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Degirmenci Uzun E, Batuk MO, D'Alessandro HD, Sennaroglu G. Auditory perception in pediatric cochlear implant users with cochlear nerve hypoplasia. Int J Pediatr Otorhinolaryngol 2022; 160:111248. [PMID: 35870254 DOI: 10.1016/j.ijporl.2022.111248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objectives of this study were to assess auditory perception and speech intelligibility outcomes in children with cochlear nerve (CN) hypoplasia who received cochlear implants (CIs) using Categories of Auditory Performance II (CAP II) and Speech Intelligibility Rating (SIR) scales. METHODS In total, 40 children who received CI and who were aged between 3 and 18 years were included in this study. The study group included 20 children with CN hypoplasia at least one ear, while the control group included 20 children with normal cochleas and cochlear nerve structures. All children in the study and control groups who participated were evaluated using the CAP II and the SIR scale. Demographic data were collected. RESULTS Significant differences were found between the study and control groups' CAP II and SIR scores (p < 0.001). It was found that CAP II scores were positively correlated with SIR scores in the study (r = 0.743, p < 0.001) and control (r = 0.601, p < 0.001) groups. In the study group, significant negative correlations were found between SIR scores and age at implantation (r = -0.674, p = 0.004) and between CAP II scores and age at implantation (r = 0.751, p = 0.003). In the control group, a significant negative correlation was found between age at implantation and CAP II scores (r = -0.805, p = 0.001). Similarly, a significant negative correlation was found between age at implantation and SIR scores (r = -0.702, p = 0.007). CONCLUSION Even for children with severe inner ear malformation and CN hypoplasia, CI is an effective treatment modality for auditory perception and speech production. However, it should be noted that CN hypoplasia affects auditory performance negatively in children with CI.
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Affiliation(s)
- Erva Degirmenci Uzun
- Department of Audiology, Faculty of Health Science, Izmir Bakircay University, Izmir, Turkey.
| | - Merve Ozbal Batuk
- Department of Audiology, Faculty of Health Science, Hacettepe University, Ankara, Turkey
| | | | - Gonca Sennaroglu
- Department of Audiology, Faculty of Health Science, Hacettepe University, Ankara, Turkey
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Leonhard L, Brewer K, Roche J. Adult Onset Bilateral Cochlear Nerve Atrophy and Cochlear Implantation: A Case Report and Review of the Literature. Ann Otol Rhinol Laryngol 2021; 131:322-325. [PMID: 34041922 DOI: 10.1177/00034894211019518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a case of idiopathic bilateral cochlear nerve atrophy acquired in adulthood. PATIENT A 75-year-old male with acquired bilateral cochlear nerve atrophy. INTERVENTION(S) Unilateral cochlear implantation. MAIN OUTCOME AND RESULTS Description of a patient with acquired bilateral cochlear nerve atrophy diagnosed at the age of 75. The patient had normal hearing and no communication deficits until the age of 66. At this point, the patient demonstrated a slight asymmetric hearing loss, which progressed to severe sensorineural hearing loss. Due to the resulting communication deficit, cochlear device implantation candidacy was pursued. Pre-operative magnetic resonance imaging (MRI) showed severe atrophy versus absence of the cochlear nerves bilaterally. After careful counseling regarding the expected communication outcomes given the MRI findings, the patient underwent left-sided cochlear implantation. The patient gained sound awareness, but no additional communication benefit compared to pre-operative baseline abilities. CONCLUSION Cochlear nerve deficiency is a known finding in certain cases of congenital and acquired hearing loss, but no cases of idiopathic adult-onset bilateral nerve atrophy have been reported. Without MR imaging, the clinically significant finding would not have been identified. Thus, MRI is advantageous when compared with other imaging modalities in patients with progressive sensorineural hearing loss and enables improved patient counseling regarding expected auditory and communication outcomes.
