Cochlear Implants International[JOURNAL]
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200 papers
Cochlear implantation outcomes in the older adult: a scoping review.
Kay-Rivest E, Schlacter J, Waltzman SB
Cochlear Implants Int · 2022 Sep · PMID 35774034 · Publisher ↗
OBJECTIVES: The current study aimed to identify and map the available evidence surrounding cochlear implantation (CI) in older adults. Five outcomes were evaluated: speech perception scores, perioperative complications,...
OBJECTIVES: The current study aimed to identify and map the available evidence surrounding cochlear implantation (CI) in older adults. Five outcomes were evaluated: speech perception scores, perioperative complications, neurocognitive outcomes, quality of life outcomes and vestibular dysfunction and fall rates after surgery. METHODS: A scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews and included patients over the age of 60. RESULTS: Ninety-seven studies met inclusion criteria, encompassing 7,182 patients. Mean (SD) speech perception scores in quiet and in noise pre-and postoperatively were 7.9% (6.7) and 52.8% (14.3) and 8.0% (68.1) and 68.1% (15.9) respectively. Postoperative cardiac arrhythmias, urinary retention, and delirium occurred slightly more frequently in older adults. In terms of cognition, most studies noted stability or improvement one year after implantation. A majority of studies indicated better quality of life post-CI. Rates of fall after surgery were rarely reported, and there was a general paucity of data surrounding vestibular function changes after CI. DISCUSSION: This scoping review identifies many positive outcomes linked to CI in older adults. No findings suggest a single patient characteristic that would warrant refusal to consider evaluation for cochlear implantation.
AzBio Sentence test in Hebrew (HeBio): development, preliminary validation, and the effect of noise.
Taitelbaum-Swead R, Dahan T, Katzenel U … +3 more , Dorman MF, Litvak LM, Fostick L
Cochlear Implants Int · 2022 Sep · PMID 35672886 · Publisher ↗
The AzBio sentence test is widely used to assess speech perception pre- and post-cochlear implantation. This study created and validated a Hebrew version of AzBio (HeBio) and tested its intelligibility amidst background...
The AzBio sentence test is widely used to assess speech perception pre- and post-cochlear implantation. This study created and validated a Hebrew version of AzBio (HeBio) and tested its intelligibility amidst background noise. In Experiment 1, 1,000 recorded Hebrew sentences were presented via five-channel vocoder to 10 normal hearing (NH) listeners for intelligibility testing. In Experiment 2, HeBio lists were presented to 25 post-lingual cochlear implant (CI) users amidst four-talker babble noise (4TBN) or in quiet, along with one-syllable word test. In Experiment 3, 20 NH listeners were presented with eight HeBio lists in two noise conditions [4TBN, speech shaped noise (SSN)] and four SNRs (+3, 0 dB, -3 dB, -6 dB). HeBio lists (33) produced 82% average understanding, no inter-list intelligibility differences among NH, and equal intelligibility for CI users. One-syllable words predicted 67% of the variance in HeBio among CI users. Higher intelligibility was found for SSN than for 4TBN, and the mean speech receptive threshold (SRT) was more negative for SSN than for 4TBN. HeBio results were similar to AzBio. Results obtained with two noise types were as expected. HeBio is recommended for evaluation of different populations in quiet and noise.
Considerations in pediatric device candidacy: An emphasis on spoken language.
Hayes NA, Davidson LS, Uchanski RM
Cochlear Implants Int · 2022 Sep · PMID 35637623 · Full text
As cochlear implant (CI) candidacy expands to consider children with more residual hearing, the use of a CI and a hearing aid (HA) at the non-implanted ear (bimodal devices) is increasing. This case study examines the co...
