Unilateral Cochlear Implantation Research Articles

Effect of different personal protective equipment on sound discrimination in children using unilateral cochlear implants during the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic obliged people to wear personal protective equipment (PPEs), which can harm verbal communication and speech intelligibility. The first aim was to study the impact of wearing PPEs on the voice and speech parameters of phoniatricians during therapy sessions. The second aim was to study the effect of phoniatricians wearing these PPEs on auditory discrimination of the Ling’s six sounds in children using unilateral cochlear implants.MethodsThe study was a case–control one, done in the phoniatrics outpatient clinics at Beni-Suef University and Cairo University hospitals. Four phoniatricians participated in this study, and the Dr. Speech software analyzed their speech and voice parameters during utterance of the Ling’s six sounds. Each phoniatrician uttered each Ling sound individually four times to assess fundamental frequency and intensity: first time without wearing any mask, second time while wearing a surgical mask, third time while wearing a face shield, and fourth time while wearing an N95 mask. The study also included forty patients using unilateral cochlear implants (group A) and forty children with normal peripheral hearing (group B). The phoniatricians again uttered the Ling’s six sounds to assess auditory discrimination in both groups. This subjective auditory discrimination was also tested in both groups four times: first time without wearing any mask, second time while wearing a surgical mask, third time while wearing a face shield, and fourth time while wearing an N95 mask.Results and conclusionThe intensity of Ling’s six sounds was significantly lowest in the face shield. Regardless of the PPE type, patients with unilateral cochlear implants showed less consonant discrimination of (mm) sound. Surgical masks and N95 provided the best acoustic performance, while face shields had the worst.

Frequency and intensity discrimination in children with cochlear implants

BackgroundFrequency discrimination underlies more complicated auditory activities like speech comprehension and interpretation. However, intensity differences indicate how far apart noises are. This study aimed to evaluate and compare results of frequency modulation and difference limen for intensity in children with cochlear Implants (CI) as well as normal hearing children.ResultsThis case–control work was performed on 40 children, aged from 5–18 years, divided into two equal groups: a study group with unilateral CI and a control group with normal peripheral hearing. All patients were subjected to otological examination, audiological evaluation, frequency modulation difference limen (FMDL) and difference limen for intensity (DLI) tests. Patients with CI, as compared to normal hearing (NH) subjects, required significantly higher frequencies to discriminate FMDL and DLI respectively (P value = 0.001). At 2000 and 4000 Hz: FMDL had a significant diagnostic power for patients with CI (AUC = 0.980, 0.998 respectively, P < 0.001), at cut off 1.5, with 100% sensitivity and 100% specificity. While, at 4000 Hz: DLI had a significant diagnostic power for patients with CI (AUC = 0.999, P < 0.001), at cut off 1.5, with 100% sensitivity and 100% specificity.ConclusionA statistically substantial variation was observed among CI and NH children in FMDL and DLI at all frequencies tested. Patients with CI required significantly higher frequencies to discriminate as compared to NH subjects. Frequencies at 2000 Hz and 4000 Hz possess the best specificity and sensitivity of FMDL. While frequency 4000 Hz possess the best specificity and sensitivity of DLI.

The Effect of Cochlear Implant Stimulation on Postural Control.

There are contradictory reports on the effect of cochlear implantation on postural control. Associated vestibular loss, electrode insertion trauma, and electrical stimulus of a cochlear implant can influence postural control. This study focused on the electrical stimulation of the cochlea. We aimed to examine whether a cochlear implant's electrical stimulation affects postural control measured by posturography. Thirty-three patients with unilateral cochlear implants were included. We used three preprogrammed main tests and their nine subtests in posturography. Postural stability [general stability index (GSI)], fall risk index (FRI), and sensory integration [modified clinical test of sensory integration of balance (m-CTSIB)] were calculated. All tests were performed under three conditions: implant off (1), implant on (2), and implant on music (3). The mean age was 46.29±16.09 years. GSI was above normal limits in 78% of adult cochlear implant users. We found that FRI was high in 30% of patients, and m-CTSIB was defective in 42%. There were no statistically significant differences in GSI, FRI, and m-CTSIB. Cochlear implant stimulation was found to have positively affected postural control when the subject's data were visualized individually. GSI, FRI, and m-CTSIB dropped to 39%, 24%, and 24%, respectively, when music was on. There was a significant correlation between age and fall index. But this correlation disappeared when music was playing. Cochlear implant stimulation affected the vestibular system in almost all patients. The effect was positive in most patients.

