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Alahmadi A, Abdelsamad Y, Salamah M, Alenzi S, Badr KM, Alghamdi S, Alsanosi A. Cochlear implantation in adults and pediatrics with enlarged vestibular aqueduct: a systematic review on the surgical findings and patients' performance. Eur Arch Otorhinolaryngol 2022; 279:5497-5509. [PMID: 35771280 DOI: 10.1007/s00405-022-07511-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/13/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Cochlear implantation (CI) has been considered a safe and effective management option for patients with severe to profound hearing loss. Patients with enlarged vestibular aqueduct (EVA) could be challenging with some variations in surgical approaches, intraoperative surgical notes, and clinical outcomes. This study aimed to review the surgical and clinical outcomes of cochlear implantation among patients with EVA. MATERIALS AND METHODS A systematic literature search was carried out in five major databases. All original studies reporting cochlear implantation in patients with EVA were included for qualitative data synthesis. The risk of bias was independently assessed through the National Intuitional of Health tool. The review protocol was registered in PROSPERO (reference number: CRD42021225900). RESULTS A total of 34 studies with 4035 subjects were included. Of them, 853 (21.14%) had EVA and underwent CI. Mondini malformation was the most frequently associated anomaly (n = 78, 11.1%). Unilateral implantation was performed in 258 cases while bilateral in 119 subjects. Postoperative complications included CSF/perilymph gusher (n = 112), CSF oozing (n = 18), and partial electrode insertion (n = 6). Closing the cochleostomy with temporalis fascia, muscle, connective tissue, or fibrin glue was the most frequently reported approach to manage CSF/perilymph gusher (n = 67, 56.7%) while packing was performed in six patients. CONCLUSION Patients with EVA demonstrated audiometric and speech performance improvement after CI. However, many patients had intra- or postoperative complications. Further research is needed as the outcomes may be affected by associated temporal bone pathology, the timing of implant, and hearing condition.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box; 245, Riyadh, 11411, Saudi Arabia.
| | | | - Marzouqi Salamah
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box; 245, Riyadh, 11411, Saudi Arabia
| | - Saad Alenzi
- King Fahad Specialist Hospital, MOH, Tabuk, Saudi Arabia
| | | | | | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box; 245, Riyadh, 11411, Saudi Arabia
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Cochlear Implantation in Children with Enlarged Vestibular Aqueduct: A Systematic Review of Surgical Implications and Outcomes. Ear Hear 2022; 44:440-447. [PMID: 36397213 DOI: 10.1097/aud.0000000000001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study investigated age at implantation, improvement in hearing and speech perception outcomes, as well as surgical complications in pediatric cochlear implant recipients with Pendred Syndrome (PS) or non-syndromic enlarged vestibular aqueduct (NSEVA). DESIGN A systematic review of the literature between 1984 and 2021 was performed. Two independent reviewers performed abstract and full-text screening using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The inclusion criteria were: English language, cochlear implant, age at implantation available, age <18 years, PS, Mondini malformation, and enlarged vestibular aqueduct. Full-text analysis was completed using the National Institute of Health assessment tool for case series and case-control studies. Studies were also graded according to the Oxford Centre for Evidence-Based Medicine grading system. RESULTS In total, 198 studies were identified and screened, and 55 studies were included for analysis. Audiological outcomes were available in 46 studies, and the four-frequency pure-tone audiogram average improved by 60 to 78 dB HL due to cochlear implantation. Auditory performance and speech intelligibility scores increased by 44%. The overall average implantation age was 60 months. The implantation age was 21 months lower in the studies where individuals were implanted after the year 2000 compared with those implanted before the year 2000. Perilymph gusher/oozing was the most common surgical incident reported, occurring in 187 of 1572 implantations. CONCLUSIONS In children with PS/NSEVA, cochlear implantation improves pure-tone average by 60 to 78 dB HL and capacity of auditory performance/speech intelligibility by 44%. The implantation age for these children has decreased during the last two decades but is still somewhat higher than reported for unselected pediatric cochlear implantation. Perilymph gusher/oozing is the most common surgical complication.