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Affiliation(s)
- Lucas Leonhard
- Division of Otolaryngology, Department of Surgery, The University of Wisconsin School of Medicine and Public Health, The University of Wisconsin-Madison
| | | | - Joseph Roche
- Division of Otolaryngology, Department of Surgery, The University of Wisconsin School of Medicine and Public Health, The University of Wisconsin-Madison
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梅 玲, 陈 向, 杨 军. [The analysis of the characteristics of hearing loss in patients with cochlear nerve aphasia identified by MRI]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:14-16. [PMID: 33540964 PMCID: PMC10128535 DOI: 10.13201/j.issn.2096-7993.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 06/12/2023]
Abstract
Objective:To explore the characteristics of hearing loss in patients with cochlear nerve aphasia(CNA) and to provide evidences for diagnosis and treatment of cochlear nerve aphasia. Methods:A retrospective study was performed. A total of 51 cases were included in the study. The data of hearing test, inner auditory canal MRI and temporal HRCT were analyzed. Results:77.19% of the affected ears had extremely severe hearing loss, and 7.02% of the affected ears had moderate hearing loss. The residual hearing was concentrated in low-medium frequency. A CNA ear with bone cochlear nerve canal atresia can exhibited moderate hearing loss. Conclusion:The patient with CNA may still present residual hearing function. CNA could not be excluded in patients with moderate hearing loss. The "three-dimensional integration" comprehensive evaluation system, which includesinternal auditory canal MRI, temporal thin-layer CT scan and audiology evaluation, could be helpful to the diagnosis of cochlear nerveaphasia.
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Affiliation(s)
- 玲 梅
- 上海交通大学医学院附属新华医院听力障碍和眩晕诊治中心(上海,200092)Hearing and Vertigo Center, Xinhua Hospital, Medical School of Shanghai Jiaotong University, Shanghai, 200092, China
| | - 向平 陈
- 上海交通大学医学院附属新华医院听力障碍和眩晕诊治中心(上海,200092)Hearing and Vertigo Center, Xinhua Hospital, Medical School of Shanghai Jiaotong University, Shanghai, 200092, China
| | - 军 杨
- 上海交通大学医学院附属新华医院听力障碍和眩晕诊治中心(上海,200092)Hearing and Vertigo Center, Xinhua Hospital, Medical School of Shanghai Jiaotong University, Shanghai, 200092, China
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Simultaneous Cochlear and Auditory Brainstem Implantation in Children With Severe Inner Ear Malformations: Initial Surgical and Audiological Results. Otol Neurotol 2020; 41:625-630. [PMID: 32150015 DOI: 10.1097/mao.0000000000002595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the initial surgical and audiological outcomes of three pediatric patients with severe inner ear malformations who were simultaneously implanted with cochlear and brainstem implants in the same surgical session. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Three pediatric patients with severe inner ear malformations between ages of 1.9 to 2.5 years, who were simultaneously implanted with cochlear implant in one ear and auditory brainstem implant in the other ear. INTERVENTION(S) Simultaneous application of cochlar implant in one ear, auditory brainstem implant in the other ear. MAIN OUTCOME MEASURES Free field thresholds with cochlear and brainstem implants. Surgical issues are also discussed. RESULTS The study is descriptive in nature. Free field thresholds with each device alone and together showed good progress. One of the patients had slower progress possibly due to comorbid CHARGE syndrome. CONCLUSIONS The results showed good progress in terms of audition with both devices. Simultaneous cochlear and brainstem application serves as a remedy for pediatric patients who are candidates for cochlear implant on one side and brainstem implant on the other side. With this simultaneous application precious time for auditory development is not lost.