Language profile of children with cochlear implants: comparative study about the effect of age of cochlear implantation and the duration of rehabilitation

PurposeThe analysis of different language domains and exploration of variables that affect the outcomes of cochlear implantation would help to document the efficacy of cochlear implantation and intervention programs. The aim of this work was to examine the language profile of children with Cochlear Implants (CI) and to assess the effect of age at the time of cochlear implantation and the impact of duration of rehabilitation on the development of linguistic abilities for cochlear implanted children.MethodsThe study was conducted on 46 Arabic speaking children using unilateral CI who are receiving regular post-cochlear auditory and language rehabilitation in the phoniatrics unit, Kasr Alaini hospital. A Proficient Preschooler Language Evaluation (APPEL TOOL) was applied for the assessment of different language domains.ResultsChildren who received post implant rehabilitation for ≥ 2 years showed significant improvement in all subtests' scores of APPEL tool than children who received same rehabilitation for ≤ 1 year. There was no significant difference of language scores between children who have received CI before age of 3 years and those who have been implanted after age of 3 years.ConclusionThis study showed that the language profile of CI children was beneficially affected by the longer duration of therapy post implantation.

Clinical Portrait of Cochlear Implantation in Patients With CHARGE Syndrome.

To examine the clinical characteristics and auditory performance of patients with CHARGE syndrome following cochlear implantation (CI), as well as the prognostic factors affecting auditory outcomes. Retrospective cohort. Tertiary academic center. A retrospective chart review was performed in patients with CHARGE syndrome who underwent CI from 2007 to 2022. The category of auditory performance (CAP) score was used to assess the CI outcomes, and factors that may affect the speech outcomes were also evaluated. In 14 children with CHARGE syndrome, 22 CIs were performed, 6 unilaterally and 8 bilaterally. The mean age at CI was 25.9 months (range: 10-62). All patients had ear abnormalities and developmental delays, and cochlear nerve deficiency (CND) was present in all ears. At the last follow-up (mean: 49.6 months), the mean CAP score improved significantly compared to the preoperative measure (from 0.36 ± 0.81 to 3.21 ± 1.70, P = .001), with 6 patients (42.9%) achieving a CAP score of 4 points or higher. However, between the unilateral and bilateral CI groups, the final CAP score or change in CAP score was similar. Factors including age, coloboma, and CND did not significantly affect speech outcomes (all P > .05). Even though CHARGE syndrome features challenging anomalies, CI can be conducted safely and can offer effective contribution to significant speech improvement. Patients with CHARGE syndrome should be given the opportunity to undergo CI to maximize their audiological progress.

Integrated bimodal fitting and binaural streaming technology outcomes for unilateral cochlear implant users

Objective Adults typically receive only one cochlear implant (CI) due to cost constraints, with a contralateral hearing aid recommended when there is aidable hearing. Standard hearing aids differ from a CI in terms of processing strategy and function as a separate entity, requiring the user to integrate the disparate signals. Integrated bimodal technology has recently been introduced to address this challenge. The aim of the study was to investigate the performance of unilateral CI users with and without an integrated bimodal fitting and determine whether binaural streaming technology offers additional benefit. Study sample Twenty-six CI users using integrated bimodal technology. Design Repeated measures where outcomes and user experience were assessed using a functional test battery more representative of real life listening (speech perception in noise tests, localisation test, tracking test) and the speech, spatial and qualities-of-hearing scale (SSQ). Results Bimodal outcomes were significantly better than for CI alone. Speech perception in noise improvements ranged from 1.4 dB to 3.5 dB depending on the location of speech and noise. The localisation and tracking tests, and the SSQ also showed significant improvements. Binaural streaming offered additional improvement (1.2 dB to 6.1 dB on the different speech tests). Conclusions Integrated bimodal and binaural streaming technology improved the performance of unilateral CI users.

