Safety and Early Outcomes of Cochlear Implantation of Nucleus Devices in Infants: A Multi-Centre Study.

This multi-center study examined the safety and effectiveness of cochlear implantation of children between 9 and 11 months of age. The intended impact was to support practice regarding candidacy assessment and prognostic counseling of pediatric cochlear implant candidates. Data in the clinical chart of children implanted at 9-11 months of age with Cochlear Ltd devices at five cochlear implant centers in the United States and Canada were included in analyses. The study included data from two cohorts implanted with one or two Nucleus devices during the periods of January 1, 2012-December 31, 2017 (Cohort 1, n = 83) or between January 1, 2018 and May 15, 2020 (Cohort 2, n = 50). Major adverse events (requiring another procedure/hospitalization) and minor adverse events (managed with medication alone or underwent an expected course of treatment that did not require surgery or hospitalization) out to 2 years post-implant were monitored and outcomes measured by audiometric thresholds and parent-reports on the IT-MAIS and LittlEARS questionnaires were collected. Results revealed 60 adverse events in 41 children and 227 ears implanted (26%) of which 14 major events occurred in 11 children; all were transitory and resolved. Improved hearing with cochlear implant use was shown in all outcome measures. Findings reveal that the procedure is safe for infants and that they show clear benefits of cochlear implantation including increased audibility and hearing development.

The Effect of Bimodal Hearing on Postoperative Quality of Life.

INTRODUCTION: The aim of this study was to examine how bimodal stimulation affects quality of life (QOL) during the postoperative period following cochlear implantation (CI). These data could potentially provide evidence to encourage more bimodal candidates to continue hearing aid (HA) use after CI. METHODS: In this prospective study, patients completed preoperative and 1-, 3-, and 6-month post-activation QOL surveys on listening effort, speech perception, sound quality/localization, and hearing handicap. Fifteen HA users who were candidates for contralateral CI completed the study (mean age 65.6 years). RESULTS: Patients used both devices at a median rate of 97%, 97%, and 98% of the time at 1, 3, and 6 months, respectively. On average, patients' hearing handicap scores decreased by 16% at 1 month, 36% at 3 months, and 30% at 6 months. Patients' listening effort scores decreased by a mean of 10.8% at 1 month, 12.6% at 3 months, and 18.7% at 6 months. Localization significantly improved by 24.3% at 1 month and remained steady. There was no significant improvement in sound quality scores. CONCLUSION: Bimodal listeners should expect QOL to improve, and listening effort and localization are generally optimized using CI and HA compared to CI alone. Some scores improved at earlier time points than others, suggesting bimodal auditory skills may develop at different rates.

Auditory brainstem implantation: surgical experience and audiometric outcomes in the pediatric population.

OBJECTIVE: Pediatric data regarding treatment via an auditory brainstem implant (ABI) remains sparse. The authors aimed to describe their experience at their institution and to delineate associated demographic data, audiometric outcomes, and surgical parameters. METHODS: An IRB-approved, retrospective chart review was conducted among the authors' pediatric patients who had undergone auditory brainstem implantation between 2012 and 2021. Demographic information including sex, age, race, coexisting syndrome(s), history of cochlear implant placement, average duration of implant use, and follow-up outcomes were collected. Surgical parameters collected included approach, intraoperative findings, number of electrodes activated, and complications. RESULTS: A total of 19 pediatric patients had an ABI placed at the authors' institution, with a mean age at surgery of 4.7 years (range 1.5-17.8 years). A total of 17 patients (89.5%) had bilateral cochlear nerve aplasia/dysplasia, 1 (5.3%) had unilateral cochlear nerve aplasia/dysplasia, and 1 (5.3%) had a hypoplastic cochlea with ossification. A total of 11 patients (57.9%) had a history of cochlear implants that were ineffective and required removal. The mean length of implant use was 5.31 years (0.25-10 years). Two patients (10.5%) experienced CSF-related complications requiring further surgical intervention. The most recent audiometric outcomes demonstrated that 15 patients (78.9%) showed improvement in their hearing ability: 5 with sound/speech awareness, 5 able to discriminate among speech and environmental sounds, and 5 able to understand common phrases/conversation without lip reading. Nine patients (47.4%) are in a school for the deaf and 7 (36.8%) are in a mainstream school with support. CONCLUSIONS: The authors' surgical experience with a multidisciplinary team demonstrates that the retrosigmoid approach for ABI placement in children with inner ear pathologies and severe sensorineural hearing loss is a safe and effective treatment modality. Audiometric outcome data showed that nearly 79% of these patients had an improvement in their environmental and speech awareness. Further multicenter collaborations are necessary to improve these outcomes and potentially standardize/enhance electrode placement.

