Benefits Of Bilateral Cochlear Implantation Research Articles

Benefit of Bilateral Cochlear Implantation on Phonological Processing Skills in Deaf Children.

Children with bilateral cochlear implants (CIs) would have better phonological processing skills than children with unilateral CIs because those with bilateral CIs have better speech perception abilities in noisy environments and higher levels of central auditory system development than those with unilateral CIs. Previous studies have focused on the performance of children with bilateral CIs on standardized clinical assessments. However, these tests are not sufficiently sensitive to explain better speech and language outcomes in children with bilateral CIs than children with unilateral CIs. Thus, this study focused on phonological processing skills at more central levels of analysis that reflect the operation of cognitive processes. Twenty children with bilateral CIs and 20 children with unilateral CIs, aged 4 to 6 years, participated in this study. The children completed the experience-dependent tasks and phonological processing tasks. The experience-dependent tasks involved the monosyllabic word, articulation, and receptive vocabulary tests. The phonological processing tasks involved the phonological awareness, phonological memory, and rapid automatic naming tasks. Task performance was compared between the unilateral and bilateral CI groups. Children with unilateral CIs performed similarly to children with bilateral CIs on all three experience-dependent tasks. However, children with bilateral CIs significantly outperformed children with unilateral CIs on all three phonological processing tasks. Among the phonological processing tasks, the rapid automatic naming task scores differentiated children with unilateral CIs from children with bilateral CIs. Bilateral cochlear implantation may positively impact the phonological processing skills of deaf children.

Bilateral Cochlear Implantation in Children: Long-Term Outcome in the Adult Population With Special Emphasis on the Bilateral Benefit.

To investigate the benefit of bilateral cochlear implantation in adults, who had been implanted being a child under the age of 10 years. Retrospective data analysis. Tertiary referral center with a large cochlear implant program. Speech understanding in the Freiburg monosyllabic words in quiet and the HSM sentence test in quiet and in background noise. Seventy-seven bilaterally cochlear implantation implanted adults. Bilateral cochlear implantation in children under the age of 10 years results in a significant benefit in speech comprehension in adulthood. In addition, a dependency regarding the time between the implantations and speech intelligibility was found. The results emphasize the benefit of bilateral cochlear implantation with a short interval between the operations in young children not only during formative years but also in adulthood.

Bilateral cochlear implantation: simultaneous versus sequential

BackgroundBilateral cochlear implantation (BiCI) has been provided with an intent to promote binaural hearing and improve quality of life (QoL). Binaural hearing maximum benefit could be optimized with BiCI, when indicated in the early stages of life through preserving the cortical hearing development. Actually, BiCI benefits wide variables among patients, and in this work, we aimed to analyze the benefit of bilateral cochlear implantation over unilateral and the simultaneous over sequential implantation in peri- and post-lingual patients. The analysis based on common clinically used audiological tests such as aided hearing threshold and speech perception measures.ResultsThe results of the aided threshold and speech perception measures in all patients revealed a significantly better response in the bilateral implantations than in unilateral each implant separately. Overall, the best response was seen in the simultaneous bilateral group followed by sequential bilateral groups. In post-lingual patients, a better response was observed in sequential and similar bilateral than in sequential and different device groups with significant differences.Change of performance across time revealed aided threshold improvement of the from 3 to 6 months. In speech perception measures, the post-lingual group revealed significant improvement of high-context sentence test (HCST) scores from 3 to 6 months and 12 months. In the peri-lingual group, Early Speech Perception test (ESPT) revealed a change in performance with time at 3, 6, and 12 months. In addition, the simultaneous patient’s scores were significantly better than sequential similar patient’s scores.ConclusionThe main finding of our study was that bilateral cochlear implants (BiCI) are better than unilateral cochlear implant, and simultaneous BiCI is preferred than the sequential cochlear implant even after escaping the early stage of language development.