As cochlear implant (CI) candidacy expands to consider children with more residual hearing, the use of a CI and a hearing aid (HA) at the non-implanted ear (bimodal devices) is increasing. This case study examines the contributions of acoustic and electric input to speech perception performance for a pediatric bimodal device user (S1) who is a borderline bilateral cochlear implant candidate. S1 completed a battery of perceptual tests in CI-only, HA-only and bimodal conditions. Since CIs and HAs differ in their ability to transmit cues related to segmental and suprasegmental perception, both types of perception were tested. Performance in all three device conditions were generally similar across tests, showing no clear device-condition benefit. Further, S1's spoken language performance was compared to those of a large group of children with prelingual severe-profound hearing loss who used two devices from a young age, at least one of which was a CI. S1's speech perception and language scores were average or above-average compared to these other pediatric CI recipients. Both segmental and suprasegmental speech perception, and spoken language skills should be examined to determine the broad-scale performance level of bimodal recipients, especially when deciding whether to move from bimodal devices to bilateral CIs.
Achondroplasia and severe sensorineural hearing loss: The role of active bone conduction implants.
Siegel L, Araslanova R, Stepniak C … +2 more , Zimmerman K, Agrawal SK
Cochlear Implants Int · 2022 Sep · PMID 35577761 · Publisher ↗
The BONEBRIDGE is a partially implantable, transcutaneous bone conduction device that can be used to treat conductive or mixed mild-to-moderate hearing loss in patients who do not attain sufficient improvement from conve...
The BONEBRIDGE is a partially implantable, transcutaneous bone conduction device that can be used to treat conductive or mixed mild-to-moderate hearing loss in patients who do not attain sufficient improvement from conventional hearing aids. The following case report describes sequential bilateral BONEBRIDGE implantation in a 25-year-old patient with achondroplasia and bilateral mixed-hearing loss with a significant sensorineural component in the setting of chronic suppurative otitis media. Although the patient did not meet the approved BONEBRIDGE criteria, implantation was successful with improvements in audiological outcomes and self-reported quality of life. There were no reported complications at 5-years post-implantation.
MELUDIA - Online music training for cochlear implant users.
Boyer J, Stohl J
Cochlear Implants Int · 2022 Sep · PMID 35534440 · Publisher ↗
BACKGROUND: Music enjoyment is of importance for many cochlear implant (CI) users, and the interest in music training is high. But many CI users report that it is a challenge to find suitable training resources and that...
BACKGROUND: Music enjoyment is of importance for many cochlear implant (CI) users, and the interest in music training is high. But many CI users report that it is a challenge to find suitable training resources and that they stall because they don't know how to practice. Meludia is an online music training program that provides structured and guided music training for musically experienced and inexperienced children and adults. OBJECTIVE: The aim of the study was to evaluate the suitability of the Meludia music training software for CI recipients based on two research questions: (1) are the easiest exercises available easy enough for CI users, and (2) are there any gaps when progressing through levels and stars with increasing difficulty? METHODS: Thirty-eight adult MED-EL CI users completed fourteen exercises involving 5 different musical dimensions of the online music training program. RESULTS: Our results show that the easiest exercises available in Meludia are easy enough for CI users to be able to use this training resource independent of age, indication, duration of CI use or musical background. CONCLUSION: With Meludia we assessed and found a suitable and comprehensive training tool that allows CI recipients to work on individual goals regardless of their present abilities.
Speech perception abilities of adult cochlear implant listeners with single-sided deafness vs. bilateral hearing loss.
Sladen DP, Zeitler DM
Cochlear Implants Int · 2022 Jul · PMID 35506493 · Publisher ↗
OBJECTIVES: The purpose of this study was to compare the speech perception abilities in adult cochlear implant recipients implanted for bilateral sensorineural hearing loss (BSNHL) with those implanted for single-sided d...
OBJECTIVES: The purpose of this study was to compare the speech perception abilities in adult cochlear implant recipients implanted for bilateral sensorineural hearing loss (BSNHL) with those implanted for single-sided deafness (SSD). DESIGN: A total of 12 adults with BSNHL and 12 adults with SSD participated. Each participant completed a battery of speech perception measures including monosyllabic words, sentences, and consonant recognition. RESULTS: Cochlear implant users with BSNHL performed higher on word and sentence recognition. Consonant recognition scores showed higher performance for CI listeners with BSNHL for voicing and manner, but not for place or articulation. CONCLUSIONS: Results of this study suggest that adults with SSD may have lower speech perception abilities with their cochlear implant when compared to adults implanted for BSNHL.
