Partial Deafness Treatment Research Articles

Preservation of hearing in partial deafness patients who received two different regimes of corticosteroid therapy following cochlear implantation: one-year observations

The objective of this study was to assess how different modes of steroid therapy affect hearing preservation in Partial Deafness Treatment group of patients. In this study, the group consisted of 46 (24 women, 22 men; aged 18-78 years) cochlear implant patients divided into 3 subgroups. In the first subgroup (N = 13), patients underwent standard intravenous (IV) steroid therapy following implantation. In the second (N = 16), patients underwent prolonged treatment with a combination of oral and IV corticosteroids. Third subgroup (N = 17) was a control group who received no steroids therapy. The mean hearing preservation rate was 52.1% (SD = 36.7) in patients receiving standard steroid therapy, 71.4% (SD = 22.7) in patients with prolonged steroid therapy, and 22.1% (SD = 33.9) in control patients. The smallest variation of hearing preservation rate was observed in patients with prolonged steroid therapy and was 9.9 dB. In comparison, the mean change in patients with standard steroid therapy was 11.7 dB and for control patients the figure was 18.0 dB. A combination of intravenous and oral steroid therapy seems to be optimal and stabilizes hearing thresholds and preserves hearing.

Sense of taste in patients after cochlear implantation-preliminary study.

Taste is the leading sense in how we determine the quality of consumed food. Proper gustatory sensation largely determines the well-being and health of an organism, and this affects their quality of life. The aim of the present study was to estimate the risk of early taste disorders following implantation surgery. Twenty patients underwent a taste test before, 1 day after, and 1 month after cochlear implantation. The taste sensations of sweet, sour, salty, and bitter were determined. Statistical analysis showed no significant differences (p > 0.05) between individual tests among the entire study group. After dividing the respondents into smoking (n=6) and non-smoking (n=14) groups, only a weak correlation (p = 0.043) was found between the results of the first and second examination in the smoker group. However, a statistically significant decrease in the number of saline-sensitive (p<0.001) and acid-sensitive (p = 0.042) subjects was observed. These findings suggest that people after a cochlear implant may have transient taste disorders. Taste disorder called dysgeusia may be an early complication after the implantation procedure contributing to deterioration of patients quality of life.

Resumption of Cochlear Implant Surgery under COVID-19 Pandemic Conditions.

(1) Background: The novel coronavirus COVID-19 has been recognized by the World Health Organization as a public health emergency of international concern and has caused cancellation of elective cochlear implantation in many countries. This article sets out our experience with resuming cochlear implant (CI) surgery under COVID-19 conditions over a period of 3 months. In addition, early results of hearing preservation (HP) after CI surgery are presented; (2) Methods: We adopted epidemic management policies and procedures according to the National Consultant for Infectious Diseases recommendations. During preoperative visits, all patients were tested for COVID-19 with a RT-PCR test. One month postoperatively, HP values in the Partial Deafness Treatment (PDT) group of patients was established using the HEARRING group formula; (3) Results: Between January and March 2021, we performed 312 CI procedures in adult and pediatric patients. Of these, none were subsequently re-admitted to hospital and found to be COVID-19 positive. Postoperative audiometric results showed that complete or partial HP was achieved in more than half the PDT patients; (4) Conclusion: Cochlear implantation during the coronavirus disease pandemic is essential and, with careful planning, is perfectly feasible.

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.

Effect on vestibular function of cochlear implantation by partial deafness treatment\u2013electro acoustic stimulation (PDT\u2013EAS)

PurposeAlthough the cochlear implantation procedure does not interfere with vestibular structures directly, both the vestibulum and the cochlea share the same inner ear fluid space, and this fluid may be responsible for transferring possibly damaging forces from one to the other. The purpose of the study is to assess postoperative vestibular function after partial deafness treatment–electro-acoustic stimulation (PDT–EAS) cochlear implantation.MethodsFifty-five patients were included in the study (30 females, 25 males, age 11–80, mean 41.8 ± 19.35). cVEMP and oVEMP were performed preoperatively and 1–3 months after cochlear implantation. Caloric and vHIT tests were conducted preoperatively and 4–6 months after cochlear implantation.ResultsOur study shows that, based on a wide range of electrodes, use of PDT–EAS is protective in terms of preserving vestibular function. It gives a rate of saccular damage of 15.79%, utricular damage of 19.04%, and a horizontal semicircular canal response reduction of 15.79%.ConclusionsPDT–EAS is protective in terms of preserving vestibular function. Nevertheless, it should be emphasized that the risk of vestibular damage cannot be totally eliminated even when hearing preservation techniques are adopted.

