Indications For Cochlear Implantation Research Articles

Indikationen zur Cochlea-Implantat Versorgung bei Kindern: Wohin geht die Reise?

AbstractThe indications for cochlear implants in children were gradually expended during the last 30 years. This concerns both the age at implantation and the audiological criteria, unilateral or bilateral treatment, the treatment of unilateral deafness and of children with multiple disabilities. Due to the improvement in hearing preservation and new technical developments, it is to be expected that the indication limits will continue to shift in the coming decades.

Bilateral Deafness Due to Relapsing Polychondritis with Semicircular Canal Calcification Treated With Cochlear Implantation: A Case Report.

Relapsing polychondritis (RP) is a rare chronic inflammatory disease characterized by recurrent inflammation of cartilages throughout the body, with treatment-resistant dizziness and hearing loss in 40%-50% of patients with RP. Although rare, severe binaural hearing loss in RP is an indication for cochlear implantation (CI). Therefore, there are only a few reports on CI insertion in cases of RP. This report describes a 68-year-old woman who developed binaural hearing loss due to RP. She was treated with steroids and immunosuppressive drugs; however, her hearing did not improve significantly, and she relied on written communication for conversation. Subsequently, the patient underwent CI in the right ear. The patient showed improvement in speech perception; at 14 months postoperatively, she was able to speak with lipreading, and at 2 years postoperatively, she was able to speak without lipreading. Previous case reports on CI in patients with RP have shown varying degrees of postoperative hearing improvement. Our case demonstrates the effectiveness of CI in improving hearing and speech recognition in patients with RP having semicircular canal calcification. However, previous reports have shown that speech recognition declines 13 years after CI for RP. Therefore, continuous long-term follow-up is necessary.

American Cochlear Implant Alliance Task Force: Recommendations for Determining Cochlear Implant Candidacy in Adults.

The indications for cochlear implantation have expanded over time due to evidence demonstrating identification and implantation of appropriate cochlear implant (CI) candidates lead to significant improvements in speech recognition and quality of life (QoL). However, clinical practice is variable, with some providers using outdated criteria and others exceeding current labeled indications. As a results, only a fraction of those persons who could benefit from CI technology receive it. This document summarizes the current evidence for determining appropriate referrals for adults with bilateral hearing loss into CI centers for formal evaluation by stressing the importance of treating each ear individually and a "revised 60/60 rule". By mirroring contemporary clinical practice and available evidence, these recommendations will also provide a standardized testing protocol for CI candidates using a team-based approach that prioritizes individualized patient care. This manuscript was developed by the Adult Cochlear Implantation Candidacy Task Force of the American Cochlear Implant Alliance using review of the existing literature and clinical consensus. LEVEL OF EVIDENCE: N/A Laryngoscope, 134:S1-S14, 2024.

Quantifying the Influence of Factors on the Accuracy of Speech Perception in Mandarin-Speaking Cochlear Implant Patients.

Rehabilitation of hearing perception in cochlear implant (CI) patients is a challenging process. A comprehensive analysis of the characteristics of hearing rehabilitation in Mandarin-speaking CI patients was conducted. We measured the aided hearing threshold (AHT) and the speech perception accuracy (SPA) and collected clinical data. A total of 49 CI patients were included. Significant linear relationships existed between the AHT and SPA. The SPA increased by about 5-7% when the AHT decreased by 5 dB. An apparent individual difference in the SPA was observed under the same AHT, which in some patients was lower than the reference value fitted by the regression model. The timing of both of cochlear implantation and rehabilitation training was found to lead to significant improvement in SPA. The SPA increases by 2.1-3.6% per year of cochlear implantation and 0.7-1.5% per year of rehabilitation training. The time of auditory deprivation can significantly reduce the SPA by about 1.0-1.6% per year. The SPA was still poor in some CI patients when the hearing compensation seemed satisfying. Early cochlear implantation and post-operative rehabilitation are essential for recovery of the patient's SPA if the indications for cochlear implantation are met.

