Factors Influencing Hearing Preservation in the Short and Long Term in Cochlear Implantation

Object. Vestibular schwannomas (VSs) are now amenable to resection with excellent hearing preservation rates. It remains unclear whether immediately postoperative hearing is a durable result and will not diminish over time. The aim of this study was to determine the rate of long-term preservation of functional hearing following surgery for a VS and to examine factors influencing hearing preservation. Methods. All patients eligible for hearing preservation (Gardner—Robertson Class I or II) who had undergone resection of a VS by a single surgeon were reviewed retrospectively. Follow-up audiograms and magnetic resonance images were obtained. Of 142 patients deemed eligible for hearing preservation surgery, 38 had immediate postoperative hearing confirmed by an audiogram. In these patients with preserved hearing, the audiographic results demonstrated functional hearing in 30 (85.7%) of 35 patients who underwent repeated testing at a mean follow-up time of 7 years. Delayed hearing loss occurred in five (14.3%) of the 35 patients and did not correlate significantly with the size of the tumor. Hearing improved one Gardner—Robertson class postoperatively in three (7.9%) of the 38 patients. Conclusions. Long-term functional hearing was maintained in 85.7% of patients when it was preserved immediately postoperatively and the result was independent of tumor size. The results of this study emphasize that long-term preservation of functional hearing is a realistic goal following VS surgery and should be attempted in all patients in whom preoperative hearing is determined to be Gardner—Robertson Class I or II.

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Costs involved in using a cochlear implant in South Africa

South African Journal of Communication Disorders ◽

10.4102/sajcd.v59i1.18 ◽

2012 ◽

Vol 59 (1) ◽

Cited By ~ 1

Author(s):

Gillian Robyn Kerr ◽

Seppo Tuomi ◽

Alida Müller

Keyword(s):

South Africa ◽

Cochlear Implant ◽

Cochlear Implants ◽

Cochlear Implantation ◽

Consumer Price Index ◽

Information Costs ◽

Profound Hearing Loss ◽

Short And Long Term ◽

Implant System

Cochlear implantation is an expensive but effective lifelong intervention for individuals with a severe-to-profound hearing loss. The primary aim of this study was to survey the short- and long-term costs of cochlear implantation. Individuals (N=154) using cochlear implants obtained from the University of Stellenbosch-Tygerberg Hospital Cochlear Implant Unit in Cape Town, South Africa were surveyed using a questionnaire and patient record review. The questionnaire used a combination of closed and open-ended questions to gather both quantitative and qualitative information. Costs were categorised as short- and long-term costs. All costs were converted to constant rands (June 2010) using the Consumer Price Index to allow for comparison in real terms over time. In the first 10 years of implantation the average estimated costs incurred by adults totalled R379 626, and by children R455 225. The initial purchase of the implant system was the most substantial cost, followed by upgrading of the processor. Travel and accommodation costs peaked in the first 2 years. On average the participants spent R2 550 per year on batteries and spares. Rehabilitation for children cost an average of R7 200. Insurance costs averaged R4 040 per year, and processor repairs R3 000 each. In addition to the upfront expense of obtaining the cochlear implant system, individuals using a cochlear implant in South Africa should be prepared for the long-term costs of maintenance, accessing the unit, support services and additional costs associated with use. Knowledge of these costs is important to ensure that individuals are successful users of their cochlear implants in the long term.

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Managing growth overfishing with multiannual compromise strategies

Canadian Journal of Fisheries and Aquatic Sciences ◽

10.1139/f97-135 ◽

1997 ◽

Vol 54 (10) ◽

pp. 2255-2276 ◽

Cited By ~ 2

Author(s):

P Marchal

Keyword(s):

Management Strategies ◽

Fishing Effort ◽

Reference Points ◽

Long Term Outcomes ◽

Northeast Atlantic ◽

Factors Influencing ◽

Optimal Balance ◽

Short And Long Term ◽

Mobile Target

Most of the Northeast Atlantic stocks are currently fished above the biological reference points (e.g., Fmax). In attempting to achieve such targets, advisers and managers have faced two main problems. First, it is impractical to (i) simultaneously maximize yields, stabilize fisheries, and safeguard stocks and (ii) optimize both short- and long-term outcomes for the industry. Second is the lack of predictability, several years ahead, in factors influencing decisions. This study addresses these twin issues by exploring the relative performances of various multiannual and compromise (or composite) management strategies. Multiannual fishing efforts are set in advance for a ``resolution'' period of several years, at the end of which they are updated. They are calculated to satisfy a prior weighted compromise amongst three criteria: (i) minimizing fishing effort variability, (ii) minimizing catch variability, and (iii) reaching a ``mobile target:'' the latter is defined with a second weighted compromise between the long-term target and the fishing effort at the beginning of the resolution period. A safe and optimal balance between all the short- and long-term fishery outcomes is found with a 5-year resolution period, during which the mobile target is split into 40-60% of the long-term target, and 60-40% of the fishing effort at the start of the resolution period, while criteria i, ii, and iii are weighted equally.

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