Implantation In Children Research Articles

Functional Result After Cochlear Implantation in Children and Adults With Single-sided Deafness.

Patients with single-sided deafness (SSD) suffer from reduced binaural hearing (i.e., sound localization and speech in noise discrimination). Cochlear implantation has recently been introduced for patients with SSD, as an alternative to hearing devices that employ contralateral routing of the signal. Application to children has also been started. We retrospectively analyze a case series of 4 children and 17 adults with SSD, treated with cochlear implantation. The outcome of adult patients was compared with a control group of 27 patients with bilateral profound hearing loss using a cochlear implant. During 12 months, the mean speech recognition score increased from 30 to 41% for monosyllabic words in adults, and from 58 to 89% for multisyllabic numbers. The cochlear implant (CI) improved hearing in noise in all SSD patients, as was demonstrated by a significant improvement of the speech reception threshold in different speech and noise configurations. Sound localization-correlated angle detection error improved with CI use at every time point. The maximum word recognition score for monosyllabic words in quiet correlated with the logarithm of the duration of deafness; improvement of the speech reception threshold and RMS angle detection error by the CI did not. All SSD patients benefitted from the CI in different hearing situations. Patients with SSD for a long period can improve after cochlear implantation.

Cataract Surgery with Primary Lens Implantation in Children with Chronic Uveitis

ABSTRACTPurpose: To evaluate the evolution of chronic uveitis in children undergoing cataract surgery with primary intraocular lens (IOL) implantation.Methods: Twelve children with chronic uveitis underwent cataract surgery with primary posterior chamber intraocular lens (IOL) implantation.Results: Fourteen eyes were implanted with a foldable hydrophobic acrylic IOL. The mean follow-up was 35.39 months (8.72–69.57). The mean BCDVA before surgery and at the end of follow-up was 1.11 (0.40–2.30; SD: 0.57) and 0.48 (0–3; SD: 0.77; p=0.007) respectively. The mean oral corticosteroids dosage after surgery and at the end of follow-up was 0.80 mg/kg/day (SD: 0.37) and 0.17 mg/kg/day (SD: 0.24; p=0.001) respectively. All patients except one were treated with methotrexate. Four patients (5 eyes) were additionally treated with anti-tumor necrosis factor agent.Conclusions: Cataract surgery with primary posterior chamber hydrophobic IOL implantation is possible and leads to a good visual recovery in cases of pediatric chronic uveitis. This surgery requires aggressive anti-inflammatory management with immunosuppressive drugs to control inflammation and reduce the corticosteroids dosage.

Prediction Error After Lens Implantation in Children With Axial Length Less than 22 mm Below 2 Yrs

Purpose: To compare the accuracy of IOL power calculation in children less than 2 years of age with axial length less than 22 mm using the SRK-T, SRK-II, and Hoffer-Q formulae. Design: Retrospective comparative study. Methods: We retrospectively analysed 68 eyes of 39 children below 2 years of age with axial length less than 22 mm who underwent cataract surgery with primary IOL implantation. We assessed the accuracy of predicted refraction using SRK-T, SRK-II and Hoffer-Q formulae in each of the eyes by calculating and comparing mean prediction error and mean absolute prediction error with each formula. Children with a minimum follow up of 6 weeks were enrolled to study the absolute prediction error. Results: Mean absolute prediction error was significantly different among the three formulae used for IOL power calculation in each eye (Friedman test, p-value=0.0009). There also existed statistically significant difference between SRK-T and SRK-II, SRK-T and Hoffer-Q, SRK-II and Hoffer-Q (Signed rank test, p-value= 0.0001). Absolute prediction error was minimum with SRK-II (1.85± 1.85) while it was maximum with Hoffer-Q (3.70± 4.01). Mean absolute prediction error with SRK-T was 2.09± 2.73. The clinical accuracy of absolute prediction error within ± 0.5D and ± 1 D was seen in 22 % and 40% of the eyes respectively with SRK-T while it was seen in 19 % and 38% of the eyes with SRK-II. Pearson correlation coefficient showed strong negative correlation between mean absolute prediction error with each of the three formulae and age at the time of surgery and also axial length. Lesser the age at surgery, more is the absolute prediction error. The shorter the axial length, more is the prediction error. There was no correlation of any of the formulae with mean keratometry reading. There existed positive correlation of SRK-II, Hoffer-Q and IOL power implanted. Higher the IOL power, more is the prediction error. Conclusion: The accuracy of SRK-T and SRK-II was comparable in calculating IOL power in children with axial length less than 22 mm and below