Electro-Natural Stimulation in Partial Deafness Treatment of Adult Cochlear Implant Users: Long-Term Hearing Preservation Results

Background: Due to the constant development of technology and medicine, the eligibility criteria for cochlear implantation (CI) are undergoing gradual expansion. Objectives: To provide long-term hearing preservation (HP) results for partial deafness treatment (PDT) of a group of adults using electro-natural stimulation (ENS). Methods: We examined a database of medical records of patients who underwent CI in a single ENT center. We identified 12 adults (3 men and 9 women) who fitted the PDT-ENS classification. To calculate HP, we used the ­HEARRING consensus and conducted statistical analyses using SPSS v24. Results: In the long-term follow-up, 7 of 12 patients had complete HP and the remaining 5 had partial HP. None of the patients experienced significant hearing impairment. A significant improvement in speech understanding in both quiet and noise conditions was also observed. Conclusions: The use of minimally invasive surgery leads to excellent HP results in PDT-ENS patients, enabling them to enjoy the benefits of good speech discrimination which they would be unable to get from traditional hearing aids. Our findings support extending the inclusion criteria for CI to include this new group of patients who would otherwise obtain only limited benefit from conventional hearing aids.

Electro-natural Stimulation (ENS) in Partial Deafness Treatment: Pediatric Case Series

To report the improvement in hearing preservation and speech understanding of five pediatric patients who received cochlear implantation via Electro-natural Stimulation Partial Deafness Treatment, the largest group so far treated. Retrospective case review. Tertiary referral center. A series of five children aged 9 to 16 years old with bilateral normal hearing at 125 to 1500 Hz and severe-to-profound hearing loss above 1500 Hz, who were subjected to unilateral cochlear implantation. All the patients underwent unilateral cochlear implantation by the same senior otosurgeon. Surgery involved six principal steps using an approach to scala tympani through the round window and use of an extremely delicate electrode with active length of up to 21 mm. Pre- and postoperative hearing for air- and bone-conduction was assessed using pure-tone audiometry. Speech understanding was evaluated with the Pruszewicz monosyllabic word test in free field. Hearing preservation was assessed using the Hearing Preservation Calculator developed by the HEARRING group. Over the 3-year observation period, preoperative hearing thresholds were completely preserved in three children (60%) and partially in the remaining two (40%). A useful improvement in speech understanding of about 30% (compared with the best fitted hearing aids in the preoperative period) was observed in both quiet and noise. Cochlear implantation seems to be a successful way of restoring hearing ability in ENS-Partial Deafness Treatment patients who are beyond the scope of effective rehabilitation with hearing aids. Excellent results of hearing preservation in ENS patients encourage discussion on extending the inclusion criteria for cochlear implantation.

Expanding pediatric cochlear implant candidacy: A case study of electro-natural stimulation (ENS) in partial deafness treatment

BackgroundSome adolescents have hearing impairments characterized by normal or slightly elevated thresholds in the low and mid-frequency bands (below 1500Hz) and nearly total deafness in the high frequency range. These patients often remain beyond the scope of effective hearing aid treatment. Case reportThis study presents the case of a 16-year-old adolescent with good hearing in the range 125–1500Hz and deafness at other frequencies. An implant was used to restore hearing at high frequencies, while preserving low and mid frequency acoustic hearing in the implanted ear. This is described as electro-natural stimulation (ENS) of the inner ear. ConclusionsThe results demonstrate that low and mid frequency hearing (up to 1500Hz) can be preserved using the round window surgical technique. A substantial improvement in speech discrimination was also observed when electrical stimulation on one side was combined with acoustic stimulation on both sides. There is scope to extend qualifying criteria for cochlear implantation to include adolescents who are suited to ENS.

Long-term results of partial deafness treatment

Treatment of the partial deafness is a great challenge in terms of preserving the preoperative hearing and complementing this hearing ability with an implant. It concerns the situations when hearing in low frequency range is normal or fully functional and it is only necessary to complement it electrically in the medium and high frequency ranges. The first in the world surgery during which an existing normal hearing had been electrically complemented was performed in 2002. It has shown a fresh direction in treatment of various partial hearing impairments. This achievement was possible due to our previous works on hearing preservation in the group of patients with marginal residual hearing. The long term observation (almost 15 years) and large material allow us to present the strategy of the partial deafness treatment and its results.During the ESPCI conference in Warsaw in 2009, PDT concept was announced, indicating groups for Acoustic Stimulation (AS) and Electric Stimulation (ES). ES patients can be divided on the following groups: Electrical Complement (PDT-EC), Electric Acoustic Stimulation (PDT-EAS), Electric Modified Stimulation (PDT-EMS), Electric Stimulation (PDT-ES).The differentiation between the groups is very important, because the groups are not equal and their goals in treatment and therapy are different. Concluding we can say that hearing was preserved in over 94% of cases, however, the results differ between the groups. Implementation of the partial deafness treatment (PDT) is connected with development and elaboration of special rehabilitation program for the specific groups of patients.