Cochlear implant technology: past, present and future

<p indent=0mm>Cochlear implant (CI) technology can help the majority of patients with severe to profound sensorineural deafness to restore hearing. This technology was first launched in 1800 by the Italian physicist Alessandro Volta who found that electrical stimulation of the normal ear can produce hearing. In the 1960s, it began to enter the practical stage, and underwent technological development in two directions, single-channel and multi-channel. In 1979, the single-channel cochlear implant was successfully developed in Peking Union Medical College Hospital (PUMCH), and the first cochlear implantation in China was performed in 1980 in PUMCH. The first multi-channel cochlear implantation in China was also performed in PUMCH in May 1995. As the technology progressed, cochlear implantation with electric-acoustic stimulation (EAS), bilateral cochlear implantation, and robot-assisted cochlear implantation gradually went on stage. The first EAS cochlear implantation in China was performed in 2012 in PUMCH, and research on bilateral cochlear implantation in PUMCH ranks at the forefront in China. With increasing successful cases of surgery, the indications for cochlear implantation have gradually extended. In 2008, preoperative electrical stimulation auditory evoked potential technology was successfully developed in PUMCH, which is novel in China, and by which a large number of difficult and complex cases were successfully implanted with CI. Cochlear implantation for unilateral deafness and tinnitus and robot-assisted cochlear implantation have also been carried out worldwide. The first robot-assisted cochlear implantation in China was successfully performed in 2020 in Shanghai 9^th People’s Hospital. At the same time, the research of optical cochlear implant has entered the experimental stage. This paper summarizes the development of cochlear implant technology in China and abroad, the current technical expansion and the future development trend, to provide reference for its technological progress.

[Update cochlear-implantation: indications and surgical aspects].

In childhood, inadequately rehabilitated hearing loss leads to impaired language acquisition and social, mental and emotional development. In adults, social withdrawal due to limited communication skills is often a consequence of unsatisfactory hearing rehabilitation. Therefore, in patients with profound hearing loss, the indication for cochlear implantation should be considered. Technical advances in cochlear implant development, as well as in microsurgical techniques and the rehabilitation process, have led to an expansion of indications in recent years. Adequate hearing rehabilitation is associated not only with an improvement in hearing function and speech understanding, but also with an increase in quality of life at all ages. In patients with unilateral profound hearing loss, cochlear implantation leads to an improvement of speech understanding and localization ability as well as to a reduction of the head shadow effect and tinnitus. The indication process, surgical treatment and the subsequent rehabilitation process require interprofessional cooperation in specialized centers.

Vestibular Function After Cochlear Implantation in Partial Deafness Treatment

Introduction: Cochlear implantation is a fully accepted method of treating individuals with profound hearing loss. Since the indications for cochlear implantation have broadened and include patients with low-frequency residual hearing, single-sided deafness, or an already implanted ear (meaning bilateral cochlear implantation), the emphasis now needs to be on vestibular protection.Materials and Methods: The research group was made up of 107 patients operated on in the otorhinolaryngosurgery department: 59 females and 48 males, aged 10.4–80.2 years (M = 44.4; SD = 18.4) with hearing loss lasting from 1.4 to 56 years (M = 22.7; SD = 13.5). The patients underwent cVEMP, oVEMP, a caloric test, and vHIT assessment preoperatively, and, postoperatively, cVEMP and oVEMP at 1–3 months and a caloric test and vHIT at 4–6 months.Results: After cochlear implantation, there was postoperative loss of cVEMP in 19.2% of the patients, oVEMP in 17.4%, reduction of caloric response in 11.6%, and postoperative destruction of the lateral, anterior, and posterior semicircular canal as measured with vHIT in 7.1, 3.9, and 4% respectively.Conclusions: Hearing preservation techniques in cochlear implantation are connected with vestibular protection, but the risk of vestibular damage in never totally eliminated. The vestibular preservation is associated with hearing preservation and the relation is statistically significant. Informed consent for cochlear implantation must include information about possible vestibular damage. Since the risk of vestibular damage is appreciable, preoperative otoneurological diagnostics need to be conducted in the following situations: qualification for a second implant, after otosurgery (especially if the opposite ear is to be implanted), having a history of vestibular complaints, and when there are no strict audiological or anatomical indications on which side to operate.