Comparative Study Between Unilateral and Bilateral Cochlear Implantation in Children of 1 and 2 Years of Age

IntroductionThe studies that have evaluated the effectiveness of bilateral cochlear implantation in children suggest an improvement in hearing about sound localisation and speech discrimination. In this paper we show the differences in audio-linguistic achievements with early bilateral cochlear implantation versus unilateral, and differences between simultaneous and sequential bilateral implantation. Material and methodsWe present 88 children with bilateral profound sensorineural hearing loss, treated with bilateral cochlear implantation in 32 cases and unilateral in 56 cases, during the first 12 months (27 children) of life and between 12 and 24 months (61 children). We conducted a statistical comparison of both groups in the audiometry, IT-Mais, Nottingham, LittlEars scales and verbal tests. ResultsNo significant differences in hearing thresholds and questionnaires between unilateral and bilateral implantation were detected in either the first or second year. Verbal tests do show statistically significant differences: children with bilateral cochlear implant obtain 100% recognition of disyllabic and phrases within 2–3 years after implantation whilst children with one implant do not obtain those results at 5 years after surgery. No differences between simultaneous and sequential bilateral implantation were detected. ConclusionWe emphasise the importance of ensuring good early audiological screening, to carry out an early and bilateral cochlear implantation with the consequent development of audio-language skills similar to normal hearing children.

Systematic Review on Surgical Outcomes and Hearing Preservation for Cochlear Implantation in Children and Adults.

The mastoidectomy with facial recess approach (MFRA) is considered the reference standard for cochlear implantation. The suprameatal approach (SMA) was developed more recently and does not require mastoidectomy, which could influence postoperative outcomes. We aim to identify the optimal operative approach for cochlear implantation based on postoperative complications and hearing preservation in children and adults. PubMed, EMBASE, Scopus, and Google Scholar. Studies comparing MFRA and SMA in children and adults were eligible for inclusion. Original reports with moderate relevance and validity were included. Relevance and validity were assessed with a self-modified critical appraisal tool. This review was reported in accordance to PRISMA guidelines. We retrieved 294 citations. Only retrospective nonrandomized studies were identified (level III evidence). Six articles were selected for full-text inclusion and 4 articles for data extraction. No article found a significant difference between MFRA and SMA with respect to postoperative complications in children and adults. One study found a significantly (P < .023) higher pediatric MFRA mastoiditis rate; however, meta-analysis did not indicate an overall effect. Hearing preservation was reported only in adults, and outcomes between techniques did not differ. No evidence was noted for lower complication rates or improved hearing preservation between the MFRA and SMA for cochlear implantation in children and adults. Pediatric data were available for children implanted above the age of 24 months only. Level I evidence is needed to resolve the uncertainty regarding differences in postoperative outcomes of pediatric and adult MFRA and SMA.

Introduction to the 14th Symposium on Cochlear Implants in Children, Nashville, TN Papers.

Introduction to the 14th Symposium on Cochlear Implants in Children, Nashville, TN Papers.

Cochlear Implantation in Children with Cochlear Malformation.

Cochlear implantation (CI) has proven to be an effective treatment for severe bilateral sensorineural hearing loss (SNHL). Inner ear malformation is a rare anomaly and occurs in approximately 20% of cases with congenital SNHL. In cases with cochlear malformation, CI can be successfully performed in nearly all patients, the exceptions being those with complete labyrinthine and cochlear aplasia. It is important to evaluate the severity of inner ear deformity and other associated anomalies during the preimplantation radiological assessment in order to identify any complication that may potentially occur during the surgery and subsequent patient management.

