Observations on hearing preservation in patients with hybrid-L electrode implanted at Poznan University of Medical Sciences in Poland

The objective of the paper is to evaluate the hearing preservation rate in patients with high frequency hearing loss, treated with Cochlear Nucleus Freedom Hybrid-L implant in the Otolaryngology Department, Poznan University of Medical Sciences in Poland. Study was designed as the retrospective analysis. Twenty-one patients were operated and implanted with Nucleus Freedom Hybrid-L implant. Pure tone thresholds were recorded prior to the surgery and at the time of speech processor switch-on. Patients were subdivided into two groups with respect to their PTA thresholds: group A—classic indications and group B—extended indications. Average PTA for three frequencies (250, 500, 1,000 Hz) were calculated for each patient pre- and postoperatively. In the group of 21 implanted patients in 17 cases we have observed preservation of hearing (12 patients from group A, 5 patients from group B) with a mean value of 13.1 dB. In 4 out of 21 patients deafness on the implanted ear was noted. Our results clearly indicate that with standard procedure hearing preservation can be obtained in majority of patients. Hearing preservation was not achieved in 19 %, but owing to design of the electrode of the Cochlear Nucleus Hybrid-L that enables to work as CI platform alone, in patients who lost their hearing after surgery re-implantations were not required. This proves that EAS is a safe and reliable method to help patients with specific type of hearing loss

Observation of improvement in mental functions by Mini-Mental method of Patients from Geriatric unit after starting to wear hearing aid

The loss of cognitive function, in addition to physiological changes, is the main illness of patients in geriatric units. There are many factors affecting cognitive ability in elderly patients. Undoubtedly, one of them is the physiological aging process of the hearing organs. One of the methods to assess cognitive functioning is the Mini-Mental Sade Examination (MMSE). The paper presents an assessment of the impact of hearing aids in patients with hearing loss on the outcome of cognitive assessment in MMSE. Analysis of the study results provides answers to questions about the improvement of mental functioning in geriatric patients with hearing loss assessed by MMSE after starting to wear hearing aids.Utrata funkcji poznawczych jest obok zmian fizjologicznych głównym schorzeniem pacjentów oddziałów geriatrycznych. Istnieje wiele czynników wpływających na zdolności kognitywne pacjentów w podeszłym wieku. Niewątpliwie jednym z nich jest fizjologiczny proces starzenia się narządu słuchu. Jedną z metod oceny funkcjonowania poznawczego jest Krótka Skala Oceny Stanu Psychicznego (Mini-Mental Sade Examinotion – MMSE). W pracy przedstawiono ocenę wpływu zaprotezowania słuchu aparatami słuchowymi u pacjentów z niedosłuchem na wynik oceny czynności poznawczych w teście MMSE. Analiza wyników przeprowadzonych badań dostarcza odpowiedzi na pytania dotyczące poprawy funkcji umysłowych u pacjentów geriatrycznych z niedosłuchem, ocenianych metodą MMSE po zaprotezowaniu słuchu aparatami słuchowymi

Uwagi dotyczące kwalifikacji pacjentów do implantacji ślimakowej

Obserwowany od ponad 30 lat postęp w  rozwoju technik chirurgicznych oraz technologii implantów ślimakowych doprowadził do zmiany podejścia i  poszerzenia wskazań do kwalifikacji chorych do leczenia ubytków słuchu typu odbiorczego. Podstawowe wskazania do implantacji ślimakowej stanowią: obustronna głuchota, obustronne resztki słuchowe lub obustronny głęboki niedosłuch typu odbiorczego oraz brak zysku akustycznego z zastosowania klasycznych aparatów słuchowych na przewodnictwo powietrzne po minimum 5–6-miesiącach użytkowania. Przy ocenie wskazań do implantacji wykorzystywane są metody subiektywne oraz obiektywne słuchu. Opinia psychologiczna ma na celu ocenę oczekiwań pacjenta/rodziców dziecka, ich motywacji oraz poziomu intelektualnego pod kątem obecności deficytów mogących powodować trudności zarówno w  późniejszej rehabilitacji, jak i  akceptacji nowego rodzaju stymulacji. W ocenie logopodycznej uwzględniany jest aktualny stopień rozwoju mowy, zaburzenia artykulacyjne związane z  upośledzeniem słuchu, sposób komunikowania się z  otoczeniem. Do ostatecznej kwalifikacji konieczne jest wykonanie badania obrazowego głowy/uszu (TK i/lub MRI). Nabywane doświadczenie chirurgiczne pozwoliło na stopniowe implantowanie dzieci z  różnymi wadami rozwojowymi w  zakresie ucha wewnętrznego. Obecność stanu zapalnego w  obrębie jamy bębenkowej i  przestrzeni pneumatycznych wyrostka sutkowatego może wymagać wcześniejszego usunięcia zmian zapalnych albo wyboru innego dojścia chirurgicznego