Bilateral cochlear implantation versus unilateral cochlear implantation in deaf children: Effects of sentence context and listening conditions on recognition of spoken words in sentences

ObjectivesPrevious studies have investigated the efficacy of bilateral cochlear implants (CIs) in deaf children. The current study focused on the use of sentence-context information in different listening conditions to better explain the benefits of bilateral cochlear implantation. We compared the word recognition abilities of children with bilateral CIs and children with unilateral CIs in relation to sentence context and listening conditions. Additionally, we investigated whether sentence context- and listening condition-dependent word recognition scores can differentiate children with bilateral CIs from children with unilateral CIs. MethodsTwenty children with bilateral CIs and 20 children with unilateral CIs participated in this study. All children were presented with semantically controlled sentences (high vs. low predictability) in quiet and noisy conditions and were asked to repeat the final words of each sentence. ResultsChildren with bilateral CIs had significantly higher word recognition scores than children with unilateral CIs on words embedded in both high- and low-predictability sentences in noisy conditions. The two groups recognized more words in high-predictability sentences than in low-predictability sentences in noisy conditions. The scores on the high-predictability sentences in noisy conditions significantly differentiated children with bilateral CIs from children with unilateral CIs. ConclusionBilateral cochlear implantation is more advantageous than unilateral cochlear implantation at the auditory-linguistic processing level in complex listening conditions.

Speech recognition outcomes following bilateral cochlear implantation in adults aged over 50 years old

Objective: To examine the speech recognition benefit of bilateral cochlear implantation over unilateral implantation in adults aged over 50 years old, and to identify potential predictors of successful bilateral implantation in this group. Design: Retrospective cohort study using data collected during standard clinical practice. Bilateral performance was compared to the unilateral performance with the first and second implanted ear and examined in relation to potential predictive variables. Study sample: Sixty-seven cochlear implant users who received a second implant after the age of 50 years old. Results: Participants obtained significantly greater speech recognition scores with the use of bilateral cochlear implants compared to the use of each individual implant. The score obtained with the first implanted ear was the most reliable predictor of the score obtained with the second and with bilateral implants. Conclusions: Older adults can obtain speech recognition benefits from sequential bilateral cochlear implantation.

Speech Perception Benefits of Bilateral Cochlear Implantation for Deaf Children

Speech Perception Benefits of Bilateral Cochlear Implantation for Deaf Children

Effect of unilateral and simultaneous bilateral cochlear implantation on tinnitus: A Prospective Study.

To determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation. Prospective study. Thirty-eight adult patients were included in this prospective study, as part of a multicenter randomized controlled trial investigating the benefits of bilateral cochlear implantation versus unilateral cochlear implantation. Pre- and postoperative tinnitus perception scores were evaluated, before and 1 year after implantation on three tinnitus questionnaires; the Tinnitus Handicap Inventory (THI), the Tinnitus Questionnaire (TQ), and a visual analogue scale for tinnitus burden. Before implantation, the tinnitus prevalence was 42.1% (16 of 38) in the whole study group. One year after implantation, the tinnitus questionnaire scores had decreased in 71.4% according to the TQ and 80.0% according to the THI. Tinnitus was induced after cochlear implantation in six patients, five in the bilateral and one in the unilateral group. Our study shows that cochlear implantation is effective in the reduction of tinnitus in patients with bilateral sensorineural hearing loss who suffered from preoperative tinnitus. Conversely, tinnitus may also increase or even be induced by the cochlear implantation itself. Cochlear implant candidates should be well informed about these possible consequences before undergoing surgery. 2b.

Use of data mining to predict significant factors and benefits of bilateral cochlear implantation.

