Audio-Vestibular Neurosensory Prosthetics: Origins, Expanding Indications and Future Directions

Approximately one-third of persons over 65 years are affected by disabling hearing loss. It is estimated that the number of people with disabling hearing loss will grow to 630 million by 2030 and maybe over 900 million by 2050. Deafness has significant consequences on many aspects of an individual’s life, including their socioeconomic status, mental and physical well-being, educational and employment opportunities. When congenital or early in the developmental years, deafness results in a delay or loss of language acquisition. Deafness can result from damage or disease anywhere along the auditory pathway. Hearing prosthetic devices help restore hearing and the use of these devices depends on the degree and type of hearing loss. This chapter will give a brief account of the currently available prosthetic hearing solutions

A Retrospective Clinical Audit of Outcomes of Cochlear Implantation in Children with Multiple Disabilities in Comparison with Normal Implantees : A South Indian Experience

Open Access via Springer Compact Agreement We would like to thank the team and the Auditory Verbal Habilitationists at Madras ENT Research Foundation (MERF), Chennai for all their support during the course of this project. Special thanks to the Medical Statistics Team at the University of Aberdeen for additional advice on the data analysis.Peer reviewedPublisher PD

Audit of Bilateral Simultaneous Cochlear Implantation in Pediatric Population: South Indian Study

Objective: To conduct a medical audit of bilateral simultaneous cochlear implantation (CI) in patients with severe prelingual sensorineural hearing loss (SNHL).Methods: A medical audit of a tertiary care ear, nose, and throat center in Southern India was conducted on data collected from January 2007 to December 2014. All cochlear implantees 6 years, sequential bilateral CI, revision cases, abnormal or malformed cochlea, and children with global developmental delay in milestones. Subjective outcome scores used were Category of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR).Results: The CAP and SIR results showed that 20% of implantees achieved peak scores of 7 and 5, respectively. Mean CAP and SIR scores at 12 months were 5.4 and 3.1, respectively.Conclusion: The present study supports the claim that bilateral CI in severe prelingual bilateral SNHL is better than unilateral and recommends that bilateral CI should be the standard of care in children

A Retrospective Study of Cochlear Re-Implantations - Experience from a Large Centre in India

Objective: Cochlear re-implantation (CRI) is becoming increasingly common throughout the world. However, studies regarding CRI incidence and etiology are lacking from developing countries like ours. The aim of this study was to present the Indian experience with CRI based on our experience. Objectives were to determine the incidence and the indications of CRI and the cumulative survival rate (CSR) of cochlear implantation (CI).Methods: Our study was a retrospective one, conducted at a tertiary care centre in southern India. 1,500 consecutive cochlear implanted ears from 1997 to 2016 were studied. All patients who underwent CRI during this period were included in the study.Results: There were a total of 53 ears (31 male and 22 female ears) who underwent CRI. This gives an incidence of 3.53%. The most common indication of CRI was device failure in 39 ears contributing to 73.6% of the total CRI. The overall CSR of CI in pediatric population was 96.5% over a 20-year period.Conclusion:The CRI incidence and etiology at our centre appears to reflect the findings of the literature. Cochlear implant centres across the world should report the CSR of devices used at their respective centres so that it can be made an important criterion in choice of implant

Outcomes of Cochlear Implantation in Auditory Neuropathy Spectrum Disorder and the Role of Cortical Auditory Evoked Potentials in Benefit Evaluation

Objective: To compare the outcomes of cochlear implantation (CI) in children with auditory neuropathy spectrum disorder (ANSD) and age-matched controls with profound sensorineural hearing loss, using categories of auditory performance (CAP), speech intelligibility rate (SIR), meaningful auditory integration scale (MAIS), and meaningful use of speech scale (MUSS), and to determine the role of Cortical Auditory Evoked Potentials (CAEP) in benefit evaluation after CI.Methods: Ten patients (8 males and two females) with ANSD who underwent CI were included in the study. Auditory and speech scores were compared between baseline and after 12 months of habilitation in children with ANSD. Post CI speech scores in children with ANSD were compared with the control group (age-matched children with profound sensorineural hearing loss) at 12 months of habilitation. P1 latency of CAEP has a good correlation with auditory and speech scores in children with ANSD in the study group.Results: Significant benefits were seen in children with ANSD who underwent CI compared to the baseline CAP and SIR scores and one year after habilitation. There is no statistically significant difference in outcomes between the two groups with CI (ANSD and profound sensorineural hearing loss) (p-value: CAP=1.00, SIR=0.84, MAIS=0.33, MUSS=0.08). Speech perception in noise test (SPIN) scores in children with ANSD were 63% and 80% with 0 dB signal noise ratio (SNR) and +10dB SNR, respectively. P1 wave of CAEP has a good correlation with the subjective outcomes.Conclusion: CI in children with ANSD has showed benefits comparable to children with profound sensorineural hearing loss. CAEP is a useful tool in objectively assessing cortical maturity in children with ANSD following CI

Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events

BACKGROUND AND OBJECTIVE: The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process. METHODS: A systematic electronic search of the literature was carried out using PubMed, Scopus, Cochrane, and Web of Science to find relevant literature on electrode tip fold over (ETFO), electrode scalar deviation (ESD), and electrode migration (EM) from both pre-shaped and straight electrode types. RESULTS: A total of 82 studies that include 8,603 ears implanted with a CI, i.e., pre-shaped (4,869) and straight electrodes (3,734), were evaluated. The rate of ETFO (25 studies, 2,335 ears), ESD (39 studies, 3,073 ears), and EM (18 studies, 3,195 ears) was determined. An incidence rate (±95% CI) of 5.38% (4.4–6.6%) of ETFO, 28.6% (26.6–30.6%) of ESD, and 0.53% (0.2–1.1%) of EM is associated with pre-shaped electrodes, whereas with straight electrodes it was 0.51% (0.1–1.3%), 11% (9.2–13.0%), and 3.2% (2.5–3.95%), respectively. The differences between the pre-shaped and straight electrode types are highly significant (p < 0.001). Laboratory experiments show evidence that robotic insertions of electrodes are less traumatic than manual insertions. The influence of round window (RW) vs. cochleostomy (Coch) was not assessed. CONCLUSION: Considering the current electrode designs available and the reported incidence of insertion complications, the use of straight electrodes in RACIS and conventional CI surgery (and manual insertion) appears to be less traumatic to intracochlear structures compared with pre-shaped electrodes. However, EM of straight electrodes should be anticipated. RACIS has the potential to reduce these complications