Objective and Subjective Measures of Spatial Hearing in Unilateral Cochlear Implant Users with Bilateral Profound Hearing Loss

Purpose: The ability to benefit from spatial separation between target and masker signals is important in multi-sound source listening environments. The goal of this study was to measure the spatial release from masking (SRM) in unilateral cochlear implant (CI) users with bilateral profound hearing loss. We also determined the relationships between the SRMs and the self-reported spatial hearing abilities.Methods: Fourteen unilateral CI users with bilateral profound hearing loss participated in this study. The target sentence was always presented to the front of the listener, and the nonfluctuating speech-shaped noise (SSN) or fluctuating speech noise was either co-located with the target (speech at 0°, noise at 0°, S0N0) or spatially separated at ± 90°. The SRM was quantified as the difference between speech recognition thresholds (SRTs) in the co-located and spatially separated conditions. The self-reported spatial hearing abilities were also measured using validated subjective questionnaires.Results: Overall, the SRTs were lower (better) with SSN than with fluctuating speech noise. When the noise was presented to the non-CI ear (speech at 0°, noise at non-CI ear, S0Nnonci), speech-in-noise recognition was the greatest due to head shadow or better-ear listening effect, resulting in the SRMs of approximately 5~6 dB regardless of noise type. When the noise was given to the CI ear (speech at 0°, noise at CI ear, S0Nci), some individuals exhibited positive SRMs (3~8 dB), while others showed negative SRMs, leading to little SRMs overall. When the SSN was given, subjects with less SRMs (less spatial separation benefits on the objective test) reported greater subjective spatial hearing difficulties.Conclusion: The spatial hearing of unilateral CI users varied by the position of the sound source. Listeners' spatial hearing abilities, which are unpredictable from clinical routine tests, need to be assessed by either objective or subjective measures.

Two are better than one: Differences in cortical EEG patterns during auditory and visual verbal working memory processing between Unilateral and Bilateral Cochlear Implanted children

Despite the proven effectiveness of cochlear implant (CI) in the hearing restoration of deaf or hard-of-hearing (DHH) children, to date, extreme variability in verbal working memory (VWM) abilities is observed in both unilateral and bilateral CI user children (CIs). Although clinical experience has long observed deficits in this fundamental executive function in CIs, the cause to date is still unknown. Here, we have set out to investigate differences in brain functioning regarding the impact of monaural and binaural listening in CIs compared with normal hearing (NH) peers during a three-level difficulty n-back task undertaken in two sensory modalities (auditory and visual). The objective of this pioneering study was to identify electroencephalographic (EEG) marker pattern differences in visual and auditory VWM performances in CIs compared to NH peers and possible differences between unilateral cochlear implant (UCI) and bilateral cochlear implant (BCI) users. The main results revealed differences in theta and gamma EEG bands. Compared with hearing controls and BCIs, UCIs showed hypoactivation of theta in the frontal area during the most complex condition of the auditory task and a correlation of the same activation with VWM performance. Hypoactivation in theta was also observed, again for UCIs, in the left hemisphere when compared to BCIs and in the gamma band in UCIs compared to both BCIs and NHs. For the latter two, a correlation was found between left hemispheric gamma oscillation and performance in the audio task. These findings, discussed in the light of recent research, suggest that unilateral CI is deficient in supporting auditory VWM in DHH. At the same time, bilateral CI would allow the DHH child to approach the VWM benchmark for NH children. The present study suggests the possible effectiveness of EEG in supporting, through a targeted approach, the diagnosis and rehabilitation of VWM in DHH children.