Early cochlear implantation for children with single sided deafness.

OBJECTIVES: Single-sided deafness (SSD) can have consequences for a child's language, educational, and social development. A cochlear implant (CI) is the only device which can restore true binaural hearing, yet they are only approved for children with (SSD) over the age of five in the United States. Reports on speech perception outcomes for children implanted at a younger age are limited. The present study aims to examine the effects of age at implantation, duration of deafness, hearing loss etiology, and presence of additional disabilities on device usage and speech perception outcomes. METHODS: A retrospective chart review was used to examine demographics and speech perception outcomes for 18 children implanted at age five or younger. RESULTS: Speech perception results were highly variable, with some children deriving significant benefit and others demonstrating no sound awareness through the implant alone. Age at implantation and duration of deafness did not have a clear impact on outcomes. Device usage was low in many children, often those with anatomical abnormalities such as a hypoplastic cochlear nerve. There are challenges to assessing speech perception in young children with SSD, leading to a lack of standardized outcome measures. CONCLUSIONS: Early CI for children with SSD may improve speech perception, but benefit is not guaranteed. Candidacy evaluation should consider both medical and audiological factors, in addition to the degree of family support and realistic expectations. Caution is especially warranted in children with significant anatomical anomalies.

Cochlear Implantation in Children Under 9 Months of Age: Safety and Efficacy.

OBJECTIVE: To assess the safety of cochlear implants (CIs) in children under 9 months of age to better understand expected postoperative complication rates, and to provide a preliminary look at efficacy. STUDY DESIGN: Single-center retrospective review. SETTING: Tertiary referral center. PATIENTS: Children 5 to 8 months of age who received a CI between 2011 and 2021. INTERVENTIONS: Therapeutic-CI. MAIN OUTCOME MEASURES: The primary outcome was 6-month postoperative complication rate. Secondary outcomes included length of stay, device explantation/reimplantation, rehabilitation supports, and hearing and language outcomes. Complications of children implanted under than 9 months of age was compared with a cohort of children implanted 9 to 18 months of age between the years 2011 and 2016 using a chi-squared test ( p < 0.05). RESULTS: One hundred six children under 9 months of age were implanted (204 CIs) at a mean age of 6.6 months (range: 5-8). Postoperative complications occurred in 28 patients (26%) and were often minor. There were no mortalities. There was no statistically significant difference in complications, including reimplantation rates, between patients implanted under 9 months of age and those implanted 9 to 18 months of age. Speech discrimination outcomes were excellent, and mean spoken language outcomes were near normative for typically developing children. CONCLUSIONS: Cochlear implantation can be a safe and effective treatment option for children 5 to 8 months of age. Early hearing screening and referral for infants to receive appropriate intervention will continue to play a critical role in optimizing speech and language outcomes.

Cochlear implants: the effects of age on outcomes.

INTRODUCTION: Cochlear implants (CIs) provide access to sound for children and adults who do not receive adequate benefit from hearing aids. Age at implantation is known to affect outcomes across the lifespan. AREAS COVERED: The effects of age on CI outcomes are examined for infants, children, adolescents, and older adults. A variety of outcome measures are considered, including speech perception, language, cognition, and quality of life measures. EXPERT OPINION/COMMENTARY: For those meeting candidacy criteria, CIs are beneficial at any age. In general, younger age is related to greater benefit when considering pre-lingual deafness. Other factors such as additional disabilities, may mitigate this effect. Post-lingually deafened adults demonstrate similar benefit regardless of age, though the oldest individuals (80+) may see smaller degrees of improvement from preoperative scores. Benefit can be measured in many ways, and the areas of greatest benefit may vary based on age: young children appear to see the greatest effects of age at implantation on language measures, whereas scores on cognitive measures appear to be most impacted for the oldest population. Future research should consider implantation at extreme ages (5-9 months or > 90 years), unconventional measures of CI benefit including qualitative assessments, and longitudinal designs.

