New Criteria of Indication and Selection of Patients to Cochlear Implant

Numerous changes continue to occur in cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound unilateral hearing loss rather then the prior requirement of a bilateral profound loss. Furthermore, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low-frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. This paper will review the new concepts in the candidacy of cochlear implant. Medline data base was used to search articles dealing with the following topics: cochlear implant in younger children, cochlear implant and hearing preservation, cochlear implant for unilateral deafness and tinnitus, genetic hearing loss and cochlear implant, bilateral cochlear implant, neuropathy and cochlear implant and neural plasticity, and the selection of patients for cochlear implant

Effect of cochlear implant electrode insertion on middle-ear function as measured by intra-operative laser Doppler vibrometry

Hypothesis: The aim of this study was to investigate the impact of cochlear implant electrode insertion on middle-ear low frequency function in humans.Background: Preservation of residual low frequency hearing with addition of electrical speech processing can improve the speech perception abilities and hearing in noise of cochlear implant users. Preservation of low frequency hearing requires an intact middle-ear conductive mechanism in addition to intact inner-ear mechanisms. Little is known about the effect of a cochlear implant electrode on middle-ear function.Methods: Stapes displacement was measured in seven patients undergoing cochlear implantation. Measurements were carried out intra-operatively before and after electrode insertion. Each patient acted as his or her own control. Sound was delivered into the external auditory canal via a speaker and calibrated via a probe microphone. The speaker and probe microphone were integrated into an individually custom-made ear mould. Ossicular displacement in response to a multisine stimulus at 80 dB SPL was measured at the incudostapedial joint via the posterior tympanotomy, using an operating microscope mounted laser Doppler vibrometry system.Results: Insertion of a cochlear implant electrode into the scala tympani had a variable effect on stapes displacement. In three patients, there was little change in stapes displacement following electrode insertion. In two patients, there was a significant increase, while in a further two there was a significant reduction in stapes displacement. This variability may reflect alteration of cochlear impedance, possibly due to differing loss of perilymph associated with the electrode insertion.Conclusion: Insertion of a cochlear implant electrode produces a change in stapes displacement at low frequencies, which may have an effect on residual low frequency hearing thresholds

Parent Interaction Between an Infant with a Cochlear Implant and Additional Disabilities

Pediatric hearing loss has many spoken language learning issues that can impact parent-infant interaction. Moreover, additional disabilities are likely to increase stress, which could have cascading effects on communication. The purpose of the study was to examine interactions between mother- and father-child dyads with and without hearing loss and/or Autism Spectrum Disorder (ASD), Cytomegalovirus (CMV), and global delay. Recordings of the parents speaking with six infants in the study were analyzed: an infant with cochlear implants and ASD (low socioeconomic status, SES), two infants with cochlear implants and normal development (high SES and low SES), one infant with a cochlear implant and CMV (average SES), one infant with a cochlear implant and global delay (average SES), and one infant who was typically developing and had normal hearing (high SES). After analyzing the results for communication measures, such as vocalization attempts, turn-taking in utterances, mean-length of utterances, and type-token ratio, it was concluded that maternal and paternal interaction was negatively affected due not only to the difficulty of the hearing loss and/or additional disability, but rather due to a combination of factors, including the disability, SES, maternal and paternal education, and the home environment

Visual activation of auditory cortex reflects maladaptive plasticity in cochlear implant users

Cross-modal reorganization in the auditory cortex has been reported in deaf individuals. However, it is not well understood whether this compensatory reorganization induced by auditory deprivation recedes once the sensation of hearing is partially restored through a cochlear implant. The current study used electroencephalography source localization to examine cross-modal reorganization in the auditory cortex of post-lingually deafened cochlear implant users. We analysed visual-evoked potentials to parametrically modulated reversing chequerboard images between cochlear implant users (n = 11) and normal-hearing listeners (n = 11). The results revealed smaller P100 amplitudes and reduced visual cortex activation in cochlear implant users compared with normal-hearing listeners. At the P100 latency, cochlear implant users also showed activation in the right auditory cortex, which was inversely related to speech recognition ability with the cochlear implant. These results confirm a visual take-over in the auditory cortex of cochlear implant users. Incomplete reversal of this deafness-induced cortical reorganization might limit clinical benefit from a cochlear implant and help explain the high inter-subject variability in auditory speech comprehensio

Cochlear Implant Outcomes and Genetic Mutations in Children with Ear and Brain Anomalies

