with many investigations, preimplantation word scores failed to significantly predict postimplantation outcomes. Analysis of temporal bone histopathology suggests that neuronal survival must fall below 40% before word scores in quiet begin to drop. Scores fall steeply with further neurodegeneration, such that only 20% survival can support acoustically driven word scores of 50%. Because almost all cochlear implant implantees have at least 20% of their spiral ganglion neurons (SGNs) surviving, it is expected that most cochlear implant users on average should improve to at least 50% word recognition score, as we observed, even if their preimplantation score was near zero as a result of widespread hair cell damage and the fact that ~50% of their SGNs have likely lost their peripheral axons. These "disconnected" SGNs would not contribute to acoustic hearing but likely remain electrically excitable. CONCLUSION: The relationship between preimplantation word scores and data describing the survival of SGNs in humans can explain why preimplantation word scores obtained in unaided conditions fail to predict postimplantation outcomes.


Asunto(s)
Implantación Coclear , Implantes Cocleares , Sordera , Percepción del Habla , Humanos , Implantación Coclear/métodos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Percepción del Habla/fisiología , Sordera/cirugía , Resultado del Tratamiento , Hueso Temporal/cirugía , Anciano de 80 o más Años , Adulto Joven , Adolescente
16.
Otol Neurotol ; 45(5): e400-e405, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38573599

RESUMEN

OBJECTIVE: To investigate the frequency, treatment, and outcomes of postoperative delayed-onset swelling around cochlear implants. STUDY DESIGN: Retrospective, observational, nonrandomized group study. SETTING: Academic medical center. PATIENTS/INTERVENTIONS: Among 354 patients (516 ears) who underwent cochlear implantation (CI) at our hospital between May 2009 and October 2022, 329 (472 ears: 138 children [246 ears] and 191 adults [226 ears]) with a follow-up period of >3 months were included. MAIN OUTCOME MEASURES: Physical examination and computed tomography of the head were performed. RESULTS: In total, 5.5% (26/472 ears) had a history of delayed-onset swelling around the implant. This complication occurred in 9.8% (24/246 ears) of children and 0.9% (2/226 ears) of adults. The mean time to onset of swelling was 50 (range, 5.5-147) months following CI. In 60% (21/35) of the cases, the cause was unknown, whereas in 25.7% (9/35) and 11.5% (4/35) of cases, it was head trauma and acute inflammation, respectively. Conservative treatment (observation, antibiotics, and/or strong magnetic compression) was adapted in 91.4% (32/35) of cases. After conservative treatment, revision CI surgery was performed in one ear. Additionally, recurrent swelling was observed in 23.1% (6/26 ears) of swelling cases. CONCLUSIONS: The results suggest that delayed-onset swelling around implants occurs more frequently in children than in adults because of the higher incidence rates of head trauma and acute otitis media in children. In most cases, conservative treatment was adequate; however, careful follow-up is necessary. Our findings can serve as a reference for optimizing care and intervention options after CI.


Asunto(s)
Implantación Coclear , Edema , Complicaciones Posoperatorias , Humanos , Implantación Coclear/efectos adversos , Masculino , Niño , Femenino , Preescolar , Estudios Retrospectivos , Adulto , Adolescente , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Persona de Mediana Edad , Lactante , Edema/etiología , Edema/epidemiología , Adulto Joven , Anciano , Resultado del Tratamiento , Implantes Cocleares/efectos adversos , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años
17.
ACS Appl Bio Mater ; 7(5): 3124-3135, 2024 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-38584364

