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

2010 ◽  
Vol 21 (03) ◽  
pp. 197-203 ◽  
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.

scholarly journals The Effect of Cochlear Size on Cochlear Implantation Outcomes

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Jafri Kuthubutheen ◽  
Amandeep Grewal ◽  
Sean Symons ◽  
Julian Nedzelski ◽  
David Shipp ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Outer Wall ◽  
X Rays ◽  
Speech Discrimination ◽  
Insertion Depth ◽  
Basal Diameter ◽  
Cochlear Duct ◽  
Significant Difference ◽  
Cochlear Duct Length ◽  
Electrode Insertion

Objectives. To determine if cochlear duct length and cochlear basal diameter, measured using routinely available radiology software, affect hearing outcomes after cochlear implantation with two different length electrodes. Methods. 55 patients who received a Med-El Flex electrode were retrospectively reviewed. 34 patients received the Flex 31 electrode (31mm) and 21 patients received the Flex 28 electrode (28mm). Preoperative high-resolution CT scans of the temporal bone were reformatted in the axial and coronal plane. The basal diameter of the cochlear (A-value) and the outer-wall lengths of the cochlear duct were measured using readily available imaging software. Postoperative plane X-rays were used to determine the degree of electrode insertion and the number of electrodes within the cochlea and speech discrimination scores at 6 months were evaluated. Results. The cochlear metrics obtained were comparable with those previously published in the literature. There was no significant difference in the degree of insertion or speech outcomes between the two electrode lengths. However, when the group who had received the shorter electrode were analysed, there was an association seen between both cochlear duct length and cochlear diameter and speech outcomes. Conclusions. Cochlear size may be a factor in determining speech outcomes that cannot be explained solely by insertion depth or degrees of insertion. Further studies are required to determine if cochlear duct length is an independent predictor of speech outcomes.

scholarly journals A maradványhallás megőrzésének lehetőségei cochlearis implantáció során Nucleus CI532 Slim Modiolar elektródasorral

2018 ◽  
Vol 159 (41) ◽  
pp. 1680-1688 ◽  
Author(s):  
Roland Nagy ◽  
János András Jarabin ◽  
Balázs Dimák ◽  
Ádám Perényi ◽  
Ferenc Tóth ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Minimally Invasive ◽  
Cochlear Implantation ◽  
Basilar Membrane ◽  
Round Window ◽  
Spiral Ganglion ◽  
Hearing Threshold ◽  
Electrode Array ◽  
Hearing Preservation ◽  
Residual Hearing

Abstract: During the rehabilitation of hearing-impaired patients, the preservation of residual acoustic hearing following cochlear implantation by minimizing the implantation trauma allows for improved hearing performance. To achieve this, minimally invasive, soft surgery methods and thinner, atraumatic electrodes were required. In our present study, we reported a case where Cochlear® Nucleus CI532 Slim Modiolar electrode was implanted in a patient with residual hearing. Our aim was to study the possible preservation of postoperative acoustic residual hearing by audiological monitoring. Since childhood, due to her congenital hearing loss, she has been wearing a conventional, airborne hearing correction device on both ears. Six months before cochlear implantation, we measured the progression on both sides of the hearing loss, so we decided to perform cochlear implantation. The patient had residual hearing on both ears prior to surgery thus the Cochlear® Nucleus CI532 Slim Modiolar Implant was used. The minimally invasive surgery was performed on the patient’s right ear through the round window approach. Compared to the preoperative hearing threshold (average 85 dBHL) in the 4th postoperative week, an initial hearing threshold progression of 20–25 dBHL was observed between 0.25 and 1.0 kHz, while of 5–10 dBHL between 2.0–4.0 kHz. Hearing threshold measured in the 6th month showed a slight progression in the range above 1 kHz, but improved by the 12th month, to the results achieved at the 4th week. The effects of cochlear implantation on residual hearing have been studied in numerous studies, in which several key surgical and technical factors have been identified. Nucleus CI532 is a Slim Modiolar electrode profile that is close to the modiolus, so it is expected to have a lower endocochlear hydrodynamic load since it lies in the covering of the osseus spiral lamina, thus less influencing the dynamics of the basilar membrane. However, the perimodiolar location of the electrode array allows the adjacent nerve elements of the spiral ganglion to be stimulated with a lower electrical intensity and a reduced surface that may be neuroprotective. Preservation of acoustic residual hearing following cochlear implantation improves the patient’s speech perception and the sound localization skills, particularly in difficult circumstances. Long-term residual hearing preservation may also be of great importance in the subsequent feasibility for regenerative procedures and drug treatments. Orv Hetil. 2018; 159(41): 1680–1688.