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Bouhadjer K, Tissera K, Farris CW, Juliano AF, Cunnane ME, Curtin HD, Mankarious LA, Reinshagen KL. Retrospective Review of Midpoint Vestibular Aqueduct Size in the 45° Oblique (Pöschl) Plane and Correlation with Hearing Loss in Patients with Enlarged Vestibular Aqueduct. AJNR Am J Neuroradiol 2021; 42:2215-2221. [PMID: 34737185 DOI: 10.3174/ajnr.a7339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/17/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vestibular aqueduct measurements in the 45° oblique (Pöschl) plane provide a reliable depiction of the vestibular aqueduct; however, adoption among clinicians attempting to counsel patients has been limited due to the lack of correlation with audiologic measures. This study aimed to determine the correlation between midpoint vestibular aqueduct measurements in the Pöschl plane in patients with an enlarged vestibular aqueduct with repeat audiologic measures. MATERIALS AND METHODS Two radiologists independently measured the midpoint vestibular aqueduct diameter in the Pöschl plane reformatted from CT images in 54 pediatric patients (77 ears; mean age at first audiogram, 5 years) with an enlarged vestibular aqueduct. Four hundred nineteen audiograms were reviewed, with a median of 6 audiograms per patient (range, 3-17; mean time between first and last audiograms, 97.4 months). The correlation between midpoint vestibular aqueduct size and repeat audiologic measures (pure tone average, speech-reception threshold, and word recognition score) using a linear mixed-effects model was determined. RESULTS The mean midpoint vestibular aqueduct size was 1.78 mm (range, 0.81-3.46 mm). There was excellent interobserver reliability with intraclass correlation coefficients for the 2 readers measuring 0.92 (P < .001). Each millimeter increase in vestibular aqueduct size was associated with an increase of 10.5 dB (P = .006) in the pure tone average, an increase of 14.0 dB (P = .002) in the speech-reception threshold, and a decrease in the word recognition score by 10.5% (P = .05). CONCLUSIONS Midpoint vestibular aqueduct measurements in the Pöschl plane are highly reproducible and demonstrate a significant correlation with audiologic data in this longitudinal study with repeat measures. These data may be helpful for clinicians who are counseling patients with an enlarged vestibular aqueduct using measurements obtained in the Pöschl plane.
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Affiliation(s)
- K Bouhadjer
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
| | - K Tissera
- Otolaryngology (K.T., L.A.M.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - C W Farris
- Department of Radiology (C.W.F.), Massachusetts General Hospital, Boston, Massachusetts
| | - A F Juliano
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
| | - M E Cunnane
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
| | - H D Curtin
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
| | - L A Mankarious
- Otolaryngology (K.T., L.A.M.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - K L Reinshagen
- From the Departments of Radiology (K.B., A.F.J., M.E.C., H.D.C., K.L.R.)
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Grover M, Sharma S, Samdani S, Gupta G, Preetam C, Gera K, Vaishnav JK, Hada MK. New SMS Classification of Cochleovestibular Anomalies: Our Experience with 25 Cases of Type I Anomaly. Indian J Otolaryngol Head Neck Surg 2021; 73:333-339. [PMID: 34471622 PMCID: PMC8364613 DOI: 10.1007/s12070-021-02442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To study and analyse the radiological and surgical findings of 25 cochlear implantees with SMS type-I cochleovestibular malformation and to compare their outcomes in terms of hearing and speech gains pre- and post-operatively. METHODS Retrospective analysis of cochlear implanted candidates over a period of 8 year from 3 institutions was undertaken and 25 patients suffering from pre-lingual profound congenital sensori-neural hearing loss along with presence of SMS type I cochleovestibular malformation were studied. Pre-operative radiology, surgical difficulties and complication, and post-operative hearing and speech outcomes upto a period of 2 years, using IT-MAIS scores were noted. Statistical comparison pre- and post-implantation was done using Wilcoxon signed rank test and a p-value of < 0.05 was considered significant. RESULTS In 25 cases, we encountered 2 posterior SCC dysplasia, 15 enlarged vestibular aqueducts (LVA), 2 dilated vestibules, 4 superior SCC dysplasia, 2 cases with both posterior and superior SCC dysplasia and of those 1 had a dilated vestibule also. Intra-operatively, CSF leak was observed in 10 patients. Complete electrode insertion and good electrical response (NRT) was detected in all. No facial nerve anomaly was encountered. IT-MAIS scores increased from a pre-operative mean of 4.32 to 34.56 two years post-operatively and this difference was found to be statistically significant. CONCLUSION Our experience with SMS Type I malformations show promising and motivating results with less chances of complications, similar to implant candidates with normal anatomy. The outcomes in this group of patients are definitely not affected by any malformations in semicircular canals, vestibule or vestibular aqueduct.