Detection accuracy of soft tissue complications during remote cochlear implant follow-up.
Holtmann LC, Deuß E, Meyer M … +6 more , Kaster F, Bastian T, Schleupner MC, Hagedorn E, Lang S, Arweiler-Harbeck D
Cochlear Implants Int · 2022 Sep · PMID 35477412 · Publisher ↗
PURPOSE: After cochlear implantation (CI), long-term follow-up is obligatory. Remote-care options which provide a standard of care comparable to in-person consultations, could be an attractive addition to a cochlear impl...
PURPOSE: After cochlear implantation (CI), long-term follow-up is obligatory. Remote-care options which provide a standard of care comparable to in-person consultations, could be an attractive addition to a cochlear implant centre's portfolio. The aim of this study was to evaluate the accuracy of photographs of the skin covering the implant to reliably detect skin irritations or soft tissue complications. METHODS: During routine follow-up consultations, 109 CI patients were examined in person and asked to take a photograph of the skin covering the implant using their smartphones. Photographs were digitally and remotely evaluated by two CI physicians who were blinded to the findings during the in-person examination. RESULTS: In nine cases, skin abnormalities were detected by the CI physician upon in-person examination, seven of which required immediate treatment. Both digital evaluators reliably detected all treatment-requiring conditions. Overall, more skin irritations were suspected digitally compared to in-person examination. Without additional information from the patients' medical record, sensitivity was 100% and specificity was 63%; with additional information provided, sensitivity was 100%, and specificity increased to 65.3%. CONCLUSION: Digital photographic assessment of the skin covering the implant is a highly sensitive method to detect skin irritations and could reduce the number of necessary in-person consultations.
National study of hearing preservation rates and outcomes after cochlear implantation in Ireland.
Gendre A, Quinn S, Jones H … +5 more , Hintze J, Simões-Franklin C, Walshe P, Viani L, Glynn F
Cochlear Implants Int · 2022 Sep · PMID 35418277 · Publisher ↗
OBJECTIVE: To study the rate of hearing preservation and outcomes of hearing preservation candidates in a national cochlear implant centre. The HEARRING criteria was used. METHODS: All cochlear implant candidates with pr...
OBJECTIVE: To study the rate of hearing preservation and outcomes of hearing preservation candidates in a national cochlear implant centre. The HEARRING criteria was used. METHODS: All cochlear implant candidates with preserved low frequency pure tone average (PTA) were included. All patients underwent cochlear implantation using a standard 'soft-surgery' technique. PTA was assessed at switch-on, 3, 6, 9 and 12 months postoperatively. The primary outcome was hearing preservation at 12 months. RESULTS: Sixty six patients were included in the study between 2015 and 2020. Seventy one ears were implanted including 33 adults and 33 children with 5 bilateral implantations. Mean preoperative PTA was 74.8 dB (range 52.3-92 dB), mean postoperative PTA was 95.3 dB corresponding to a mean shift of 20.5 dB. In the adult population, HP rates were as follows: complete HP in 13%, partial HP in 39.1%, minimal HP in 30.4%, loss of hearing in 17.4%. In the paediatric population: complete HP in 20.7%, partial HP in 51.7%, minimal HP in 13.8% and loss of hearing in 13.8%. After the initial postoperative shift, there was no significant worsening of residual hearing during follow-up between 3 and 12 months. There were no significant prognostic factors for hearing preservation. CONCLUSION: Hearing preservation rates using the HEARRING criteria are described. This study will help counselling and decision making in patients eligible for cochlear implantation with hearing preservation. Further studies are required to assess the performances and outcomes of electronatural and electroacoustic stimulation.