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Batuk MO, Cinar BC, Yarali M, Aslan F, Ozkan HB, Sennaroglu G, Yucel E, Bajin MD, Bilginer B, Sennaroglu L. Bimodal stimulation in children with inner ear malformation: One side cochlear implant and contralateral auditory brainstem implant. Clin Otolaryngol 2020; 45:231-238. [DOI: 10.1111/coa.13499] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/24/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Merve Ozbal Batuk
- Department of Audiology Hacettepe University Faculty of Health Sciences Ankara Turkey
| | - Betul Cicek Cinar
- Department of Audiology Hacettepe University Faculty of Health Sciences Ankara Turkey
| | - Mehmet Yarali
- Department of Audiology Hacettepe University Faculty of Health Sciences Ankara Turkey
| | - Filiz Aslan
- Department of Audiology Hacettepe University Faculty of Health Sciences Ankara Turkey
| | - Hilal Burcu Ozkan
- Department of Audiology Hacettepe University Faculty of Health Sciences Ankara Turkey
| | - Gonca Sennaroglu
- Department of Audiology Hacettepe University Faculty of Health Sciences Ankara Turkey
| | - Esra Yucel
- Department of Audiology Hacettepe University Faculty of Health Sciences Ankara Turkey
| | - Munir Demir Bajin
- Department of Otorhinolaryngology Hacettepe University Ankara Turkey
| | - Burcak Bilginer
- Department of Neurosurgery Hacettepe University Ankara Turkey
| | - Levent Sennaroglu
- Department of Otorhinolaryngology Hacettepe University Ankara Turkey
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A Ten-Year Review of Audiological Performance in Children with Inner Ear Abnormalities after Cochlear Implantation in Singapore. Int J Otolaryngol 2019; 2019:6483714. [PMID: 31885597 PMCID: PMC6915011 DOI: 10.1155/2019/6483714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/26/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives To evaluate children with inner ear malformations following cochlear implantation (CI) in a tertiary pediatric hospital in Singapore to identify factors influencing outcomes after CI. Methods This is a retrospective cohort study of children aged 0 to 18 years, who had CI between 2000 and 2013. Demographic information, data on risk factors, type of inner ear malformation (IEM), age at implantation, speech pre- and postimplantation, and duration of follow-up were collected from clinical records. Operative details and audiological outcomes were also analyzed. Results A total of 70 children underwent 83 CI surgeries. The mean age of the patients was 4.05 ± 3.17 years (range 1–18 years). Twenty patients (28.57%) had abnormal CT scan findings. CSF gusher occurred in 15 out of 26 CI (57.69%) in the group with IEM. Nine out of twenty patients (45.00%) had poor IT-MAIS scores prior to implantation. The average preoperative IT-MAIS score for children with anomalous inner ear anatomy was 14.1. The older CI patients, 3/20 (15.00%), mean age 8.33 years (range 7–10 years), were mostly referred for persistently unclear speech following hearing aids. Eleven patients (55.00%) had good speech and aided hearing threshold within speech limits after CI and were eligible for reintegration into mainstream schools. Five patients (25.00%) had improvement in speech but continued to receive education in special schools. Four patients (20.00%) had poor progress after surgery. Conclusion The presence of absent cochlear nerve, electrode folding, and underlying neurological disorders seemed to be associated with poorer outcomes.
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Hearing Restoration in Cochlear Nerve Deficiency: the Choice Between Cochlear Implant or Auditory Brainstem Implant, a Meta-analysis. Otol Neurotol 2019; 39:428-437. [PMID: 29494474 DOI: 10.1097/mao.0000000000001727] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To answer the dilemma clinician's face when deciding between cochlear implant (CI) and auditory brainstem implant (ABI) treatment options in patients with cochlear nerve deficiency (CND). STUDY DESIGN Case study supplemented with literature review and meta-analysis. SETTING Tertiary referral center. PATIENT(S) Child with CHARGE syndrome and congenital deafness. INTERVENTION(S) ABI as there was no benefit after bilateral cochlear implantation. MAIN OUTCOME MEASURES Speech and language development, quality of life. RESULTS In one ear the cochleovestibular nerve was present on magnetic resonance imaging (MRI) without preoperative ABR responses. In the contra lateral ear the nerve could not be identified, despite present ABR responses. Nevertheless, there was no positive outcome with CI. The patient had improved speech and language and quality of life with ABI. Of the 108 patients with CND and CI identified in the literature review, 25% attained open-set speech perception, 34% attained closed-set speech perception, and 41% detected sounds or less. The appearance of the cochlear nerve on MRI was a useful predictor of success, with cochlear nerve aplasia on MRI associated with a smaller chance of a positive outcome post cochlear implantation compared with patients with cochlear nerve hypoplasia. CONCLUSION Although patients with (apparent) cochlear nerve aplasia are less likely to benefit from CI, CI before ABI is supported as some patients attain closed or open-set levels of speech perception after cochlear implantation.
