Audiological outcomes of cochlear implantation in Ramathibodi Hospital.

OBJECTIVE: To evaluate the outcomes of the patients at 1-year post cochlear implantation emphasized on audiological outcomes. MATERIALS AND METHOD: Retrospective study of hearing response follow in three, six, and 12 months of 143 ears undergoing cochlear implantation between 1995 and 2009. Only 77 ears were found to have the completed data for analysis. Deaf patients were categorized into five groups in which they were operated by four different cochlear implant devices. The two parameters used to evaluate the outcomes included the aided response (AR), assessing the hearing threshold of cochlear implant user; and the Categories of Auditory Performance (CAP) which assess their auditory receptive abilities. RESULTS: Demographic data showed male:female ratio was 4:3. Age ranged from 2 to 68 years. Although the aided hearing threshold among five groups of deafness showed improvement without statistical difference, the auditory ability showed significance higher score in post-lingual than pre-lingual deaf patients (p < 0.05). Patients with aural communication prior to surgery also showed higher auditory ability than those without aural communication (p < 0.05). The outcomes of CAP were analyzed among patients operated with different cochlear implant devices. Users with Pulsar CI 100 Opus 2, HiRes 90K Auria, and HiRes 90 K Harmony showed better auditory ability than with Combi 40+ Tempo+. Both mean scores of AR and CAP were higher at six and 12 months than at three months. At 12 months the scores were higher than at six months (p < 0.05). CONCLUSIONS: Cochlear implant surgery resulted in good hearing, however the improvement of speech understanding need more time to practice. Patients using cochlear implant at 12 months showed more improvement of hearing and performance than those using for less than 12 months.

Listening and speaking ability of Thai deaf children in preschool aural rehabilitation program.

BACKGROUND: An auditory-oral approach can help deaf children achieve success in oral communication. Many studies confirm that deaf children with access to sound through high-powered and appropriate hearing aids at the youngest age possible have the capability to acquire communication skills similar to their hearingpeers. OBJECTIVE: Evaluate the listening and speaking progress made by 27 Thai hearing-impaired children who attended a preschool aural rehabilitation program, which was established at Audiology and Speech clinic. After hearing aids fitting, deaf children were enrolled to the preschool aural rehabilitation program after receiving their parents consent. MATERIAL AND METHOD: Hearing impaired children were divided into groups of 4-6 children with approximately the same level of performance. The listening and speaking performance at the initial period were recorded. Each group participated in the 3-hour-program once a week, included auditory training, conversation (maternal reflexive method), and speech stimulation. The improvements and problems of each child were recorded at the end of session. Listening and speaking performance evaluation were recorded at six months intervals. RESULTS: There were 12 boys and 15 girls. The average hearing loss in the better ear was 104 dBHL, range from 83-117 dBHL, SD = 8.33. The mean age of enrollment was 2 years and 10 months. The majority gradually developed listening skills and speaking ability. There was no relationship between age of enrollment and the listening and speaking ability (p > 0.05). However, listening skills had positive relationship with length of speech (r = 0.685), number of spoken vocabulary (r = 0.665), and speech character (r = 0.598); p < 0.01. CONCLUSION: Auditory training is an important task to develop listening skills and improve length of speech, speaking vocabulary, and speech character Other benefits from the aural rehabilitation program included monitoring the auditory progression after hearing aid fitting, parents meeting, and promotion a better quality of life by enabling hearing impaired children to participate in hearing society.

Fourteen-years experience with cochlear implantation in Ramathibodi Hospital.

OBJECTIVE: To review the cochlear implant program in Ramathibodi Hospital and share experience of cochlear implantation emphasized on clinical and surgical outcomes. MATERIAL AND METHOD: Retrospective review of 143 ears (140 patients) operated with cochlear implant between 1995 and 2009. The demographic data including etiology of deafness and findings from temporal bone CTscans were reviewed. The authors' experience with cochlear implant surgery in terms of patient selection, patient advisory clinic, necessary equipment, pre- and postoperative evaluations, surgical techniques and complications were discussed. RESULTS: Most congenital origin was unknown etiology and congenital rubella was the most common known cause. From the CT scans of congenital deafness, vestibular aqueduct dilatation was the most common and found in 29.31% while Mondini malformation was shown to be 16.37%. The authors' surgical technique of using the pocket method and designed bony ridge at cortical mastoid rim had helped stabilizing the implant and electrode fancoil. During the last two years, no complication or revision surgery was detected. CONCLUSION: Cochlear implant surgery in both children and adults can result in good surgical outcome and fewer complications under experienced surgeons and a good team.