Ceiling effects for speech perception tests in pediatric cochlear implant users.

OBJECTIVES: The purpose of this study was to determine the prevalence of ceiling effects for commonly used speech perception tests in a large population of children who received a cochlear implant (CI) before the age of four. A secondary goal was to determine the demographic factors that were relevant for predicting which children were more likely to reach ceiling level performance. We hypothesize that ceiling effects are highly prevalent for most tests. DESIGN: Retrospective chart review of children receiving a CI between 2002 and 2014. RESULTS: 165 children were included. Median scores were above ceiling levels (≥90% correct) for the majority of speech perception tests and all distributions of scores were highly skewed. Children who were implanted earlier, received two implants, and were oral communicators were more likely to reach ceiling-level performance. Age and years of CI listening experience at time of test were negatively correlated with performance, suggesting a non-random assignment of tests. Many children were re-tested on tests for which they had already scored at ceiling. CONCLUSIONS: Commonly used speech perception tests for children with CIs are prone to ceiling effects and may not accurately reflect how a child performs in everyday listening situations.

Acceptance and Benefit of Electroacoustic Stimulation in Children.

OBJECTIVE: Children with high-frequency severe-to-profound hearing loss and low-frequency residual hearing who do not derive significant benefit from hearing aids are now being considered for cochlear implantation. Previous research shows that hearing preservation is possible and may be desirable for the use of electroacoustic stimulation (EAS) in adults, but this topic remains underexplored in children. The goal of this study was to explore factors relating to hearing preservation, acceptance, and benefits of EAS for children. STUDY DESIGN: Retrospective review. SETTING: Tertiary academic medical center. PATIENTS: Forty children (48 ears) with preoperative low-frequency pure-tone averages of 75 dB HL or less at 250 and 500 Hz (n = 48). INTERVENTION: All patients underwent cochlear implantation with a standard-length electrode. MAIN OUTCOME MEASURE: Low-frequency audiometric thresholds, speech perception, and EAS usage were measured at initial stimulation, and 3 and 12 months postoperatively. Outcomes were compared between children with and without hearing preservation, and between EAS users and nonusers. RESULTS: Hearing was preserved at similar rates as adults but worse for children with an enlarged vestibular aqueduct. Fewer than half of children who qualified to use EAS chose to do so, citing a variety of audiologic and nonaudiologic reasons. No differences were detected in speech perception scores across the groups for words, sentences, or sentences in noise tests. CONCLUSIONS: Neither hearing preservation nor EAS use resulted in superior speech perception in children with preoperative residual hearing; rather, all children performed well after implantation.

HiRes ultra series cochlear implant field recall: failure rates and early outcomes.

OBJECTIVE: Evaluate rates of Advanced Bionics Ultra 3D/Ultra cochlear implant failure in the setting of a worldwide device recall and report surgical and auditory outcomes after revision. METHODS: Retrospective chart review was performed for adult and pediatric patients implanted with at risk devices at our center from 2016 to 2020. Device failure rates, surgical, and auditory outcomes were recorded and analyzed. RESULTS: Of 113 at-risk devices, 20 devices (17.7%) in 18 patients (two bilaterally implanted) were identified as failures. All devices were with mid-scala electrodes. Eleven patients (61.1%) were children and 7 (38.9%) adults. Twelve patients were found to have failing devices after reporting subjective performance decline; the remainder were prompted by manufacturer notification. All were revised, with the majority (83.3%) choosing the same manufacturer. All had uncomplicated original and revision insertions. Among adults, average word scores on the revised side were stable pre- to post-revision (P = 0.95). DISCUSSION: Patients with device failure due to this field action performed well after revision implantation. Patients with bilateral at-risk devices but evidence of unilateral failure may elect to undergo simultaneous empiric revision of the contralateral device. Three patients who elected to change device manufacturers on revision have variable results that require further investigation. CONCLUSIONS: Patients requiring revision for a device field action overall perform well. At-risk devices continue to require monitoring as a growing number are likely to fail over time.