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Affiliation(s)
- Mohnish Grover
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Shivam Sharma
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Sunil Samdani
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Gaurav Gupta
- Department of Otorhinolaryngology and Head Neck Surgery, S.P Medical College and Hospital, Bikaner, Rajasthan India
| | - Chappati Preetam
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa India
| | - Kriti Gera
- S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
| | - Jairaj Kumar Vaishnav
- Department of Otorhinolaryngology and Head Neck Surgery, RVRS Medical College and Hospital, Bhilwara, Rajasthan India
| | - Mahendra Kumar Hada
- Department of Otorhinolaryngology and Head Neck Surgery, S.M.S Medical College and Hospital, Jaipur, Rajasthan 302004 India
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Benchetrit L, Jabbour N, Appachi S, Liu YC, Cohen MS, Anne S. Cochlear Implantation in Pediatric Patients With Enlarged Vestibular Aqueduct: A Systematic Review. Laryngoscope 2021; 132:1459-1472. [PMID: 34233033 DOI: 10.1002/lary.29742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE(S) To describe cochlear implantation (CI) outcomes, with speech perception, auditory, language, and parent-reported auditory and speech behaviors, in children with an enlarged vestibular aqueduct (EVA) and incomplete partition type 2 (IP-II) and compare to control children without inner ear malformations (IEMs) and to determine cerebrospinal fluid gusher rates and effect on outcomes. STUDY DESIGN Systematic review and meta-analysis. METHODS MEDLINE, Embase, Cochrane, and CINAHL databases were searched from inception to February 2020. Studies reporting relevant outcomes in children with EVA or EVA + IP-II and controls without IEMs undergoing CI were included. Mean differences in speech perception, auditory, and language scores between cases and controls were meta-analyzed. Gusher rates were determined by proportion meta-analyses. RESULTS Of 214 identified articles, 42 met inclusion criteria, evaluating 775 cases and 2,191 controls. Of -cases, 578 (74.6%) had EVA and 197 (25.4%) had EVA + IP-II. Cases showed a significant improvement in speech perception, auditory and language performance, comparable to controls. Parent-reported auditory and speech production behaviors outcomes were positive among cases and comparable to controls. Pooled gusher proportions in EVA and EVA + IP-II cases were 27.7% (95% CI: 17.6-39.1) and 48.6% (95% CI: 28.6-69.0), respectively, with a proportion difference of 20.9% (95% CI: 11.0-30.1). Gusher occurrence did not impact speech perception or language outcomes. CONCLUSION Outcomes in children with EVA or EVA + IP-II undergoing CI are favorable and largely comparable to outcomes in children with hearing loss undergoing CI without IEMs. Intraoperative gusher is more prevalent among children with EVA + IP-II as compared to iEVA. Gusher does not influence speech perception and language development outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Liliya Benchetrit
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, U.S.A
| | | | - Swathi Appachi
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, U.S.A
| | - Yi-Chun Liu
- Texas Children's Hospital, Division of Pediatric Otolaryngology, Houston, Texas, U.S.A
| | - Michael S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Samantha Anne
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, U.S.A
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Forli F, Lazzerini F, Auletta G, Bruschini L, Berrettini S. Enlarged vestibular aqueduct and Mondini Malformation: audiological, clinical, radiologic and genetic features. Eur Arch Otorhinolaryngol 2020; 278:2305-2312. [PMID: 32910226 PMCID: PMC8165072 DOI: 10.1007/s00405-020-06333-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE When referring to enlarged vestibular aqueduct (EVA) we should differentiate between nonsyndromic enlarged vestibular aqueduct (NSEVA) and Pendred Syndrome (PDS), a disease continuum associated with pathogenic sequence variants of Pendrin's Gene (SLC26A4) in about half of the cases. The study was aimed to analyse the clinical and audiological features of a monocentric cohort of Caucasian patients with NSEVA/PDS, their genetic assessment and morphological inner ear features. METHODS We retrospectively reviewed the audiologic, genetic and anamnestic data of 66 patients with NSEVA/PDS followed by our audiology service. RESULTS SLC26A4 mutations was significantly correlated with the presence of PDS rather than NSEVA (p < 0.019), with the expression of inner ear malformations (p < 0.001) and with different severity of hearing loss (p = 0.001). Furthermore, patients with PDS showed significantly worse pure tone audiometry (PTA) than patients with NSEVA (p = 0.001). Anatomically normal ears presented significantly better PTA than ears associated with Mondini Malformation or isolated EVA (p < 0.001), but no statistically significative differences have been observed in PTA between patients with Mondini Malformation and isolated EVA. CONCLUSION NSEVA/PDS must be investigated in all the congenital hearing loss, but also in progressive, late onset, stepwise forms. Even mixed or fluctuating hearing loss may constitute a sign of a NSEVA/PDS pathology. Our findings can confirm the important role of SLC26A4 mutations in determining the phenotype of isolated EVA/PDS, both for the type/degree of the malformation, the hearing impairment and the association with thyroid dysfunction.