The cost evaluation of day-case compared to inpatient cochlear implantation in adults: subanalysis of a randomized controlled trial

ObjectiveTo investigate the assumption that day-case cochlear implantation is associated with lower costs, compared to inpatient cochlear implantation, while maintaining equal quality of life (QoL) and hearing outcomes, for the Dutch healthcare setting.Study designA single-center, non-blinded, randomized controlled trial in a tertiary referral center.MethodsThirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group (i.e., one night admission). We performed an intention-to-treat evaluation of the difference of the total health care-related costs, hospital and out of hospital costs, between day-case and inpatient cochlear implantation, from a hospital and patient perspective over the course of one year. Audiometric outcomes, assessed using CVC scores, and QoL, assessed using the EQ-5D and HUI3 questionnaires, were taken into account.ResultsThere were two drop-outs. The total health care-related costs were €41,828 in the inpatient group (n = 14) and €42,710 in the day-case group (n = 14). The mean postoperative hospital stay was 1.2 days (mean costs of €1,069) in the inpatient group and 0.7 days (mean costs of €701) for the day-case group. There were no statistically significant differences in postoperative hospital and out of hospital costs. The QoL at 2 months and 1 year postoperative, measured by the EQ-5D index value and HUI3 showed no statistically significant difference. The EQ-5D VAS score measured at 1 year postoperatively was statistically significantly higher in the inpatient group (84/100) than in the day-case group (65/100). There were no differences in postoperative complications, objective hearing outcomes, and number of postoperative hospital and out of hospital visits.ConclusionA day-case approach to cochlear implant surgery does not result in a statistically significant reduction of health care-related costs compared to an inpatient approach and does not affect the surgical outcome (complications and objective hearing measurements), QoL, and postoperative course (number of postoperative hospital and out of hospital visits).Level of evidence1.

Quality of Life With Cochlear Implantation Using the CIQOL-35 at a Tertiary Urban Medical Center: Our Experience.

Assessment of quality-of-life (QOL) outcomes after cochlear implantation (CI) using the Cochlear Implant Quality of Life-35 questionnaire (CIQOL-35). Retrospective cohort. Single-institution tertiary care center. Patients 18 years and older who have undergone CI and CIQOL-35 survey. Implementing CIQOL-35 from 2019 to 2022 to measure change in QOL after CI. Statistical analysis included nonparametric, univariate, and multivariate analyses. Significance was set at 0.05. Differences in QOL among CI patients in each of the CIQOL-35 domains. Ninety-three patients (40 female, 53 male) aged 20 to 93 years (median 70 years) turned in 164 QOL surveys (68 preactivation, 96 postactivation). Postactivation median QOL was 5 to 15 points higher across all domains ( p < 0.001). QOL score distributions among unilateral CI only, bilateral CI, and unilateral CI with contralateral hearing aid users were not statistically different ( p > 0.05). Multivariate analysis identified that male sex ( β = -2.0; 95% confidence interval, -3.9 to -0.1) was a negative predictor for environment scores and not being married ( β = 2.0; 95% confidence interval, 0.02 to 4.0) was a positive predictor for entertainment scores. Median follow-up time was 13 months post-CI (interquartile range [IQR], 7.1-21.5 months). CI patients experienced improved QOL postactivation among all QOL domains, whereas specific CI use pattern in regard to unilateral, bilateral, or bimodal did not affect QOL. Multivariate analysis identified marital status and sex as possible QOL predictors.

Loudness Balancing Optimization for Better Speech Intelligibility, Music Perception, and Spectral Temporal Resolution in Cochlear Implant Users.

The behaviorally based programming with loudness balancing (LB) would result in better speech understanding, spectral-temporal resolution, and music perception scores, and there would be a relationship between these scores. Loudness imbalances at upper stimulation levels may cause sounds to be perceived as irregular, gravelly, or overly echoed and may negatively affect the listening performance of the cochlear implant (CI) user. LB should be performed after fitting to overcome these problems. The study included 26 unilateral Med-EL CI users. Two different CI programs based on the objective electrically evoked stapedial reflex threshold (P1) and the behaviorally program with LB (P2) were recorded for each participant. The Turkish Matrix Sentence Test (TMS) was applied to evaluate speech perception; the Random Gap Detection Test (RGDT) and Spectral-Temporally Modulated Ripple Test (SMRT) were applied to evaluate spectral temporal resolution skills; the Mini Profile of Music Perception Skills (mini-PROMS) and Melodic Contour Identification (MCI) tests were applied to evaluate music perception, and the results were compared. Significantly better scores were obtained with P2 in TMS tests performed in noise and quiet. SMRT scores were significantly correlated with TMS in quiet and noise, and mini-PROMS sound perception results. Although better scores were obtained with P2 in the mini-PROMS total score and MCI, a significant difference was found only for MCI. The data from the current study showed that equalization of loudness across CI electrodes leads to better perceptual acuity. It also revealed the relationship between speech perception, spectral-temporal resolution, and music perception.

