Production of Mandarin Tone by Adults and Children with Normal Hearing: Significance for Children with Cochlear Implants

Mandarin Chinese is a tone language in which pitch variations are used to change the meanings of words. This study focused on the production of the four tones of Mandarin by adults and eight-year-old children with normal hearing, who spoke Mandarin as their first language. All speakers were recorded producing the tones in the syllable [ma]. Analysis of the speakers' productions of the four tones in [ma] showed that all of the children were able to produce the appropriate tonal contrasts. Some differences between the children and adult speakers were found in the duration of the tones. These data represent a benchmark against which the speech of children with implants can be compared.     

Improved Residual Hearing Preservation Using Peri-Operative Minocycline during Cochlear Implantation

Abstract

Objective: To determine whether peri-operative minocycline improves preservation of residual hearing in adult patients undergoing cochlear implantation.

Study Design: Retrospective age, gender matched study design.

Setting: Tertiary/quaternary referral centre.

Patients: Nine patients undergoing cochlear implantation who received minocycline peri-operatively and a historical control group of nine matched patients who did not receive minocycline.

Intervention(s): Minocycline 200mg orally pre-operatively and 100mg daily post-operatively for ten days.

Main Outcome Measure(s): Change in residual hearing thresholds at 250 and 500 Hz.

Results: The average loss of residual hearing at 250 Hz post-cochlear implant for those who had not received minocycline was 18.9 dB (SD 12.2) compared to 16.7 dB (SD 15.0) for those who had received peri-operative minocycline (p-value 0.77). The average loss of residual hearing at 500 Hz post-cochlear implant for those who had not received minocycline was 24.4 dB (SD 15.9) compared to 19.4 dB (SD 14.3) for those who had received minocycline (p-value 0.48). Two patients who did not receive minocycline lost all residual hearing at both 250 Hz and 500 Hz post-implantation and only one patient who had received minocycline lost all residual hearing at 500 Hz.

Conclusions: The neuroprotective effect of minocycline may help to preserve residual hearing post-cochlear implant. Further studies are warranted.     

Case Report: Early bilateral simultaneous cochlear implantation in a five-year-old following head injury complicated by acute bacterial meningitis

Abstract

Meningitis is an important cause of profound sensorineural hearing loss, especially in children. In this case, a five-year-old suffered a head injury complicated by bacterial meningitis and developed a profound hearing loss. Magnetic resonance imaging at four weeks following injury showed evidence of developing labyrinthitis ossificans and a decision was made to perform bilateral cochlear implantation at an early stage. This report outlines the progress of this interesting case to date and discusses the rationale for the decision to implant in this way.     

A Framework for Good Practice: Managing Failures in a Cochlear Implant Service

Cochlear implants can provide the recipient and their family with wonderful outcomes in terms of their improved access to sound and to speech. However the experience of a cochlear implant failing is distressing for all concerned. Clinicians endeavour to ensure that the process of confirming the failure, re-implantation and subsequent rehabilitation is as smooth as possible. In order to benefit from each others experience, a working party of cochlear implant centre coordinators and representatives from the Ear Foundation met on a number of occasions to draw up a protocol which could be used widely throughout the British Cochlear Implant Group. The protocol indicates quality standards of clinical care to be used in the event of device failure.     

Cochlear reimplantation in children: soft signs,symptoms and results

Abstract

Objectives Cochlear implant device failures and reimplantation have mainly been reported on in adults. The purpose of this study was to isolate precursors of device failures and assess the effects of reimplantation in children.

Methods From 1997 to 2003, 27 children underwent cochlear reimplantation at our institution. The pre-failure complaints were categorized and correlated with actual failure modes and postimplantation results. Speech-recognition tests were used to evaluate preand post-reimplantation performance.

Results Pre-failure length of usage ranged from 0 to 12 years. Symptoms including pain, intermittence, reduced performance, noise and the need for frequent device adjustments were associated with device failures, although not with a particular mode of failure. Post reimplantation performance was equal to but not immediately better than pre-failure results in children who received upgraded devices.

Conclusions Specific complaints, frequent need for device adjustments and reduced speech recognition can be precursors to device failures, underscoring the need for routine follow-up evaluations. Reimplantation with newer technology does not guarantee improved speech understanding and often requires an adjustment period to reach prereimplantation levels.     