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Affiliation(s)
- F Forli
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy.
| | - F Lazzerini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - G Auletta
- UOC Audiologia, DAI Testa Collo, AOU Federico II, Naples, Italy
| | - L Bruschini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - S Berrettini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Demir B, Cesur S, Incaz S, Alberalar ND, Ciprut A, Batman C. The effect of canal diameter on audiologic results in patients with cochlear implantation with large vestibular aqueduct syndrome. Eur Arch Otorhinolaryngol 2019; 277:743-750. [DOI: 10.1007/s00405-019-05764-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022]
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Bianchin G, Polizzi V, Formigoni P, Russo C, Tribi L. Cerebrospinal Fluid Leak in Cochlear Implantation: Enlarged Cochlear versus Enlarged Vestibular Aqueduct (Common Cavity Excluded). Int J Otolaryngol 2016; 2016:6591684. [PMID: 27847516 PMCID: PMC5101390 DOI: 10.1155/2016/6591684] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/03/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. To share our experience of cerebrospinal fluid gusher in cochlear implantation in patients with enlarged cochlear or vestibular aqueduct. Study Design. Case series with comparison and a review of the literature. Methods. A retrospective study was performed. Demographic and radiological results of patients with enlarged cochlear aqueduct or enlarged vestibular aqueduct in 278 consecutive cochlear implant recipients, including children and adults, were evaluated between January 2000 and December 2015. Results. Six patients with enlarged cochlear aqueduct and eight patients with enlarged vestibular aqueduct were identified. Cerebrospinal fluid gusher occurs in five subjects with enlarged cochlear aqueduct and in only one case of enlarged vestibular aqueduct. Conclusion. Based on these findings, enlarged cochlear aqueduct may be the best risk predictor of cerebrospinal fluid gusher at cochleostomy during cochlear implant surgery despite enlarged vestibular aqueduct.
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Affiliation(s)
- Giovanni Bianchin
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
| | - Valeria Polizzi
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
| | - Patrizia Formigoni
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
| | - Carmela Russo
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
| | - Lorenzo Tribi
- Otorhinolaryngology and Audiology Department, ASMN-IRCCS Hospital, Reggio Emilia, Italy
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Pritchett C, Zwolan T, Huq F, Phillips A, Parmar H, Ibrahim M, Thorne M, Telian S. Variations in the cochlear implant experience in children with enlarged vestibular aqueduct. Laryngoscope 2015; 125:2169-74. [DOI: 10.1002/lary.25187] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/19/2014] [Accepted: 12/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Cedric Pritchett
- Department of Otolaryngology-Head and Neck Surgery; Northwestern University; Chicago Illinois
| | - Teresa Zwolan
- Division of Otology-Neurotology; Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health System; Ann Arbor Michigan
| | - Farhan Huq
- Department of Otolaryngology-Head and Neck Surgery; Henry Ford Health System; Detroit Michigan
| | | | | | | | - Marc Thorne
- Department of Radiology; University of Michigan Health System; Ann Arbor Michigan
- Division of Pediatric Otolaryngology; Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health System; Ann Arbor Michigan U.S.A
| | - Steven Telian
- Division of Otology-Neurotology; Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health System; Ann Arbor Michigan
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Prognostic Factors for Sudden Drops in Hearing Level After Minor Head Injury in Patients With an Enlarged Vestibular Aqueduct. Otol Neurotol 2015; 36:4-11. [DOI: 10.1097/mao.0000000000000659] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pradhananga R, Natarajan K, Devarasetty A, Kameswaran M. Cochlear Implantation in Isolated Large Vestibular Aqueduct Syndrome: Report of Three Cases and Literature Review. Int Arch Otorhinolaryngol 2014; 19:359-63. [PMID: 26491485 PMCID: PMC4593917 DOI: 10.1055/s-0034-1395791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/11/2014] [Indexed: 11/06/2022] Open
Abstract
Introduction Large vestibular aqueduct syndrome (LVAS) is characterized by the enlargement of the vestibular aqueduct associated with sensorineural hearing loss. It is the most common radiographically detectable inner ear anomaly in congenital hearing loss. LVAS may occur as an isolated anomaly or in association with other inner ear malformations. Objective To report three cases of isolated LVAS with a focus on preoperative assessment, surgical issues, and short-term postoperative follow-up with preliminary auditory habilitation outcomes. Resumed Report One girl and two boys with LVAS were assessed and cochlear implantation was performed for each. Various ways of intraoperative management of cerebrospinal fluid gusher and postoperative care and outcomes are reported. Conclusion Cochlear implantation in the deaf children with LVAS is feasible and effective.