scholarly journals Electrode Afterload: A Valuable Technique in a Case of Short Electrode Insertion

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
C. Riemann ◽  
S. Scholz ◽  
H. Sudhoff ◽  
I. Todt
Keyword(s):  
Case Report ◽  
Revision Surgery ◽  
Round Window ◽  
Hearing Preservation ◽  
Residual Hearing ◽  
Speech Understanding ◽  
Insertion Depth ◽  
Speech Performance ◽  
Electrode Insertion ◽  
The Right

Introduction. The location of the electrode inside the cochlea is important for speech performance. However, many variables, including array length, insertion depth, and individual anatomy, may affect the intracochlear position of the electrode. Insertion deeper than 20 mm and revision surgery are critical situations in which residual hearing and electrode integrity may be at risk. This case report challenges this hypothesis and raises the following question: is it possible to achieve a better speech understanding with an electrode afterload without compromising residual hearing? Case Report. A 73-year-old female patient showed up for evaluation of hearing loss. The patient was operated four times in an external hospital due to cholesteatoma formation in the right ear. Related to a poor aided speech understanding, a CI-surgery was performed. 5 months after the surgery, the subject returned with poor speech understanding. A revision surgery was performed, where the first white marker of the electrode was seen in the round window (20 mm). The electrode was inserted 4 mm deeper into the cochlea. After six and twelve months, the results of the Freiburger monosyllabic speech test improved till 25% and 45%, respectively. Discussion. Hearing preservation is possible with a revisional deeper insertion from 20 mm to 24 mm. In this case, a partial obliteration of an open cavity made the electrode surgically easily accessible. This allowed the deeper insertion during the revision surgery. In a regular surgical field with a posterior tympanotomy, the revision surgery is more challenging and brings the electrode into the risk of an iatrogenic destruction. Conclusion. This case of an electrode afterload after having inserted the electrode initially to mm, demonstrates that hearing can be preserved and speech perception can improve after performing this maneuver.

scholarly journals Hearing Preservation after Cochlear Implantation: UNICAMP Outcomes

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Guilherme Machado de Carvalho ◽  
Alexandre C. Guimaraes ◽  
Alexandre S. M. Duarte ◽  
Eder B. Muranaka ◽  
Marcelo N. Soki ◽  
...  
Keyword(s):  
Speech Perception ◽  
Surgical Technique ◽  
Hearing Aids ◽  
Cochlear Implantation ◽  
Hearing Preservation ◽  
Acoustic Stimulation ◽  
Residual Hearing ◽  
Low Frequencies ◽  
Great Satisfaction ◽  
New Device

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.

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

2007 ◽  
Vol 122 (3) ◽  
pp. 246-252 ◽  
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.

scholarly journals 805 Eluting Electrodes for Hearing Preservation – the Future of Cochlear Implantation?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Y Nikookam ◽  
A Radotra ◽  
C Metcalfe ◽  
J Muzaffar ◽  
P Monksfield ◽  
...  
Keyword(s):  
Cochlear Implants ◽  
Cochlear Implantation ◽  
Web Of Science ◽  
Hearing Preservation ◽  
Narrative Synthesis ◽  
Residual Hearing ◽  
Inclusion Criteria ◽  
Growth Promoting ◽  
Anti Inflammatory ◽  
Electrode Insertion