Variables Affecting Speech Perception in Postlingually Deaf Adults Following Cochlear Implantation

Objective--To evaluate the time span over which there is greatest improvement in postlingually deaf adults undergoing cochlear implantation. Additionally, to quantify potential patient and device factors that may predict the postoperative results. Material and methods--A longitudinal study was conducted. Numbers, monosyllables and sentence test results were collected for 66 cochlear implant subjects [Combi 40/40+, n=60; Clarion HF2, n=2; Nucleus 24m/k, n=4] at regular intervals for up to 6 years following cochlear implantation. Results--All patients showed a steady improvement over time on all tests. Progress during the first 12 months was statistically significant, with further improvements being recorded after the 12-month testing period. The duration of deafness and the number of electrodes (8 for the Combi 40, 12 for the Combi 40+) appeared to be weakly correlated with postoperative performance. Re-implantation after device failure had no negative effect on speech reception. Subjects who were "upgraded" from an analogue to a digital cochlear implant improved their test results almost twofold. Conclusion--All the patients in our study gained substantial benefit from their cochlear implants. It is encouraging to note that the factors examined were not deemed to be relevant predictors of performance. Even long-term deaf subjects and re-implantees are able to achieve an excellent level of speech perception.     

9例双侧人工耳蜗植入儿童双音节词识别效果分析

目的比较双侧人工耳蜗植入(CI)儿童安静和噪声条件下双耳与单耳开放式双音节词识别率的差异,以及噪声条件下易词与难词识别率差异,结合个案基本情况和CAP和SIR问卷评估结果,分析影响双音节词识别率的个性化因素。方法利用普通话儿童相邻性词表测试工具对9例双侧CI儿童进行安静和噪声条件下的双音节词测试,通过配对t检验,比较双耳与单耳双音节词识别率及易词与难词识别率差异。结果在安静和噪声条件下,双耳与单耳CI双音节识别率差异显著(P<0.05);在噪声条件下,双耳与单耳易词和难词识别率差异极显著(P<0.01);双音节词识别率受个体CI年龄、言语可懂度、内耳畸形类型等因素影响。结论在安静和噪声条件下,双耳CI可提高双音节识别率;在噪声条件下,双耳CI优势更加突出;儿童言语识别率受易词和难词以及儿童个性化等因素影响。     

Barriers to Cochlear Implant Access: Acknowledging the Challenges,Changing the Future: The Impact of Cochlear Implantation: Cognitive Function,Quality of Life,and Frailty in Older Adults

This review examines the relationship between cochlear implantation and cognition and quality of life in older adults, as well as how frailty affects outcomes for older patients with cochlear implants. A growing body of evidence suggests that there is a strong association between hearing loss and cognitive impairment. Preliminary studies suggest that cochlear implantation in older adults may be protective against cognitive decline. While studies have observed a positive impact of cochlear implantation on quality of life, currently it is unclear what factors contribute the most to improved quality of life. Frailty, as a measurement of general health, likely plays a role in complication rates and quality-of-life outcomes after cochlear implantation, though larger prospective studies are required to further elucidate this relationship.     

人工耳蜗术后早期电极阻抗变化规律的研究

目的探讨人工耳蜗植入术后电极阻抗值与电极位置的关系及电极阻抗的总体变化特点。方法对2018年9月至2019年9月在中国科学技术大学附属第一医院行人工耳蜗植入术的患者100例(100耳),于术中、术后3天、术后1月(开机时)及术后3月测试电极阻抗值,分析结果。结果①100例患者总体及不同分区电极阻抗均值术中时最低,开机时(术后1月)升至最高,开机后(术后3月)呈降低趋势,三个时间点均值比较,差异均有统计学意义(P<0.05);②在术中、术后1月与术后3月均为蜗顶区电极阻抗值最高,与蜗中区及蜗底区比较,差异均有统计学意义(P<0.05);③蜗顶区1号和2号电极的阻抗值在术后3天即已升高,与术中差异有统计学意义(P<0.05)。结论电极阻抗值总体变化趋势为术中最低,术后1月(开机时)升至最高,开机后下降。蜗顶区阻抗值术后3天即明显升高且始终较蜗中区和蜗底区高。     

Barriers to Cochlear Implant Access: Acknowledging the Challenges,Changing the Future: Mythbusters! The Truth about Common Misconceptions in Cochlear Implantation

Cochlear implantation (CI) is the preferred method of hearing rehabilitation when patients cannot perform well with traditional amplification. Unfortunately, there are still significant misconceptions around this life-changing intervention. The goal of this article is to address some of the most common myths around CI surgery. After reading this article, the learner will be able to explain the utility of CI in patients with residual hearing and recognize that insurance coverage is widespread. The reader will be able to list common risks associated with this well-tolerated procedure including anesthetic risk and the risk of vestibular dysfunction. Additionally, the reader will be able to identify the significant positive impact of CI on patients'' quality of life. Finally, the reader will identify that many patients can safely have an MRI scan after implantation, including nearly all contemporary recipients.     