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Affiliation(s)
- Rabindra Pradhananga
- Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal ; Department of Implantation Otology, Madras ENT Research Foundation, Chennai, Tamil Nadu, India
| | - Kiran Natarajan
- Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, Tamil Nadu, India
| | - AmarNath Devarasetty
- Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, Tamil Nadu, India
| | - Mohan Kameswaran
- Department of Implantation Otology, Madras ENT Research Foundation, Chennai, Tamil Nadu, India
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Ko HC, Liu TC, Lee LA, Chao WC, Tsou YT, Ng SH, Wu CM. Timing of surgical intervention with cochlear implant in patients with large vestibular aqueduct syndrome. PLoS One 2013; 8:e81568. [PMID: 24282608 PMCID: PMC3839901 DOI: 10.1371/journal.pone.0081568] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 10/15/2013] [Indexed: 11/21/2022] Open
Abstract
Objectives (1) To report the speech perception and intelligibility results of Mandarin-speaking patients with large vestibular aqueduct syndrome (LVAS) after cochlear implantation (CI); (2) to compare their performance with a group of CI users without LVAS; (3) to understand the effects of age at implantation and duration of implant use on the CI outcomes. The obtained data may be used to guide decisions about CI candidacy and surgical timing. Methods Forty-two patients with LVAS participating in this study were divided into two groups: the early group received CI before 5 years of age and the late group after 5. Open-set speech perception tests (on Mandarin tones, words and sentences) were administered one year after implantation and at the most recent follow-up visit. Categories of auditory perception (CAP) and Speech Intelligibility Rating (SIR) scale scores were also obtained. Results The patients with LVAS with more than 5 years of implant use (18 cases) achieved a mean score higher than 80% on the most recent speech perception tests and reached the highest level on the CAP/SIR scales. The early group developed speech perception and intelligibility steadily over time, while the late group had a rapid improvement during the first year after implantation. The two groups, regardless of their age at implantation, reached a similar performance level at the most recent follow-up visit. Conclusion High levels of speech performance are reached after 5 years of implant use in patients with LVAS. These patients do not necessarily need to wait until their hearing thresholds are higher than 90 dB HL or PB word score lower than 40% to receive CI. They can do it “earlier” when their speech perception and/or speech intelligibility do not reach the performance level suggested in this study.
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Affiliation(s)
- Hui-Chen Ko
- Department of Otolaryngology, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Linkou, Taiwan
| | - Tien-Chen Liu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Ang Lee
- Department of Otolaryngology, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Linkou, Taiwan
| | - Wei-Chieh Chao
- Department of Otolaryngology, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Linkou, Taiwan
| | - Yung-Ting Tsou
- Department of Otolaryngology, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Linkou, Taiwan
| | - Shu-Hang Ng
- Molecular Imaging Center and Departments of Diagnostic Radiology and Medical Imaging, Chang-Gung University, Linkou, Taiwan
- Radiological Sciences, Chang-Gung University, Linkou, Taiwan
| | - Che-Ming Wu
- Department of Otolaryngology, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Linkou, Taiwan
- * E-mail:
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Pakdaman MN, Herrmann BS, Curtin HD, Van Beek-King J, Lee DJ. Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy. Otolaryngol Head Neck Surg 2011; 146:180-90. [DOI: 10.1177/0194599811429244] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To determine the influence of inner ear dysplasia on both surgical and audiologic outcomes following pediatric cochlear implant (CI) surgery. Data Sources. MEDLINE (1982-2009) and data from Massachusetts Eye and Ear Infirmary. Review Methods. A systematic review of the literature was performed. Variables assessed included age at implantation, duration of CI use, radiologic and operative findings, and speech perception outcome data. Results. The initial search yielded 1326 articles. Including data from our own study, twenty-two fulfilled criteria for inclusion, representing 311 patients. Data for bilateral implants were recorded only for the first implant. Data on simultaneous bilateral implants were not recorded. The most common anomaly seen was large vestibular aqueduct (89/311 or 29%). When comparing patients with mild-moderate or severe dysplasia, rates of cerebrospinal fluid gusher were 31% versus 35% (odds ratio [OR] = 0.50), anomalous facial nerve anatomy was seen in 11% versus 51% (OR = 0.15), and postoperative speech perception abilities were found in 84% versus 54% (OR = 1.93), respectively. A large heterogeneity was found among studies regarding all outcome measures. Conclusion. Although we found that severe inner ear dysplasia was associated with increased surgical difficulty and lower speech perception, the lack of uniformity in published clinical data limited the strength of these results. Standardization of surgical and radiologic reporting as well as more consistent speech perception testing is needed to better determine the association between anomalous cochleovestibular anatomy and clinical outcomes.
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Affiliation(s)
- Michael N. Pakdaman
- Department of Otorhinolaryngology, University of Texas Medical School, Houston, Texas, USA
| | - Barbara S. Herrmann
- Department of Audiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Hugh D. Curtin
- Department of Radiology, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Van Beek-King
- Department of Otolaryngology–Head and Neck Surgery, Georgia Health Sciences University, Augusta, Georgia, USA
| | - Daniel J. Lee
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Gopen Q, Zhou G, Whittemore K, Kenna M. Enlarged vestibular aqueduct: Review of controversial aspects. Laryngoscope 2011; 121:1971-8. [DOI: 10.1002/lary.22083] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 05/10/2011] [Indexed: 11/07/2022]
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15
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Asma A, Anouk H, Luc VH, Brokx JPL, Cila U, Van De Heyning P. Therapeutic approach in managing patients with large vestibular aqueduct syndrome (LVAS). Int J Pediatr Otorhinolaryngol 2010; 74:474-81. [PMID: 20189254 DOI: 10.1016/j.ijporl.2010.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 01/25/2010] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To discuss the clinical approach in managing patients with large vestibular aqueduct syndrome. METHODS Over the period from November 1997 to March 2005, 106 children have been fitted with cochlear implants in Antwerp University Hospital (UZA). The Hospital University of Maastricht (azM) had implanted 36 children since 1999 to March 2005. The present study focuses on nine children and one adult patient with large vestibular aqueduct syndrome (LVAS). The medical, report and radiology report were retrospectively analysed. RESULTS Eight out of nine children with LVAS had been implanted and one child was on the waiting list. One adult patient was implanted with Nucleus 24M at the age of 22 years old. Nine out of 10 patients had bilateral large vestibular aqueduct. There were no intraoperative or postoperative complications encountered. CONCLUSION Cochlear implantation is a safe operation for patients with LVAS.