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Ehrmann-Müller D, Kühn H, Matthies C, Hagen R, Shehata-Dieler W. Outcomes after cochlear implant provision in children with cochlear nerve hypoplasia or aplasia. Int J Pediatr Otorhinolaryngol 2018; 112:132-140. [PMID: 30055722 DOI: 10.1016/j.ijporl.2018.06.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cochlear nerve aplasia or hypoplasia is found in up to a half of patients with unilateral or bilateral hearing loss. There is an ongoing discussion regarding the indication of cochlear implants for hearing rehabilitation in cases with radiologically-defined aplasia or hypoplasia of the cochlear nerve in those patients, especially in children. At present there is conflicting evidence whether the audiological outcomes of those children with a CI are comparable to those of children with a CI and a radiologically-normal cochlear nerve. The primary aim of this study was to assess the audiological abilities before and after CI provision in children with cochlear nerve hypoplasia or aplasia. Additionally, we aimed to determine if audiological outcomes differed in children with aplasia from those with hypoplasia. Such data should be helpful in determining if CI provision is appropriate for such children. METHODS This retrospective study presents 7 children who were diagnosed with cochlear nerve aplasia or hypoplasia and received a CI. The pre- and postoperative audiological performance and the hearing and speech development of the children were examined. RESULTS 4 children were unilateral CI users and 3 were bilateral CI users. Hearing reactions could be detected in all children. Already at first fitting, prompt responses and reactions to songs were observed. The aided thresholds in free field in children with hypoplasia were between 30 and 60 dB. Even in children with aplasia, the results in free field with CI averaged between 30 and 70 dB. Therefore the aided thresholds in children with hypoplasia and in children with aplasia of the CN are similar. It could be demonstrated that hearing reactions improve with the long term use of the implant. Improvement in general development could be observed in all children despite the very heterogeneous conditions and the accompanying handicaps. CONCLUSION The results of this study support the hypothesis that children with radiologically-defined CN hypoplasia or aplasia and detectable responses to electrical or acoustical stimuli can improve their sound detection thresholds and their awareness of sound when provided with a CI.
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Affiliation(s)
- Désirée Ehrmann-Müller
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany.
| | - Heike Kühn
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
| | - Wafaa Shehata-Dieler
- Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
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Abstract
OBJECTIVE To assess cochlear implant (CI) outcomes, and factors affecting outcomes, for children with aplasia/ hypoplasia of the cochlea nerve. We also developed a new grading system for the nerves of the internal auditory meatus (IAM) and cochlea nerve classification. STUDY DESIGN Retrospective patient review. SETTING Tertiary referral hospital and cochlear implant program. PATIENTS Children 0 to 16 years inclusive with a CI who had absent/hypoplastic cochlea nerve on magnetic resonance imaging (MRI). INTERVENTION Cochlear implant. MAIN OUTCOME MEASURES MRI, trans-tympanic electrical auditory brainstem response, intraoperative electrical auditory brainstem response, Neural Response Telemetry, Categories of Auditory Perception score, Main mode of communication. RESULTS Fifty CI recipients (26 males and 24 females) were identified, 21 had bilateral CIs, 27 had developmental delay. MRI showed cochlea nerve aplasia in 64 ears, hypoplasia in 25 ears, and a normal nerve in 11 ears. Main mode of communication was analyzed for 41 children: 21 (51%) used verbal language (15 speech alone, 5 speech plus some sign, 1 bilingual in speech and sign), and 20 (49%) used sign language (10 sign alone, 9 sign plus some speech, 1 tactile sign). Seventy-three percent of children used some verbal language. Cochlea nerve aplasia/ hypoplasia and developmental delay were both significant factors affecting main mode of communication. Categories of Auditory Performance scores were available for 59 CI ears; 47% with CN Aplasia (IAM nerve grades 0-III) and 89% with CN hypoplasia (IAM nerve grade IV) achieved Categories of Auditory Performance scores of 5 to 7 (some verbal understanding) (p = 0.003). CONCLUSION Our results are encouraging and useful when counselling families regarding the likelihood of language outcomes and auditory understanding.