The Frailty Phenotype in Older Adults Undergoing Cochlear Implantation.

OBJECTIVE: To prospectively evaluate the frailty phenotype in a population of older adults and determine its association with 1) perioperative complications, 2) need for vestibular rehabilitation after surgery, and 3) early speech perception outcomes. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary care hospital. PATIENTS: Adults older than 65 years undergoing cochlear implantation. INTERVENTIONS: The Fried Frailty Index was used to classify patients as frail, prefrail, or not frail based on five criteria: 1) gait speed, 2) grip strength, 3) unintentional weight loss, 4) weekly physical activity, and 5) self-reported exhaustion. MAIN OUTCOMES MEASURES: Rates of intraoperative and postoperative complications, postoperative falls, need for vestibular rehabilitation, and early speech perception outcomes. RESULTS: Forty-six patients were enrolled in this study. Five patients (10.8%) were categorized as frail and 10 (21.7%) as prefrail. The mean ages of frail, prefrail, and not frail patients were 80.9, 78.8, and 77.5, respectively. There were no intraoperative complications among all groups. Three patients required postoperative vestibular rehabilitation; all were not frail. One postoperative fall occurred in a nonfrail individual. Mean (standard deviation) device use times at 3 months in frail, prefrail, and not frail patients were 7.6 (3.5), 11.1 (3.6), and 11.6 (2.9) hours per day, respectively. Consonant-nucleus-consonant word scores 3 months after surgery in frail, prefrail, and not frail patients were 13% (12.2), 44% (19.7), and 51% (22.4), respectively. The median (range) number of missed follow-up visits (surgeon, audiologist, speech language pathologist combined) was 7 (1-10) in frail patients, compared with a median of 3 (0-4) and 2 (0-5) in prefrail and not frail patients. CONCLUSIONS: Frail patients did not have increased rates of surgical complications, need for vestibular rehabilitation, or postoperative falls. However, frail patients experienced challenges in accessing postoperative care, which may be addressed by using remote programming and rehabilitation.

Predictive Value of Transimpedance Matrix Measurements to Detect Electrode Tip Foldover.

OBJECTIVE: To evaluate the ability of the transimpedance matrix (TIM) measurement to detect cochlear implant electrode tip foldover by comparing results to a "gold standard," the intraoperative plain film radiograph. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral hospital. PATIENTS: One hundred three patients who underwent cochlear implantation between June 2020 and August 2021. INTERVENTIONS: Intraoperative electrophysiologic monitoring (electrode impedances, neural response telemetry, and TIM measurement) and modified Stenver's view plain film radiographs. MAIN OUTCOME MEASURES: Identification of tip foldover on both TIM and plain films. RESULTS: In total, 103 patients (117 ears) had both a TIM measurement and intraoperative X-ray available for review, including 68 adults and 35 children. One hundred patients (85%) received the Cochlear Slim Modiolar electrode. Tip foldovers were noted in three of 117 implants (2.5%). In all cases, TIM was able to detect the foldover, and the electrode arrays were reinserted with the patients still under anesthesia, with repeat X-ray demonstrating a normal configuration. Two other abnormal TIM patterns were identified. One was in a patient with an obstructed cochlea in whom only 10 electrodes could be inserted, the other was in a patient with a common cavity abnormality. One additional patient underwent electrode repositioning intraoperatively because of overinsertion. In this patient, the TIM appeared to be within normal limits, but the over-insertion was apparent on X-ray. Overall, the sensitivity and specificity of TIM measurements in detecting electrode tip foldover were both 100%. CONCLUSION: TIM measurements were able to accurately identify tip foldovers. More research is needed to define the adjunctive role of TIM as an intraoperative measure.

Cochlear implantation outcomes in the older adult: a scoping review.