Cochlear Implant Outcomes in Prelingually Deafened Adults with and without Sound Deprivation: Are There Differences in Quality of Life?

BackgroundIndications for cochlear implantation (CI) are constantly being updated, and with them, the audiometric results achieved by patients. Patient satisfaction should always be considered, even in patients with lower audiological results. The aim of the present study was to compare quality of life (QoL), self-perceived hearing benefit, and audiometric results between prelingually and postlingually deafened patients, with and without sound deprivation, after CI.Material/MethodsThe sample included 46 patients with bilateral sensorineural hearing loss: 22 postlingually deafened and 24 prelingually deafened, further subdivided into sound-deprived (n=10) and non-sound-deprived (n=14). Auditory performance was evaluated with pure tone audiometry, speech recognition scores (SRS), and self-perceived hearing benefit, whereas QoL was evaluated with 2 self-reported questionnaires (Comprehensive Cochlear Implant Questionnaire and World Health Organization Quality of Life-BREF).ResultsAudiometric results were worse in the prelingually deafened than in the postlingually deafened group, and worse in the prelingually deafened patients with sound deprivation. There was no marked difference in perceived CI benefit or QoL between the 2 groups or within the 2 prelingually deafened subgroups. No correlation was found between SRS and duration of CI use or between QoL and SRS in the prelingually and postlingually deafened groups.ConclusionsOur findings demonstrate better auditory performance for the postlingually deafened group and no differences in perceived QoL or benefit of CI between the groups. The sound-deprived patients had equal scores on the perceived QoL questionnaire. These analyses suggest that sound-deprived, prelingually deafened patients may benefit from CI.

Current indications for the treatment with cochlear and brainstem implants in children. New directions and possibilities.

The publication presents the latest trends in indications for cochlear implantation in children. The principles of early detection of hearing loss in children as well as the detailed methodology and tools for diagnosis of a child before cochlear implant were discussed. Based on a review of publications from recent years, reference was made to the latest trends in implantation, taking into account: electroacoustic stimulation, electronatural stimulation, unilateral deafness, asymmetric sensorineural hearing loss, early implantation in children under 12 months of age and indications for brainstem implants in children with inner ear malformations . The significance of residual hearing in patients with cochlear implants as well as the use of appropriate electrodes for a specific clinical situation were also discussed. These factors may influence future development of speech and hearing.

Vestibular status in partial deafness

IntroductionThe hair cells of the cochlea and the vestibulum are closely connected and may be susceptible to the same noxious factors. The relationship between their function has been a continuing field of investigation. The indications for cochlear implantation have been broadened and now include the patients with partial deafness. This raises the question of their vestibular status. ObjectiveThe aim of the study was to investigate whether there is any difference between the vestibular function of patients with low frequency residual hearing and those with totally deaf ears. MethodsA total of 360 ears with profound sensorineural hearing loss were analysed before cochlear implantation. The patients were divided into four groups, according to their low frequency residual hearing (Group 1 ‒ normal or slightly elevated low frequency residual hearing; Group 2 ‒ elevated threshold but still usable hearing at low frequencies; Group 3 – non-functional residual hearing; Group 4 ‒ no detectable hearing threshold within the limits of the audiometer). The patients underwent vestibular tests: cervical vestibular evoked myogenic potential, ocular vestibular evoked myogenic potential, caloric test and video-head impulse test. ResultsThe rates of elicited responses in cervical vestibular evoked myogenic potential were as follows: in Group 1 (59.3 %); Group 2 (57.5 %); Group 3 (35.2 %); Group 4 (7.7 %). For ocular vestibular evoked myogenic potential the percentage of correct outcomes was: Group 1 (70.8 %); Group 2 (56.0 %); Group 3 (40.0 %); Group 4 (14.3 %). For the caloric test we counted normal responses in 88.9 % of Group 1; 81.6 % of Group 2; 57.9 % of Group 3; 53.3 % of Group 4. For video-head impulse test we also found markedly better results in Group1, followed by Group 2, and much worse in Group 3 and 4. ConclusionPatients with partial deafness not only have a better cochlea but also better vestibular function, which needs to be protected. In summary, the better the low frequency residual hearing, the better the vestibular status.