Low dose transtympanic gentamicin treatment for intractable Meniere's disease: a prospective study.

OBJECTIVE: To evaluate the effectiveness of low dose transtympanic gentamicin treatment in Meniere's disease. MATERIAL AND METHOD: Prospective study of 20 disable Meniere's patients in Ramathibodi Hospital who received transtympanic gentamicin treatment for Meniere's disease by fixed dose regimen of 12 injections during a period of 4 days. The study took place from March 1999 to December 2004. The hearing and equilibrium guidelines for reporting treatment results in Meniere's disease of the American Academy of Otolaryngology and Head & Neck Surgery (1995) were used. The outcomes of treatment were evaluated at the 6th month. The multivariate repeated measures ANOVA was used for statistical comparisons. RESULTS: During the 5-year period, there were 20 patients, 9 men, and 11 women. The six-month outcomes of vertigo control, the functional level scale and tinnitus score were significantly improved by the treatment. Whereas, the mid frequency pure tone threshold average and the speech discrimination score were not significantly affected. CONCLUSION: Fixed low dose transtympanic gentamicin treatment was found to be an effective treatment option for patients with disabling or intractable Meniere's disease, with a low incidence of hearing deterioration. The use of this method appears to be practical and has been set as the standard protocol replacing the vestibular surgery in Ramathibodi Hospital.

Transtympanic gentamicin treatment in Meniere's disease: a preliminary report.

OBJECTIVE: To evaluate the effectiveness of transtympanic gentamicin treatment in Meniere's disease. MATERIAL AND METHOD: The present study is a prospective study of 8 patients in Ramathibodi Hospital who had transtympanic gentamicin treatment of Meniere's disease by fixed dose regimen of 12 injections during a period of 4 days. The committee on hearing and equilibrium guidelines for reporting treatment results in Meniere's disease of the American Academy of Otolaryngology and Head & Neck Surgery (1995) were used. Paired t-test or Wilcoxon Signed Ranks Test was used for statistical comparisons. RESULTS: Among 8 patients, there were 2 males and 6 females. All patients (100%) had either complete (37.5%) or substantial (62.5%) control of vertigo. Disability was also improved in all of the subjects (100%). Tinnitus was improved in 62.5%. Their tinnitus score and functional level scale were much improved with statistical significance (p = 0.001, p < 0.005, respectively). Hearing was unchanged in 87.5% and slightly worse in 12.5%. This was not significant. CONCLUSION: Transtympanic gentamicin treatment was found to be an effective treatment option for patients with disabling or intractable Meniere's disease, with a low incidence of hearing loss. The use of this method appears to be practical and may replace the vestibular surgery.

Pediatric cochlear implantation: experience in Thai patients.

OBJECTIVE: This study was to evaluate the result of cochlear implantation in Thai pediatric patients from 1999-2003. DESIGN: A prospective, open-labeled study. SETTING: University teaching hospital. MATERIAL AND METHOD: Long term surgical and audiologic results comparison after cochlear implantation in 2 cases with Mondini anomality, 7 normal cochlea cases and a case of post meningitis post lingual child. MAIN OUTCOME MEASURES: Speech perception tests battery. RESULTS: Among 10 children, 8 were implanted with Nucleus 22/24; the other two were implanted with Med-el device system. The pre-operated cochlea in 2 cases showed Mondini deformity; both had gushers during the operation with a good outcome. The other 8 cases had normal cochlea although one was deaf from bacterial meningitis. There were 3 re-implantations. Speech production and perception was improved faster in the two children implanted with Med-el than those implanted with Nucleus devices. CONCLUSION: Cochlear implantation in Mondini cases can be successful in speech production and perception. Speech perception ability depended on the age of implantation and preoperative rehabilitation.