Hearing Preservation after Cochlear Implantation: UNICAMP Outcomes

Background. Electric-acoustic stimulation (EAS) is an excellent choice for people with residual hearing in low frequencies but not high frequencies and who derive insufficient benefit from hearing aids. For EAS to be effective, subjects' residual hearing must be preserved during cochlear implant (CI) surgery.Methods. We implanted 6 subjects with a CI. We used a special surgical technique and an electrode designed to be atraumatic. Subjects' rates of residual hearing preservation were measured 3 times postoperatively, lastly after at least a year of implant experience. Subjects' aided speech perception was tested pre- and postoperatively with a sentence test in quiet. Subjects' subjective responses assessed after a year of EAS or CI experience.Results. 4 subjects had total or partial residual hearing preservation; 2 subjects had total residual hearing loss. All subjects' hearing and speech perception benefited from cochlear implantation. CI diminished or eliminated tinnitus in all 4 subjects who had it preoperatively. 5 subjects reported great satisfaction with their new device.Conclusions. When we have more experience with our surgical technique we are confident we will be able to report increased rates of residual hearing preservation. Hopefully, our study will raise the profile of EAS in Brazil and Latin/South America.

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Cochlear Implantation in Children with Postlingual Progressive Steeply Sloping High-Frequency Hearing Loss

Journal of the American Academy of Audiology ◽

10.3766/jaaa.16115 ◽

2017 ◽

Vol 28 (10) ◽

pp. 913-919 ◽

Cited By ~ 7

Author(s):

Margaret A. Meredith ◽

Jay T. Rubinstein ◽

Kathleen C. Y. Sie ◽

Susan J. Norton

Keyword(s):

Hearing Loss ◽

Speech Perception ◽

Hearing Aids ◽

Cochlear Implantation ◽

High Frequency ◽

Case Series ◽

Hearing Preservation ◽

Rapid Improvement ◽

Retrospective Case ◽

Monosyllabic Word

Background: Children with steeply sloping sensorineural hearing loss (SNHL) lack access to critical high-frequency cues despite the use of advanced hearing aid technology. In addition, their auditory-only aided speech perception abilities often meet Food and Drug Administration criteria for cochlear implantation. Purpose: The objective of this study was to describe hearing preservation and speech perception outcomes in a group of young children with steeply sloping SNHL who received a cochlear implant (CI). Research Design: Retrospective case series. Study Sample: Eight children with steeply sloping postlingual progressive SNHL who received a unilateral traditional CI at Seattle Children’s Hospital between 2009 and 2013 and had follow-up data available up to 24 mo postimplant were included. Data Collection and Analysis: A retrospective chart review was completed. Medical records were reviewed for demographic information, preoperative and postoperative behavioral hearing thresholds, and speech perception scores. Paired t tests were used to analyze speech perception data. Hearing preservation results are reported. Results: Rapid improvement of speech perception scores was observed within the first month postimplant for all participants. Mean monosyllabic word scores were 76% and mean phoneme scores were 86.7% at 1-mo postactivation compared to mean preimplant scores of 19.5% and 31.0%, respectively. Hearing preservation was observed in five participants out to 24-mo postactivation. Two participants lost hearing in both the implanted and unimplanted ear, and received a sequential bilateral CI in the other ear after progression of the hearing loss. One participant had a total loss of hearing in only the implanted ear. Results reported in this article are from the ear implanted first. Bilateral outcomes are not reported. Conclusions: CIs provided benefit for children with steeply sloping bilateral hearing loss for whom hearing aids did not provide adequate auditory access. In our cohort, significant improvements in speech understanding occurred rapidly postactivation. Preservation of residual hearing in children with a traditional CI electrode is possible.