Cognition in older adults with severe to profound sensorineural hearing loss compared to peers with normal hearing for age

Objective: Cognitive performance of older adults with severe to profound sensorineural hearing loss and indication for cochlear implantation was evaluated compared to peers with age appropriate hearing.Design: Prospective matched case control study.Study sample: Study group consisted of n = 30 patients aged between 60 and 80 years, with adult onset, severe to profound sensorineural hearing loss on both sides and indication for cochlear implantation. Matched control group consisted of n = 30 peers with age-adjusted hearing abilities, based on age- appropriate norms.Results: Differences in Constructional Praxis and Recall, Trail Making Test A and Stroop were not significant between both groups. However, the differences in Clock Drawing Test, Word Lists and Trail Making Test B were significant. The impairment in TMT B (cognitive flexibility) was mediated via the severity of depressive problems. Cognitive performance was not related to word recognition, the percentage and duration of hearing loss and hearing aid use.Conclusion: Severely hearing-impaired older adults show widespread impairments in cognitive performance.

Cochlear implantation as a treatment for single-sided deafness and asymmetric hearing loss: a randomized controlled evaluation of cost-utility

BackgroundSingle-sided deafness (SSD) and asymmetric hearing loss (AHL) have recently been proposed as a new indication for cochlear implantation. There is still no recommended treatment for these hearing deficits, and most options considered rely on the transfer of sound from the poor ear to the better ear, using Contralateral Routing of the Signal (CROS) hearing aids or bone conduction (BC) devices. In contrast, cochlear implantation allows the poor ear to be stimulated and binaural hearing abilities to be partially restored. Indeed, most recently published studies have reported an improvement in the spatial localisation of an incoming sound and better speech recognition in noisy environments after cochlear implantation in SSD/AHL subjects. It also provides consistent relief of tinnitus when associated. These encouraging hearing outcomes raise the question of the cost-utility of this expensive treatment in an extended indication.MethodsThe final endpoint of this national multicentre study is to determine the incremental cost-utility ratio (ICUR) of cochlear implantation in comparison to the current standard of care in France through simple observation, using a randomised controlled trial. Firstly, the study comprises a prospective and descriptive part, where 150 SSD/AHL subjects try CROS hearing aids and a BC device for three weeks each. Secondly, the choice is made between CROS hearing aids, BC implanted device and cochlear implantation. Hearing outcomes and quality of life measurements are described after 6 months for the subjects who chose CROS, BC or declined any option. The subjects who opt for cochlear implantation are randomised between one group where the cochlear implant is inserted without delay and one group of simple initial observation. Hearing outcomes and quality of life measurements are compared after 6 months.DiscussionThe present study was designed to assess the efficiency of cochlear implantation in SSD/AHL. A favourable cost-utility ratio in this extended indication would strengthen the promising clinical results and justify a reimbursement by the health insurance. The efficiency of other options (CROS, BC) will also be described.Trial registrationThis research has been registered in ClinicalTrials.gov (http://www.clinicaltrials.gov/), the 29th July 2014 under the n°NCT02204618.

