Simultaneous bilateral cochlear implantation in adults: a multicenter clinical study

OBJECTIVE: To determine the efficacy of "simultaneous" bilateral cochlear implantation (both implants placed during a single surgical procedure) by comparing bilateral and unilateral implant use in a large number of adult subjects tested at multiple sites. DESIGN: Prospective study of 37 adults with postlinguistic onset of bilateral, severe to profound sensorineural hearing loss. Performance with the bilateral cochlear implants, using the same speech processor type and speech processing strategy, was compared with performance using the left implant alone and the right implant alone. Speech understanding in quiet (CNCs and HINT sentences) and in noise (BKB-SIN Test) were evaluated at several postactivation time intervals, with speech presented at 0 degrees azimuth, and noise at either 0 degrees , 90 degrees right, or 90 degrees left in the horizontal plane. APHAB questionnaire data were collected after each subject underwent a 3-wk "bilateral deprivation" period, during which they wore only the speech processor that produced the best score during unilateral testing, and also after a period of listening again with the bilateral implants. RESULTS: By 6-mo postactivation, a significant advantage for speech understanding in quiet was found in the bilateral listening mode compared with either unilateral listening modes. For speech understanding in noise, the largest and most robust bilateral benefit was when the subject was able to take advantage of the head shadow effect; i.e., results were significantly better for bilateral listening compared with the unilateral condition when the ear opposite to the side of the noise was added to create the bilateral condition. This bilateral benefit was seen on at least one of the two unilateral ear comparisons for nearly all (32/34) subjects. Bilateral benefit was also found for a few subjects in spatial configurations that evaluated binaural redundancy and binaural squelch effects. A subgroup of subjects who had asymmetrical unilateral implant performances were, overall, similar in performance to subjects with symmetrical hearing. The questionnaire data indicated that bilateral users perceive their own performance to be better with bilateral cochlear implants than when using a single device. CONCLUSIONS: Findings with a large patient group are in agreement with previous reports on smaller groups, showing that, overall, bilateral implantation offers the majority of patients advantages when listening in simulated adverse conditions.     

Superiority of bilateral cochlear implantation over unilateral cochlear implantation in tone discrimination in chinese patients

PURPOSE: The benefits of bilateral cochlear implants (CIs) versus unilateral CIs were evaluated by comparing the Cantonese lexical tone discrimination scores conducted in a quiet environment and against a background noise. MATERIALS AND METHODS: Four postlingually deafened Cantonese-speaking adults (2 men and 2 women) with bilateral CIs were included in this study. The subjects were their own control in the monaural hearing condition. Both the Cantonese lexical tone stimuli and the speech-weighted background noise were presented at 0(0) azimuth and at a distance of 1 m from the subject. The speech stimuli, which were maintained at 65 dB sound pressure level, were presented in both a quiet environment and against a background noise at signal to noise ratios (SNRs) of +15, +10, +5, 0, -5, -10, and -15. RESULTS: Against a background noise, the bilateral CIs required +5 dB SNR only to obtain significant scores in discriminating Cantonese lexical tones and to achieve discrimination scores that were comparable to the optimal discrimination scores obtained in quiet. No significant difference in the discrimination scores was observed between binaural and monaural hearing conditions when the tests were conducted in quiet. CONCLUSIONS: Our study showed that in the presence of background noise, bilateral CIs were better than unilateral CIs in discriminating Cantonese lexical tones.     

A cost-utility scenario analysis of bilateral cochlear implantation

CONTEXT: Unilateral cochlear implantation is a cost-effective intervention for profound bilateral hearing loss. There is worldwide interest in providing implants bilaterally. OBJECTIVE: To use modeling to estimate the cost of gaining a quality-adjusted life-year by providing implants to both ears of profoundly postlingually deafened adults. DESIGN: Economic scenario analysis relating the costs of providing implants to estimates of the gain in health-related quality of life (utility) from unilateral and bilateral implantation. SETTING: Fourteen hospitals in the United Kingdom National Health Service and 1 Medical Research Council research unit. PARTICIPANTS: Normal-hearing adult volunteers with knowledge of implantation (n = 70). Adults undergoing unilateral implantation who either did not benefit from acoustic hearing aids preoperatively (type 1, n = 87) or benefited marginally (type 2, n = 115). MAIN OUTCOME MEASURES: Changes in utility from unilateral and bilateral implantation estimated with the time trade-off technique (volunteers) and from unilateral implantation measured with the Mark II Health Utilities Index (patients); costs of providing implants and sustaining patients who have undergone implantation (health care perspective). RESULTS: Gains in utility from unilateral implantation estimated by volunteers did not differ significantly from gains recorded by patients, giving credibility to the volunteers' estimate of the gain from bilateral compared with unilateral implantation. Cost-utility ratios, in pounds sterling per quality-adjusted life-year, based on volunteers' estimates, were pound 16,774 (type 1: unilateral implantation vs no intervention), pound 27,401 (type 2: unilateral implantation vs management with hearing aids), pound 61,734 (simultaneous bilateral implantation vs unilateral implantation), and pound 68,916 (provision of an additional implant vs no additional intervention). CONCLUSION: More quality of life is likely to be gained per unit of expenditure on unilateral implantation than bilateral implantation.     