Tracking development of speech recognition: longitudinal data from hierarchical assessments in the Childhood Development after Cochlear Implantation Study.

OBJECTIVE: To develop a speech recognition index that summarizes data collected through an array of age-appropriate hierarchical speech recognition tests in a longitudinal study. STUDY DESIGN: Prospective cohort. SETTING: Six tertiary referral centers in the Childhood Development after Cochlear Implantation (CDaCI) Study. PATIENTS: One hundred eighty-eight children implanted at age 5 years or younger and 97 age-comparable normal-hearing controls. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: Outcome measures were the following: Infant-Toddler Meaningful Auditory Integration Scale, Meaningful Auditory Integration Scale, Early Speech Perception Test, Pediatric Speech Intelligibility Test, Multisyllabic Lexical Neighborhood Test, Lexical Neighborhood Test, and Hearing in Noise Test, obtained before implantation and at 6, 12, 18, and 24 months postimplant. RESULTS: A speech recognition cumulative index, speech recognition index in quiet (SRI-Q), was created to combine information from tests administered in quiet. This index allows simultaneous display of data from all tests in the speech recognition hierarchy and is sensitive to improvements in performance over time as a function of age. SRI-Q also provides a composite of performance on multiple tests, allowing both the tracking of "growth curve" in speech recognition across a wide age range over an extended follow-up period and the comparison of normal-hearing and implanted children on multiple measures. The data range for individual tests is also preserved for ease of interpretation. CONCLUSION: SRI-Q allows tracking of global development of speech recognition over time as children progress through a hierarchy of speech perception measures and complements the more detailed assessments obtained from individual tests within the hierarchy.     

中耳感染性疾病Ⅰ期和分期人工耳蜗植入病例分析

目的总结中耳感染性疾病患者人工耳蜗植入(Cochlear Implant,CI)的临床经验。方法对2000年12月-2019年3月在解放军总医院行CI伴中耳感染性疾病患者的临床资料进行回顾性研究。对Ⅰ期或Ⅱ手术患者的中耳病变性质和范围、手术方式、术腔填塞物种类、手术疗效以及术后并发症等进行总结分析。结果术后随访9个月-10年,Ⅰ期植入11例,其中,慢性化脓性中耳炎静止期5例,活动期2例,中耳胆脂瘤4例(胆脂瘤范围较小,或有完整包膜)。Ⅱ期植入9例,其中,慢性化脓性中耳炎活动期6例,静止期1例;中耳胆脂瘤2例(胆脂瘤范围较大,或包绕正常组织,不易完整清除)。分期植入组中有1例耳蜗植入术后9年电极脱出。其余病例通过结合病例特点,采用不同手术方式均取得满意的治疗效果。结论对于中耳感染性疾病的患者,人工耳蜗分期植入相对于同期植入更加安全。Ⅰ期植入应尽可能选择病变较轻,病灶局限易完整清理的病例,术式选择应在彻底清除病灶的基础上尽量选择损伤范围较小的术式。     

Barriers to Cochlear Implant Access: Acknowledging the Challenges,Changing the Future: Defining Disparities in Cochlear Implantation through the Social Determinants of Health

Hearing loss is a global public health problem with high prevalence and profound impacts on health. Cochlear implantation (CI) is a well-established evidence-based treatment for hearing loss; however, there are significant disparities in utilization, access, and clinical outcomes among different populations. While variations in CI outcomes are influenced by innate biological differences, a wide array of social, environmental, and economic factors significantly impact optimal outcomes. These differences in hearing health are rooted in inequities of health-related socioeconomic resources. To define disparities and advance equity in CI, there is a pressing need to understand and target these social factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which include the following domains: healthcare access/quality, education access/quality, social and community context, economic stability, and neighborhood and physical environment. This article defines these domains in the context of CI and examines the published research and the gaps in research of each of these domains. Further consideration is given to how these factors can influence equity in CI and how to incorporate this information in the evaluation and management of patients receiving cochlear implants.     

Coblation vs. Electrocautery Tonsillectomy: A Prospective Randomized Study Comparing Clinical Outcomes in Adolescents and Adults

Objectives

Coblation is operated in low temperature, so it is proposed that tonsillectomy with coblation involves less postoperative pain and allows accelerated healing of the tonsillar fossae compared with other methods involving heat driven processes. However, the results of the previous studies showed that the effect of coblation tonsillectomy has been equivocal in terms of postoperative pain and hemorrhage. Though, most of the previous studies which evaluated coblation tonsillectomy were performed in children. Recently, electrocautery tonsillectomy has been used most widely because of the reduced intraoperative blood loss and shorter operative time compared to other techniques. This prospective study compared intraoperative records and postoperative clinical outcomes in adolescents and adults following coblation and electrocautery tonsillectomies.