Cochlear Implants in Children: Recent Advances

ABSTRACT Cochlear implants (CIs) are the best-performing neural prostheses today. Clinical data have demonstrated that early implantation facilitates advancements in auditory, cognitive and developmental milestones, enabling children to succeed in mainstream schools. With recent improvements in engineering design, signal processing, as well as surgical and rehabilitation techniques, CIs have ushered in expanded candidacy criteria. This review aims to provide a critical evaluation of recent developments in CI strategies --specifically within the areas of implantation of malformed inner ears, outcomes following bilateral CIs, implantation for single-sided deafness and newer, adjuvant biological therapies to augment CI technology. How to cite this article Isaiah A, Lee KH. Cochlear Implants in Children: Recent Advances. Int J Head Neck Surg 2016;7(2):115-119.

Surgical Visual Reference for Auditory Brainstem Implantation in Children with Cochlear Nerve Deficiency

Surgical Visual Reference for Auditory Brainstem Implantation in Children with Cochlear Nerve Deficiency

Long-Term Visual Outcomes of Secondary Intraocular Lens Implantation in Children with Congenital Cataracts.

AimThe aim of this study was to evaluate the long-term visual outcomes and factors affecting visual results in children undergoing secondary intraocular lens (IOL) implantation following primary congenital cataract extraction.MethodsChildren with congenital cataracts who underwent secondary IOL implantation for aphakia at the Eye and ENT Hospital of Fudan University between January 1, 2001, and December 31, 2007, were retrospectively reviewed. One eye was randomly selected in children with bilateral cataracts. Laterality, type of cataract (total or partial opacity), sex, age at primary and secondary surgeries, visual axis opacity (VAO), compliance with amblyopia therapy, postoperative ocular complications, refractive error, ocular alignment, and best corrected visual acuity (BCVA) at last follow-up were recorded; potential factors that might have affected the visual results were evaluated.ResultsSeventy-six bilateral and 34 unilateral congenital cataract cases were analyzed; the mean ages of the children were 12.70±5.06 and 12.50±2.71 years at final follow-up, the mean follow-up periods from IOL implantation were 94.93±24.22 and 109.09±18.89 months, and the mean BCVA (Log MAR) values were 0.51±0.37 and 1.05±0.46, respectively. Final BCVA after secondary IOL implantation was significantly associated with laterality, type of cataract, age at primary cataract extraction, compliance with amblyopia therapy, and refractive correction after surgery. No significant associations were found between BCVA and sex, age at secondary IOL implantation, VAO, or other ocular complications. The most common ocular complications were VAO and elevated intraocular pressure after surgery. There were no other complications, with the exception of one eye with IOL dislocation.ConclusionsThe results indicate that the important determinants of long-term visual outcomes in children with congenital cataracts undergoing secondary IOL implantation are laterality, cataract type, age at initial cataract extraction, compliance with amblyopia therapy, and refractive error.

Cochlear Implantation in Children with Single-Sided Deafness: Does Aetiology and Duration of Deafness Matter?

For adult patients with single-sided deafness (SSD), treatment with a cochlear implant (CI) is well established as an acceptable and beneficial hearing rehabilitation method administered routinely in clinical practice. In contrast, for children with SSD, CI has been applied less often to date, with the rationale to decide either on a case-by-case basis or under the realm of clinical research. The aim of our clinical study was to evaluate the longitudinal benefits of CI for a group of children diagnosed with SSD and to compare their outcomes with respect to patient characteristics. Evaluating a pool of paediatric SSD patients presenting for possible CI surgery revealed that the primary aetiology of deafness was congenital cochlear nerve deficiency. A subgroup of children meeting the CI candidacy criteria for the affected ear (the majority with acquired hearing loss) were enrolled in the study. Preliminary group results suggest substantial improvements in speech comprehension in noise and in the ability to localise sound, which was demonstrated through objective and subjective assessments after CI treatment for the group, with results varying from patient to patient. Our study shows a trend towards superior outcomes for children with acquired hearing loss and a shorter duration of hearing loss compared to congenitally deafened children who had a longer duration of SSD. This indicates an interactive influence of the age at onset, aetiology and duration of deafness upon the restoration of binaural integration and the overall benefits of sound stimulation to two ears after CI treatment. Continued longitudinal investigation of these children and further studies in larger groups may provide more guidance on the optimal timing of treatment for paediatric patients with acquired and congenital SSD.