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Peng KA, Kuan EC, Hagan S, Wilkinson EP, Miller ME. Cochlear Nerve Aplasia and Hypoplasia: Predictors of Cochlear Implant Success. Otolaryngol Head Neck Surg 2017; 157:392-400. [DOI: 10.1177/0194599817718798] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To identify factors predicting performance outcomes following cochlear implantation in patients with cochlear nerve aplasia or hypoplasia. Data Sources Individual patient data extracted from published case series and reports. Review Methods The MEDLINE database, Cochrane Library, Embase, Web of Science, and Google Scholar were queried for “cochlear implant” in conjunction with “aplasia” or “hypoplasia” between 1985 and 2015. Eighteen studies were included describing 97 subjects with individual postimplant auditory data. Postimplant performance was categorized as follows: level 1, nonstimulation/minimal detection; level 2, improved detection; level 3, closed-set speech perception; or level 4, open-set speech perception. The subjects achieving speech perception (levels 3 and 4) were descriptively compared with those who did not. Results Subjects with a hypoplastic cochlear nerve on magnetic resonance imaging had higher reported rates of achieving speech perception than those with an aplastic nerve. Subjects with syndromic medical comorbidities had higher reported rates of nonstimulation than nonsyndromic subjects. The data showed that some children with an aplastic cochlear nerve or those with partial electrode insertion could obtain levels of speech discrimination. Reporting of patient characteristics and auditory outcomes was extremely variable across studies. Conclusion As previously shown, cochlear implant in patients with cochlear nerve aplasia or hypoplasia can provide meaningful hearing for select patients. The current study suggests that presence of a cochlear nerve on magnetic resonance imaging and lack of comorbid medical syndrome are associated with better auditory outcomes in such patients. Future efforts to report individual data in a consistent manner may allow better determination of predictive factors.
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Affiliation(s)
| | - Edward C. Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
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Predicting Auditory Outcomes From Radiological Imaging in Cochlear Implant Patients With Cochlear Nerve Deficiency. Otol Neurotol 2017; 38:685-693. [DOI: 10.1097/mao.0000000000001382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rance G, Starr A. Pathophysiological mechanisms and functional hearing consequences of auditory neuropathy. Brain 2015; 138:3141-58. [PMID: 26463676 DOI: 10.1093/brain/awv270] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/05/2015] [Indexed: 01/19/2023] Open
Abstract
The effects of inner ear abnormality on audibility have been explored since the early 20th century when sound detection measures were first used to define and quantify 'hearing loss'. The development in the 1970s of objective measures of cochlear hair cell function (cochlear microphonics, otoacoustic emissions, summating potentials) and auditory nerve/brainstem activity (auditory brainstem responses) have made it possible to distinguish both synaptic and auditory nerve disorders from sensory receptor loss. This distinction is critically important when considering aetiology and management. In this review we address the clinical and pathophysiological features of auditory neuropathy that distinguish site(s) of dysfunction. We describe the diagnostic criteria for: (i) presynaptic disorders affecting inner hair cells and ribbon synapses; (ii) postsynaptic disorders affecting unmyelinated auditory nerve dendrites; (iii) postsynaptic disorders affecting auditory ganglion cells and their myelinated axons and dendrites; and (iv) central neural pathway disorders affecting the auditory brainstem. We review data and principles to identify treatment options for affected patients and explore their benefits as a function of site of lesion.