CROS or hearing aid? Selecting the ideal solution for unilateral CI patients with limited aidable hearing in the contralateral ear.

A hearing aid or a contralateral routing of signal device are options for unilateral cochlear implant listeners with limited hearing in the unimplanted ear; however, it is uncertain which device provides greater benefit beyond unilateral listening alone. Eighteen unilateral cochlear implant listeners participated in this prospective, within-participants, repeated measures study. Participants were tested with the cochlear implant alone, cochlear implant + hearing aid, and cochlear implant + contralateral routing of signal device configurations with a one-month take-home period between each in-person visit. Audiograms, speech perception in noise, and lateralization were evaluated. Subjective feedback was obtained via questionnaires. Marked improvement in speech in noise and non-implanted ear lateralization accuracy were observed with the addition of a contralateral hearing aid. There were no significant differences in speech recognition between listening configurations. However, the chronic device use questionnaires and the final device selection showed a clear preference for the hearing aid in spatial awareness and communication domains. Individuals with limited hearing in their unimplanted ears demonstrate significant improvement with the addition of a contralateral device. Subjective questionnaires somewhat contrast with clinic-based outcome measures, highlighting the delicate decision-making process involved in clinically advising one device or another to maximize communication benefits.

Listening-Related Fatigue in New and Experienced Adult Cochlear Implant Users.

Active listening in everyday settings is challenging and requires substantial mental effort, particularly in noisy settings. In some cases, effortful listening can lead to significant listening-related fatigue and negatively affect quality of life. However, our understanding of factors that affect the severity of fatigue is limited. Hearing aids and cochlear implants (CIs) can improve speech understanding and thus, potentially, reduce listening effort and fatigue. Some research supports this idea for adult hearing aid users with mild-to-moderate hearing loss, but similar work in CI users is very limited. This study examined (1) longitudinal changes in listening-related fatigue in new and established CI users, and (2) relationships between demographic and audiologic factors and preimplantation and postimplantation listening-related fatigue. Participants included an experimental group of 48 adult CI candidates receiving either a unilateral implant (n = 46) or simultaneous, bilateral implants (n = 2) and a control group of 96 experienced (>12 months experience) adult CI users (50 unilateral, 46 bilateral). Listening-related fatigue was evaluated using the 40-item version of the Vanderbilt Fatigue Scale for Adults. Experimental group ratings were obtained before implantation and again at 0.5-, 1-, 2-, 3-, 6-, and 12-month(s) postactivation. Control group participants completed the scale twice-upon study entry and approximately 3 months later. Additional measures, including a social isolation and disconnectedness questionnaire, hearing handicap inventory, and the Effort Assessment Scale, were also administered at multiple time points. The role of these measures and select demographic and audiologic factors on preimplant and postimplant fatigue ratings were examined. Adult CI candidates reported significantly more fatigue, greater self-perceived hearing handicap, greater listening effort, and more social isolation than experienced adult CI users. However, significant reductions in fatigue and effort were observed within 2 weeks postimplantation. By 3 months, there were no significant differences in fatigue, effort, hearing handicap, or social isolation between new CI recipients and experienced CI users. Secondary analyses revealed that age at onset of hearing loss (before or after 2 years of age) and subjective hearing handicap contributed significantly to the variance of preimplantation fatigue ratings (those with higher handicap reported higher fatigue). In contrast, variance in postimplantation fatigue ratings was not affected by age of hearing loss onset but was affected by gender (females reported more fatigue than males) and subjective ratings of effort, handicap, and isolation (those reporting more effort, handicap, and isolation reported more fatigue). Listening-related fatigue is a significant problem for many CI candidates, as well as for many experienced unilateral and bilateral CI users. Receipt of a CI significantly reduced listening-related fatigue (as well as listening effort, hearing handicap, and social isolation) as soon as 2 weeks post-CI activation. However, the magnitude of fatigue-related issues for both CI candidates and experienced CI users varies widely. Audiologic factors, such as hearing loss severity and aided speech recognition, were not predictive of individual differences in listening-related fatigue. In contrast, strong associations were observed between perceived hearing handicap and listening-related fatigue in all groups suggesting fatigue-related issues may be a component of perceived hearing handicap.

