COCHLEAR IMPLANTS INTERNATIONAL最新文献

Objectives: Quality of life plays an important place in the psychosocial development of children with Cochlear Implants (CI). We assesd health-related quality of life (HRQoL) in children with CI and in hearing children and determined relationships between HRQoL and other developmental characteristics (social-emotional development, Theory of Mind (ToM), spoken language skills).

Methods: A longitudinal study was conducted including children with CI and hearing children. We used instruments that are widely employed and have been validated for research. At time 1 social-emotional development, ToM and spoken language skills were assessed.HRQoL was assessed using the generic KINDL questionnaire, as was social-emotional development, 2.5 years later (time 2).

Results: No significant difference was seen in HRQoL between hearing children and children with CI. We show that the age of detection, the age of hearing care, and the start of early intervention are not related to HRQoL of children with CI, but relationships with some domains of social-emotional development are evident.

Conclusions: This study highlights the importance of targeted intervention not only to improve spoken language skills at preschool age, but also strengthen social-emotional and social-cognitive competences.

Objective: To compare vestibular outcomes in cochlear implant (CI) surgery, between robotic-assisted insertion of the electrodes versus manual insertion.

Methods: We performed a monocentric retrospective study. From March 2021, the robotic system RobOtol© was used for all CI cases. We compared this robotic-assisted insertion group with a manual insertion group of patients who received a CI between July 2020 and March 2021. Primary objective was vestibular outcome. We used objective vestibular function tests: caloric testing, Vestibular Evoked Myogenic Potential (VEMP), and Video Head Impulse Test (VHIT). Secondary objectives were postoperative complications including patient-reported postoperative vertigo.

Results: We found no statistically significant difference between the two groups in terms of caloric testing, VEMP or VHIT outcomes. In patient-reported outcomes, there was significantly more vertigo in the manual insertion group compared with robotic-assisted insertion.

Conclusion: It is hypothesized that a non-traumatic insertion would cause less vestibular dysfunction postoperatively. Larger prospective studies are required to determine whether robotic-assisted CI insertion has a significant impact on vestibular outcomes in CI surgery.

Objectives: To assess an evidence-based model (EBM) approach to cochlear implant (CI) aftercare that includes a modified, reduced treatment schedule for newly-implanted adult CI recipients consisting of four appointments (initial activation, 1-, 3- and 6- months postactivation) in the first year post-surgery.

Method: This prospective multicenter proof-of-concept study was conducted across three clinics in the United States by five experienced CI clinicians. Seventeen newly-implanted adult patients with postlingual hearing loss enrolled in the study. Hearing outcomes were measured using objective speech testing and subjective self-report measures.

Results: Most recipients (14/17; 82%) were able to follow the four-appointment EBM schedule. The reduced number of visits translated into an average time savings of 3 hours per patient. Significant improvements in speech perception were observed at both 3- and 6-months postactivation, as measured by CNC words in quiet and AzBio sentences at +10 dB SNR, consistent with published results achieved by traditional practices. Recipients were significantly satisfied with telephone, music, small group conversation, and television listening at 6 months postactivation. Recipient satisfaction with overall service was rated as "excellent" by 14/14 (100%) respondents.

Conclusion: The four-appointment EBM approach delivered efficient and effective audiological aftercare to CI recipients in the first year following CI implantation.

Objectives: To audit surgical complications and their management in cochlear implant (CI) recipients in a tertiary care referral otorhinolaryngology center in South India.

Materials and methods: Hospital data on 1,250 CI surgeries performed from June 2013 to December 2020 was reviewed. This is an analytical study with data collected from medical records. The demographic details, complications, management protocols and relevant literature were reviewed. Patients were divided into the following five age groups: 0-3 years, 3-6 years, 6-13 years, 13-18 years and above 18 years. Complications were divided into major and minor and complication occurrence was divided into peri-operative, early post-operative, and late post-operative, and the results were analyzed.

Results: The overall major complication rate was 9.04% (including 6.0% due to device failure). If the device failure rate was excluded, the major complication rate was 3.04%. The minor complication rate was 6%.

Discussion: CI is the gold standard in the management of patients with severe to profound hearing loss with minimal benefit from conventional hearing aids. Experienced tertiary care CI referral and teaching centers manage complicated implantation cases. Such centers typically audit their surgical complications, providing important reference data for young implant surgeons and newer centers.

Conclusion: Although not bereft of complications, the list of complications and its prevalence is sufficiently low to warrant the advocacy of CI worldwide, including developing countries with low socio-economic status.

Cerebellopontine angle (CPA) meningiomas commonly involve the internal auditory canal (IAC). We report a case of a 68-year-old lady with idiopathic profound bilateral deafness with a meningioma which was discovered on workup for cochlear implantation. We performed simultaneous excision of her CPA and IAC meningioma with insertion of a cochlear implant (CI). She regained functional hearing with marked improvement in quality of life. Intraoperative electrophysiological testing can be used to confirm preservation of the cochlear nerve enabling simultaneous implantation which is preferable for clinical and logistical reasons. This creates an option for hearing rehabilitation at the time of IAC/CPA tumour surgery in appropriate patients.

Purpose: Cochlear implant (CI) recipients struggle to hear in competing background noise. ForwardFocus is a spatial noise reduction setting from Cochlear Ltd. (Sydney) that can simultaneously attenuate noise from multiple sources behind the listener. This study assessed hearing performance with ForwardFocus in an off-the-ear (OTE) sound processor.