Hydroxyapatite orbital implant in children following enucleation: analysis of 531 sockets.

To evaluate the features and long-term outcomes of hydroxyapatite (HA) orbital implant following enucleation in pediatric patients. A retrospective review was performed on clinical records of patients ≤18 years of age , managed with enucleation and HA implant placement. Recorded outcomes included implant-related complications, implant and prosthesis motility, and patient cosmetic satisfaction. There were 525 children (531 sockets) with HA implant following enucleation. The mean age at HA implant placement was 3 years (median, 2 years; range, 4 days to 17 years). Indications for enucleation included retinoblastoma (n = 457, 86%), uveal melanoma (n = 17, 3%), medulloepithelioma (n = 8, 2%), and others (n = 49, 9%). The HA implant was uncoated (n = 370, 70%) or polymer coated (n = 161, 30%). For the 370 uncoated implants, wrapping was provided with scleral (n = 346, 94%) or bovine pericardium (n = 1, <1%), and 23 patients (6%) had no wrapping. The extraocular muscles were attached to the implant/polymer coat/wrap (n = 531, 100%), by suturing 4 rectus muscles (n = 349, 66%) or all 6 muscles (n = 182, 34%). Over mean follow up of 60 months, in 477 orbital implants, complications included conjunctival thinning (n = 10, 2%), implant infection (n = 6, 1%), implant exposure (n = 13, 3%), and implant migration/extrusion (n = 0, 0%). Motility for implant was judged as excellent (n = 245, 78%) and small-angle prosthesis motility was excellent (n = 196, 59%). Patient/family satisfaction with cosmetic outcome was rated as excellent in 471 implants (99%). Following enucleation in children, long-term outcomes of the HA orbital implant are excellent with favorable patient cosmetic satisfaction and rare complication.

Auditory Brainstem Implants in Children: Results Based on a Review of the Literature

after surgery showed that 112 (93.3%) of the patients improved in their ability to recognize environmental sounds and speech perception. Patients with tumors or those with cochlear or cochlear nerve malformations had good outcomes as well. Two of the children did not achieve any sound perception upon ABI activation. The results obtained in 120 children fitted with an ABI showed that the patients globally improved in their ability to detect sounds and communication skills. The phenomenon could be seen both in patients with tumoral diseases of the inner ear and those with malformations of the cochlea or cochlear nerve, although patients with non-tumoral issues achieved better results than patients with schwannomas. We propose that the Food and Drug Administration (FDA) ABI indications should be extended to patients younger than 12 years old with NT diseases of the cochlea and cochlear nerve.

Complications and Visual Outcomes after Secondary Intraocular Lens Implantation in Children

