Minimally Invasive Cochlear Implantation with Mastoidal Three-Layer Flap Technique

Conclusion: The TLF cochlear implantation enables complete receiver-stimulator coverage and safe fixation without any additional procedures, while allowing reduced operation time.

from ORL -Journal for Oto-Rhino-Laryngology and Its Related Specialties

Cochlear implantation in children

Cochlear implantation has revolutionized the treatment and prognosis of children with severe to profound sensorineural hearing loss who receive limited benefits from hearing aids. Children who receive cochlear implantation at young age, in particular before 2 years of age, can be expected to reach their normal age-equivalent developmental milestones and have higher chance to integrate into the mainstream educational settings. With the positive outcomes after cochlear implantation and the improvements in technology and surgical techniques, candidacy for cochlear implantation in children has been expanding to include hearing-impaired children with significant residual hearing, severe inner ear malformations, multiple handicaps such as mental retardation or visual impairment, and auditory neuropathy. Furthermore, there is growing interest in offering bilateral cochlear implantation to give children the benefits of binaural hearing. As the candidacy criteria expand, cochlear implant programs including preoperative evaluation, surgery, and habilitation have become more complex. Therefore, candidates should be selected prudently by multidisciplinary approach and cochlear implantation in children is much better to be provided by experienced cochlear implant team consisting of experts in relevant fields for the best results.

from Auris Nasus Larynx

Bilateral cochlear implantation: Current concepts, indications, and results

The optimal treatment for bilateral hearing loss continues to evolve as cochlear implant (CI) and hearing aid technologies advance, as does our understanding of the central auditory system. Ongoing discussions continue on the validity and feasibility of bilateral CI in terms of performance, justification of need, medical/surgical safety concerns, and economics. The purpose of this review article is to provide an update on the advantages and disadvantages of bilateral CI and to provide a discussion on timing (simultaneous vs. sequential), technology (bimodal vs. binaural) and feasibility. Binaural advantages are found in both adult and pediatric bilateral CI recipients, the greatest being the head shadow effect and improvements in localization and loudness summation. This theoretically offers an advantage over their unilateral implanted counterparts in terms of improved sound localization and enhanced speech perception under noisy conditions. Most investigators agree that bilateral stimulation during critical periods of development is paramount for optimizing auditory functioning in children. Currently, bilateral CI is widely accepted as a safe and effective means of bilateral auditory stimulation. Laryngoscope, 2009

from The Laryngoscope

Burow’s solution-induced acute sensorineural hearing loss: Report of two cases

This is the report of rare cases to show the potential ototoxicity of Burow’s solution in clinical use. We encountered two cases of acute sensorineural hearing loss occurring after the administration of 8% Burow’s solution (pH 2.93) into the tympanic cavities. Prior to treatment, both cases presented with tympanic membrane perforations in the posterior and inferior portions and a small amount of serous discharge. Fortunately, hearing loss recovered almost completely except for high tones within a few weeks. These two case reports demonstrate that the ototoxicity of Burow’s solution should be considered when it is used to treat otitis media accompanied by tympanic membrane perforation.

from Auris Nasus Larynx

Newborn hearing screening on infants at risk

Conclusion
Our selected hearing screening on infants at risk allowed 60 deaf children access to early management. However, too many children were lost to follow up; which revealed that better information regarding risk of hearing loss must be provided to parents and paramedics and universal newborn screening needs to be performed. The most important result of this study is that in a population of hearing impaired children, with an impairment incidence close to what is commonly reported, the association of several risk factors proves to be a significant additional risk factor for hearing impairment.

from the International Journal of Pediatric Otorhinolaryngology

Noise-induced hearing loss evolution: influence of age and exposure to noise

The aims of this study were to evaluate the influence of age and exposure to noise in determining the evolution of hearing loss after noise-induced hearing loss has been already established and to define the further evolution of presbycusis. This is a cross-sectional study based on the evaluation of pure-tone audiometry threshold on 568 subjects affected by noise-induced hearing loss and exposed to noise for at least 10 years; noise exposure at testing was 85–90 dB Leqd(A). The further evolution of hearing loss was found to be more related to age than to noise exposure and was significantly less than expected for presbycusis. In conclusion our data support the hypothesis that once NIHL has manifested, it tends to worsen slightly with continued noise exposure and that progressive hearing loss is chiefly due to aging. However, in individuals with NIHL, age-related hearing loss is significantly less at frequencies damaged by noise than in non-noise-exposed individuals.

from ORL -Journal for Oto-Rhino-Laryngology and Its Related Specialties

Bilateral simultaneous cochlear implantation in children: Our first 50 cases

Objectives/Hypothesis:
To assess the safety and surgical technique of bilateral simultaneous cochlear implantation in children.