Associations between illness perceptions, word recognition, and perceived sound quality in cochlear implant users.

Illness perceptions refer to thoughts and ideas an individual has about an illness. The aim was to understand how cochlear implant (CI) users' illness perceptions, in addition to their monosyllabic word recognition abilities, are associated with their self-perceived sound quality. Data were collected during routine CI check-up appointments. Participants completed the Brief Illness Perception Questionnaire (assessing their illness perceptions) and the Hearing Implant Sound Quality Index (assessing their subjective sound quality). Additionally, monosyllabic word recognition abilities were measured with the Freiburg Monosyllable Word Test. Hierarchical regression analysis were utilised to model users' sound quality ratings. Participants' age was entered first as a control variable. In the next step, monosyllabic word recognition was entered. Finally, participants' illness perceptions were entered. Fifty-five participants with unilateral CI provision. Monosyllabic word recognition was significant in the second step. When illness perceptions and monosyllabic word recognition were both included in the third step, illness perceptions, but not monosyllabic word recognition, were significant. The model explained 22% of the variance of subjective sound quality. Monosyllabic word recognition abilities and illness perceptions of CI users are important for their self-reported sound quality, but illness perceptions appear to be potentially more relevant.

Psychophysical and Electrophysiological Parameters of the Auditory Analyzer as Indicators of the Effectiveness of Cochlear Implantation in Children with Bilateral Deafness

Background. The results of rehabilitation of patients with deafness after cochlear implantation (CI) depends on many factors related on both the individual characteristics of the patient and the technical parameters of auditory nerve stimulation — fitting of the CI system processor. Article presents the results of a study of the relationship between psychophysical (subjective) auditory sensations and electrophysiological (objective) responses of the structures of the auditory analyzer to electrical stimulation. Aims — to evaluate the relationship between the electrophysiological responses of the auditory analyzer and the psychophysical parameters of the thresholds of sound perception and speech intelligibility in patients with deafness after CI. Methods. The study involved 88 patients with IV bilateral sensorineural hearing loss, borderline with deafness, aged 6 to 17 years 11 months, among whom 54.5% (n = 48) of girls and 45.5% (n = 40) of boys. Of the patients included in the follow-up, 40% (n = 35) underwent unilateral CI; 60% (n = 53) of children underwent bilateral sequential CI. In our study, slightly more than half of the patients (51.1%) had experience using the CI system for more than 5 years. At the first stage of the study, we studied the relationship between sound perception thresholds (tonal audiometry in a free field) and registered ASSR (auditory steady state response) thresholds in patients with deafness receiving rehabilitation after CI surgery. The relationship between behavioral and electrophysiological (objective) thresholds was assessed by comparing the results of tonal threshold audiometry and the responses received during ASSR registration to acoustic stimulation in a free field. At the second stage, patients with indications for processor fitting (decreased speech intelligibility, uncomfortable sensations) underwent speech audiometry, evoked compound action potentials (ECAP) registration, according to the results of which the parameters of the CI processor were changed. Results. Research data showed the effectiveness of the approach of including the ECAP registration test, followed by the creation of a fitting card and correction of the level of auditory nerve stimulation under the control of speech audiometry in the protocol of fitting the CI processor. Conclusions. The results of the conducted studies allow us to recommend the use of the developed method of objective recording of sound perception thresholds in patients with CI as one of the indicators of the effectiveness of CI in the early period of auditory-speech rehabilitation in patients with undeveloped speech skills and when it is impossible to conduct objective tests accompanied by supra-threshold stimulation of the auditory nerve.

