Audiological Outcomes and Associated Factors after Pediatric Cochlear Reimplantation

Cochlear implants are the most common and successful sensory neuroprosthetic devices. However, reimplantation can be required for medical reasons, device failure, or technological upgrading. Resolving the problem driving the intervention and offering stable or better audiological results are the main challenges. We aimed to analyze the success rate of this intervention and to identify factors influencing speech perception recovery after reimplantation in the pediatric population. We retrospectively collected the causes and the outcomes of 67 consecutive reimplantations in one cochlear implant center over 30 years. Reimplantation resolved the cause without recurrence for 94% of patients. The etiology of deafness, time since implantation, indication of reimplantation, sex, and age did not influence word discrimination test scores in silence, 3 years after surgery. However, adherence to a speech rehabilitation program was statistically associated with gain in perception scores: +8.9% [−2.2; +31.0%] versus −19.0% [−47.5; −7.6%] if no or suboptimal rehabilitation was followed (p = 0.0037). Cochlear reimplantation in children is efficient and is associated with predictable improvement in speech perception, 3 years after intervention. However, good adherence to speech rehabilitation program is necessary and should be discussed with the patient and parents, especially for the indication of reimplantation for technological upgrading

Outcomes after cochlear reimplantation in children

International audienceOBJECTIVES:With cochlear implantation now a routine procedure, reimplantation is becoming more commonplace for medical/surgical complications or device malfunctions. This study investigated the indications for reimplantation and the auditory outcomes following reimplantation surgery in prelingually-deafened children.METHODS:Of the 539 prelingually deafened children implanted between 1990 and 2013, 45 were reimplanted (8.3% of implantations). Causes of reimplantation, type of device and angle of insertion at initial implantation were recorded, as well as type of implant reinserted, number of electrodes inserted and angle of insertion (calculated on cone beam computed tomography) on reimplantation, and finally any surgical findings. Speech perception test scores (phonetically balanced kindergarten (PBK) words, open-set sentence testing in quiet and in noise (S/N+ 10 dB SNR), and speech tracking scores) were obtained 1, 2 and 3 years after reimplantation, and compared against the best speech recognition score obtained with the first implant before failure.RESULTS:Medical reasons for reimplantation were found in 10 cases (22.2%). A malfunctioning device had occurred in 35 cases (77.7%) including hard failure in 24 and soft failure in 11. Complete insertion was achieved in the scala tympani in 42 cases and in the scala vestibuli in one case; partial insertion occurred in the remaining two cases. In two cases, one or two electrode rings snatched off from the electrode array during removal. The mean insertion angle was 330.5° before surgery and 311.8° after reimplantation (no statistical difference p=0.48). The postoperative speech perception outcome measures showed no significant difference to the best score before reimplantation. Angle of insertion, type of device and etiology of deafness did not influence the results. The PBK performance improved over 10% in 43.2% of children, was similar in 40.5%, and showed a more than 10% decrease in 16.2% of children after reimplantation. The latter decline in performance was explained for some children by a partial insertion.CONCLUSIONS:Reimplantation has no negative effect on auditory outcome. In rare cases, speech perception outcome may not improve, requiring a specific rehabilitation program

Evaluation of otoscopy simulation as a training tool for real-time remote otoscopy

International audienceOBJECTIVE:Teleotoscopy requires the assistance of telehealth facilitators; but their training requirements remain to be determined. We evaluated the use of an otoscopy simulator to train facilitators to remote otoscopies sent via the Internet using a teleaudiology platform.DESIGN:Neurotologists experts were asked to identify images using the otoscopy simulator and to perform an identification task of significant anatomical landmarks. The experts were asked to repeat those tasks remotely, with the help of facilitators who either received basic training, or no training prior to the experiment.STUDY SAMPLE:Three experts, three trained facilitators and three untrained facilitators participated in this study.RESULTS:The use of an otoscopy simulator in addition to remote otoscopy yielded a good inter- and intrarater agreement (κ between 0.81-1, and 0.80-0.87, respectively). The accuracy of diagnosis was high on-site (11.7% error) and remotely (0% error). The time required for landmark identification task was not increased when performed remotely with a trained facilitator versus on-site otoscopy (9.3 versus 9.2 s/landmark). Conversely, the lack of training of facilitators increased significantly this time (15.6 s/landmark, p < 0.001).CONCLUSION:An otoscopic simulator coupled to teleaudiology software can be used to efficiently train both experts and facilitators to perform remote otoscopy