Maximum acceptable level for the determination of ECAP and ESRT in a paediatric population.
Di Berardino F, Cavicchiolo S, Del Carmen Fuentes M … +3 more , Kontides A, Lauss K, Zanetti D
Cochlear Implants Int · 2022 Jul · PMID 35380097 · Publisher ↗
OBJECTIVES: Two of the most used objective measures are electrically evoked action potentials (ECAPs) and electrically evoked stapedius reflex thresholds (ESRTs). Although stimuli used for these measures differ considera...
OBJECTIVES: Two of the most used objective measures are electrically evoked action potentials (ECAPs) and electrically evoked stapedius reflex thresholds (ESRTs). Although stimuli used for these measures differ considerably, both measures are influenced by subjective loudness percept. We focus on the subjective maximum acceptable loudness (MAL) to investigate if loudness sensitivity varied along the electrode array during ECAP recordings. In addition, we explored how the MAL reached during an ECAP recording related to the postoperative ESRT. METHODS: Uni- and bilaterally implanted young CI users (= 15, average age = 9 y, age range 3-18 y) underwent ECAP and ESR recordings using the clinical software MAESTRO (MED-EL, Innsbruck, Austria) and a commercially available immittance instrument (PATH MEDICAL GmbH, Germering, Germany). RESULTS: Loudness tolerance during ECAP recordings was lowest at the two apical-most electrode contacts (number 1 and 2). There was a moderate correlation between the MAL achieved during ECAP recordings and ESR maximum stimulation amplitudes. (r: 0.44344). CONCLUSIONS: ECAP recordings should commence at basal or medial contacts to increase the users' comfort and loudness tolerance, especially in young CI users. A higher maximum stimulation appears to increase the chance of the automatic determination of ECAP thresholds for all electrode contacts.
Neural recovery function of the auditory nerve in cochlear implant surgery: Comparison between different regions of the cochlea.
Carvalho B, Richter Minhoto Wiemes G, Richter Minhoto Wiemes N … +1 more , Hamerschmidt R
Cochlear Implants Int · 2022 Jul · PMID 35337245 · Publisher ↗
INTRODUCTION: Cochlear implants allow measures of neural function, through Neural response telemetry (NRT) and Auditory nerve recovery function (REC). These help in programming the speech processor and understanding the...
INTRODUCTION: Cochlear implants allow measures of neural function, through Neural response telemetry (NRT) and Auditory nerve recovery function (REC). These help in programming the speech processor and understanding the auditory system. However, not many studies have evaluated and compared these in different regions of the cochlea. OBJECTIVE: Comparing NRT and REC in different regions of the cochlea. METHODS: Cross-sectional, descriptive and prospective. NRT and REC (through the function of T0 - absolute refractory period, A - amplitude and TAU - time constant of the relative refractory period parameters) were evaluated, in three groups according to the stimulated electrode of the cochlea: apical, medial and basal. RESULTS: 26 adult patients were evaluated, 2 bilateral, totalling 28 ears. Data analysis showed no statistically significant difference between NRT between medial and basal but showed between apical and medial and apical and basal. For T0, there was a significant difference between medial and basal; for A, there was a significant difference between apical and basal and also medial and basal; and for TAU, there was no significant difference. CONCLUSION: There was a statistically significant difference in NRT and REC when compared between different regions of the cochlea.
Variability in surgical techniques for cochlear implantation: an international survey study.
Kant E, Markodimitraki LM, Stegeman I … +1 more , Thomeer HGXM
Cochlear Implants Int · 2022 Jul · PMID 35317714 · Publisher ↗
OBJECTIVE: This study aimed to gain insight into current practices regarding the surgical techniques used for positioning and fixation of internal components of the cochlear implant. METHODS: A questionnaire focused on s...