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Affiliation(s)
- A Asma
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakub Latif, 56000 Cheras, Kuala Lumpur, Malaysia.
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16
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Wu CM, Sun YS, Liu TC. Long-term speech perception of cochlear implantation in children with large vestibular aqueduct syndrome: how we do it. Clin Otolaryngol 2008; 33:472-5. [DOI: 10.1111/j.1749-4486.2008.01713.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Cochlear implant and large vestibular aqueduct syndrome in children. Braz J Otorhinolaryngol 2008; 74:260-4. [PMID: 18568206 PMCID: PMC9442073 DOI: 10.1016/s1808-8694(15)31098-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 09/29/2007] [Indexed: 11/24/2022] Open
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Steinbach S, Brockmeier SJ, Kiefer J. The large vestibular aqueduct--case report and review of the literature. Acta Otolaryngol 2006; 126:788-95. [PMID: 16846919 DOI: 10.1080/00016480500527276] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patients with a large vestibular aqueduct (LVA) suffer from a loss of hearing in childhood at an early onset. An acute loss of hearing can be precipitated by minor head trauma. Until now there seems to be no sufficient therapy for stopping the progression of a loss of hearing. It has been shown that a cochlear implantation is a worthwhile procedure if the patient is almost deaf. We report the case of a patient with a bilateral LVA. A loss of hearing was confirmed at the age of 16 months. Exposure to loud noise triggered an acute progression of the hearing loss. At the age of 18 years, LVA was confirmed radiologically, revealing an enlarged endolymphatic duct and sac in MRI scans and an enlarged vestibular aqueduct in the CT scan. We successfully performed a cochlear implant (MED-EL, Combi 40+ flex). Proceeding from this case report, the paper reviews the literature on LVA.
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Affiliation(s)
- Silke Steinbach
- Department of Otolaryngology-Head and Neck Surgery, Klinikum rechts der Isar, Munich, Germany
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19
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Chen YW, Wu CM. Cochlear implantation in patients with large vestibular aqueduct syndrome (LVAS). Cochlear Implants Int 2006. [DOI: 10.1002/cii.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Chen YW, Wu CM. Cochlear implantation in patients with large vestibular aqueduct syndrome (LVAS). Cochlear Implants Int 2004; 5 Suppl 1:124-6. [DOI: 10.1179/cim.2004.5.supplement-1.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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21
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Can IH, Göçmen H, Kurt A, Samim E. Sudden hearing loss due to large vestibular aqueduct syndrome in a child: should exploratory tympanotomy be performed? Int J Pediatr Otorhinolaryngol 2004; 68:841-4. [PMID: 15126029 DOI: 10.1016/j.ijporl.2004.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2003] [Revised: 01/13/2004] [Accepted: 01/17/2004] [Indexed: 11/15/2022]
Abstract
A 16-year-old girl applied to our ENT clinic with a 3-day history of right hearing loss, tinnitus, and pressure in the right ear. She had had surgery for right perilymph fistula two times, one at the age of 7 and the second at the age of 9. She had recovered after both of these surgeries. This time she had exploratory tympanotomy and perylymh fistula was detected. Computerized tomography investigation obtained after 5 days postoperatively showed bilateral large vestibular aqueducts and otherwise normal inner ear structures. Thyroid function tests and neck palpation were normal. It was an unusual case with both large vestibular aqueduct syndrome (LVAS) and simultaneous spontaneous perilymph fistula.
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Affiliation(s)
- Ilknur Haberal Can
- ENT Clinic, Ministry of Health Ankara Education and Research Hospital, Camlica Bulvar Sitesi F Blok No: 19, Umitköy Ankara 06530, Turkey.