Data mining (DM) is a technique used to discover pattern and knowledge from a big amount of data. It uses artificial intelligence, automatic learning, statistics, databases, etc. In this study, DM was successfully used as a predictive tool to assess disyllabic speech test performance in bilateral implanted patients with a success rate above 90%. 60 bilateral sequentially implanted adult patients were included in the study. The DM algorithms developed found correlations between unilateral medical records and Audiological test results and bilateral performance by establishing relevant variables based on two DM techniques: the classifier and the estimation. The nearest neighbor algorithm was implemented in the first case, and the linear regression in the second. The results showed that patients with unilateral disyllabic test results below 70% benefited the most from a bilateral implantation. Finally, it was observed that its benefits decrease as the inter-implant time increases.

Cost‐utility analysis of bilateral cochlear implantation in adults: A health economic assessment from the perspective of a publicly funded program

To determine the cost-effectiveness of bilateral cochlear implantation (CI) in deaf adults. Cost-utility analysis. Ninety patients and 52 health professionals served as proxies to estimate the benefit of bilateral cochlear implantation, utilizing the Health Utility Index. Three scenarios were created to reflect 1) deafness without intervention, 2) unilateral CI, and 3) bilateral CI. Cost evaluation reflected the burden on a publicly funded healthcare system. The base case included 25 years of service provision, processor upgrades every 5 years, 50% price reduction for second side, and 15% failure rate. Discounting and sensitivity analyses were applied. Costs were $63,632 (unilateral CI), $111,764 (bilateral CI), and $48,132 (incremental cost of second CI). The health preference gained from no intervention to unilateral CI, and to bilateral CI were 0.270 and 0.305. Incremental utility gained by the second implant was 11.5% of total. The incremental cost-utility ratio (ICUR) was $14,658/quality-adjusted life year (QALY) for bilateral CI compared to no intervention. It was stable regardless of discounting or sensitivity analyses. ICUR was $55,020/QALY from unilateral to bilateral CI with higher uncertainties. It improved with differential discounting, further second-side price reduction, and reduced frequency of processor upgrades. ICUR worsened with reduced length of use and higher failure rates. Sequential bilateral CI was cost-effective when compared to no intervention, although gains were made mostly by the first implant. Cost-effectiveness compared to unilateral implantation was borderline but improved through base case variations to reflect long-term gains or cost-saving measures. 2C.

Communication Benefits of Bilateral Cochlear Implantation. Retrospective Study in 12-Year-Old Children

Introduction and objectivesSome studies suggest that simultaneous or sequential cochlear implantation in a short period of time offers additional benefits. There is a controversy regarding the existence of an age limit after which a second implantation offers less benefit for the acquisition of communication skills. The objectives of this study were to confirm that sequential cochlear implantation offers benefits compared to unilateral implantation and to study whether, at 12 years of age, there are significant differences regarding the age at the time of the second implantation. MethodsDescriptive and observational study of a population of 12-year-old children carrying cochlear implants (n=69). A liminal pure tone audiometry and an open-field verbal discrimination test (disyllables, common phrases in an open context, with and without noise) were conducted to evaluate audiological benefits. ResultsVerbal discrimination results were better among patients who had been implanted before the age of 2 years, although the differences were not statistically significant (P>.5). Children who had received bilateral cochlear implants before the age of 2 years and with a period less than 4 years between both implants presented better verbal discrimination percentages (P<.05). ConclusionsIn our sample, early cochlear implantation with a short period between both implants provided significant benefits regarding intelligibility. There seem to be a specific age and interimplant period, after which the auditory benefit on the first implant becomes reduced.

Rationale for Bilateral Cochlear Implantation in Children and Adults

Provision of binaural hearing should be considered the standard of care for hearing impaired patients whenever it can be provided without significant risks. In the case of patients with severe to profound hearing loss, effective binaural hearing may require bilateral cochlear implantation. The combined experience of many centers around the world has provided substantial insight into the benefits of bilateral cochlear implantation. At the Dallas Otolaryngology Cochlear Implant Program, over 40 children and 40 adults have been implanted bilaterally. Although there are some benefits that require further detailed study to quantify, there are many benefits that have become both objectively and subjectively apparent. Our experience, combined with published results of other centers, has allowed us to define guidelines for which the benefits of bilateral cochlear implantation significantly outweigh the risks. For these patients, bilateral implantation should be considered the standard of care, even as we continue to define the increasing benefits and expand the criteria to more patients over the long term.