OBJECTIVE: This study aimed to gain insight into current practices regarding the surgical techniques used for positioning and fixation of internal components of the cochlear implant. METHODS: A questionnaire focused on surgical techniques used for cochlear implantation was distributed among 441 cochlear implant surgeons. Descriptive statistics were reported. RESULTS: The questionnaire was completed by 59 surgeons working in 13 different countries. The most preferred incision shapes were the S-shape (41%) and the C-shape (36%). The preferred implantation angle for the receiver/stimulator device was either 45° (64%) or 60° (30%), relative to the Frankfurter Horizontal Plane. Most respondents used a drilled bony well with (42%) or without a subperiosteal pocket (31%) to fixate the receiver/stimulator device. All respondents used the facial recess approach. Most used the round window insertion technique to enter the scala tympani (73%). Approximately half of the respondents preferred the lateral wall electrode array, whereas the other half preferred the perimodiolar electrode array. During their career, most (86%) changed their technique towards structure preservation and minimizing trauma. CONCLUSION: This study indicates variability in the surgical techniques used to position and fixate the internal components of the cochlear implant. Additionally, surgical preference transits towards structure preservation and minimal invasiveness.
New approach in programming sequentially implanted children: Towards balanced dynamic ranges (DR).
Kosgallana PC, Viani Walsh D, Simões-Franklin C … +5 more , Thapa J, Walshe P, Glynn F, Reilly RB, Viani L
Cochlear Implants Int · 2022 Jul · PMID 35317705 · Publisher ↗
There is a tendency for children undergoing sequential cochlear implant after a long period of unilateral implant use to have a smaller dynamic range in their second implant compared to their first implant. This study ai...
There is a tendency for children undergoing sequential cochlear implant after a long period of unilateral implant use to have a smaller dynamic range in their second implant compared to their first implant. This study aimed to investigate if balancing the dynamic ranges between the two implants influenced functional outcomes in sequentially implanted children. Nineteen participants with long inter-implant time delays were randomly assigned to a study group or a control group. Children in the study group received progressive minimal changes to both first and second implants over a period of nine months to achieve balanced dynamic ranges, while the children in the control group received only changes to their sequential implant. Functional outcomes were collected 24-months after sequential implantation and consisted of speech discrimination scores, spatial localisation, device use and quality of life measures. Results show that spatial discrimination skills improved over time for both groups of children; however children in the study group had smaller localisation errors compared with the children in the control group. No other differences between the two groups were observed. Balanced dynamic ranges in sequentially implanted children can contribute to better performance, particularly in spatial discrimination tasks that rely in inter-aural level differences.
A comparison of imaging techniques to measure skin flap thickness in cochlear implant patients to enable pre-operative device selection.
Rees J, Abrar R, Stapleton E
Cochlear Implants Int · 2022 Jul · PMID 35236259 · Publisher ↗
OBJECTIVES: Magnetic resonance imaging (MRI)-compatible cochlear implants have weaker internal magnets than non-MRI-compatible devices. Their suitability for individual patients is limited by skin flap thickness, traditi...
OBJECTIVES: Magnetic resonance imaging (MRI)-compatible cochlear implants have weaker internal magnets than non-MRI-compatible devices. Their suitability for individual patients is limited by skin flap thickness, traditionally measured with a needle in the operating theatre. We aimed to establish the accuracy of imaging modalities to measure skin flap thickness pre-operatively, with the goal of streamlining device selection and simplifying the consent process. METHODS: Skin flap measurements were taken using ultrasound (US), computed tomography (CT) and MRI and compared for agreement with intra-operative needle measurement. RESULTS: Twenty-seven skin flaps were included. Absolute agreement between needle and imaging methods was low: needle/US: 44.4% (95% confidence interval [CI]: 27.7-62.7), needle/CT: 39.1% (95% CI: 22.2-59.2), needle/MRI: 20.8% (95% CI: 9.2-40.5). However, US and CT showed 95.7% agreement (95% CI: 76.0-99.8) with intraclass correlation of 0.996 (95% CI: 0.991-0.998) and narrow Bland-Altman limits of agreement (-0.37, 0.45 mm). BMI and skin flap thickness showed a significant positive correlation (= 0.664, P0.002) but no significant correlation was observed for age (P= 0.659). DISCUSSION: The high level of agreement between US and CT suggests that there are more accurate measurements of skin flap thickness compared with needle or MRI. Needle measurements are consistently smaller. CONCLUSION: The use of CT or US should be considered when making pre-operative device choices.