Study Design:
Prospective case series at a tertiary academic pediatric hospital.

Methods:
Surgical times, complications, and patient outcomes are reported from the first 50 consecutive simultaneous cochlear implants performed at the Hospital for Sick Children between 2005 and 2008. These results were compared to the same measures in a group of sequentially implanted children consecutively implanted from 2001 to 2008.

Results:
The group of children receiving simultaneous bilateral cochlear implants showed no difference in complications, length of hospital stay, or use of analgesia and antiemetics compared with children receiving single implants. The simultaneously implanted children had a reduced cumulative surgical time and hospital stay than is required for bilateral implantation performed sequentially.

Conclusions:
Bilateral simultaneous cochlear implantation in this series of children was safe and required no significant increase in surgical time and hospital stay compared with unilateral procedures. Laryngoscope, 2009

from The Laryngoscope

Effects of neonatal partial deafness and chronic intracochlear electrical stimulation on auditory and electrical response characteristics in primary auditory cortex

The use of cochlear implants in patients with severe hearing losses but residual low-frequency hearing raises questions concerning the effects of chronic intracochlear electrical stimulation (ICES) on cortical responses to auditory and electrical stimuli. We investigated these questions by studying responses to tonal and electrical stimuli in primary auditory cortex (AI) of two groups of neonatally-deafened cats with residual high-threshold, low-frequency hearing. One group were implanted with a multi-channel intracochlear electrode at eight weeks of age, and received chronic ICES for up to nine months before cortical recording. Cats in the other group were implanted immediately prior to cortical recording as adults. In all cats in both groups, multi-neuron responses throughout the rostro-caudal extent of AI had low characteristic frequencies (CFs), in the frequency range of the residual hearing, and high-thresholds. Threshold and minimum latency at CF did not differ between the groups, but in the chronic ICES animals there was a higher proportion of electrically but not acoustically excited recording sites. Electrical response thresholds were higher and latencies shorter in the chronically stimulated animals. Thus, chronic implantation and ICES affected the extent of AI that could be activated by acoustic stimuli and resulted in changes in electrical response characteristics.

from Hearing Research

Hearing loss in vestibular schwannomas: analysis of cochlear function by means of distortion-product otoacoustic emissions

Our results confirm that sensorineural hearing loss due to VS can be of sensory and/or neural origin. DPOAEs still remain just a complementary auditory test; nevertheless, in case of severe or profound unilateral hearing loss, recorded acoustic responses may be suspicious for the presence of a vestibular schwannoma.

from Auris Nasus Larynx

Hearing loss in vestibular schwannomas: analysis of cochlear function by means of distortion-product otoacoustic emissions

Our results confirm that sensorineural hearing loss due to VS can be of sensory and/or neural origin. DPOAEs still remain just a complementary auditory test; nevertheless, in case of severe or profound unilateral hearing loss, recorded acoustic responses may be suspicious for the presence of a vestibular schwannoma.

from Auris Nasus Larynx

Permanent Bilateral Sensory and Neural Hearing Loss of Children After Neonatal Intensive Care Because of Extreme Prematurity: A Thirty-Year Study

CONCLUSIONS. Permanent hearing loss remains an adverse outcome of extreme prematurity, complicated by significant delayed-onset and progressive loss. Prolonged supplemental oxygen use is a marker for predicting permanent hearing loss; this requires detailed analysis of the pathophysiologic features, to reduce the prevalence of permanent hearing loss.

from Pediatrics

Imaging case study: enlarged superior vestibular nerve canal with sensorineural hearing loss

Conclusion: Enlarged superior vestibular nerve canal malformation may be a marker for sensorineural hearing loss. Increased vigilance amongst otologists may establish the prevalence of this anomaly and its possible effects on hearing.