Evidence of a ‘critical age’ for sequential implantation of the second ear in congenitally deaf children

The benefits of bilateral cochlear implantation in congenitally deaf children are well established. These mainly consist of better speech perception in the presence of background noise and the avai...

European Multi-Centre Paediatric Bilateral Study: Benefits of Bilateral Cochlear Implantation with HiRes® 120

(2010). European Multi-Centre Paediatric Bilateral Study: Benefits of Bilateral Cochlear Implantation with HiRes® 120. Cochlear Implants International: Vol. 11, Proceedings of the 9th European Symposium on Paediatric Cochlear Implantation, Warsaw, 2009, pp. 83-87.

Bilateral cochlear implantation: current concepts

The goal of this review is to examine the most recent literature exploring the indications, outcomes, and long-term benefit of bilateral cochlear implantation in children and adults. The indications for cochlear implantation have expanded, as many unilaterally implanted individuals are able to achieve open-set word recognition. Despite the benefits seen in unilateral implantation, many individuals have difficulty perceiving speech in noisy environments. Bilateral cochlear implantation has made great strides in providing individuals access to sound information from both ears, allowing improved speech perception in quiet and in noise, as well as sound localization. Recently, the House Cochlear Implant study group released a position statement in which the group strongly endorsed bilateral cochlear implantation. Improved speech perception in quiet has also been demonstrated by many groups with bilateral implantation. Improved sound localization abilities have been shown to be dependent on interaural level differences. The binaural benefits of head shadow and summation have been long shown in bilaterally implanted individuals. Recently, a growth in squelch has been seen in these individuals likely as a result of increased experience with both implants. This may indicate neural integration of the inputs over time. The literature supports the binaural benefit of bilateral cochlear implantation with demonstrated improved speech perception outcomes in quiet and in noise, sound localization data, and subjective benefits.

Subjective Benefits of Sequential Bilateral Cochlear Implantation in Young Children after 18 Months of Implant Use

Objective: To investigate the subjective benefits of bilateral cochlear implantation in 33 young children after 18 months of second implant use. Method: The Würzburg questionnaire inquiring into a range of hearing functions was filled out by the parents. Additional data concerning the daily life and well-being of the children were gathered with an open-ended questionnaire and the Categories of Auditory Performance. Results were analyzed separately for children younger and older than 6 years at the time of the second implantation. Results: After 18 months of bilateral implant use 30% of the younger and 6% of the older children made the transition to an auditory-oral communication. In this period, 15% of all children switched to mainstream schools. The parents reported an evolution of their children’s auditory abilities, which included a better sound and speech perception. Multiregression analysis revealed that early hearing aid fitting and the age at the second cochlear implantation significantly contributed to the variance of the Würzburg results. Conclusions: The results indicate a wide range of positive subjective changes associated with bilateral cochlear implantation, even in older children. This progress led to a better and easier communication and a better integration in the normal-hearing world.

Benefits of bilateral cochlear implantation: a review

Although unilateral cochlear implantation generally provides good speech understanding under quiet conditions, cochlear implantation patients frequently report difficulty understanding speech when exposed to background noise and with sound localization. Since these two listening functions require binaural stimulation for normal individuals and hearing aid recipients, it is not surprising that there is growing interest in binaural implants. This update reviews the basics of binaural listening and the advantages and disadvantages of binaural cochlear implantation. Although the psychoacoustic literature has long demonstrated the benefits of binaural hearing, only recently have studies shown improvement in speech intelligibility with bilateral implants compared with unilateral implants. Of the three known binaural mechanisms, the head shadow effect provides greater benefit than binaural squelch or summation. In addition, binaural cochlear implants improve the ability to localize sound. Bilateral implantation provides multiple benefits to patients with severe to profound hearing loss. Research is currently directed at improving speech intelligibility by utilizing evolving technologies in speech-processing strategies.