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The evaluation of a slim perimodiolar electrode: surgical technique in relation to intracochlear position and cochlear implant outcomes

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-019-05696-y ◽

2019 ◽

Vol 277 (2) ◽

pp. 343-350 ◽

Cited By ~ 1

Author(s):

Floris Heutink ◽

Berit M. Verbist ◽

Lucas H. M. Mens ◽

Wendy J. Huinck ◽

Emmanuel A. M. Mylanus

Keyword(s):

Speech Perception ◽

Surgical Technique ◽

Round Window ◽

Hearing Preservation ◽

Electrode Position ◽

Residual Hearing ◽

High Resolution Computed Tomography ◽

Absolute Increase ◽

Window Approach

Abstract Purpose In cochlear implantation (CI), the two factors that are determined by the surgeon with a potential significant impact on the position of the electrode within the cochlea and the potential outcome, are the surgical technique and electrode type. The objective of this prospective study was to evaluate the position of the slim, perimodiolar electrode (SPE), and to study the influence of the SPE position on CI outcome. Methods Twenty-three consecutively implanted, adult SPE candidates were included in this prospective cohort study conducted between December 2016 and April 2019. Mean age at surgery was 59.5 years. Mean preoperative residual hearing was 92.2 dB. Intra-operative fluoroscopy and high-resolution computed tomography scans were performed to evaluate electrode position after insertion using a cochleostomy (CS) approach. Follow-up was 12 months after implantation; residual hearing (6–8 weeks) and speech perception (6–8 weeks and 12 months) were evaluated in relation to the intracochlear SPE position. Results In most patients in whom the SPE was positioned in the scala tympani residual hearing was preserved [mean absolute increase in PTA of 4.4 dB and 77.2% relative hearing preservation (RHP%)]. Translocation into the scala vestibuli occurred in 36% of the insertions, resulting in a mean absolute increase in PTA of 17.9 dB, and a RHP% of 19.2%. Participants with a translocation had poorer speech perception scores at 12-month follow-up. Conclusion Given the incidence of CS-associated translocations with the SPE and the negative effect on outcome, it is advised to insert the SPE using the (extended) round window approach.

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Cochlear implant placement: round window approach

Neurosurgical FOCUS ◽

10.3171/2014.v1.focus13537 ◽

2014 ◽

Vol 36 (v1supplement) ◽

pp. 1 ◽

Cited By ~ 3

Author(s):

Douglas D. Backous

Keyword(s):

Clinical Trials ◽

Surgical Technique ◽

Cochlear Implant ◽

Cochlear Implantation ◽

Round Window ◽

Hearing Preservation ◽

Residual Hearing ◽

Implant Placement ◽

Single Sided Deafness ◽

Window Approach

The indications for cochlear implantation continue to extend to patients with increased levels of residual hearing. Single-sided deafness and tinnitus are currently under various clinical trials as even further expansion of the application of cochlear implant device and programming technology is underway. This video details a round window and hearing preservation approach for cochlear implant placement, and incorporates the most recent advances in surgical technique.The video can be found here: http://youtu.be/bDqkbboXrU4.

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Preservation of residual hearing following cochlear implantation: comparison between three surgical techniques

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000254 ◽

2007 ◽

Vol 122 (3) ◽

pp. 246-252 ◽

Cited By ~ 36

Author(s):

S Berrettini ◽

F Forli ◽

S Passetti

Keyword(s):

Cochlear Implant ◽

Cochlear Implantation ◽

Surgical Techniques ◽

Electrode Array ◽

Lateral Wall ◽

Hearing Preservation ◽

Acoustic Stimulation ◽

Residual Hearing ◽

Electrode Arrays ◽

Electrode Insertion

AbstractThe preservation of residual hearing is becoming a high priority in cochlear implant surgery. It allows better speech understanding and ensures long-lasting and stable performance; it also allows the possibility, in selected cases, of combining electro-acoustic stimulation in the same ear.We present the results of a retrospective study of the conservation of residual hearing in three different groups of patients who had undergone cochlear implantation using three different cochlear implant electrode arrays, combined with three different surgical techniques for the cochleostomy. The study aimed to evaluate which approach allowed greater preservation of residual hearing.The best residual hearing preservation results (i.e. preservation in 81.8 per cent of patients) were achieved with the Contour Advance electrode array, using the Advance Off-Stylet technique and performing a modified anterior inferior cochleostomy; this combination enabled reduced trauma to the lateral wall of the cochlea during electrode insertion.