Background. Specific clinical conditions could compromise cochlear implantation outcomes and drastically reduce the chance of an acceptable development of perceptual and linguistic capabilities. These conditions should certainly include the presence of inner ear malformations or brain abnormalities. The aims of this work were to study the diagnostic value of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in children with sensorineural hearing loss who were candidates for cochlear implants and to analyse the anatomic abnormalities of the ear and brain in patients who underwent cochlear implantation. We also analysed the effects of ear malformations and brain anomalies on the CI outcomes, speculating on their potential role in the management of language developmental disorders. Methods. The present study is a retrospective observational review of cochlear implant outcomes among hearing-impaired children who presented ear and/or brain anomalies at neuroimaging investigations with MRI and HRCT. Furthermore, genetic results from molecular genetic investigations (GJB2/GJB6 and, additionally, in selected cases, SLC26A4 or mitochondrial-DNA mutations) on this study group were herein described. Longitudinal and cross-sectional analysis was conducted using statistical tests. Results. Between January 1, 1996 and April 1, 2012, at the ENT-Audiology Department of the University Hospital of Ferrara, 620 cochlear implantations were performed. There were 426 implanted children at the time of the present study (who were <18 years). Among these, 143 patients (64 females and 79 males) presented ear and/or brain anomalies/lesions/malformations at neuroimaging investigations with MRI and HRCT. The age of the main study group (143 implanted children) ranged from 9 months and 16 years (average = 4.4; median = 3.0). Conclusions. Good outcomes with cochlear implants are possible in patients who present with inner ear or brain abnormalities, even if central nervous system anomalies represent a negative prognostic factor that is made worse by the concomitant presence of cochlear malformations. Common cavity and stenosis of the internal auditory canal (less than 2 mm) are negative prognostic factors even if brain lesions are absent

Auditory training strategies for adult users of cochlear implants

There has been growing interest recently in whether computer-based training can improve speech perception among users of cochlear implants (Fu et al., 2005; Oba et al., 2011; Ingvalson et al., 2013). This paper reports a series of experiments which first evaluated the effectiveness of different training strategies with normal-hearing participants who listened to noise-vocoded speech, before conducting a small-scale study with users of cochlear implants. Our vocoder studies revealed (1) that ‘High-Variability’ training led to greater generalisation to new talkers than training with a single talker, and (2) that word-and sentence-based training materials led to greater improvements than an approach based on phonemes in nonsense syllables. Informed by these findings, we evaluated the effectiveness of a computer-based training package that included word-and sentence-based tasks, with materials recorded by 20 talkers. We found good compliance with the training protocol, with 8 out of the 11 participants completing 15 hours of training as instructed. Following training, there was a significant improvement on a consonant test, but in general the improvements were small, highly variable, and not statistically significant. A large-scale randomised controlled trial is needed before we can be confident that computer-based auditory training is worthwhile for users of cochlear implants

Frontal brain asymmetries as effective parameters to assess the quality of audiovisual stimuli perception in adult and young cochlear implant users

How is music perceived by cochlear implant (CI) users? This question arises as "the next step" given the impressive performance obtained by these patients in language perception. Furthermore, how can music perception be evaluated beyond self-report rating, in order to obtain measurable data? To address this question, estimation of the frontal electroencephalographic (EEG) alpha activity imbalance, acquired through a 19-channel EEG cap, appears to be a suitable instrument to measure the approach/withdrawal (AW index) reaction to external stimuli. Specifically, a greater value of AW indicates an increased propensity to stimulus approach, and vice versa a lower one a tendency to withdraw from the stimulus. Additionally, due to prelingually and postlingually deafened pathology acquisition, children and adults, respectively, would probably differ in music perception. The aim of the present study was to investigate children and adult CI users, in unilateral (UCI) and bilateral (BCI) implantation conditions, during three experimental situations of music exposure (normal, distorted and mute). Additionally, a study of functional connectivity patterns within cerebral networks was performed to investigate functioning patterns in different experimental populations. As a general result, congruency among patterns between BCI patients and control (CTRL) subjects was seen, characterised by lowest values for the distorted condition (vs. normal and mute conditions) in the AW index and in the connectivity analysis. Additionally, the normal and distorted conditions were significantly different in CI and CTRL adults, and in CTRL children, but not in CI children. These results suggest a higher capacity of discrimination and approach motivation towards normal music in CTRL and BCI subjects, but not for UCI patients. Therefore, for perception of music CTRL and BCI participants appear more similar than UCI subjects, as estimated by measurable and not self-reported parameters

CORRELATION BETWEEN NEURAL RESPONSE TELEMETRY (NRT) MESUREMENT LEVEL AND BEHAVIORL (T-LEVEL AND C-LEVEL) IN PRELINGUAL COCHLEAR IMPLANT PATIENTS

 Objectives: To study the correlation between Neural Response Telemetry (NRT) measurement level and behavioral (Threshold level and Comfort level) in pre lingual cochlear implant patients age between 2 -10 years old at one and three months post implant. Methods: A cross sectional study conducted at University Kebangsaan Malaysia Medical Center from September 2010 to January 2012. Total numbers of hundred patients were involved in this study.All recipients implanted with Nucleus 24 cochlear implant and had full insertion and normal activation of the electrode array. Comparison between intra-operative NRT measurement level and behavioral (T-level and C-level) in cochlear implant patients at one month and three months post implantation were obtained respectively. Results: This study showed the intra-operative NRT levels were seen to fall between the T and C levels in one and three months respectively. There was also a positive correlation between NRT value measurements and both T and C value measurements in both one and three months (p value 0.01). There is a fair strength of the linear relationship between NRT and behavioral level in both one and three month post implant as shown by the r value (0.4 at one month, 0.2 at three months) Conclusion: It is useful to use the NRT values to predict the behavioral T and C values in prelingual children and an additional tool for the mapping. Key words: Neural Response Telemetry (NRT); Threshold level; Comfort level; Nucleus 24 cochlear implant.