Sound Localization Ability of Young Children With Bilateral Cochlear Implants

To evaluate the benefit of bilateral cochlear implantation in young children. Clinical trial comparing a group of bilaterally implanted children with a group of unilaterally implanted children. Tertiary referral center. Five bilaterally implanted children (mean age at testing, 3 yr 7 mo) were compared with 5 unilaterally implanted children (mean age at testing, 5 yr 3 mo). Meningitis was the cause of deafness in all of the children. Children were asked to localize a prerecorded melody band limited from 500 to 4,000 Hz presented from loudspeakers placed at either -90 or 90 degrees or -30 or 30 degrees azimuth. Their parents filled in the Speech, Spatial and Qualities of Hearing Scale (SSQ) and PedsQL questionnaires on hearing and health-related quality of life of their children. The bilaterally implanted children had significantly better scores on the localization test than the children with unilateral cochlear implants. The scores of the children with bilateral cochlear implants were also significantly higher on the spatial domain of the SSQ, which concerns localization. No significant differences were found in the speech and quality of hearing domains and the total scores on the SSQ or the PedsQL between the two groups. Children with bilateral cochlear implantation already demonstrate an advantage over unilaterally implanted children at a young age.

Bilateral cochlear implantation: current concepts

Recent experience has shown an advantage of bilateral cochlear implantation over unilateral implantation. These documented benefits include improved speech perception in noisy environments and improved sound localization. Recently, investigators have studied the long-term benefit, evaluation of neural integration, programming, vestibular effects, and complications of bilateral cochlear implantation. This article summarizes the current research endeavors to improve our understanding and utilization of bilateral cochlear implantation. Numerous positive benefits of bilateral cochlear implantation have been confirmed. Patients receive significant head shadow benefit from bilateral implantation, and obtain nominal benefits from summation and squelch effects. Sound localization benefits have been confirmed. Speech perception in noise with bilateral implantation is significantly better than unilateral implantation and continues to improve 24 months after implantation. Areas for further improvement have also been identified. Despite technological improvements in speech processing strategies, measured intraaural time differences in bilateral cochlear implant recipients remain considerably greater than those with normal hearing. Programming challenges persist to optimize sound processing with bilateral implants. Vestibular effects of bilateral cochlear implantation appear safe but need further study. Important considerations including the duration of implant function, long-term complication rate, and improvements in implant technology will continue to strongly influence the role of bilateral cochlear implantation. Bilateral cochlear implantation provides advantages over unilateral implantation including improved speech perception in noise and improved sound localization. Further research is needed to define the optimal indications and to maximize the benefit of bilateral implantation.

Bilateral cochlear implantation

There is rapidly emerging data that clearly show the benefits of bilateral cochlear implantation (CI). For those surgeons who wish to begin bilateral implantation, several important technical differences from traditional implant surgery must be considered. First, the surgeon must determine whether to perform bilateral simultaneous CI (ie, when both implants are placed during the same procedure) or bilateral sequential CI placement of each implant at separate operations. Technical issues that must be considered during sequential implantation include symmetrical placement of the second implant receiver, the avoidance of monopolar cautery during the procedure, and careful preservation of the chorda tympani. Additional considerations during simultaneous implantations include anticipation of increased operating time, including both ears in the preparation, reduced range of neck rotation, bilateral facial nerve monitoring, the use of a headlight, and symmetrical placement of the implants.

Bilateral cochlear implantation—9-year results

The topic about the patients benefit of bilateral cochlear implantation still causes a controversial discussion. We report about our experience of bilateral cochlear implantation and the importance of bilateral cochlear implantation in meningitis deafened patients.