FS4 for partial deafness treatment

In cochlear implants each signal delivered to the cochlea can be considered as a ‘carrier’: the temporal fine structure TFS, which is determined by the dominant frequencies in the signal that fall ...

SURGICAL TECHNIQUES IN PARTIAL DEAFNESS TREATMENT

BackgroundTo maximise the success of cochlear implantation, optimal placement of the electrodes inside the cochlea is required. Hearing preservation also means that intracochlear spaces must be approached in a way that avoids traumatising inner ear structures.Material and MethodsIn order to examine this issue a literature search was performed targeting articles on surgical techniques used in partial deafness cochlear implantation. The aim was to evaluate the advantages and shortcomings of each technique.ResultsIn cochlear implantation two main approaches to the middle ear have been described: mastoidectomy/posterior tympanostomy and suprameatal. Two approaches to the inner ear are in use: cochleostomy and round window.ConclusionsFrom temporal bone studies and clinical work some general conclusion can be drawn: straight arrays should use round window insertion, and precurved arrays should use cochleostomy

A new audio processor for combined electric and acoustic stimulation for the treatment of partial deafness

Conclusion: The results of this study demonstrate that a conversion from the Duet to Duet 2 audio processor greatly improved patient satisfaction and subjective benefits. Objectives: The aims of this study were to compare the DUET 2 audio processor to the DUET speech processor and to evaluate DUET 2 user satisfaction subjectively. Methods: Ten experienced electric acoustic stimulation (EAS) users following partial deafness treatment upgraded from the MED-EL DUET to the DUET 2 were tested with the adaptive auditory speech test, Pruszewicz monosyllabic word test, visual analog scales, and Duet 2 user questionnaire. Tests were performed post-upgrade and compared simultaneously to the DUET at three test intervals over 3 months. Results: Objective analyses showed that all subjects performed as well with the DUET 2 as the DUET. There was a tendency toward better results with the DUET 2. Subjective testing indicated DUET 2 user preference upon speech and musical stimuli. DUET 2 subject satisfaction was high for wearing comfort, sound quality, and for FineTuner and Private Alert features.

PARTIAL DEAFNESS TREATMENT IN CHILDREN: A PRELIMINARY REPORT OF THE PARENTS’ PERSPECTIVE

BackgroundCochlear implant (CI) eligibility criteria have broadened recently to include individuals with partial deafness (PD). In 2002, the Institute of Physiology and Pathology of Hearing, Poland, pioneered a particular technique of cochlear implantation termed partial deafness treatment (PDT) and achieved unrivalled rates of functional hearing preservation. Encouraged by the results in adults, a pediatric PDT program was initiated in 2004. The outcome of PDT for both adults and children has been well documented and assessed with objective measures of sound detection and speech discrimination. The current study explores outcomes in real life rather than in a clinical setting. We hypothesized that if PDT provides children with renewed listening ability it is likely to have a major impact on family life and that this impact should be able to be documented by parental reports.Material and MethodSeven parents of PDT cochlear-implanted children were surveyed using 20 open-ended prompts. The questionnaires were sent to patients’ homes. The parents were asked to answer the prompts in their own words.ResultsAll parents reported that after their child received cochlear implant there was a significant improvement in speech understanding and better perception of high pitched sounds. More than half the parents also noticed positive changes in speech production. The changes in communication abilities after CI positively influenced the child’s relationships with family members and school mates.ConclusionsThe results of this study support expanding the criteria for receiving a cochlear implant to include children with partial deafness.