OBJECTIVES: The current study aimed to identify and map the available evidence surrounding cochlear implantation (CI) in older adults. Five outcomes were evaluated: speech perception scores, perioperative complications, neurocognitive outcomes, quality of life outcomes and vestibular dysfunction and fall rates after surgery. METHODS: A scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews and included patients over the age of 60. RESULTS: Ninety-seven studies met inclusion criteria, encompassing 7,182 patients. Mean (SD) speech perception scores in quiet and in noise pre-and postoperatively were 7.9% (6.7) and 52.8% (14.3) and 8.0% (68.1) and 68.1% (15.9) respectively. Postoperative cardiac arrhythmias, urinary retention, and delirium occurred slightly more frequently in older adults. In terms of cognition, most studies noted stability or improvement one year after implantation. A majority of studies indicated better quality of life post-CI. Rates of fall after surgery were rarely reported, and there was a general paucity of data surrounding vestibular function changes after CI. DISCUSSION: This scoping review identifies many positive outcomes linked to CI in older adults. No findings suggest a single patient characteristic that would warrant refusal to consider evaluation for cochlear implantation.

Cochlear Implants in Veterans: 10-Year Experience at a Single Referral Center.

PURPOSE: Severe hearing loss is particularly prevalent among Veterans. In response, the Veterans Affairs (VA) provides hearing aids and cochlear implants as part of their comprehensive hearing loss treatment. The VA's national health care system and integrated electronic health records offer a unique opportunity to examine patterns and outcomes in the management of severe hearing loss. METHOD: We retrospectively reviewed an urban VA center's database for all Veterans who underwent cochlear implantation between 2010 and 2019. We collected preoperative demographic and audiological data including cochlear implant outcomes. RESULTS: During the study period, 61 Veterans received a cochlear implant, totaling 70 ears implanted. Median age at implantation was 70.2 years. Over 90% of Veterans reported preoperative hearing aid use, and median preoperative four-frequency pure-tone average and aided word recognition score in the ear to be implanted were 100 dB HL and 7%, respectively. The median onset of severe hearing loss bilaterally was over 4 years prior to cochlear implant evaluation based on available audiometric data. Postoperative word recognition score was negatively correlated with self-reported duration of hearing loss. CONCLUSIONS: This study provides unique insights into how Veterans with severe hearing loss are managed at one VA center. Compared to data published on cochlear implant recipients in the civilian population, Veterans in this cohort were older and had higher rates of preoperative hearing aid use. Available VA data suggest most Veterans were appropriate candidates for cochlear implant referral years prior to undergoing an evaluation. Reasons for treatment delays in this population remain to be studied.

Cochlear Implant Outcomes in CHARGE Syndrome: Updated Perspectives.

OBJECTIVE: To evaluate outcomes of auditory implants in children with CHARGE syndrome and describe the evolution in management of hearing loss in this complex population. METHODS: A retrospective case review was performed at a tertiary referral center. Children with CHARGE syndrome who received either a cochlear implant (CI) or auditory brainstem implant (ABI) were included. Clinical records, demographic information, CHARGE features, neuroimaging, audiology, hearing rehabilitation interventions, operative notes, and outcomes were reviewed. RESULTS: Thirteen children with CHARGE syndrome underwent a total of 19 cochlear implants between 2008 and 2020. Among the congenitally deafened children (n = 9), six underwent bilateral implantation (five simultaneous and one sequential). Bilateral implantation was performed even in the presence of diminutive-appearing cochlear nerves. The average age of implantation was 1.1 years, and the mean device use time was 9.4 hours per day. Patients showed improvements in subjective family assessment related to hearing. In this group, two patients use oral communication, five use total communication, and two use sign language exclusively. Among the children with progressive hearing loss, the mean age of hearing deterioration was 4.4 years of age, and the device use time on average was 9.8 hours per day. The highest performer in the cohort was a child who lost hearing in their only hearing ear at age 4 and had normal cochleovestibular anatomy on that side. One child received an auditory brainstem implant at age two after deriving no benefit from a CI and can detect environmental sounds but is currently a nonuser. Over time, we noted that implantation occurred earlier in life and that practice has shifted toward bilateral implantation. CONCLUSIONS: Compared to a previous institutional cohort, children evaluated in this study were often implanted at a younger age and bilaterally with significantly improved outcomes. A CI evaluation should be considered in children with CHARGE syndrome to maximize sensory input and auditory ability.

