The Effects of Gusher-Related Intracochlear Pressure Changes on Hearing Preservation in Cochlear Implantation: A Comparative Series.

AIM: To investigate and compare residual hearing preservation between patients based on the presence of intraoperative gusher. METHODOLOGY: We retrospectively compared 2 cohorts of cochlear implant recipients significantly distinguished by whether or not they experienced gusher intraoperatively. Patients underwent cochlear implantation using 24-mm lateral wall electrode arrays as well pharmacologic steroid protection. All patients were assessed by a hearing implant MDT. Hearing preservation rates and speech perception outcomes were assessed at 1, 6, 12, 24, 36, 48, and 60 months. RESULTS: The patients with no gusher demonstrated complete hearing preservation. The patients with gusher demonstrated significant postoperative reduction of hearing thresholds, which declined at a significantly higher pace during follow-up. All patients demonstrated significantly better speech performance after cochlear implantation. CONCLUSION: The present study suggests that intraoperative gusher is associated with a significant drop in residual hearing, both immediately and over time, which may be related to the large change in intracochlear pressure intraoperatively.

Cochlear implantation for unilateral deafness with and without tinnitus: a case series.

OBJECTIVES/HYPOTHESIS: To investigate cochlear implantation (CI) in patients with unilateral deafness with and without tinnitus. STUDY DESIGN: Prospective case series of patients undergoing cochlear implantation for unilateral deafness and tinnitus in a tertiary academic unit. METHODS: Nine postlingually deafened subjects with unilateral hearing loss, with and without tinnitus ipsilaterally, and functional hearing in the contralateral ear were implanted with a standard electrode. Speech perception in noise was tested using the Bamford-Kowal-Bench presented at 65 dB SPL. The Speech, Spatial, and Qualities (SSQ) of Hearing Scale was used to evaluate the subjective perception of hearing outcomes, and the Tinnitus Reaction Questionnaire assessed the effect on tinnitus. RESULTS: All patients were implanted with the Med-El Flex soft electrode, Innsbruck, Austria. They are regularly wearing the speech processor and find it beneficial in improving their ability to hear, particularly in noise. Decrease of tinnitus perception and an improvement of sound localization sounds were also reported by these patients. CONCLUSION: In our case series, CI was successful for all nine patients, with improvement of speech recognition in noise, self-perceived improvement of hearing, and for tinnitus control. Several factors such as deafness duration, age of deafness onset, the presence of residual hearing, patient motivation, and the rehabilitation intensity need to be further investigated in order to understand their impact on performance after implantation. LEVEL OF EVIDENCE: 4.

Incomplete cochlear partition type II variants as an indicator of congenital partial deafness: a first report.

INTRODUCTION: The increased understanding on the impact of partial deafness (PD) with residual low-frequency hearing has led to new hearing rehabilitation strategies using hearing preservation techniques during cochlear implantation with the aim to make use of the combined electric acoustic stimulation (EAS) in the affected ear. As a first report, we describe minor forms of the incomplete cochlear partition type II (IP- II) involving the apical 1.5 turns, which were found in the majority of our patients presenting with congenital PD. We investigated the hearing preservation rates and hearing outcomes of these patients after EAS cochlear implantation (EAS-CI). MATERIALS AND METHODS: We present a review of a case series of 4 children and 1 adult with documented congenital PD. They all underwent audiologic and radiologic assessment for CI. Hearing preservation rates and speech perception outcomes were assessed at 1, 3, 6, 12, and 24 months after EAS-CI. RESULTS: Three (75%) of the 4 pediatric patients and 1 adult patient with congenital PD showed the pattern of isolated IP-II variants involving the apical 1.5 cochlear turns with a normal basal turn, without associated inner ear anomalies. Complete hearing was preserved in all patients. Speech performance improved significantly in all patients. CONCLUSION: As a first report, we describe minor IP-II variants identified in the majority of our patients with congenital PD; these IP-II variants could be useful as an indicator of malformation for congenital PD. Detection requires careful radiologic evaluation of the cochlea. EAS-CI is not a contraindication in these patients and should be considered early to prevent permanent speech and language deficits.

The role of preoperative, intratympanic glucocorticoids for hearing preservation in cochlear implantation: a prospective clinical study.

BACKGROUND: Hearing Preservation is becoming increasingly important in cochlear implantation as there is growing evidence that preserving the residual hearing, especially in the low frequencies in combination with the electric stimulation can significantly improve hearing and speech outcomes in noise. Besides the ongoing development of atraumatic implant electrodes and insertion techniques, the implementation of pharmacologic hair cell protection is thought to increase hearing preservation. This study investigates the effects of preoperative intratympanic glucocorticoid application on hearing preservation rates in cochlear implantation. STUDY DESIGN: Prospective interventional study. SETTING: Tertiary neurotology referral center. PATIENTS: Patients undergoing cochlear implantation with measurable preoperative hearing thresholds using either a Flex soft electrode or a Flex EAS electrode depending on the degree of residual low frequency hearing. INTERVENTION: Preoperative intratympanic steroid application during cochlear implantation via round window insertion. MAIN OUTCOME MEASURES: Level of hearing preservation after cochlear implantation; electrode- and frequency-specific hearing preservation rates. RESULTS: Preoperative hearing thresholds were comparable in the control group and the interventional Flex soft group (70.5 db±12.5 dB vs. 73.5 dB±10.5 dB, P=.27). As per selection criteria the low-frequency hearing thresholds were significantly lower in interventional Flex EAS groups when compared to the control group. Hearing preservation was significantly better in the interventional group with no case of complete hearing loss in this group (11 dB±2.5 dB vs. 19.5 dB 3.5 dB, P<.05). The interventional group displayed a higher stability of hearing preservation after implantation (r=.8, P=.03). Level of hearing preservation was higher when a specific hearing preservation electrode was used (r=.85, P<.05). Hearing preservation in the low frequencies was significantly higher than in the high frequencies. CONCLUSIONS: Our study suggests that the additional preoperative use of intratympanic glucocorticoids improves and stabilizes hearing preservations rates in round window cochlear implantation for adults and children with residual hearing.

Newborn hearing screening in Western Australia.

AIM: To report the preliminary findings of a pilot program to screen newborn babies for congenital bilateral permanent hearing loss. SETTING: The five largest maternity hospitals in Perth, Western Australia. Screening was gradually introduced over seven months from February to August 2000. PARTICIPANTS: All babies born at these hospitals after the introduction of hearing screening until 30 June 2001. METHODS: One or both of two automated screening devices were used: one measuring transient evoked otoacoustic emissions (TEOAE) and the other automated auditory brainstem responses (AABR). If a "pass" was not obtained in both ears, screening was repeated. All babies who did not obtain a pass in either ear at follow-up were referred for audiological assessment. MAIN OUTCOME MEASURES: Prevalence of permanent bilateral hearing loss. RESULTS: Of 13 214 eligible babies, 12 708 (96.2%) received screening. The main reason for missing screening was early hospital discharge (309; 2.3%). Of the screened babies, 99% had a pass response in both ears at either the initial or follow-up screen. Twenty-three babies were referred for audiological assessment, and nine were diagnosed with bilateral permanent hearing loss (0.68/1000; 95% CI, 0.31-1.28). CONCLUSIONS: Despite our program meeting process quality indicators, our detection rate was low. Before extending the program to smaller hospitals, we need to validate our screening instruments and put in place a system to monitor false negative results.