Cochlear Implant in Severe Impaired Psychiatric Patients: A Case Series.

OBJECTIVE: Psychotic disorders and intelligence deficiencies are no longer contraindications for cochlear implantation regarding the revised German guidelines from May 2012. This article aims to evaluate the outcome of patients with severe psychiatric comorbidities. Therefore the database of the Cochlear Implant Center of the University Hospital of Heidelberg was investigated. STUDY DESIGN: Retrospective case review. METHODS: We present three patients who received a cochlear implant (CI) despite a serious psychiatric disorder. Two were sent from psychiatrists asking if a CI was possible for their profound hearing loss. One patient had acoustic hallucinations and a recurrent depressive disorder, the other had a schizophrenic psychosis and a minor impairment of intelligence. The third patient had a recurrent depressive disorder, a posttraumatic stress disorder, a chronic pain disorder, and paranoid personality traits. We discuss the preoperative diagnosis, course of diseases, and psychosocial situation. RESULTS: All three patients received a CI and rehabilitation in the Cochlear Implant Center of the University Hospital of Heidelberg. All three of them opted for a second implant and developed a good hearing outcome. Free field understanding of words in quite is for all three of them over 60% in the Freiburger monosyllable test with two implants, similar to nonpsychiatric patients' results. No patient has acceptance problems. In the long run, no aggravation of the psychiatric diseases occurred. CONCLUSION: With interdisciplinary evaluation, a cochlear implantation is possible in severely impaired psychiatric patients. For a good result the indication is to be discussed interdisciplinary.

Cochlear implantation in recipients with single-sided deafness: Audiological performance.

OBJECTIVE: To examine the auditory benefit of cochlear implants (CI) in patients with single-sided deafness (SSD). MATERIAL AND METHODS: Twenty patients with a normal pure tone audiogram (n = 8) or moderate hearing loss (n = 12) in one ear and a CI system MED-EL SONATA/CONCERTO + OPUS2 (n = 12), COCHLEAR CI24RE(ST) + CP810 (n = 7) and Advanced Bionics HiRes90 K + Harmony (n = 1) in the contralateral ear and with at least 6 months of CI experience were tested with respect to directional hearing, speech perception in noise, binaural loudness matching, and binaural pitch matching. Twenty-six normal hearing controls were included for normative reference. RESULTS: Addition of the CI significantly improves directional hearing (percentage of correct source identifications improved from 14.9 to 15.6%, root mean square error decreased from 125 to 93°) and improves speech perception in noise (speech perception threshold median improved from -2.3 to -6.0 dB signal to noise ratio, equivalent to a binaural intelligibility level difference = 3.7 dB). Alternate binaural loudness balancing showed that matching takes place at levels between 48 and 55 dB HL (group averages). In the pitch matching experiment, the standard deviation of the relative interaural frequency difference at 500, 1000, and 2000 Hz was 24.5, 22.8, and 24.0%, respectively (compared to 11.7, 14.4, and 12.3% in the control group). CONCLUSIONS: In SSD, cochlear implantation considerably improves audiological performance in terms of directional hearing, binaural signal equivalence, and speech perception.