FUNCTIONAL MAGNETIC RESONANCE IMAGING OF AUDITORY CORTEX IN PARTIAL DEAFNESS TREATMENT

BackgroundRecently, there has been a surge of interest in neuroimaging techniques that might help to objectively evaluate the residual hearing abilities of patients with hearing abilities of patients considered for partial deafness treatment (PDT). Such an evaluation might allow a wider range of PD candidates to benefit from cochlear implantation (CI). Although existing studies suggest that functional magnetic resonance (fMRI) may help predict the benefits of CI for hearing-impaired patients, little is known about the activity of the primary auditory cortex in patients with partial deafness. This study is the first to apply fMRI to examine BOLD signal changes in the auditory cortex induced by chirp stimulation in patients with partial deafnessMaterial and MethodTen patients considered for partial deafness treatment with electro-acoustic stimulation (PDT-EAS) and 10 patients considered for electrical complement treatment (PDT-EC) according to Skarżyński’s categorization of partial deafness treatment (PDT) participated in the study. fMRI measurements were performed in a 3T Siemens Magnetom Trio scanner at the Bioimaging Research Center (BRC) of the Institute of Physiology and Pathology of Hearing in Kajetany, Poland. During the fMRI study, subjects were presented with a chirp of two different bandwidths: 50–950 Hz (middle frequency 500 Hz) and 3000–5000 Hz (middle frequency 4000 Hz) at 90 dB(C) via MRI-compatible earphones. A sparse paradigm was used and the data was analyzed using the SPM8 package (Statistical Parametric Mapping, http://www.fil.ion.ucl.ac.uk/spm/). Standard preprocessing was followed by a second-level analysis for contrast of low and high frequencies.ResultsAs expected, bilateral activation in the auditory cortex was observed in response to stimulation by 500 Hz chirps in PDT-EAS and PDT-EC candidates. Activation in response to 4000 Hz chirps were found only in the PDT-EAS group but less strongly than for 500 Hz chirps.ConclusionsfMRI can be used as an objective way of assessing residual hearing in the auditory cortex of patients with partial deafness.

TEN YEARS EXPERIENCE WITH A NEW STRATEGY OF PARTIAL DEAFNESS TREATMENT

What is now known as partial deafness treatment (PDT) began as a great challenge: insert a cochlear implant and preserve residual preoperative hearing. PDT addresses the situation where patients have low frequency hearing which is not badly affected, or is even fully functional, and it is necessary to complement it electrically in the medium and high frequency ranges. The first surgery in which existing normal hearing was electrically complemented, performed 10 years ago, has opened up a new direction in the treatment of other (more frequent) partial hearing impairments. The long term observation of more than 1200 ears has allowed us to refine a new strategy of PDT. The first surgery to electrically complement the existing hearing of an adult was performed in 2002, and led in 2004 to the same treatment in a child. It was preceded with 3 years of research on how to enhance the low-frequency residual hearing of patients by amplifying it with conventional hearing aids while supplying high frequencies with an electrically stimulated implant. Results of these studies, presented in 2000 at international conferences, demonstrated the potential for widening the first, cautious indications for the use of cochlear implants to situations where there are various levels of residual low-frequency hearing. Experience with 1200 cases of partial deafness surgery have proven its general validity and have refined the surgical guidelines. The surgical strategy is based on 6 main steps involving an approach to scala tympani through the round window, and use of electrodes with an active length of 20 to 28 mm.

Partial Deafness Treatment in children: educational settings after 5 to 7 years of cochlear implant use

Partial Deafness Treatment in children: educational settings after 5 to 7 years of cochlear implant use

ACOUSTIC STRUCTURE OF THE VOICE IN CHILDREN CONSIDERED FOR PARTIAL DEAFNESS TREATMENT

BackgroundPartial deafness (PD) is a condition in which normal hearing is preserved in the low frequency range, while severe to profound hearing loss is observed in the middle and high frequency ranges. The aim of this study was to assess the acoustic structure of the voice in children considered for partial deafness treatment (PDT).Material and MethodsThe material included 127 children aged from 5 to 12 years old. The study group included children with partial deafness (PD). Depending on age, patients in the study group were divided into 2 groups. The first included 40 children aged 5–6 years, and the second consisted of 44 school-age children aged 7–12 years. The control group included 20 healthy normally hearing children aged 5–6 years and 23 healthy, normally hearing children with clear voices, aged 7–12 years. Children’s voices were assessed subjectively by the physician and objectively with the use of a digital CSL KAY Multidimensional Voice Profile analyser (MDVP). The sustained vowel “a” was used for analysis.ResultsAcoustic features of PD vs. normally hearing children were different. Statistically significant parameters differentiating voices in the group of younger children were fundamental frequency (Fo); shimmer, a parameter describing changes in amplitude (ShdB); and noise-to-harmonic-ratio (NHR). In the group of older children more acoustic parameters characterizing voices of PD children were defined. They included fundamental frequency (Fo); fundamental frequency variation (vFo); amplitude change (vAm, sAPQ); noise-to-harmonic-ratio (NHR); and voice tremor (FTRI).ConclusionsThe acoustic structure of the voice in children with partial deafness is different from that in children with normal hearing.