Cochlear implant explantation: An in vitro model to evaluate electrode explant force and trauma.
Asfour L, Risi F, Miah H … +1 more , Roland JT
Cochlear Implants Int · 2022 Jul · PMID 35236258 · Publisher ↗
OBJECTIVES: Removal of a cochlear implant and its intracochlear electrode array is sometimes necessary, potentially causing cochlear explant trauma. Explantation typically occurs years post-implantation by which time rea...
OBJECTIVES: Removal of a cochlear implant and its intracochlear electrode array is sometimes necessary, potentially causing cochlear explant trauma. Explantation typically occurs years post-implantation by which time reactive tissue has formed around the electrode. We aimed to create an in-vitro electrode explant model to examine explant forces and intracochlear trauma across multiple electrode types and insertion depths. STUDY DESIGN: An in-vitro model using gel to represent tissue surrounding the electrode was developed. Pre-curved electrodes and straight electrodes at different insertion depths (20mm, 25mm, 28mm) were explanted from the model. During explantation, explant force was measured, and high-definition videos were recorded to capture electrode exit path and gel disruption. RESULTS: Explant force patterns varied based on electrode position in the scala tympani. Explant forces did not correlate with gel disruption, which represented explant trauma. The least gel disruption occurred with pre-curved electrodes and the under-inserted straight electrode. The greatest disruption occurred with the overly inserted straight electrode. CONCLUSION: An in-vitro model using gel to mimic tissue surrounding the electrode may provide insights into potential electrode explant trauma. Explant force did not correlate with explant trauma in our model. Pre-curved electrodes and shallower insertion depth of a straight electrode resulted in the least amount of explant trauma.
Effect of adaptive beamforming and noise reduction algorithms on speech intelligibility and noise tolerance in bimodal cochlear implant users.
Michels A, Oukheira Y, Brendel M … +3 more , Aschendorff A, Arndt S, Wesarg T
Cochlear Implants Int · 2022 May · PMID 35193474 · Publisher ↗
OBJECTIVE: To evaluate the effect of a directional microphone (beamformer) and continuous noise reduction algorithms (CNRs) in bimodally aided cochlear implant (CI) users and to find the optimum hearing aid (HA) and CI s...
OBJECTIVE: To evaluate the effect of a directional microphone (beamformer) and continuous noise reduction algorithms (CNRs) in bimodally aided cochlear implant (CI) users and to find the optimum hearing aid (HA) and CI settings of the beamformer and CNRs. METHODS: Speech reception threshold (SRT) and acceptable noise level (ANL) were assessed in twelve adult CI users for unilateral CI, unilateral HA and bimodal listening. To assess the effect of the UltraZoom beamformer and the ClearVoice™ and NoiseBlock CNRs on SRT and ANL, speech was presented from the front in multi-source speech-shaped noise. RESULTS: With unilateral CI, application of UltraZoom resulted in a significant improvement of the median SRT and ANL by 3.8 and 4.3 dB, respectively. For bimodal listening with UltraZoom, a significant improvement of 3.5 dB in median SRT was found. There was no significant effect of using the CNRs on speech intelligibility in noise or noise tolerance in either listening condition. CONCLUSION: UltraZoom should be applied on the CI to improve speech intelligibility in face to face conversations with multi-source background noise. However, due to the heterogeneous data, no recommendations for the settings of UltraZoom on the HA or of ClearVoice/NoiseBlock on either device can be given. TRIAL REGISTRATION: German Clinical Trials Register identifier: DRKS00010807.
Patient, parental and multi-disciplinary team rationale for non-implantation following the paediatric cochlear implantation assessment.