Abstract Introduction Cochlear implants (CIs) utilising eluting electrodes are a relatively new phenomenon. CI surgery can lead to a variety of complications, namely electrode insertion trauma. This affects CI function leading to a loss of residual hearing. To minimise this, electrodes eluting anti-inflammatory or growth-promoting agents can be used to protect and enhance residual hearing through the sustained release of an agent. Eluting agents include glucocorticoids, steroids, growth factors and neurotrophins. Method Systematic review and narrative synthesis. Databases searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov and Web of Science. Results Searches identified 66 abstracts and 37 full texts. Of these, 15 studies met the inclusion criteria, reporting outcomes in 469 animals and 24 humans, with at least 233 implants. Eluting electrodes included dexamethasone (n = 13), growth factor (n = 1) and neurotrophins (n = 1). Audiological outcomes improved across all studies following cochlear implantation with an eluting electrode to a greater extent when compared to a standard electrode. Outcomes improved significantly when a higher concentration of dexamethasone was used. Conclusions Audiological outcomes with eluting electrodes following cochlear implantation are generally superior to the omission of medication following cochlear implantation. An electrode elution enables a sustained, localised release of anti-inflammatory or anti-apoptotic agents, therefore reducing the advent of fibrosis, scarring and subsequent impedance.

Hearing loss in diabetics

1993 ◽  
Vol 107 (3) ◽  
pp. 179-182 ◽  
Author(s):  
J. R. Cullen ◽  
M. J. Cinnamond
Keyword(s):  
Hearing Loss ◽  
Sensorineural Deafness ◽  
Insulin Dosage ◽  
Speech Discrimination ◽  
Low Frequencies ◽  
High Frequencies ◽  
History Of ◽  
Insulin Dependent ◽  
Stapedial Reflex ◽  
The Relationship

The relationship between diabetes and senbsorineural hearing loss has been disputed. This study compares 44 insulin-dependent diabetics with 38 age and sex matched controls. All had pure tone and speech audiometry performed, with any diabetics showing sensorineural deafness undergoing stapedial reflecx decat tests. In 14 diabetics stapedial reflex tests showed no tone decay in any patient, but seven showed evidence of recruitment. Analysis of vaiance showed the diabetics to be significantly deafer than the control population.The hearing loss affected high frequencies in both sexes, but also low frequencies in the male. Speech discrimination scores showed no differences. Further analysis by sex showed the males to account for most of the differences. Analysys of the audiograms showered mostly a high tone loss. Finally duration of disbetes, insulin dosage and family history of diabtes were not found to have a significant effect on threshold.

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

2017 ◽  
Vol 28 (10) ◽  
pp. 913-919 ◽  
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.

Outcome of Cochlear Implantation in Postmeningitis Profound Sensorineural Hearing Loss at Rajavithi Hospital

2021 ◽  
Vol 104 (2) ◽  
pp. 260-263
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Cochlear Implantation ◽  
Sensorineural Hearing ◽  
Preoperative Imaging ◽  
Profound Hearing Loss ◽  
Language Status ◽  
Auditory Performance ◽  
Electrode Insertion ◽  
One Year

