[AUDITORY BRAINSTEM IMPLANTS (ABI) IN CHILDREN: CASE SERIES IN SHAARE ZEDEK MEDICAL CENTER].

BACKGROUND: Cochlear implants (CI) are the treatment of choice for individuals with severe to profound sensorineural hearing loss. A small group of patients, with pathology central to the cochlea, cannot benefit from CI. Examples in children include absence of the cochlear-nerve or cochlear aplasia. In these cases, implantation of an auditory brainstem implant (ABI), directly stimulating the cochlear nucleus, bypassing the inner-ear and auditory-nerve, may be beneficial. OBJECTIVES: Describe a series of children with ABI's treated in Shaare-Zedek, including the first ABI implantation in Israel (2017). METHODS: Of 9 patients with ABI's treated in Shaare Zedek Medical Center ,7 were children implanted between ages 2-8.6 years. Five boys and two girls. Surgeries were conducted in collaboration between neurosurgeons, neurotologists and audiologists (five implanted in Shaare-Zedek and two in New-York University). Follow-up was between 2-6 years. Hearing evaluation was conducted, mainly, with audiograms, categories of auditory performance (CAP), speech perception testing when possible and estimation of device use per day. RESULTS: Six of the seven children, who initially underwent unsuccessful CI, had deficient auditory-nerves. One child had cochlear-aplasia. In 3 children hearing loss was part of the CHARGE syndrome. CAP scores ranged from 0-7 (0,1,3,5,5,7). One child was able to achieve open-set speech perception. CONCLUSIONS: Although functional auditory outcomes for children with ABI are inferior to CI recipients and are highly variable, some children were able to obtain significant benefit. In these children, who are not candidates for CI, the ABI presents the only chance for auditory awareness and may be recommended. DISCUSSION: John Thomas Roland is a consultant and recipient of research support from Cochlear Americas.

[Fluoroscopic assisted cochlear implantation in children with inner ear malformations].

BACKGROUND: Cochlear implants are the treatment of choice for individuals with severe to profound sensorineural hearing loss. In most cases, the anatomy is normal and the insertion of the electrode-array is straightforward, complete and in the correct position. In the presence of inner-ear malformations, the risk of an intra or extra-cochlear malpositioned electrode-array increases. OBJECTIVES: To describe the technique of fluoroscopic assisted cochlear implantation in children with severe inner-ear malformations and present the results with respect to the number of active electrodes and function. METHODS: Fifteen fluoroscopy assisted implantations in 9 children were conducted at the Shaare Zedek Cochlear Implant Center between 2009-1014. All implanted ears had severe anatomic malformations. Mean implantation age was 3.5 years (range 1-11). Six children underwent sequential bilateral implantation. Two children underwent revision surgery due to a malpositioned electrode initially implanted without fluoroscopy at other centers. RESULTS: There was no radiologic or electro-physiologic evidence of kinking, bending or electrode damage in all 15 implantations. Complete insertion was achieved in all ears except one with partial insertion. There were no extra-cochlear or intrameatal placements. In 9 ears, all electrodes were active at switch-on and in the remaining, 15-20 were active. In all ears the Ling-6 sounds were detected and in 13 they were also identified. CONCLUSION: Fluoroscopy is an effective tool in complex cochlear implant surgeries and its use is simple and safe. As demonstrated in this study, with fluoroscopy assistance, good results are achieved in children with inner-ear malformations.

Time from sudden sensory neural hearing loss to treatment as a prognostic factor.

Introduction: The widely accepted treatment for sudden sensorineural hearing loss (SSNHL) is corticosteroid treatment (oral or intratympanic). The main goal of this work is to define the significance of the time between symptom onset and treatment initiation, as well as other prognostic factors, for hearing improvement. Methods: This retrospective study included 666 patients treated for SSNHL. Demographic data, audiometry, treatment method, time since symptom onset, and associated symptoms were recorded for each patient. The patients were divided into five groups according to the treatment initiation time-half a week, one week, 2 weeks, 3 weeks, or 4 weeks and over-after symptom onset. The degree of improvement was assessed by comparing the audiometry at the beginning and the end of the treatment. Results: The average period of hearing loss from symptom onset to treatment initiation was 10.8 days. Significant differences were found between the groups of half a week, one week, and 2 weeks and the groups of 3 weeks and 4 weeks and over (each separately, p < 0.001). No difference was found between the half-week, one-week, and two-week groups, nor was there a difference between the three-week and four-week-and-over groups. A correlation was found between the treatment initiation time in days and the degree of improvement in hearing for both speech recognition threshold (SRT) and discrimination, R = 0.26 p < 0.001 and R = 0.17 p < 0.001, respectively. No correlation was found for gender, age of the patients, comorbidities, or associated symptoms. Conclusion: The threshold for treatment initiation time is up to 2 weeks, after which the amplitude of hearing improvement decreases significantly. The other prognostic factors measured were not found to be statistically significant predictors.

Revision cochlear implantation using a double array device in the post-meningitis ossified cochlea.

PURPOSE: To describe the surgical technique and outcome in a series of patients who underwent revision cochlear implantation using a double array or split electrode device. All patients developed ossified cochleae due to meningitis and were functioning poorly with the previous implant. METHODS: Four patients between the ages of 4-15 years underwent revision with five double-array cochlear implant devices. One patient underwent bilateral revision surgery. All patients had previous meningitis with CT and MRI imaging studies that demonstrated completely ossified cochleae. The time interval range between the disease and the initial cochlear implantation and was 4 months to 3 years. The patient's data were retrospectively analyzed with emphasis on the surgical technique, the number of electrodes inserted, and the number of active electrodes at follow-up. In addition, pre and post-revision surgery function was compared. RESULTS: The revision surgery was carried out 2-11 years after the initial surgery. Two tunnels, basal and apical, were drilled in the ossified cochlea. In each of the tunnels, 5 to 11 electrodes were inserted. While the number of active electrodes before revision was 0-5, after revision with the double array, it was increased to 8-12, resulting in improved auditory and speech function. CONCLUSION: Revision cochlear implantation with a double array implant using the two tunnel technique can increase the number of active electrodes. This leads to a better outcome in post-meningitis children with completely ossified cochleae and a poor functioning previous device.

The Acute Effect of Exercise on Executive Function and Attention: Resistance Versus Aerobic Exercise.

Acute aerobic exercise was shown to enhance such cognitive functions as executive function (EF) and attention. Acute resistance exercise was also shown to enhance cognitive functions, however, only few studies directly compared these two exercise modalities. The aim of this study was to evaluate the acute effect of a typical moderate intensity resistance exercise session as compared to a typical moderate intensity aerobic session, on executive function and attention. A counterbalanced repeated measures experimental design was applied. Forty physical education students (21 women; 19 men, age = 25.7±2.84 years) were tested before and after three sessions: aerobic, resistance, and control. Each session consisted of 30 minutes of exercise or a rest. Executive function and attention were assessed by components of the computerized Stroop Catch game and Go-NoGo cognitive tests. A two-way ANOVA showed a greater increase in attention scores after the resistance sessions (p < .05) compared to the control condition. Attention scores in the aerobic sessions showed a trend toward improvement but did not reach statistical significance. Scores of EF significantly increased, both after the resistance session and the aerobic session (p < .05), but not after rest in the control condition. Our findings show that an acute session of resistance exercise increased both Attention and EF test scores, while an aerobic exercise session improved only the EF scores.