Stimulating the Cochlear Apex Without Longer Electrodes: Preliminary Results With a New Approach.

OBJECTIVE: To investigate a new surgical and signal processing technique that provides apical stimulation of the cochlea using a cochlear implant without extending the length of the electrode array. PATIENTS: Three adult patients who underwent cochlear implantation using this new technique. INTERVENTIONS: The patients received a cochlear implant. The surgery differed from the standard approach in that a ground electrode was placed in the cochlear helicotrema via an apical cochleostomy rather than in its typical location underneath the temporalis muscle. Clinical fitting was modified such that low frequencies were represented using the apically placed electrode as a ground. MAIN OUTCOME MEASURES: Pitch scaling and speech recognition. RESULTS: All surgeries were successful with no complications. Pitch scaling demonstrated that use of the apically placed electrode as a ground lowered the perceived pitch of electric stimulation relative to monopolar stimulation. Speech understanding was improved compared with preoperative scores. CONCLUSIONS: The new surgical approach and clinical fitting are feasible. A lower pitch is perceived when using the apically placed electrode as a ground relative to stimulation using an extracochlear ground (i.e., monopolar mode), suggesting that stimulation can be provided more apically without the use of a longer electrode array. Further work is required to determine potential improvements in outcomes and optimal signal processing for the new approach.

Delayed cochlear implantation in congenitally deaf children-identifying barriers for targeted interventions.

OBJECTIVES: Age of cochlear implantation (CI) is an important predictor of language development in those with congenital sensorineural hearing loss. Despite universal newborn hearing screening initiatives and the known benefits of early CI, a subset of congenitally deaf children continue to be evaluated for cochlear implants later in childhood. This study aims to identify the barriers to early cochlear implantation in these children. METHODS: A retrospective review was conducted for all pediatric cochlear implants aged 3 years or older performed at a single academic institution between 2013 and 2017. Children implanted before the age three, those with a prior unilateral cochlear implant, and those with progressive or sudden hearing loss were excluded. Variables included newborn hearing screen results, age at hearing loss diagnosis, time of initiation and documented benefit of hearing aids, age of implantation, pre/post-implantation evaluation scores, and reason for delayed referral for cochlear implantation. RESULTS: Thirty-one patients were identified meeting these inclusion criteria. Twenty-one children were subject to UNBS in the U.S. Fourteen of those children failed their newborn hearing screening. Average age at implantation was 6.2 years. Four reasons were identified for increased age at cochlear implantation. Two categories represent delays related to (1) Amplification continually prescribed even though the range of hearing loss and speech development assessment suggests CI may have been more appropriate well before referral (N = 13) (2) Patients were not subject to newborn hearing screening and/or timely diagnosis of their hearing loss (N = 8). In other cases, patients were appropriately fit with hearing aids until evidence that they derived limited benefit and then referred for CI (N = 8). Lastly, in a few cases, records were indeterminate with regards to the timing and appropriate diagnosis of their hearing loss (N = 2). CONCLUSION: Understanding the reasons for delayed cochlear implantation in congenitally deaf children might allow the development of targeted interventions to improve outcomes. Specifically, those children who were not referred before age 3 despite use of amplification with limited benefit offer one potential target population for earlier CI.

Cochlear Implantation in Infants: Why and How.

In children with congenital deafness, cochlear implantation (CI) prior to 12 months of age offers the opportunity to foster more typical auditory development during late infancy and early childhood. Recent studies have found a positive association between early implantation and expressive and receptive language outcomes, with some children able to achieve normal language skills by the time of school entry. Universal newborn hearing screening improved early detection and diagnosis of congenital hearing loss, allowing for earlier intervention, including decision-making regarding cochlear implant (CI) candidacy. It can be more challenging to confirm CI candidacy in infants; therefore, a multidisciplinary approach, including objective audiometric testing, is recommended to not only confirm the diagnosis but also to counsel families regarding expectations and long-term management. Surgeons performing CI surgery in young children should consider both the anesthetic risks of surgery in infancy and the ways in which mastoid anatomy may differ between infants and older children or adults. Multiple studies have found CI surgery in infants can be performed safely and effectively. This article reviews current evidence regarding indications for implantation in children younger than 12 months of age and discusses perioperative considerations and surgical technique.