RESUMEN

The durability of photografted zwitterionic hydrogel coatings on cochlear implant biomaterials was examined to determine the viability of these antifouling surfaces during insertion and long-term implant usage. Tribometry was used to determine the effect of zwitterionic coatings on the lubricity of surfaces with varying hydration levels, applied normal force, and time frame. Additionally, flexural resistance was investigated using mandrel bending. Ex vivo durability was assessed by determining the coefficient of friction between tissues and treated surfaces. Furthermore, cochlear implantation force was measured using cadaveric human cochleae. Hydrated zwitterionic hydrogel coatings reduced frictional resistance approximately 20-fold compared to uncoated PDMS, which led to significantly lower mean force experienced by coated cochlear implants during insertion compared to uncoated systems. Under flexural force, zwitterionic films resisted failure for up to 60 min of desiccation. The large increase in lubricity was maintained for 20 h under continual force while hydrated. For loosely cross-linked systems, films remained stable and lubricious even after rehydration following complete drying. All coatings remained hydrated and functional under frictional force for at least 30 min in ambient conditions allowing drying, with lower cross-link densities showing the greatest longevity. Moreover, photografted zwitterionic hydrogel samples showed no evidence of degradation and nearly identical lubricity before and after implantation. This work demonstrates that photografted zwitterionic hydrogel coatings are sufficiently durable to maintain viability before, during, and after implantation. Mechanical properties, including greatly increased lubricity, are preserved after complete drying and rehydration for various applied forces. Additionally, this significantly enhanced lubricity translates to significantly decreased force during insertion of implants which should result in less trauma and scarring.


Asunto(s)
Materiales Biocompatibles Revestidos , Implantes Cocleares , Hidrogeles , Ensayo de Materiales , Hidrogeles/química , Humanos , Materiales Biocompatibles Revestidos/química , Materiales Biocompatibles Revestidos/farmacología , Propiedades de Superficie , Tamaño de la Partícula
19.
Int J Pediatr Otorhinolaryngol ; 180: 111923, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38636180

RESUMEN

OBJECTIVES: Children with cochlear implants exhibit lower phonological awareness and sound discrimination skills compared to their normal-hearing peers. However, music training has been shown to have a positive effect on speech discrimination and awareness skills. METHODS: Our study included 23 cochlear implant users and 23 normal hearing participants aged 5-6 years with language skills. The aim was to observe the effect of a music-integrated phonological awareness program on cochlear implant users and to compare the phonological awareness skills of children with cochlear implants before and after online training with their normal hearing peers. RESULTS: Results showed that the trained study group scored higher on the Scale of Early Childhood Phonological Awareness (PASECP) after training than the control group (p < 0.05). In addition, SMRT scores increased between before and after training in the study group, and Mismatch Negativity (MMN) amplitudes increased and latencies decreased as a result of training (p < 0.05). CONCLUSIONS: The study suggests that phonological awareness training integrated with music can effectively improve the phonological awareness skills of children with cochlear implants and has the potential to enable them to achieve phonological awareness levels similar to or even better than their normal hearing peers.


Asunto(s)
Implantación Coclear , Implantes Cocleares , Percepción del Habla , Humanos , Femenino , Masculino , Preescolar , Niño , Percepción del Habla/fisiología , Concienciación , Estudios de Casos y Controles , Fonética , Musicoterapia/métodos , Sordera/rehabilitación , Sordera/cirugía , Resultado del Tratamiento
20.
Int J Pediatr Otorhinolaryngol ; 180: 111907, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38688185

RESUMEN

OBJECTIVE: Stress levels among caregivers of children with hearing loss could influence caregiver-child interactions and ultimately, children's developmental outcomes. Given the limited understanding of stress levels among caregivers of Australian children with hearing loss, the present study aimed to examine stress in caregivers of 5-year-old children with hearing loss wearing hearing aids or cochlear implants and to identify factors associated with greater stress levels. METHODS: A total of 99 caregivers of 70 hearing aid users and 29 cochlear implant users participated in the study. Caregivers' stress was measured using the 68-item Pediatric Hearing Impairment Caregiver Experience (PHICE) questionnaire that examines caregivers' context-specific stress levels in relation to caring for a child with hearing loss. Factors contributing to stress were identified in relation to eight domains including communication, education, emotional well-being, equipment, financial, healthcare, social, and support. RESULTS: Across domains, the three most common predictors of increased stress were the use of cochlear implants over hearing aids, use of sign and oral language (mixed) over oral language as the communication mode at home, and increased behavioural difficulties of the child. CONCLUSION: Overall, reported stress levels among Australian caregivers were low. Identified factors influencing stress levels can inform service provision improvement.


Asunto(s)
Cuidadores , Implantes Cocleares , Audífonos , Pérdida Auditiva , Estrés Psicológico , Humanos , Preescolar , Femenino , Cuidadores/psicología , Masculino , Australia , Pérdida Auditiva/psicología , Encuestas y Cuestionarios , Adulto
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