Влияние герпесвирусной инфекции на послеоперационный период при кохлеарной имплантации у детей

The authors conducted a clinical and audiological examination of 100 children with high degree of sensorineural hearing loss and indications for cochlear implantation. In the process of the study, they calculated the frequency of postsurgical complications. Two comparative groups were formed. The first group included 27 patients with complicated postsurgical period. The second group included 73 patients without complications. To clarify the specific features of hemostasis, the children after the surgery underwent the analysis of laboratory and diagnostic tests (of the 1st and 2nd level). In the process of the study, the patients of the two study groups underwent serological and molecular genetic examination for herpesviral infections (Epstein Barr virus, cytomegalovirus). The authors analyzed the correlation between the development of post-surgical complications and the persistent herpesviral infection. In the group of patients with postsurgical complications herpesviral infection was diagnosed in 77.8% (n = 21) of cases, in the group without complications – only in 39.7% (n = 29) of cases. We have confirmed the research data that surgical injury in combination with general anesthesia can cause reactivation of persistent herpesviral infection. The active infectious process markers were found in the first group in 14.8% (n = 4) of cases. The persistent herpesviral infection could trigger the development of both inflammatory and non-inflammatory complications after surgical treatment.

Herpesvirus infection in children with high grade sensoneural hearing loss

Clinical and audiological investigation of 100 children with indications for cochlear implantation was made. Indirect signs of intrauterine infection were identified, as well as the presence of predisposing factors to the development of exudative otitis media. During the investigation frequency of exudative otitis media (up to 21%) in children with high grade sensoneural hearing loss was made. The severity of lymphoproliferative syndrome and it’s combination with herpesvirus infection markers (Cytomegalovirus, Epstein-Barr virus). It was found out, that in group of patients with combination of high grade sensoneural hearing loss and exudative otitis media lymphoproliferative syndrome in more, than 77% cases had herpesvirus ethiology and significantly exceed the same data in group of patients with isolated hearing loss.

Expanding Cochlear Implant Criteria: Real World Applications and Outcomes

This article discusses the evolution, current criteria, expanded/expanding indications, and potential future indications for cochlear implants. Some of these areas of expansion include earlier implantation in pediatrics, electroacoustic stimulation for both adults and pediatrics, cochlear implants for single-sided deafness, significant asymmetric hearing loss, and cases of severe debilitating tinnitus associated with hearing loss. Note: Some of the discussion in this article is viewed/regarded as off label from the current Food and Drug Administration (FDA) criteria. The authors' intent for this article is for it to be a helpful overview in the current trends that are changing in cochlear implants. This article is not indented to be a definitive paper about new trends in cochlear implants.

Functional magnetic resonance imaging in seven borderline cochlear implant candidates: a preliminary research study.

The indications for cochlear implants (CIs) are constantly expanding, as are the numbers of patients who are not ideal or classical CI candidates. For these patients, a careful decision-making process is needed to minimize the risk of poor outcomes. Preoperatively, it may be unclear whether they will benefit from an implantation. As conventionally performed hearing tests (i.e. subjective and electrophysiological examinations, stapedial reflex testing) have limitations, further objective and effective methods for assessment of the central auditory pathway (CAP) are required [1-3]. This article is protected by copyright. All rights reserved.

Temporal High-Resolution Computed Tomography and Magnetic Resonance Imaging of Congenital Inner Ear Anomalies in Children.

Imaging plays an important role in determining indications of cochlear implantation and choosing candidates for the procedure in children. Temporal high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) can display precisely the complex anatomic structure of inner ear. Although HRCT permits detailed imaging of bony structures, MRI gives valuable information about membranous labyrinth, internal acoustic canal, and vestibulocochlear nerve. Magnetic resonance imaging examination of the brain should be performed at the same time to evaluate any coexistent brain parenchymal abnormality. These imaging modalities are complementary methods in evaluating congenital inner ear anomalies. The aim of this pictorial essay is to reviewing temporal HRCT and MRI findings of congenital inner ear anomalies.