FITTING OF AUDIO PROCESSORS IN PARTIAL DEAFNESS TREATMENT

Recently, cochlear implant (CI) eligibility criteria have broadened to include individuals with partial deafness, a condition in which, prior to implantation, a significant amount of low-frequency hearing remains. Cochlear implantation aimed for hearing preservation in partial deafness has been recognized as a new method of partial deafness treatment. However, it is not only hearing preservation that has a great influence on the performance of such users; it is also the fitting of the audio processor consisting of acoustic and electric part. In this paper the authors review results of recent studies that underline the importance of correct fitting of the audio processor in order to achieve good benefits in Electric-Acoustic Stimulation (EAS).

OTOACOUSTIC EMISSIONS FOR EVALUATING THE LOW-FREQUENCY HEARING OF PATIENTS CONSIDERED FOR PARTIAL DEAFNESS TREATMENT

BackgroundIn the present study otoacoustic emissions (OAEs) were used to evaluate the hearing of partial deafness subjects who had normal hearing up to 0.5 kHz and severe hearing loss above that frequency. The purpose of the study was to detect OAEs at 0.5 kHz and determine whether broad-band or band-limited values of OAE parameters were better for distinguishing ears with OAEs from those without.Material and MethodsThe study group consisted of 15 subjects with high-frequency hearing loss above 0.5 kHz. For reference, a group of 15 subjects with severe to profound sensorineural hearing loss over the whole of the 0.125–8 kHz range was used. In both groups, click-evoked OAEs (CEOAEs) and tone burst-evoked OAEs (TBOAEs) of 1 or 0.5 kHz were evaluated using a reproducibility parameter, taking into consideration broad-band, octave, and half-octave band values.ResultsIn the study group the best results were obtained by using 0.5 kHz TBOAEs. Clicks and 1 kHz tone bursts generally did not produce a response at 0.5 kHz. TBOAEs at 0.5 kHz enabled the separation of partially deaf ears from ears with severe hearing impairment. Half-octave band filtering yielded the best results; however, it was only slightly better than broadband and octave band filteringConclusionsThe results of the study indicate that the 0.5 kHz TBOAE is a better stimulus than CEOAE and 1 kHz TBOAE when cochlear function at low frequency needs to be tested. The half-octave band seems the best choice in order to get frequency-specific information. However the results should be treated with caution since the studied groups were relatively small.

Partial Deafness Treatment with the Nucleus Straight Research Array Cochlear Implant

Introduction: The Nucleus Straight Research Array (SRA) cochlear implant has a new 25-mm electrode carrier designed to minimize insertion trauma, in particular allowing easy insertion via the round window. The aims of this study were to measure preoperative to postoperative benefit in terms of speech recognition in quiet and in noise in three groups of patients (electrical complement, EC; electrical stimulation, ES; electro-acoustic stimulation, EAS) with varying levels of low-frequency hearing, and to evaluate the preservation of residual hearing after implantation with the SRA cochlear implant. Methods: The study design was prospective with sequential enrolment and within-subject comparisons: 23 adult cochlear implant candidates were divided into three groups according to their level of preoperative residual hearing at 500 Hz (EC ≤50 dB; 50 dB < EAS < 80 dB; ES ≧80 dB). Monosyllabic word recognition using the SRA cochlear implant in combination with residual low-frequency hearing was assessed at 4 and 13 months after implantation. Hearing threshold levels were also monitored over time. Results: Subjects across all three groups had significant improvements in speech recognition scores (i.e. >20 percentage points) both for listening in quiet (71% of subjects) and in noise (100% of subjects). The average score at 4 months after operation for words presented in quiet was 61.7%, and in 10 dB SNR noise 46.5%, compared to 34.4 and 10.6% preoperatively (p < 0.001). All subjects retained measurable hearing at 500 Hz in the implanted ear at 4 months after the operation; mean increases were 19, 29 and 1 dB for the EC, EAS and ES groups (n = 21). Across frequencies of 125–1000 Hz, the median increase in thresholds was 15 dB up to 13 months postoperatively (n = 15). Conclusions: Speech recognition performance of subjects with various levels of residual low-frequency hearing was significantly improved with the SRA cochlear implant. A high level and rate of hearing preservation was achieved with the SRA implanted using a round window surgical technique. Subjects with preoperative low-frequency hearing levels between 50 and 80 dB HL (EAS group) tended to lose more hearing than those with either better or worse hearing.