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Buchman CA, Copeland BJ, Yu KK, Brown CJ, Carrasco VN, Pillsbury HC. Cochlear Implantation in Children with Congenital Inner Ear Malformations. Laryngoscope 2004; 114:309-16. [PMID: 14755210 DOI: 10.1097/00005537-200402000-00025] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE/HYPOTHESIS To assess the audiologic and surgical outcomes for pediatric cochlear implant patients with inner ear malformations. STUDY DESIGN Retrospective review of 315 pediatric cochlear implant cases from 1994 to 2002. METHODS Twenty-eight pediatric cochlear implant patients with known inner ear malformations determined on high-resolution computed tomography (HRCT) of the temporal bone were the subjects of review. Results of HRCT findings, intraoperative findings, postoperative complications, and objective measures of both closed- and open-set testing of speech perception were analyzed. RESULTS Patients with the constellation of an incompletely partitioned (IP) cochlea, enlarged vestibular aqueduct (EVA), and a dilated vestibule (i.e., Mondini's malformation) as well as those with an isolated EVA or partial semicircular canal aplasia have relatively good levels of speech perception. Patients with total semicircular canal aplasia, isolated IP, cochlear hypoplasia, or common cavity demonstrated lower levels of performance. Poor performance may be related to associated developmental delays rather than labyrinthine anatomy alone. Complications of surgery were relatively limited. CONCLUSIONS Cochlear implantation can be successfully performed in children with inner ear malformations. These children and their parents can expect significant auditory benefits from this intervention. The various types of inner ear malformations may have quite different prognoses for good auditory performance.
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Affiliation(s)
- Craig A Buchman
- W. Paul Biggers, MD, Carolina Children's Communication Disorders Program, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, 27599-7600, USA.
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Abstract
The past 20 years have seen the cochlear implant evolve from an innovative but radical concept to the standard of care in the management of children with severe to profound hearing loss. All children receiving the cochlear implant achieve substantial benefit; however, performance gains are optimized by a team approach to the evaluation and management of these children. The critical elements of this team include audiologists, speech pathologists, and surgeons with specific interest, expertise, and dedication to the management of children with cochlear implants. Children are not well served by practitioners who delegate follow-up to educational programs not experienced in children with implants. Long-term involvement and dedication on the part of teachers, speech pathologists, audiologists, surgeons, and family are critical to maximizing the benefit the child receives.
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Affiliation(s)
- H Alexander Arts
- Cochlear Implant Program, Department of Otolaryngology-Head and Neck Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0312, USA.
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Abstract
OBJECTIVES In this investigation, we report the outcomes of 14 adults (age >18 y) and 9 children (age <18 y) with radiographically proven large vestibular aqueduct syndrome (LVAS) who received cochlear implants at Indiana University School of Medicine. STUDY DESIGN This is a retrospective case-control study detailing the outcomes of 23 patients with LVAS and 46 control patients implanted with Nucleus (Cochlear Corp., Englewood, CO), Clarion (Advanced Bionics Corp., Sylmar, CA), or Med-El (MED-EL Corp., Innsbruck, Austria) cochlear implants. METHODS Performance data on pure-tone averages, speech detection thresholds, and a variety of auditory and speech recognition tasks from these patients with LVAS were compared with performance data obtained from a matched group of 46 cochlear implant users who did not have LVAS. Specific patient characteristics used in matching included the age of the patient, the age at implant of the patient, and whether the patient was pre- or postlingually deafened. Data for the adult group was analyzed using the Student t test, and data for the pediatric patient group was compared using a chi2 test. RESULTS The results indicated positive outcomes for both pediatric and adult groups. With both adult and pediatric groups, auditory and speech recognition performance did not differ significantly between those patients with LVAS and control subjects. CONCLUSIONS This study adds further support for the use of cochlear implantation in patients with LVAS. Cochlear implantation is beneficial and can be offered as an eventual treatment of LVAS if hearing loss progresses to profound levels in these patients.
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Affiliation(s)
- Richard T Miyamoto
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202-5230, U.S.A.