Language, cognitive, and speech in noise perception abilities of children with cochlear ımplants: a comparative analysis by implantation period and bilateral versus unilateral cochlear implants

PurposeThe purpose of this study was to compare the language, cognitive, and speech in noise (SiN) perception abilities of children with cochlear implants (CIs) to those of their peers with NH by grouping them according to their implantation period (12–18 months/19–24 months) and unilateral/bilateral CI use.MethodsThe sample comprised 50 children with cochlear implants (CIs) and 20 children with normal hearing (NH), ages 6–9 years. Children’s language, cognitive, and speech in noise (SiN) perception skills were assessed.ResultsChildren with CIs between 12 and 18 months and 19 and 24 months performed more poorly than children with NH on language, verbal memory (VM), verbal-short-term memory (V-STM), verbal working memory (V-WM), rapid naming, and speech in noise (SiN) perception abilities measures (p < 0.001). In addition, children with CIs between 19 and 24 months performed worse on rapid naming and V-WM tasks than children with CIs between 12 and 18 months (p < 0.017). Children with unilateral and bilateral CI performed more poorly than children with NH on language, VM, V-STM, V-WM, rapid naming, and SiN perception abilities assessments (p < 0.001). Additionally children with unilateral CI users performed poorly than children with bilateral CI users on SiN perception (p < 0.017).ConclusionsIn children with congenital hearing loss (CHL), cochlear implantation between 12 and 18 months or sequential bilateral implantation is not sufficient for these children to perform like their NH peers in language, cognitive, and SiN perception abilities. In addition, intervention approaches should focus not only on increasing language skills, but also on cognitive abilities.

Quality of life, hearing results, patient satisfaction and postoperative complications of day-case versus inpatient unilateral cochlear implantation in adults: a randomized controlled, equivalence trial

ObjectiveTo investigate the hypothesis that day-case cochlear implantation is associated with equal quality of life, hearing benefits and complications rates, compared to inpatient cochlear implantation.Study designA single-center, non-blinded, randomized controlled, equivalence trial in a tertiary referral center.MethodsThirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group. The effect on general quality of life, patient satisfaction, (subjective) hearing improvement, postoperative complications and causes of crossover and/or readmission were assessed using questionnaires, auditory evaluations and patients’ charts over a follow-up period of 1 year.ResultsOverall quality of life measured by the HUI3 was equal between the day-case (n = 14) and inpatient group (n = 14). The overall patients’ satisfaction showed a slight favor towards an inpatient approach. There was no significant difference in the subjective and objective hearing improvement between both treatment groups. During the 1-year follow-up period no major complications occurred. Minor complications occurred intraoperatively in three day-case patients resulting in three out of nine admissions of day-case patients. Other causes of admission of day-case patients were nausea and vomiting (n = 1), drowsiness (n = 1), late scheduled surgery (n = 2), social reasons (n = 1), or due to an unclear reason (n = 1). No patients required readmission.ConclusionWe found equal outcomes of QoL, patient satisfaction, objective, and subjective hearing outcomes between day-case and inpatient unilateral cochlear implantation. Nine out of 14 day-case patients were admitted for at least one night postoperatively (crossover). No major complications occurred in both groups. A day-case approach seems feasible when using specific patient selection, surgical planning and the preoperative provision of patient information into account. Besides this, the familiarity with a day-case approach of both patient and the surgical team can increase the feasibility of day-case surgery.Level of evidence1.

Como a judicialização da cirurgia de implante coclear impacta o Sistema Único de Saúde

ABSTRACT Purpose To describe the impact of Judicialization on the performance of Cochlear Implant (CI) surgery in the Brazilian Unified Health System (SUS), including the public service and supplementary health. Methods A documentary survey of judgments of all National Courts and the Dominant Jurisprudence focused on CI surgery in the SUS from 2007 to 2019 was carried out through the Jusbrasil Platform using the term “cochlear implant” to carry out the search. A survey was also carried out on the DATASUS platform on how many uni and bilateral CI procedures were performed in the same period. Results According to DATASUS, from 2008 to 2019, 8,857 CI surgery procedures were performed by Public Entities or Health Plan Operators in the country. With regard to Judicialization, for requesting unilateral or bilateral CI surgery, a total of 216 processes were found, representing a total of 2.43% of Judicialization of Cochlear Implant (CI) surgery. Conclusion In view of the data, it is possible to perceive that the Judicialization of Health when we consider the CI surgery has represented a small portion of the cases, which does not demonstrate a large impact on the public budget and does not have an impact on the organization of the SUS.