Background: Bacterial meningitis is one of the major factors in the etiology of acquired sensorineural hearing loss in children and adults. Cochlear implantation in these patients is challenging because of inner ear ossification and fibrosis, and this procedure sometimes achieves poorer outcomes in this scenario than with other causes of sensorineural hearing loss. There has been little research into the factors affecting the outcomes of this procedure. Objective: To evaluate the outcomes of cochlear implantation in patients with postmeningitis profound sensorineural hearing loss and to evaluate the factors that affect the results. Materials and Methods: A retrospective review was conducted of thirty patients who were diagnosed with post meningitis profound hearing loss and underwent cochlear implantation at Rajavithi Hospital between 2001 and 2016. Preoperative language status, duration of deafness, preoperative imaging, and degree of electrode insertion were recorded. Categories of auditory performance-II test (CAP-II) was evaluated in all cases, one year postoperative. Results: Thirty postmeningitis deafness patients underwent cochlear implantation. The median age at diagnosis of meningitis and age at implantation were 41 years (range 1 to 75) and 49.50 years (range 3 to 75), respectively. The median duration of deafness was 12 months (range 4 to 300), and the overall mean CAP-II at one year after surgery was 5.47±2.21. The postlinguistic group had a significantly higher CAP-II score than the prelinguistic one (p=0.006). Electrodes were successfully totally inserted in 19 patients (63.3%) and partially inserted in 11 (36.7%). The average CAP-II score in the group with fully-inserted electrodes was significantly higher than in the group with partially-inserted electrodes (p=0.045). There was no correlation between CAP-II score and age at meningitis diagnosis (p=0.069), age at time of surgery (p=0.105), duration of deafness (p=0.506), or preoperative CT (p=0.228) or MRI abnormality (p=0.078). Conclusion: Cochlear implantation in patients with postmeningitis profound hearing loss had high success rates and favorable outcomes. Preoperative language status and degree of electrode insertion were factors that affected auditory performance results. Keywords: Cochlear implantation, Postmeningitis hearing loss, Sensorineural hearing loss, Meningitis, Rajavithi Hospital

Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery

2013 ◽  
Vol 118 (3) ◽  
pp. 571-578 ◽  
Author(s):  
Andrew M. Baschnagel ◽  
Peter Y. Chen ◽  
Dennis Bojrab ◽  
Daniel Pieper ◽  
Jack Kartush ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Gamma Knife Surgery ◽  
Speech Discrimination ◽  
Before And After ◽  
Nerve Dysfunction ◽  
Preservation Rate

Object Hearing loss after Gamma Knife surgery (GKS) in patients with vestibular schwannoma has been associated with radiation dose to the cochlea. The purpose of this study was to evaluate serviceable hearing preservation in patients with VS who were treated with GKS and to determine if serviceable hearing loss can be correlated with the dose to the cochlea. Methods Forty patients with vestibular schwannoma with serviceable hearing were treated using GKS with a median marginal dose of 12.5 Gy (range 12.5–13 Gy) to the 50% isodose volume. Audiometry was performed prospectively before and after GKS at 1, 3, and 6 months, and then every 6 months thereafter. Hearing preservation was based on pure tone average (PTA) and speech discrimination (SD). Serviceable hearing was defined as PTA less than 50 dB and SD greater than 50%. Results The median cochlear maximum and mean doses were 6.9 Gy (range 1.6–16 Gy) and 2.7 Gy (range 0.7–5.0 Gy), respectively. With a median audiological follow-up of 35 months (range 6–58 months), the 1-, 2-, and 3-year actuarial rates of maintaining serviceable hearing were 93%, 77%, and 74%, respectively. No patient who received a mean cochlear dose less than 2 Gy experienced serviceable hearing loss (p = 0.035). Patients who received a mean cochlear dose less than 3 Gy had a 2-year hearing preservation rate of 91% compared with 59% in those who received a mean cochlear dose of 3 Gy or greater (p = 0.029). Those who had more than 25% of their cochlea receiving 3 Gy or greater had a higher rate of hearing loss (p = 0.030). There was no statistically significant correlation between serviceable hearing loss and age, tumor size, pre-GKS PTA, pre-GKS SD, pre-GKS Gardner-Robertson class, maximum cochlear dose, or the percentage of cochlear volume receiving 5 Gy. On multivariate analysis there was a trend toward significance for serviceable hearing loss with a mean cochlear dose of 3 Gy or greater (p = 0.074). Local control was 100% at 24 months. No patient developed facial or trigeminal nerve dysfunction. Conclusions With a median mean cochlear dose of 2.7 Gy, the majority of patients with serviceable hearing retained serviceable hearing 3 years after GKS. A mean cochlear dose less than 3 Gy was associated with higher serviceable hearing preservation.

Sign in / Sign up

Export Citation Format

Share Document