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Bichey BG, Hoversland JM, Wynne MK, Miyamoto RT. Changes in quality of life and the cost-utility associated with cochlear implantation in patients with large vestibular aqueduct syndrome. Otol Neurotol 2002; 23:323-7. [PMID: 11981389 DOI: 10.1097/00129492-200205000-00016] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A group of 20 patients with large vestibular aqueduct syndrome was identified at the Indiana University School of Medicine. The major objective of this study was to explore the improvements in quality of life associated with cochlear implantation in patients with large vestibular aqueduct syndrome, as well as the cost-utility of cochlear implantation in this group. SETTING A total of 70 patients were identified with large vestibular aqueduct syndrome through analysis of thin-section computed tomography of the temporal bone over the past 6 years at this medical center. Data collected from the medical records for each patient included demographic data, hearing-related statistics, implantation data, and audiometric data. Sixteen children and adults with large vestibular aqueduct syndrome had undergone cochlear implantation before the beginning of this study, and the remaining 54 children and adults were identified as undergoing treatment of progressive or fluctuant sensorineural hearing loss. Health utility indexes used in this analysis were taken through the use of the Ontario Health Utility Index, Mark III. The range of costs used for cost-utility analysis was derived from the costs of cochlear implantation at this medical center, as well as from costs associated with implantation published in the medical literature. METHODS Participants were selected from the total population of patients with large vestibular aqueduct syndrome at this center who were postlingually deafened and who currently had severe hearing loss. Two groups were formed. These groups comprised either cochlear implant patients with large vestibular aqueduct syndrome or patients with large vestibular aqueduct syndrome currently using hearing aids. Ten of the 16 cochlear implant patients and 10 of the remaining 54 patients with large vestibular aqueduct syndrome met these criteria. Mark III health utility indexes were distributed to patients in each group and scored. Those health utility indexes not completed by the patients were scored by proxy, using the audiologist at this center who was the most familiar with the patient. Changes in quality of life associated with cochlear implantation were derived by comparison of the health utility index results of the two groups. Cost-utility measures were then made using discounted costs per quality-of-life years (QALYs) (5%), and a sensitivity analysis was performed that evaluated changes in scoring done by proxy. The cost-utility results were then compared with the cost-utilities derived from similar studies and associated with other disease states. RESULTS Although both groups of patients had significant hearing loss, the hearing aid group had a better mean pure-tone average. The mean pure-tone average for the hearing aid group was 70.8 dB (SD 24.4), and the mean pure-tone average for the cochlear implant group was 107.0 dB (SD 21.7). Seven of the 20 health utility indexes were scored by proxy. Results from the base case indicate a 0.20 gain in health utility from cochlear implantation (hearing aid = 0.62, cochlear implant = 0.82, p = 0.037), resulting in a discounted cost per QALY of $12,774. Sensitivity analysis of the proxy scoring indicated that decreasing the hearing score one level on the health utility index resulted in a gain in health utility with cochlear implantation of 0.15, resulting in a discounted cost per QALY of $17,832. A decrease of the hearing score by two levels on the health utility survey resulted in no significant gain in quality of life with cochlear implantation. CONCLUSION This study found an improvement in quality of life associated with cochlear implantation in postlingually deafened patients with large vestibular aqueduct syndrome. By weighing this improvement in quality of life against the significant difference noted between the pure-tone averages of each group, further strength can be given to this conclusion. This gain in quality of life, as well as the results derived for the cost-utility of cochlear implantation, was similar to that in previous published studies of cochlear implantation in all types of patients. These results also indicate a favorable cost-utility when compared with published data about other disease states. As patients with large vestibular aqueduct syndrome progress to profound levels of hearing loss, these results indicate that cochlear implantation can be offered as a beneficial, life-improving therapy.
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Affiliation(s)
- Bradford G Bichey
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 702 Barnhill Drive, Indianapolis, IN 46202-5230, U.S.A.
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Fahy CP, Carney AS, Nikolopoulos TP, Ludman CN, Gibbin KP. Cochlear implantation in children with large vestibular aqueduct syndrome and a review of the syndrome. Int J Pediatr Otorhinolaryngol 2001; 59:207-15. [PMID: 11397503 DOI: 10.1016/s0165-5876(01)00487-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Children with Large Vestibular Aqueduct Syndrome (LVAS) frequently develop speech and language skills prior to deterioration of their hearing. Operations designed to halt the progression of hearing loss have largely failed so the question of Cochlear Implantation in these children has arisen. It had been suggested that there would be technical difficulties in implanting these patients and, therefore, there had been an initial reluctance to proceed to implantation. The aim of the present paper is to assess surgical and functional outcomes in implanted children with LVAS and review the related literature. MATERIAL AND METHODS From the 170 children assessed by MRI in the Nottingham Paediatric Cochlear Implant Programme, seven (4%) were identified as having LVAS. Four of these children were implanted and had at least 12 months follow up. Two of the children are on the waiting list for implantation and one child was not implanted because of absence of the cochlear nerve. Operative findings, complications and outcome measures were recorded. The auditory skills of the children were assessed before implantation and 1 year following implantation. A literature search was done to identify other series with experience in implanting children with LVAS. RESULTS Full insertion of the electrode array was achieved in all our cases. After cochleostomy two patients experienced a mild CSF leak that was easily controlled by the muscle graft. On the first day post-operation two patients were nauseous and one had an episode of vomiting, however, all were discharged within 24 h of surgery. Initial outcome measures at 12 months post-implantation were encouraging showing significant progress in children's auditory skills. CONCLUSIONS The results of the present study and the review of the literature suggest that LVAS is not a contraindication to implantation as initial concerns about severe perilymph leaks and surgical complications have proved to be unfounded. The post-operative progress of these children in listening skills also suggest that these children are suitable for cochlear implantation
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Affiliation(s)
- C P Fahy
- Department of Otorhinolaryngology, Head and Neck Surgery, Queen's Medical Centre, NG7-2UH, Nottingham, UK.
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