To evaluate safety and visual outcomes in surgically aphakic children undergoing secondary intraocular lens (IOL) implantation. Retrospective, consecutive, interventional case series. One hundred seventy-four eyes of 104 children (70 bilateral, 34 unilateral) who underwent secondary IOL implantation for aphakia after congenital cataract surgery at L. V. Prasad Eye Institute, Hyderabad, India, were analyzed. A minimum of 3months of follow-up after surgery was required for inclusion in the study. Eyes with aphakia after surgery for traumatic cataracts and other associated ocular comorbidities were excluded. Main outcome measures were intraoperative and postoperative complications and visual outcome at the last follow-up. Mean age at secondary IOL implantation was 6.08 ± 3.75 years. The mean follow-up was 25.7 ± 24.9months. Mean best-corrected visual acuity improved from 1.08 ± 0.65 in aphakic children to 0.55 ± 0.51 logarithm of the minimal angle of resolution in pseudophakic children at last follow-up (P < .0001). Overall, 51 eyes (35%) attained a final best-corrected visual acuity of 20/40 (0.3 logarithm of the minimal angle of resolution) or better, whereas only 2 eyes (8.7%) attained a final best-corrected visual acuity of 20/40 (0.3 logarithm of the minimal angle of resolution) or better in children who underwent secondary IOL implantation for unilateral aphakia. The most common postoperative complications were secondary membrane formation (17 eyes; 9.77%), optic capture (15 eyes; 8.6%), IOL decentration (9 eyes; 5.17%), and secondary glaucoma (11 eyes; 5%). Secondary sulcus IOL implantation in children is a relatively safe procedure and leads to favorable visual postoperative outcomes.

Is "no response" on diagnostic auditory brainstem response testing an indication for cochlear implantation in children?

To compare the results of a "no response" (NR) result on auditory brainstem response (ABR) testing with those of behavioral pure-tone audiometry and ultimate clinical tracking to cochlear implantation (CI). Retrospective review of pediatric patients who underwent multifrequency ABR testing in a 5 year span. Total of 1143 pediatric patients underwent ABR testing during the study period and 105 (9.2%) were identified with bilateral NR based on absent responses to both click and tone burst stimuli. For the children with NR, various clinical parameters were evaluated as these children progressed through the CI evaluation process. Children were grouped based on whether they underwent ABRs for diagnostic or for confirmatory purposes. Of the 105 children who met inclusion criteria, 94 had sufficient follow-up to be included in this analysis. Ninety-one (96.8%) of 94 children with bilateral NR ABRs were ultimately recommended for and received a CI. Three (3.2%) children were not recommended for implantation based on the presence of multiple comorbidities rather than auditory factors. None of the children (0%) had enough usable residual hearing to preclude CI. For those who had diagnostic ABRs, the average time at ABR testing was 5.4 months (SD 6.2, range 1-36) and the average time from ABR to CI was 10.78 months (SD 5.0, range 3-38). CI should tentatively be recommended for children with a bilateral NR result with multifrequency ABR, assuming confirmatory results with behavioral audiometric testing. Amplification trials, counseling, and auditory-based intervention therapy should commence but not delay surgical intervention, as it does not appear to change the eventual clinical course. Children not appropriate for this "fast-tracking" to implantation might include those with significant comorbidities, auditory neuropathy spectrum disorder, and unreliable or poorly correlated results on behavioral audiometric testing.

Incidence of Brain Abnormalities Detected on Preoperative Brain MR Imaging and Their Effect on the Outcome of Cochlear Implantation in Children with Sensorineural Hearing Loss.

The incidence of sensorineural hearing loss (SNHL) increased gradually in the past decades. High-resolution computed tomography (HRCT) and magnetic resonance (MR) imaging, as an important part of preimplantation evaluation for children with SNHL, could provide the detailed information about the inner ear, the vestibulocochlear nerve, and the brain, so as to select suitable candidate for cochlear implantation (CI). Brain abnormalities were not rare in the brain MR imaging of SNHL children; however, its influence on the effect of CI has not been clarified. After retrospectively analyzing the CT and MR imaging of 157 children with SNHL that accepted preoperative evaluation from June 2011 to February 2013 in our hospital and following them during a period of 14.09 ± 5.08 months, we found that the white matter change, which might be associated with the history of medical condition, was the most common brain abnormality. Usually CI was still beneficial to the children with brain abnormalities, and the short-term hearing improvement could be achieved. Further study with more patients and longer follow-up time was needed to confirm our results.

HRCT Correlation with Round Window Identification during Cochlear Implantation in Children.