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Electric and Acoustic Stimulation in Cochlear Implant Recipients with Hearing Preservation

Seminars in Hearing ◽

10.1055/s-0038-1670707 ◽

2018 ◽

Vol 39 (04) ◽

pp. 414-427 ◽

Cited By ~ 6

Author(s):

Christopher Welch ◽

Margaret Dillon ◽

Harold Pillsbury

Keyword(s):

Hearing Loss ◽

Speech Perception ◽

Cochlear Implant ◽

Hearing Aids ◽

High Frequency ◽

Low Frequency ◽

Hearing Preservation ◽

The United States ◽

Acoustic Stimulation ◽

Electric Hearing

AbstractHearing loss affects 30 million people in the United States, and a subset of these patients have normal low-frequency hearing and ski-sloped high-frequency hearing loss. For these patients, hearing aids alone may not provide adequate benefit. Cochlear implantation alone has been utilized to improve speech perception. The addition of high-frequency electric hearing to low-frequency acoustic hearing in these patients is beneficial. Technical improvements have allowed preservation of low-frequency hearing in cochlear implant recipients, allowing for electric and acoustic stimulation in the same ear with significant improvements in speech perception, sound localization, music appreciation, and quality of life.

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Hearing preservation in children with electric-acoustic stimulation after cochlear implantation

HNO ◽

10.1007/s00106-018-0532-3 ◽

2018 ◽

Vol 66 (S2) ◽

pp. 56-62 ◽

Cited By ~ 2

Author(s):

T. Rader ◽

A. Bohnert ◽

C. Matthias ◽

D. Koutsimpelas ◽

M-A. Kainz ◽

...

Keyword(s):

Cochlear Implantation ◽

Low Frequency ◽

Hearing Preservation ◽

Acoustic Stimulation ◽

Residual Hearing ◽

Short Term ◽

Mean Values ◽

Minimal Trauma ◽

Electric Acoustic Stimulation ◽

The Mean

Abstract Background Cochlear implantation in patients with functional residual low-frequency hearing is performed according to an established hearing-preserving surgical technique in order to cause minimal trauma of inner ear structures. Due to the increasing number of cochlear implants in children, the preservation of residual hearing is becoming increasingly important in this patient collective. Objectives Short- and mid-term hearing preservation outcome in pediatric patients is investigated. Materials and methods A group of 9 children (12 ears) between 5 and 12 years of age were examined after hearing-assisted cochlear implantation with respect to the pure tone audiometric thresholds. Retrospectively, short-term hearing preservation (up to 3 months after surgery) was examined. In a subgroup of 5 children, mid-term hearing preservation (7.5 to 16 months after surgery) was also analyzed. The mean values of hearing preserved (HL%) and hearing loss (HL) due to electrode insertion were calculated as measured values. Results In the whole group, the mean values of the preoperative PTAlow were 29.8 dB and the short-term postoperative PTAlow 42.6 dB. The mean value of the HL% was 73.6%, corresponding to an HL of 9.4 dB. In the subgroup, the mean PTAlow postoperatively was 46.0 dB in the mid-term and the HL% at 80.7% with a HL of 6.6 dB. Conclusions The results in children are consistent with the results in adults. Electric-acoustic stimulation (EAS) should be used in the treatment of children with existing low-frequency residual hearing, as good residual hearing preservation can also be achieved in children after implantation.

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Partial Deafness Cochlear Implantation at the University of Kansas: Techniques and Outcomes

Journal of the American Academy of Audiology ◽

10.3766/jaaa.21.3.8 ◽

2010 ◽

Vol 21 (03) ◽

pp. 197-203 ◽

Cited By ~ 30

Author(s):

Sandra Prentiss ◽

Kevin Sykes ◽

Hinrich Staecker

Keyword(s):