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Affiliation(s)
- Gary Rance
- 1 Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Parkville 3010 Australia
| | - Arnold Starr
- 2 Department of Neurology, The University of California (Irvine), 200 S. Manchester Ave., Suite 206, Orange, CA 92868-4280, USA
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Cochlear implantation in children with cochlear nerve deficiency. Int J Pediatr Otorhinolaryngol 2014; 78:912-7. [PMID: 24690223 DOI: 10.1016/j.ijporl.2014.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/01/2014] [Accepted: 03/04/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to report on auditory performance after cochlear implantation in children with cochlear nerve deficiency. METHODS A retrospective case review was performed. Five patients with pre-lingual profound sensorineural hearing loss implanted in an ear with cochlear nerve deficiency participated in the study. Postoperative auditory and speech performance was assessed using warble tone average threshold with cochlear implant, speech perception categories, and speech intelligibility ratings. All patients underwent high resolution computed tomography and magnetic resonance imaging. RESULTS According to Govaerts classification, three children had a type IIb and two a type IIa cochlear nerve deficiency. Preoperatively, four patients were placed into speech perception category 1 and one into category 2. All patients had an improvement in hearing threshold with the cochlear implant. Despite this, at the last follow-up (range 18-81 months, average 45 months), only one girl benefited from cochlear implantation; she moved from speech perception category 2 to 6 and developed spoken language. Another child developed closed set speech perception and had connected speech that was unintelligible. The other 3 children showed little benefit from the cochlear implant and obtained only an improved access to environmental sounds and improved lipreading skills. None of these 4 children developed a spoken language, but they were all full-time users of their implants. CONCLUSIONS The outcomes of cochlear implantation in these five children with cochlear nerve deficiency are extremely variable, ranging from sporadic cases in which open set speech perception and acquisition of a spoken language are achieved, to most cases in which only an improved access to environmental sound develops. Regardless of these limited outcomes, all patients in our series use their device on a daily basis and derive benefits in everyday life. In our opinion, cochlear implantation can be a viable option in children with cochlear nerve deficiency, but careful counseling to the family on possible restricted benefit is needed.
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Nikolopoulos TP. Very young age at implantation and eight nerve deficiency: two important and controversial issues in pediatric cochlear implantation. Int J Pediatr Otorhinolaryngol 2013; 77:1057-8. [PMID: 23746415 DOI: 10.1016/j.ijporl.2013.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Young NM, Kim FM, Ryan ME, Tournis E, Yaras S. Pediatric cochlear implantation of children with eighth nerve deficiency. Int J Pediatr Otorhinolaryngol 2012; 76:1442-8. [PMID: 22921779 DOI: 10.1016/j.ijporl.2012.06.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/18/2012] [Accepted: 06/20/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the auditory outcomes of children implanted in an ear with eighth nerve hypoplasia or aplasia and to determine whether preoperative characteristics are predictive of auditory performance achieved. STUDY DESIGN retrospective case review. SETTING tertiary care medical center. PATIENTS ten children implanted in an ear with eighth nerve hypoplasia or aplasia, as determined by high resolution magnetic resonance imaging. MAIN OUTCOME MEASURES Neural response test measurements, detection and speech awareness thresholds, Meaningful Auditory Integration Scale scores, as well as speech perception level achieved. RESULTS Post-implantation, three children demonstrated little to no detection of sound, three had improved detection and awareness of environmental sounds, one developed closed-set speech perception and spoken language, and three developed open-set speech perception and spoken language. No imaging findings appeared related to outcomes. Significantly better implant detection thresholds and Meaningful Auditory Integration Scale scores were found in children who had preoperative aided auditory detection (p's ≤ 0.02-0.05). CONCLUSION Some children with eighth nerve hypoplasia or aplasia may derive significant benefit from a cochlear implant. In our study high resolution magnetic resonance imaging was more sensitive than high resolution computer tomography in detecting neural deficiency. However, no imaging findings were predictive of auditory performance level achieved post-implantation.
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Affiliation(s)
- Nancy M Young
- Section of Otology and Neurotology, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, United States.
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Electrophysiologic and Behavioral Outcomes of Cochlear Implantation in Children With Auditory Nerve Hypoplasia. Ear Hear 2012; 33:3-18. [DOI: 10.1097/aud.0b013e3182263460] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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