Surgical efficiency in bilateral cochlear implantation: A cost analysis

Abstract

Objective

(1) Compare the non-device-related costs of bilateral simultaneous cochlear implantation (BSiCI) vs. unilateral, and (2) establish a dollar amount for potential cost savings in direct costs for BSiCI vs. sequential cochlear implantation (CI).

Methods

Data from all CI cases performed during the fiscal year 2010–2011 were retrospectively reviewed without exception. Fifty-four patients received unilateral CI and 36 received BSiCI. Demographics and data regarding direct costs associated with the operation and immediate in hospital post-operative period were collected.

Results

The total operating room (OR) time for unilateral and BSiCI was 3 hours 00 minutes and 4 hours 37 minutes, respectively, with a mean difference of 1 hour and 36 minutes (SD = 0 hours:06 minutes). The cost of OR and post-anesthetic care unit supporting staff was $3102 and $4240 for unilateral and BSiCI, respectively, with a mean difference of $1138 (SD = 216). Unilateral CI supplies totaled $1348 compared to $1822 for BSiCI supplies with an average difference of $438 (SD = 123).

Conclusion

The total direct costs for a unilateral CI (excluding implantable device and surgeon fees) were $4362 compared to $5823 dollars for BSiCI. Simultaneous implantation can lead to a potential saving of $2901 compared to sequential implantation.     

Benefits of cochlear implantation in early-deafened adults: the Toronto experience

OBJECTIVE: To present the results of a survey administered to a group of early-deafened cochlear implants adults and to report the level of perceived benefit. DESIGN: Prospective. SETTING: Large tertiary referral centre. METHOD: A 47-item questionnaire designed to evaluate cochlear implant use and benefit was sent to 42 early-deafened adult cochlear implant users. The questionnaire can be divided into seven subcategories: time of use, associated symptoms, communication, employment status and function, socialization, perceived benefit, and the impact on quality of life. Responses from 30 patients were received. RESULTS: The majority of our patients use their cochlear implant all of their waking hours. The majority of patients continue to depend on lip-reading and hearing as their main mode of communication, although they reported improved lip-reading skills with their cochlear implant. Twenty-three patients (76.7%) were employed. Eleven patients had a change in employment subsequent to cochlear implantation, nine (81.8%) of whom attributed this to their cochlear implant. Our patients als reported greater independence, a greater sense of safety in their environment, and an improved social life. Twenty-nine patients (96.7%) said that they were satisfied with their implant, 28 (93.3%) said that they would go through the same process again, and 27 (90%) said that they would recommend it to a friend in a similar situation. Twenty-nine patients (96.7%) stated that the cochlear implant has had a positive effect on their quality of life. Family and peer support, prior auditory-verbal therapy, and a positive attitude were the most commonly cited factors in successful cochlear implant use. CONCLUSIONS: Early-deafened adult cochlear implant users perceive significant benefit from cochlear implantation. Importantly, family and peer support, prior auditory-verbal therapy, and a positive attitude are considered important factors in maximizing this benefit.     

Binaural cochlear implantation after bilateral temporal bone fractures

Abstract

In this clinical note we discuss the indications, feasibility, and outcomes of binaural simultaneous cochlear implantation (CI) following bilateral transverse temporal bone (TB) fractures. A 41-year-old male, totally deaf after a bilateral TB fracture, underwent an audiological, electrophysiological, and imaging investigation in order to assess the integrity of the VIIIth cranial nerves. Five months later he received a simultaneous bilateral CI. Speech perception tests were conducted at different time points. A significant advantage by dichotic listening was observed since the beginning of the habilitation program. The patient achieved a 100% word and sentences recognition in quiet at 12 months. His listening skills in noisy conditions were improved by the use of two implants. A CI in TB fractures is feasible if the VIII nerve is intact and the cochlea is spared by the fracture rim. The early timing of the procedure probably contributed to its success by preventing cochlear fibrosis and ossification.

Sumario

En esta nota clínica discutimos las indicaciones, la factibilidad, y los resultados de la implantación coclear (CI) bilateral simultánea posterior a fracturas transversas bilaterales del hueso temporal (TB). Un varón de 41 años de edad, totalmente sordo después de una fractura bilateral del TB, fue sometido a una investigación audiológica, electrofisiológica y por imágenes, para evaluar la integridad de ambos octavos nervios craneales. Cinco meses después, el sujeto recibido IC bilaterales simultáneos. Se realizaron pruebas de percepción de lenguaje en diferentes momentos. Se observó una ventaja significativa en la audición dicótica desde el inicio del programa de habilitación. El paciente logró un 100% de reconocimiento de palabras y frases en silencio a los 12 meses. Sus habilidades para escuchar mejoraron con el uso de dos implantes. Una IC en fracturas del TB es factible si el VIII par está intacto y la cóclea no está involucrada en el trazo de la fractura. La oportuna realización del procedimiento probablemente contribuyó al éxito al prevenir la fibrosis coclear y la osificación.     