Objective:To determine the accuracy of High Resolution Computer Tomography (HRCT) temporal bone measurements in predicting the actual visualization of round window niche as viewed through posterior tympanotomy (i.e. facial recess).Materials and Methods:This is a prospective study of 37 cochlear implant candidates, aged between 1and 6 years, who were referred for HRCT temporal bone during the period December 2013 to July 2014. Cochlear implantation was done in 37 children (25 in the right ear and 12 in the left ear). The distance between the short process of incus and the round window niche and the distance between the oval window and the round window niche were measured preoperatively on sub-millimeter (0.7 mm) HRCT images. We classified the visibility of round window niche based on the surgical view (i.e. through posterior tympanotomy) during surgery into three types: 1) Type 1- fully visible, 2) Type 2- partially visible, and 3) Type 3- difficult to visualize. The preoperative HRCT measurements were used to predict the type of visualization of round window niche before surgery and correlated with the findings during surgery.Results:The mean and standard deviation for the distance between the short process of incus and the round window niche and for the distance between the oval window and the round window niche for Types 1, 2, and 3 were 8.5 ± 0.2 mm and 3.2 ± 0.2 mm, 8.0 ± 0.4 mm and 3.8 ± 0.2 mm, 7.5 ± 0.2 mm and 4.4 ± 0.2 mm respectively, and showed statistically significant difference (P < 0.01) between them. The preoperative HRCT measurements had a sensitivity and specificity of 92.3% and 96.2%, respectively, in determining the actual visualization of round window niche.Conclusion:This study shows preoperative HRCT temporal bone measurements are useful in predicting the actual visualization of round window niche as viewed through posterior tympanotomy.

Benefits and Shortcomings of Cochlear Implantation in Children: Parental Reports from India.

Objective : The aim of the study was to understand the rationale for choosing cochlear implantation as a rehabilitation option and the benefits and shortcomings of cochlear implants in children as reported by their parents. Method : Ninety parents of children with cochlear implants from various parts of India completed open-ended questionnaires. Results : The main reasons for choosing cochlear implantation include: no benefit from hearing aids, the expectation that children would have better hearing and develop age appropriate speech and language abilities. Most of the participants reported benefits of cochlear implantation in a home setting but not in school and other social settings. Most participants reported shortcomings in a home setting but only less than half reported in school and other social settings. Conclusions : Not all respondents reported benefits and shortcomings in all settings, particularly school and other social settings. This may raise some questions about knowledge of parents about what to expect from their child’s performance with a cochlear implant in different settings.

Auditory Brainstem Implants in Children—Results Based on a Literature Review

Objective: Review the literature regarding auditory brainstem implant (ABI) indications, surgical techniques, activation methods, and post-surgery follow-up in children.

Impedance, Neural Response Telemetry, and Speech Perception Outcomes After Reimplantation of Cochlear Implants in Children

To compare mean impedance levels, neural response telemetry (NRT), and auditory perception after initial and explant-reimplant pediatric cochlear implants. Retrospective case review. Tertiary referral hospital and cochlear implant program. Children 0 to 16 years inclusive who have undergone explant-reimplant of their cochlear implant. Impedance levels, NRT, and speech perception performance. Impedance, NRT, and auditory perception at switch on, 3 months, 12 months, 3 years, and 5 years after initial cochlear implant and reimplantation. The explant-reimplant group receiving Cochlear contour array had significantly (p < 0.001) raised impedance at switch on, 3 months, 12 months, and 3 years, compared with their initial implant. The explant-reimplant group receiving Cochlear straight array had marginally significant (p = 0.045) raised impedance at switch on, 3 months, 12 months, and 3 and 5 years. Infection was associated with greater increases in impedance in the reimplant Contour group. NRT was increased in the explant-reimplant group but not significantly (p = 0.06). Auditory perception returned to preexplant levels within 6 months in 61% of children. Impedance is higher after explant-reimplant and remains increased for years after explant-reimplant with Cochlear contour and to a lesser degree the straight array device.