Multicomponent tympanometry in ears with cochlear implant

Abstract Introduction: Multifrequency and multicomponent tympanometry procedures enable the evaluation of minute changes in the middle ear system and the estimation of resonant frequency. Changes in the resonant frequency beyond normative values indicate the presence of pathology or change in the natural characteristics of the middle ear. The present study aimed to investigate if there is a difference in the admittance of the middle ear on the side of cochlear implantation and the contralateral ear for different probe tones. The study also investigated if there was a difference in the type of multicomponent tympanogram obtained in ears that have undergone cochlear implantation when compared to the contralateral ear. Methods: Twenty children in the age range of 4–14 years with bilateral severe to profound sensorineural hearing loss, having undergone unilateral cochlear implantation, were included in the study. Tympanometry using four probe-tone frequencies (226 Hz, 678 Hz, 800 Hz, and 1000 Hz) was carried out in each ear. Total compliance (Y) and type of tympanogram were compared across the ear with cochlear implantation and the contralateral ear. Results: It was found that the implanted ears had lower mean admittance values as compared to the contralateral side at all four probe-tone frequencies. Wilcoxon signed-rank test indicated that the difference was statistically significant for 226 Hz, 678 Hz, and 800 Hz probe tones, suggesting increased stiffness in the ear with cochlear implantation. There was a significant difference in the type of tympanograms obtained in the two ears for 800 Hz and 1000 Hz probe-tone frequencies. Conclusions: These results warrant the testing of the contralateral ear for obtaining electrically evoked stapedial reflex thresholds (eSRT).

Electrically evoked late latency response using single electrode stimulation and its relation to speech perception among paediatric cochlear implant users.

Aided auditory late latency response (LLR) serves as an objective tool for evaluating auditory cortical maturation following cochlear implantation in children. While aided LLR is commonly measured using sound-field acoustic stimulation, recording electrically evoked LLR (eLLR) offer distinct advantages, such as improved stimulus control and the capability for single electrode stimulation. Hence, the study aimed to compare eLLR responses with single electrode stimulation in the apical, middle, and basal regions and to evaluate their relationship with speech perception in paediatric cochlear implant (CI) recipients. eLLR responses with single electrode stimulation were measured in 27 paediatric unilateral CI users with an active recording electrode placed at Cz. The stimuli consisted of 36 msec biphasic pulse trains presented across three electrode sites (apical-E20, middle-E11, and basal-E03). eLLR responses were compared across these electrode sites, and the relationship between speech recognition scores in quiet and age at implantation with eLLR components was evaluated. eLLR responses were detected in 77 out of 81 tested electrodes of all participants combined (27 for apical, 26 for middle, and 24 for basal stimulation). There were no significant differences in P1, N1 latencies and P1 amplitude across electrode site. However, significantly larger N1 and P1-N1 amplitudes were observed for apical stimulations compared to basal stimulations. No differences in N1 amplitude were found between middle and apical stimulations, and the P1-N1 amplitude was significantly larger for middle compared to basal electrode stimulation, with no difference between the apical and middle electrodes stimulation. A moderate positive correlation was present between speech recognition scores in quiet and both N1, P1-N1 amplitudes for apical stimulation. Age at implantation was negatively correlated with N1 amplitude for the apical and P1-N1 amplitude for basal stimulation. eLLR responses could be elicited in majority of paediatric CI users across electrode sites. Variations in eLLR responses across electrode sites suggest disparities in auditory cortical maturation. The findings underscore the significance of the N1 biomarker in evaluating higher-order auditory cortical development. Therefore, utilizing eLLR with single electrode stimulation may serve as a valuable tool for assessing post-cochlear implantation maturational changes in paediatric populations.