Hall A, McClenaghan F, Nash R … +1 more , Shaida A
Cochlear Implants Int · 2022 May · PMID 35168472 · Publisher ↗
OBJECTIVES: To assess paediatric patients referred to the cochlear implant team, who despite undergoing the assessment, did not receive cochlear implantation. To identify the underlying reasons for this. METHODS: A retro...
OBJECTIVES: To assess paediatric patients referred to the cochlear implant team, who despite undergoing the assessment, did not receive cochlear implantation. To identify the underlying reasons for this. METHODS: A retrospective case-note review of patients was assessed from June 2014 to June 2019 at two separate London teaching hospitals with paediatric cochlear implantation programmes. RESULTS: A total of 921 paediatric patients were assessed during the study period across both institutions. And, 196 (21%) did not proceed with the surgery. The decision not to undergo surgery was primarily parental/patient-directed in 114 (61%) and cochlear implant team-directed in 74 (39%). In total, eight (4%) patients exited the programme without a documented reason. DISCUSSION: A myriad of factors influenced the decision-making process for clinicians, patients and parents. The most cited parental/patient rationale against implantation was the wish to continue current means of communication 40 (35%), followed by concern regarding the risks of surgery 18 (15.8%) and the wish to allow the patient to make future decisions independently in view of the future technology 7 (6.1%). Cochlear implant team-directed decisions were largely due to being outside of the NICE criteria 27 (36.5%) or the risks of general anaesthesia 19 (25.7%) in addition to communication concerns 11 (14.9%). CONCLUSION: Decision-making in cochlear implantation should not be underestimated. Extensive discussion and exploration of options with the multi-disciplinary team can aid decision-making, but the timescale and appreciation of the consequences of the decision inevitably lead to pressure. Exploration of reasons for non-implantation emphasises the importance of a multi-professional approach to manage these patients.
Autologous fat grafting as a minimally invasive technique to avoid cochlear implant extrusion.
Aldè M, Mazzola RF, Ambrosetti U … +2 more , Di Berardino F, Cantarella G
Cochlear Implants Int · 2022 May · PMID 35144526 · Publisher ↗
Infection of the skin-muscle flap is one of the most severe risks of cochlear implantation. The aim of this paper is to describe a novel and minimally invasive procedure to avoid cochlear implant (CI) extrusion. A 79-yea...
Infection of the skin-muscle flap is one of the most severe risks of cochlear implantation. The aim of this paper is to describe a novel and minimally invasive procedure to avoid cochlear implant (CI) extrusion. A 79-year-old woman with severe comorbidities developed a pressure injury of the skin-muscle flap overlying the CI receiver/stimulator (R/S) nine years after surgery. Skin thinning and failure of conventional pressure injury management led the patient to a high risk of CI extrusion. Therefore, she underwent a single procedure of autologous fat grafting under local anesthesia to increase scalp thickness and vascularization over the CI R/S. Within one month, complete healing of the pressure injury was observed, and the patient was able to safely use her CI. No further signs of infection and skin deterioration were detected at the 15-months follow-up. Fat grafting has been proven to promote neoangiogenesis and tissue regeneration. To the best of our knowledge, this is the first report of fat grafting utilized in the skin-muscle flap area to avoid incipient CI R/S extrusion. The described case demonstrates the efficacy of this salvage procedure to avoid major surgery and the additional costs related to CI reimplantation.
Facial nerve stimulation in cochlear implant users - a matter of stimulus parameters?
Gärtner L, Lenarz T, Ivanauskaite J … +1 more , Büchner A
Cochlear Implants Int · 2022 May · PMID 35068356 · Publisher ↗
OBJECTIVES: To describe the influence of stimulus parameters on aberrant facial nerve stimulation in cochlear implant users. METHODS: Retrospective case series (three ears - two patients). Cochlear implant patients with...