Method: Twenty-two experienced adult CI recipients participated. Speech reception data was collected in fixed noise acutely in the clinic. After three to five weeks take home experience, subjective impressions were recorded, and evaluations were conducted for speech reception in quiet and roving noise.

Results: Group mean speech reception thresholds (SRT) were below 0 dB in two spatially-separated noise test conditions when using ForwardFocus in the OTE sound processor. SRT were -8.5 dB (SD 2.9) in 4-talker babble roving in a rear hemi-field (S0Nrearhemi) and -3.9 dB (SD 3.3) in 12-talker babble presented laterally and behind (S0N3). Results in S0N3 were significantly better with ForwardFocus On (p = 0.0018). Subjective ratings with the OTE were comparable to, or better than, with their walk-in BTE or OTE sound processor.

Conclusions: ForwardFocus provides significant benefits for speech recognition in competing background noise in an OTE sound processor. These results support clinicians in counselling CI recipients on potential sound processor options to consider.

Objectives: This study investigates the role of sentence stress on the comprehension of sentences with clitic pronouns (unstressed morphemes and a typical feature of Romance languages) by children with cochlear implants (CIs).

Methods: Thirteen children (seven girls) with CIs and 15 children (seven girls) with NH between eight and 12 years who are monolingual speakers of Brazilian Portuguese participated on a computerized sentence comprehension task that involved manipulation of stress placement of possible antecedent words to clitic pronouns.

Results: Children with CIs were significantly less accurate than children with NH in comprehending sentences with clitics, regardless of sentence stress. For children with NH, stress on the correct antecedent significantly increased sentence comprehension accuracy. For children with CI, there was no significant effect of sentence stress on selecting the correct antecedent for clitic pronouns.

Discussion: Comprehension of sentences with clitic pronouns is challenging for children with CIs and this challenge holds cross-linguistically. Furthermore, children with CIs do not use prosodic information to support comprehension of sentences with clitics similarly to NH children.

Conclusion: Language-specific syntactic, morphosyntactic, and prosodic contrasts affecting sentence comprehension need to be assessed in children with CIs to plan an effective intervention.

Purpose: Patient suitability for cochlear implant (CI) devices compatible with magnetic resonance imaging and CI processor configuration is dependent on their retro-auricular skin flap thickness. This is typically measured intra-operatively using a needle and therefore patients are not guaranteed their implant of choice prior to surgery. We aimed to identify an accurate method to measure skin flap thickness pre-operatively to streamline CI selection and simplify the consent process.

Methods: Blinded prospective skin flap thickness measurements for patients undergoing CI surgery were recorded using pre-operative computed tomography (CT) and ultrasound (US), and intraoperative needle measurement.

Results: Fifty-six adult patients (36 females, 20 males; mean age 59 years) were included. The mean flap thickness was measured highest by CT (6.9 mm, 95% CI 6.5-7.3 mm), followed by US (6.3 mm, 95% CI 5.9-6.7 mm) and lastly needle (5.5 mm, 95% CI 5.1-5.9 mm) (p < 0.0001). A strong positive correlation (p < 0.001) was noted between all three modalities: CT vs needle (r = 0.869), US vs needle (r = 0.865), and CT vs US (r = 0.849).

Conclusion: Accurate, non-invasive measurement of skin flap thickness prior to CI surgery can be achieved using CT or US. We recommend the routine use of US in the outpatient clinic to minimise unnecessary radiation exposure.

Objective: To compare cochlear implant (CI) data logging of patients with single-sided deafness (SSD) and bilateral sensorineural hearing loss (biSNHL) in various acoustic environments and study the implications of data logging on auditory performance.

Study design: Retrospective case control study.

Methods: Adult CI patients with SSD or biSNHL from 2010 to 2021 with usage data collected at 3-, 6-, and 12-months following device activation were identified. The CI listening environment was defined as speech in noise, speech in quiet, quiet, music or noise. Auditory performance was measured using the CNC word, AzBio sentence tests and the Tinnitus Handicap Index (THI).

Results: 60 adults with SSD or biSNHL were included. CI patients with biSNHL wore their devices more than those with SSD at 3-months post-activation (11.18 versus 8.97 hours/day, p = 0.04), though there were no significant differences at 6-12 months. Device usage was highest in the speech in quiet environment. In SSD CI users, there was a positive correlation (p = 0.03) between device use and CNC scores at 12-months and an improvement in THI scores at 12-months (p = 0.0004).

Conclusions: CI users with SSD and biSNHL have comparable duration of device usage at longer follow-up periods with greatest device usage recorded in speech in quiet environments.

Purpose: Cochlear implant (CI) decision-making is particularly challenging for families of children who have residual hearing. Parents of these children may be uncertain about whether the potential benefits of CIs outweigh the risks. This study aimed to understand parents' decisional needs during the decision-making process for children with residual hearing.

Method: Semi-structured interviews were conducted with parents of 11 children who had received CIs. Open-ended questions were asked to encourage parents to share their experiences about the decision-making process, their values/preferences, and their needs. The interviews were transcribed verbatim and analyzed using thematic analysis.

Results: Data were organized according to three key themes: (1) Parents' decisional conflict, (2) values and preferences, (3) decision support and parents' needs. We found that overall parents were satisfied with their decision-making process and the decision support from practitioners. However, parents stressed the importance of receiving more personalized information that considers their specific concerns, values and preferences related to family's circumstances.

Conclusions: Our research provides additional evidence to guide the CI decision-making process for children with residual hearing. Additional collaborative research with audiology and decision-making experts specifically on facilitating shared decision-making is needed to provide better decision coaching for these families.