from the Journal of Laryngology and Otology

Auditory intensity discrimination as a function of level-rove and tone duration in normal-hearing and impaired subjects: The “mid-level hump” revisited

The just-noticeable difference (ΔI) in the intensity (I) of sound is typically reported to be a constant or a slightly decreasing ratio of the baseline intensity (known as Weber’s law, and the “near-miss to Weber’s law”, respectively). However, in the relatively few studies on the intensity discrimination of very brief sounds, ΔI/I is usually found to be non-monotonic, with poorest discrimination in the middle of the auditory dynamic range. Here it is demonstrated that this “severe departure from Weber’s law” or “mid-level hump” is not merely a phenomenon of short-duration sounds. In normal-hearing subjects (n=8), the near-miss to Weber’s law that is observed with the discrimination of 300 ms-long, 4 kHz tones, gives way to a significant mid-level hump if tone intensities are not fixed over a great many trials (as is standard practice) but are instead randomly roved, trial-to-trial, over a wide intensity range. This was not the case in subjects with mild to moderate hearing impairment (n=4). Furthermore, in the discrimination of widely-roved, 4 ms-long, 4 kHz tone bursts, the performance of normal-hearing subjects did not significantly worsen at mid-levels compared to the unroved condition, unlike what was found with the 300 ms-long tones. It is suggested that mid-level humps could simply be the product of the well-known mid-level compressive nonlinearity in cochlear mechanics. We further suggest that the hump is eliminated, and the near-miss to Weber’s law is produced, by a more central mechanism such as the recently reported “adaptation to sound-level statistics”, which is bypassed during wide-range roving and possibly when sound durations are brief.

from Hearing Research

How long should the sudden hearing loss patients be followed after early steroid combination therapy?

Abstract To evaluate the beginning time and the completion time of hearing improvement in patients with sudden hearing loss who were treated with combination therapy including oral steroid. From September 2006 to December 2007, 102 idiopathic sudden hearing loss patients who showed any ‘recovery’ in hearing according to the Siegel’s criteria after treatment were analyzed. Pure tone audiometries were performed on the pretreatment day and on the third, seventh, fourteenth post-treatment day, and on the first, second, third, sixth post-treatment month. The time of initial hearing improvement and the completion time of hearing improvement were analyzed. Of 102 patients who showed any improvement, cumulatively, 93.1% showed beginning of hearing improvement within 14 days after treatment. Complete recovery or an end of change was achieved in cumulatively 80.4% of the patients within 1 month after treatment and in 92.2% of the patients within 2 months after treatment. Prognosis can be predicted approximately 2 weeks after start of treatment because time of commencement shows plateau after 2 weeks in improved cases. Hearing should be followed-up for at least 2 months after treatment in patients who show incomplete or delayed hearing improvement.

from the European Archives of Oto-Rhino-Laryngology

Rehabilitation and outcome of severe profound deafness in a group of 16 infants affected by congenital cytomegalovirus infection

Abstract The aim of the study was to characterize the audiological consequences of congenital cytomegalovirus infection (CMV) and to evaluate the outcome of rehabilitation with hearing aids and/or cochlear implant (CI), associated with an adequate speech–language therapy. A retrospective review of data was made from a total of 16 infants, affected by severe to profound hearing loss from congenital CMV infection, referred to a tertiary audiological center for rehabilitation. Audiological evaluation was performed using behavioral audiometry, auditory brainstem responses (ABR) and/or electrocochleography (ECochG). Of the 16 children (median age at diagnosis of hearing loss: 21.33 ± 0.7 months) with CMV hearing loss, 14 were affected by profound bilateral hearing loss and received a CI, while 2 were affected by bilateral severe hearing loss and received hearing aids. Cochlear implants can provide useful speech comprehension to patients with CMV-related deafness, even if language development is lower when compared to a group of Connexin (Cx) 26+ cochlear-implanted children (eight subjects), matched for age. Congenital CMV infection still represents a serious clinical condition, as well as an important cause of hearing loss in children. More studies have claimed to identify the pathophysiological mechanisms of damage and thus to ensure a better therapeutic approach. Nonetheless, in cases of CMV-deafened babies, the overall outcome of cochlear implantation is good.

from the European Archives of Oto-Rhino-Laryngology