OBJECTIVES: To describe the influence of stimulus parameters on aberrant facial nerve stimulation in cochlear implant users. METHODS: Retrospective case series (three ears - two patients). Cochlear implant patients with severe facial nerve stimulation and degraded speech comprehension who underwent re-implantation with Neuro Zti EVO (Oticon Medical). RESULTS: In all three ears, side effects evoked by aberrant facial nerve stimulation could be resolved and thereby speech comprehension was improved. CONCLUSIONS: Aberrant facial nerve stimulation in cochlear implant patients was successfully resolved by re-implantation. We hypothesize that one or more of the specific stimulus paramet ers are responsible for this success: combined common ground and monopolar stimulation mode, asymmetric pulse waveform with active anodic leading first phase followed by slow capacitive discharge, and pulse width modulation for loudness coding.
CI decision making and expectations by older adults.
Illg A, Bräcker T, Batsoulis C … +2 more , Opie JM, Lesinski-Schiedat A
Cochlear Implants Int · 2022 May · PMID 34963418 · Publisher ↗
OBJECTIVE: To document and analyze the cochlear implant (CI) decision-making process of hearing-impaired older adults. The aim of this study is to assess what support could be helpful during this process in order to impr...
OBJECTIVE: To document and analyze the cochlear implant (CI) decision-making process of hearing-impaired older adults. The aim of this study is to assess what support could be helpful during this process in order to improve care delivery. METHODS: 32 older adult CI recipients (≥ 60 years) with severe to profound sensorineural hearing loss were interviewed about their CI decision-making process 3-12 months after obtaining their first CI. RESULTS: Minimal information was provided to CI candidates by hearing aid acousticians or patient associations. High to very high expectations were reported by patients concerning issues beyond hearing improvement per se. Even though not all expectations were fulfilled by the CI, nearly all recipients who used an implant for at least six months would recommend a CI to others. DISCUSSION: We identified an opportunity for those professionals to play a greater role in supporting older CI candidates during the decision-making process. It is desirable to establish a comprehensive network of hearing care professionals to collaborate with CI clinics. CONCLUSION: In order to support older patients adequately in deciding about CI, intensive training should be offered to hearing care professionals in order to provide realistic expectations and reduce fear and uncertainty about the implantation process. These topics need to be communicated in a professional manner and adapted to the candidate's age and personality.
Impact of preoperative antibiotic use in preventing complications of cochlear implantation surgery.
Košec A, Živko J, Marković S … +3 more , Bedeković V, Ries M, Ajduk J
Cochlear Implants Int · 2022 May · PMID 34915825 · Publisher ↗
OBJECTIVE: To examine the impact of preoperative antibiotic prophylaxis on the occurrence of postoperative complications. MATERIALS AND METHODS: Data of 491 patients undergoing cochlear implantation were included in a no...
OBJECTIVE: To examine the impact of preoperative antibiotic prophylaxis on the occurrence of postoperative complications. MATERIALS AND METHODS: Data of 491 patients undergoing cochlear implantation were included in a non-randomized retrospective comparative cohort study. Demographic data, cochlear implant and surgical details, use of preoperative antibiotics and occurrence of postoperative complications were analyzed using a binary logistic regression model. RESULTS: There were 317 patients (64.56%) who did not receive preoperative antibiotic prophylaxis and 174 (35.44%) patients who received preoperative antibiotic prophylaxis with ceftriaxone. The overall rate of complications requiring surgical treatment was 2.85%. Younger patient age was identified as a positive predictive factor for administering preoperative antibiotic prophylaxis (p<0.001, OR 1.05 CI 95% 1.0124-1.0826). No difference in complication rate was observed between the two groups. No correlation between sex, age, manufacturer, surgeon and postoperative complications were noted (p=0.45). CONCLUSION: There is insufficient evidence to inform decision making regarding preoperative intravenous ceftriaxone use for prevention of infection after cochlear implantation surgery, with data failing to show that administration of preoperative antibiotics leads to a decrease in complication rate. Considering a very low overall complication rate, with few complications related to infection, routine use of preoperative antibiotic prophylaxis should be analyzed further.
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