Hearing Loss ◽

Cochlear Implantation ◽

Signal To Noise Ratio ◽

Hearing Preservation ◽

Residual Hearing ◽

Speech Discrimination ◽

Insertion Depth ◽

Low Frequencies ◽

Hearing In Noise ◽

Electrode Insertion

Background: One of the most significant recent advances in cochlear implantation is the implantation of patients with residual hearing. These patients have a downsloping sensorineural hearing loss with poor speech discrimination and perform poorly with standard amplification. Studies using a variety of different electrode designs have demonstrated that it is possible to implant an inner ear and preserve residual hearing. Initial studies have demonstrated that a combination of residual acoustic hearing in the low frequencies with electrical stimulation in the mid- to high frequencies resulted in superior hearing performance in background noise. Purpose: The objective of this study was to determine the effect of electrode insertion depth on hearing preservation. Study Sample: Eighteen patients with mild to severe hearing loss in the low frequencies combined with poor word recognition were recruited for the study. Intervention: Cochlear implantation. Data Collection and Analysis: Pre- and postoperative hearing test, Hearing in Noise Test, and consonant–nucleus–consonant testing. Data analysis was performed with Kruskal Wallis and Mann-Whitney testing. Results: In our study of 18 patients implanted with a Med-El PulsarCI100 we demonstrated the ability to preserve residual hearing with implant insertion depths ranging from 20 to 28 mm, giving us the possibility of near complete cochlear frequency coverage with an implant array while preserving residual hearing. These patients performed well both in quiet and in 10 dB signal-to-noise ratio conditions. Conclusion: Hearing preservation was achievable even with deep implant insertion. Patients performed well in combined acoustic and electric conditions.

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A Role for Acoustic Stimulation in Advanced Otosclerosis: Direct Acoustic Cochlear Implant versus Cochlear Implant

Audiology and Neurotology ◽

10.1159/000491990 ◽

2018 ◽

Vol 23 (2) ◽

pp. 89-97

Author(s):

Nicolas Verhaert ◽

Charlotte Borgers ◽

Katleen De Voecht ◽

Ellen Boon ◽

Christian Desloovere

Keyword(s):

Speech Perception ◽

Cochlear Implant ◽

Hearing Aids ◽

Standard Treatment ◽

Acoustic Stimulation ◽

Grading System ◽

Effective Treatment Option ◽

Computed Tomographic ◽

Direct Acoustic Cochlear Implant ◽

Acoustic Component

Recent findings support the efficacy of the direct acoustic cochlear implant (DACI) in patients with advanced otosclerosis whose rehabilitation is very challenging. Standard treatment consists of stapes surgery combined with hearing aids or a cochlear implant (CI). CI surgery, however, is often challenging depending on the grade of otosclerosis. This study aims to compare speech perception scores in quiet and noise of 6 DACI and 12 CI patients with advanced otosclerosis at 3 and 12 months after fitting. Preoperative computed tomographic scans of all patients were scored by experts using an existing otosclerosis grading system (stages 1–3). Speech perception in quiet was significantly better for DACI compared to CI users at 3 months after fitting. At 12 months, no difference was found between DACI and CI patients. Speech perception scores in noise were significantly better in the DACI group. In summary, a DACI system seems to provide an effective treatment option as the acoustic component can be preserved in patients with advanced otosclerosis.

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Electroacoustic Stimulation: Now and into the Future

BioMed Research International ◽

10.1155/2014/350504 ◽

2014 ◽

Vol 2014 ◽

pp. 1-17 ◽

Cited By ~ 9

Author(s):

S. Irving ◽

L. Gillespie ◽

R. Richardson ◽

D. Rowe ◽

J. B. Fallon ◽

...

Keyword(s):

Cochlear Implants ◽

Cochlear Implantation ◽

Auditory Pathway ◽

Acoustic Stimulation ◽

Music Appreciation ◽

Residual Hearing ◽

Current Field ◽

Eligibility Criteria ◽

Gene Therapies ◽

Current Trends

Cochlear implants have provided hearing to hundreds of thousands of profoundly deaf people around the world. Recently, the eligibility criteria for cochlear implantation have been relaxed to include individuals who have some useful residual hearing. These recipients receive inputs from both electric and acoustic stimulation (EAS). Implant recipients who can combine these hearing modalities demonstrate pronounced benefit in speech perception, listening in background noise, and music appreciation over implant recipients that rely on electrical stimulation alone. The mechanisms bestowing this benefit are unknown, but it is likely that interaction of the electric and acoustic signals in the auditory pathway plays a role. Protection of residual hearing both during and following cochlear implantation is critical for EAS. A number of surgical refinements have been implemented to protect residual hearing, and the development of hearing-protective drug and gene therapies is promising for EAS recipients. This review outlines the current field of EAS, with a focus on interactions that are observed between these modalities in animal models. It also outlines current trends in EAS surgery and gives an overview of the drug and gene therapies that are clinically translatable and may one day provide protection of residual hearing for cochlear implant recipients.

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