Methods

Eighty patients over 16 years of age with histories of recurrent tonsillitis were enrolled. The patients were randomly allocated into coblation (n=40) and electrocautery tonsillectomy groups (n=40). All operations were performed by one surgeon who was skilled in both surgical techniques. Intraoperative parameters and postoperative outcomes were checked.

Results

Postoperative pain and otalgia were not significantly different between the two groups; however, there was a tendency towards reduced pain and otalgia in the coblation group. More cotton balls for swabbing the operative field were used introoperatively in the electrocautery group (P=0.00). There was no significant difference in postoperative hemorrhage, wound healing, commencement of a regular diet, and foreign body sensation between the groups.

Conclusion

Only cotton use, which represented the amount of blood loss, was less in the coblation tonsillectomy group. Coblation tonsillectomy warrants further study with respect to the decreased postoperative pain and otalgia.     

Barriers to Cochlear Implant Access: Acknowledging the Challenges,Changing the Future: The Importance of Access to Bilateral Hearing through Cochlear Implants in Children

Children with hearing loss require early access to sound in both ears to support their development. In this article, we describe barriers to providing bilateral hearing and developmental consequences of delays during early sensitive periods. Barriers include late identification of hearing loss in one or both ears and delayed access to intervention with hearing devices such as cochlear implants. Effects of delayed bilateral input on the auditory pathways and brain are discussed as well as behavioral effects on speech perception and other developmental outcomes including language and academics. Evidence for these effects has supported an evolution in cochlear implant candidacy in children that was started with unilateral implantation in children with profound deafness bilaterally to bilateral implantation to implantation of children with asymmetric hearing loss including children with single-side deafness. Opportunities to enhance the developmental benefits of bilateral hearing in children with hearing loss are also discussed including efforts to improve binaural/spatial hearing and consideration of concurrent vestibular deficits which are common in children with hearing loss.     

Changes in Vestibular Symptoms and Function After Cochlear Implantation: Relevant Factors and Correlations With Residual Hearing

ObjectivesThe aim of this study was to evaluate vestibular function loss after cochlear implantation (CI) and the relationship between vestibular function and hearing changes.MethodsSeventy-five patients with CI were enrolled and divided into those with normal preoperative caloric function (group I) and those with a normal preoperative waveform in cervical vestibular evoked myogenic potential (c-VEMP) testing (group II). The relationship between hearing and changes in the vestibular system was analyzed preoperatively and at 3 and 6 months postoperatively.ResultsIn group I, unilateral weakness on the implanted side was detected in five (7.7%) and eight (12.3%) patients at 3 and 6 months post-CI, respectively. By 3 months post-CI, the total slow-phase velocity (SPV; warm and cold stimulations) was significantly different between the implanted and non-implanted sides (P=0.011), and the shift in total SPV from pre- to post-CI was significantly correlated with the average hearing threshold at 6 months post-CI. In group II, an abnormal c-VEMP was detected on the implanted side in six patients (16.2%) at 3 months post-CI, and in six patients (16.2%) at 6 months post-CI. Significant changes were noticed in the P1 and N1 amplitude at 3 months postCI (P=0.027 and P=0.019, respectively).ConclusionVestibular function and residual hearing function should be afforded equal and simultaneous consideration in terms of preservation.     

Barriers to Cochlear Implant Access: Acknowledging the Challenges,Changing the Future: Determining Cochlear Implant Candidacy in Adults: Limitations,Expansions, and Opportunities for Improvement

The safety, efficacy, and success of cochlear implants (CIs) are well established and have led to changes in criteria used by clinicians to determine who should receive a CI. Such changes in clinical decision-making have out-paced the slower-occurring changes that have taken place with regulatory bodies'' and insurers'' indications. We review the historical development of indications for CIs, including those of the U.S. Food and Drug Administration (FDA), Medicare, Medicaid, and private insurers. We report on expansion to include patients with greater residual hearing, such as those who receive Hybrid and EAS devices, and report on recent FDA approvals that place less emphasis on the patient''s best-aided condition and greater emphasis on the ear to be treated. This includes expansion of CIs to patients with single-side deafness and asymmetric hearing loss. We review changes in the test materials used to determine candidacy, including transition from sentences in quiet to sentences in noise to the recent use of monosyllabic words and cognitive screening measures. Importantly, we discuss the recent trend to recommend CIs despite a patient not meeting FDA or insurers'' indications (a practice known as “off-label”), which serves as attestation that current indications need to be updated.     

Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study)

ObjectivesThis study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy.Methods The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates.ResultsThe mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections.ConclusionRW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.