Vestibular and taste disorders after bilateral cochlear implantation

The objective of this study was to investigate the occurrence of vestibular receptor deficiency and taste disorders after bilateral cochlear implantation in postlingually deafened patients and to find out whether the risk for these complications is higher for the second implantation. In a retrospective cohort study, we examined 20 patients (11–58 years, mean age 41.5 years), implanted sequentially between 2000 and 2007 (mean period between cochlear implantation 32.9 ± 25 months). Pre- and postoperative vestibular testing was performed by subjective rating [Dizziness Handicap Inventory (DHI)], caloric irrigation [vestibuloocular reflex (VOR)] and by vestibular-evoked myogenic potential (VEMP) recordings for saccular function. The sense of taste was evaluated pre- and postoperatively by a questionnaire and testing (sour/sweet/bitter/salty bilaterally on the tongue). DHI evaluation showed a moderate not significant mean increase by 2.7 ± 7.7 SD points after the first and a significant increase by 9.4 ± 16.6 SD points after the second implantation. Ipsilateral VEMP responses disappeared in three ears (27.3%) after the first and in two ears (18.2%) after the second operation. VOR disappeared only once (5.9%) after the first implantation. One (5%) patient complained of a persisting disturbance of taste in the questionnaire after unilateral and 3 (15%) after bilateral implantation. Specific testing showed in one case (5%) a unilateral taste disorder after ipsilateral cochlear implantation. Our data show that there is a higher risk for subjective vertigo after the second implantation. The occurrence of unilateral and/or bilateral vestibular dysfunction and the potential risk of taste disorder should be included in the risk counseling before bilateral cochlear implantation to increase patients’ and medicolegal safety in the decision-making process.     

Bilateral cochlear implantation in bilateral Langerhans cell histiocytosis

Abstract

Background

Langerhans’ cell histiocytosis (LCH) is a rare proliferative disorder that can have otologic manifestations in up to 30% of patients. Treatment of local and systemic disease may include medical, surgical, and radiation therapies. Involvement of the temporal bone can lead to conductive and, rarely, sensorineural hearing loss. Post-labyrinthectomy cochlear implantation can be an effective treatment option for sensorineural hearing loss in the setting of persistent LCH.

Methods

A retrospective case review at a tertiary academic medical center. Hearing in Noise Test (HINT) performed before and after bilateral cochlear implantation was examined.

Results

Following bilateral partial labyrinthectomy, post-operative testing showed a HINT in quiet of 17%. Left-sided cochlear implant followed by immunosuppressive therapy for persistent disease showed marked improvement with post-operative HINT in a quiet room of 80% and 63% at 1 and 2 years. Fifty-five months after left implantation, and 10 months after right cochlear implantation, binaural post-operative HINT in quiet was 81%.

Conclusion

Surgical excision of LCH lesion remains a mainstay of treatment for temporal bone involvement. Bilateral cochlear implant with adjuvant immunosuppression in our patient demonstrated both immediate and delayed improvement in auditory function after staged cochlear implantation in the setting of persistent disease.     

Bilateral cochlear implantation in a patient with bilateral temporal bone fractures

With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation.     

The experience of bilateral cochlear implantation in a child with LEOPARD syndrome

We present a 3-year old boy with Leopard syndrome. His clinical manifestations included a congenital bilateral sensorineural hearing loss. He underwent cochlear implantation on the right side at age 1 year and on the left side at age 1.5 years. The patient is doing very well and mainstreamed in a regular pre-school program with a teacher of the deaf and home based speech therapy. Bilateral cochlear implantation in the case of a child with Leopard syndrome can be successful.     

Evaluating inter-aural hearing preservation in bilateral paediatric cochlear implantation

Objective: To examine inter-aural hearing preservation results in children undergoing simultaneous bilateral cochlear implantation (CI).

Methods: Retrospective case review in tertiary referral centre. All children undergoing simultaneous bilateral CI between January 2013 and June 2014 (18 months). Patients eligible for inclusion in the study had pre-operative hearing thresholds of <90?dB at 250?Hz and ≥100?dB at 500?Hz. Patients with anatomical cochlear anomalies or missing data were excluded. Seven patients were included, 1 male, 6 female, mean age of 12 years 11 months at the time of surgery. All patients had simultaneous bilateral cochlear implant surgery, using the same implant and technique. All patients had pre- and post-operative unaided pure tone audiometry. Inter-aural hearing preservation results were compared in each patient.

Results: The achieved hearing preservation for 14 ears was complete in 5, partial in 7, and minimal in 2. Measurable hearing preservation was achieved in 86% overall. Inter-aural analysis revealed that only 2 (subjects 1 and 4) of the 7 patients had preservation results within the same preservation group (complete/partial/minimal). The mean inter-aural preservation difference was 30.7% with a range from 12.4% to 65.2%.

Conclusions: Several factors and techniques have already been identified in the wider literature to explain differences in hearing preservation results in CI. However, despite controlling for known factors, we demonstrate variable inter-aural results. This suggests that there may be more factors beyond the surgeon’s control influencing our ability to provide consistent results.