Implantation of the CLARION cochlear implant in an ossified cochlea

Open-set speech perception in adult cochlear implant users with ossified cochleae

This study describes open-set speech recognition in cochlear implant subjects with ossified cochleae and compares it to a control group with open cochleae. Twenty-one postlingually deafened adults with a Med-El Combi 40/40+GB split- electrode implant were matched to patients using a Med-El cochlear implant with a standard electrode. Speech recognition was assessed over an 18-month period. Split- electrode patients improved significantly over time, but their scores were significantly lower and increased significantly slower than those of controls. Of 14 patients with a duration of deafness less than 20 years, average sentence test scores were 50%, and average monosyllabic word test scores were 31%. This study provides evidence that cochlear implantation is beneficial to patients with ossified cochleae, but early implantation is advisable.

Long-term data on children implanted with a short electrode array

Ossification and cochlear malformations are no longer seen as a contra-indication to cochlear implantation. The MED-EL COMBI 40+ short electrode was designed specifically for cases where major ossification has occurred, or where full insertion of an electrode may not be possible due to abnormal structure of the cochlea. This study investigates outcomes of 18 children implanted with the short electrode array. These children were assessed using the EARS test battery pre-operatively and at a number of intervals thereafter. Results show a consistent improvement in time on most tests; these results appear to be independent of aetiology. Data from these children were compared to 18 matched pairs implanted with the standard COMBI 40+ electrode array. The short electrode children do not perform as well as the standard children initially, but do tend to catch-up at later test intervals. Results indicate the benefit of using a short electrode when complete insertion of the standard electrode is not viable.

Auditory brainstem implant in bilateral and completely ossified cochleae

OBJECTIVE

To report and evaluate the results of auditory brainstem implantation in a case of postmeningitis hearing loss with totally ossified cochleae on both sides.

STUDY DESIGN

Case report.

SETTING

Tertiary referral center.

PATIENT

A 49-year-old man was referred to the authors' department for bilateral total hearing loss subsequent to bacterial meningitis 2 years earlier. Pure tone audiometry, auditory brainstem response tests, and promontory tests did not reveal any cochlear activity. Computed tomography showed bilateral and totally ossified cochleae. Magnetic resonance imaging confirmed the diagnosis by showing no cochlear signal on T2-weighed images and ruled out brainstem and cerebellopontine angle abnormalities.

INTERVENTION

A left auditory brainstem implantation was performed through a translabyrinthine route, using a Nucleus 22-channel device.

MAIN OUTCOME MEASURES

Word and sentence recognition tests in sound-only and sound plus vision modes.

RESULTS

No postoperative complication was observed. Twelve electrodes could be activated, and their tonotopy was defined. Nine other electrodes were inactivated because of an absence of auditory response (4 electrodes) or paresthesia (5 electrodes). At the last follow-up visit, 26 months after the implantation, 50% of disyllabic word scores and 60% of sentence scores were achieved using auditory brainstem implant sound only. These scores reached 80% and 93%, respectively, with lip-reading.

CONCLUSION

Auditory brainstem implantation is an efficient means of auditory rehabilitation in cases of bilateral total hearing loss with totally ossified cochleae. It should be considered in cases of predictable failure in cochlear implantation.

School-Based Services for Children With Cochlear Implants

School-based speech, language, and hearing professionals are instrumental in the provision of rehabilitative, consultative, and support services for children with cochlear implants. This article reviews current candidacy requirements as well as factors that are considered when a child is evaluated for a cochlear implant. Following implantation, school professionals play a pivotal role in providing an appropriate educational program that should include auditory training and the integration of listening into the child’s daily routine. The article presents procedures for maintaining and troubleshooting the device, and suggestions for establishing routines for device use and for improving the listening environment for children in classrooms.