Remarks on qualification of patients for cochlear implantation

Over thirty years of progress in development of surgical techniques and cochlear implant technology led to a change in approach and extending of indications for qualifying patients to treatment of sensorineural hearing loss. Basic indications for cochlear implants include bilateral deafness, bilateral residual hearing or profound bilat-eral sensorineural hearing impairment as well as lack of acoustic gain from classic air conduction hearing aids af-ter a minimum of 5-6 months of use. Methods of subjective and objective hearing assessment are applied. Psycho-logical evaluation is aimed at assessing expectations of the patient/child’s parents, motivation, and intellect with regard to the presence of deficits that might pose difficulty in the course of further rehabilitation as well as accep-tance of this new type of stimulation. Speech and language evaluation takes into consideration the current level of speech development, articulation disorders related to hearing impairment, and the way to communicate with the environment. Final qualification requires imaging diagnostics of the head/ears (CT and/or MRI). Our surgi-cal experience allowed for implanting children with various congenital anomalies of the inner ear. Inflammation within the tympanic cavity and air-filled spaces of the mastoid process might require removal of inflammatory foci prior to surgery or selection of different surgical approach

Current indications for cochlear implantation in adults and children

Introduction: Surgical treatment of deafness by cochlear implants is used for more than 40 years, and during this period permanently, gradual and significant expansion of indications for this surgery has been observed. Material and methods: In our Department in the years 1994-2018 1480 cochlear implantations were performed, both in adults (647) and in children (883). In this study current indications and the rules for eligibility of patients based on 25 years of experience are presented. Results: Indications for cochlear implantation in adults are: 1) bilateral postlingual deafness, 2) bilateral sensorineural hearing loss - in pure tone audiometry > 70 dB HL (average 500-4000 Hz) and in speech audiometry in hearing aids understanding 80dB HL confirmed by hearing tests, after about 6 months of rehabilitation with the use of hearing aids. Discussion: Although cochlear implantation is used for more than 40 years, the indications for this treatment underlies constant modifications. They concern the age of eligible patients, implantation in patients with partially preserved hearing, as well as treatment for patients with difficult anatomical conditions. In many countries, bilateral implantations are commonly performed, and more and more centers recommend this treatment in the case of unilateral deafness or asymmetric hearing loss, especially with the accompanying tinnitus in the deaf ear

Evaluation of quality of life in patients after cochlear implantation surgery in 2014-2017

Introduction: Profound hearing loss significantly affects the quality of life of deaf people as well as their families. Observation of the benefit from the use of cochlear implants in deaf patients allows to assess the success of treatment with this method and its impact on the quality of life of these patients. The aim of this study was to determine the quality of life in patient after the cochlear implantation in the material of Department of Phoniatrics and Audiology of the Medical University in Poznań. Material and methods: The study involved implanted patients who voluntarily joined to the project entitled "Observational study of the implanted patient (Cochlear-IROS)". It has a prospective character, it is an international and long-term study, covering the observation of patients up to three years after implantation. Standardized HUI and SSQ questionnaires were used. 70 patients were included in the analysis, the mean age at the time of the cochlear implantation was 47.6 years. In the research group there were 33 men and 37 women. In the whole group, the patients' age at implantation was at least 18 years, max. 80 years. Results: The results of the SSQ questionnaire, which deals with the self-assessment of hearing ability in everyday situations, indicate that in the subjective assessment of patients one year after surgery the speech hearing improved by 77%, spatial hearing by 84%, and the quality of hearing by 49%. The general quality of life before the first connection of the sound processor according to the HUI questionnaire, the patients rated at 0.49 (0-1 scale, where 0 - corresponds to the death condition and 1 - full health). After one year from the implantation, this rating increased to 0.56. Conclusions: The implantation of the cochlear implant significantly increases the patient's quality of life, its physical and emotional functioning. Statistically significant better self-assessment of patients mainly concerned hearing speech and spatial hearing - especially after 1 year of connecting the speech processor