Cochlear Implantation in Infants: Evidence of Safety.

The aim of this study was to investigate surgical, anesthetic, and device-related complications associated with cochlear implantation (CI) in children younger than 1 year of age. This was a multicenter, retrospective chart review of all children with severe-to-profound sensorineural hearing loss who underwent cochlear implantation with a Cochlear Nucleus Implant System before 1 year of age. Endpoints included perioperative course, major and minor surgical, anesthetic and device-related complications, and 30-day readmission rates. One hundred thirty-six infants (242 ears) met criteria. The mean age at implantation was 9.4 months (standard deviation 1.8). Six-month follow-up was reported in all patients. There were no major anesthetic or device-related complications. Adverse events were reported in 34 of implanted ears (14%; 7 major, 27 minor). Sixteen adverse events occurred ≤30 days of surgery, and 18 occurred >30 days of surgery. The 30-day readmission rate was 1.5%. The rate of adverse events did not correlate with preexisting medical comorbidities or duration under anesthesia. There was no significant difference detected in complication rate for patients younger than 9 months of age versus those 9 to 11 months of age. This study demonstrates the safety of CI surgery in infants and supports reducing the indication for cochlear implantation to younger than 1 year of age for children with bilateral, profound sensorineural hearing loss obtaining a Cochlear Nucleus Implant System.

Outcomes of cochlear implantation in adults over 85 years of age.

AIM: Untreated hearing loss is risk factor for dementia, depression and falls in the elderly population. The present study evaluated the outcomes of cochlear implantation in adults over age 85, including surgical outcomes, speech perception, and implant use. METHODS: Retrospective chart review of 78 patients implanted at a tertiary academic medical center. Co-morbidities, pre-operative hearing thresholds and speech perception scores at 4 time points (pre-operative, and 3 months, 1, 2, and 3 years post-operatively) were collected from charts. Linear mixed models were used to account for missing data points. RESULTS: Medical comorbidities such as hypertension (56%) and heart disease (53%) were common. Surgical complications were rare (5% or less) and minor. Local anesthesia was used for 71% of study patients implanted in the last three years. Significant improvements were seen for speech perception scores on monosyllabic words (37 percentage points), sentences in quiet (45 percentage points) and sentences in noise (28 percentage points). These improvements remained stable to at least two years post-activation. Seventy-one percent of patients wore their implant full time. CONCLUSION: Cochlear implantation is safe and effective for very elderly adults. The use of local anesthesia may increase adoption of cochlear implantation and thus improve the quality of life for this population.

Cochlear Implantation in Adults With Single-sided Deafness: Outcomes and Device Use.

OBJECTIVE: To describe our experience with adults undergoing cochlear implantation (CI) for treatment of single-sided deafness (SSD). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Fifty-three adults with SSD. INTERVENTIONS: Unilateral CI. MAIN OUTCOME MEASURES: Speech perception testing in quiet and noise, tinnitus suppression, and device usage from datalogs. RESULTS: The mean age at CI was 53.2 years (SD 11.9). The mean duration of deafness was 4.0 years (SD 7.8). The most common etiology was idiopathic sudden SNHL (50%). Word recognition improved from 8.7% (SD 15) preoperatively to 61.8% (SD 20) at a mean follow-up of 3.3 years (SD 1.8) (p < 0.0001). Adaptive speech recognition testing in the "binaural with CI" condition (speech directed toward the front and noise toward the normal hearing ear) revealed a significant improvement by 2.6-dB SNR compared to the preoperative unaided condition (p = 0.0002) and by 3.6-dB SNR compared to when a device to route sound to the contralateral side was used (p < 0.0001). Tinnitus suppression was reported to be complete in 23 patients (43%) and improved in 20 patients (38%) while the device was on. The addition of the CI did not lead to a decrement in hearing performance in any spatial configuration. Device usage averaged 8.7 (SD 3.7) hours/day. CONCLUSIONS: Cochlear implantation in adult SSD patients can suppress tinnitus and achieve speech perception outcomes comparable with CI in conventional candidates. Modest improvements in spatial hearing were also observed and primarily attributable to the head shadow effect. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.