Asymmetric Hearing During Development: The Aural Preference Syndrome and Treatment Options

Deafness affects ∼2 in 1000 children and is one of the most common congenital impairments. Permanent hearing loss can be treated by fitting hearing aids. More severe to profound deafness is an indication for cochlear implantation. Although newborn hearing screening programs have increased the identification of asymmetric hearing loss, parents and caregivers of children with single-sided deafness are often hesitant to pursue therapy for the deaf ear. Delayed intervention has consequences for recovery of hearing. It has long been reported that asymmetric hearing loss/single-sided deafness compromises speech and language development and educational outcomes in children. Recent studies in animal models of deafness and in children consistently show evidence of an "aural preference syndrome" in which single-sided deafness in early childhood reorganizes the developing auditory pathways toward the hearing ear, with weaker central representation of the deaf ear. Delayed therapy consequently compromises benefit for the deaf ear, with slow rates of improvement measured over time. Therefore, asymmetric hearing needs early identification and intervention. Providing early effective stimulation in both ears through appropriate fitting of auditory prostheses, including hearing aids and cochlear implants, within a sensitive period in development has a cardinal role for securing the function of the impaired ear and for restoring binaural/spatial hearing. The impacts of asymmetric hearing loss on the developing auditory system and on spoken language development have often been underestimated. Thus, the traditional minimalist approach to clinical management aimed at 1 functional ear should be modified on the basis of current evidence.

Cochlear implantation in irradiated tympanojugular paraganglioma

Objective: Indications for cochlear implantation have extended progressively over the years both from an audiological and clinical point of view, including the introduction of cochlear implants (CI) for hearing rehabilitation following skull base surgeries and neurotological procedures. In the past, cochlear implantation has been used for hearing rehabilitation in radiation-induced sensorineural hearing loss in nasopharyngeal and tonsillar carcinoma with successful outcomes. Here we describe a similar outcome following total deafness after tympanojugular paraganglioma irradiation, which is also the first such report in literature. Design: The irradiated ear of this patient was implanted with a CI through standard posterior tympanotomy. Study sample: A 26 year old male with multiple paragangliomas with bilateral deafness, secondary to surgery on one ear and radiotherapy for the opposite ear. Results: After a follow-up of 48 months, no local complications have occurred and the hearing results have remained stable with 100% sentence recognition. Conclusions: Bilateral and multiple paragangliomas are rare tumors. Despite the modality of treatment, the hearing is almost always compromised. In these patients, cochlear implantation offers a new perspective for hearing restoration. This report demonstrates that cochlear implantation can be effectively performed after tympanojugular paraganglioma irradiation with long-lasting, satisfactory results, even in the presence of residual tumor.

Auditory Rehabilitation - Cochlear Implantation

The first cochlear implant was approved about 30 years ago. It just provided a limited sensation of sound and facilitated lip-reading based communication. Recent advances in the cochlear implant system and surgical techniques have enabled the majority of recipients to communicate orally without visual cues. The cochlear implantation has become a standard means of auditory rehabilitation for profound sensorineural deafness. To evaluate candidacy for cochlear implantation, an objective and behavioural audiological test, imaging and functional studies to identify the status of the cochlea and the auditory nerve, and evaluation of additional medical conditions are needed. Although the cochlear implantation can restore auditory function, sound perceived with the cochlear implant is different from normal hearing. Therefore postoperative rehabilitation is crucial for good speech performance. Nowadays, the indications for cochlear implantation have been extended. Hearing loss patients with residual low-frequency hearing could be candidates for cochlear implantation. Therefore, residual hearing preservation during cochlear implantation has been an important issue. In addition, bilateral cochlear implantation, cochlear implantation for single-sided deafness and fully implantable cochlear implant systems have been receiving more attention. The purpose of this article is to review current knowledge concerning the cochlear implantation.