Outcome analysis of cochlear implant reimplantation in children.

OBJECTIVES: We review our experience gained in performing cochlear reimplantation in 25 children who have had multichannel cochlear implant device failure at the Cochlear Implant Center of the Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital (New York, NY), to assess the feasibility of cochlear reimplantation in children and the effect of reinsertion on audiological performance. STUDY DESIGN: We retrospectively analyzed the outcome of 27 consecutive multichannel cochlear implant reinsertions performed in 25 children at the Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital. These reimplantations were performed between 1990 and 1999, with a minimum follow-up of 6 months for both surgical and audiological performance. METHODS: Charts were reviewed for patient factors, findings at the time of initial operation and repeat operation, and results of audiological testing both before and after reimplantation. RESULTS: Surgical complications of reimplantation included two intraoperative cerebral spinal fluid leaks and two late postoperative flap breakdowns with implant extrusions. For the most part, depth of electrode insertion was unchanged. Open-set speech recognition scores and speech perception abilities remained stable or improved compared with results before reimplantation. CONCLUSION: Our results confirm that cochlear implant reimplantation is technically feasible and allows for continued auditory development for the child who has a cochlear implant device failure.

Auditory perceptual abilities in a child with a nucleus and a Clarion cochlear implant.

This case study will review the performance of a 7-year-old female who was implanted at the age of 3 years 9 months with a Nucleus 22 channel device. This child was deafened from pneumococcal meningis at the age of 8 months and was placed in an early intervention program which uses simultaneous communication (i.e. speech with sign language). The teaching staff of this particular educational setting has collaborated closely with the Cochlear Implant Center at Manhattan Eye, Ear and Throat Hospital and the team's teacher of the deaf. The child utilized the implant on a daily basis for a period of 2 years 10 months. Performance on a variety of auditory perceptual tests were obtained at 1 year and two year intervals. After almost 3 years of implant use, the child suffered an internal receiver failure. The Nucleus device was explanted and the child was implanted with a Clarion Cochlear Implant System. Performance on a similar set of auditory perceptual tests obtained after 3 and 6 months use indicated better performance with the Clarion device. In addition to the scores on the individual tests, a comparison questionnaire was used to obtain impressions from the parents and the school personnel. Results should be reviewed with caution since this study investigates the responses of a single child who uses each of these two different implants and cannot be generalized.

Surgical techniques for cochlear implantation in the very young child.

Early cochlear implantation to treat prelingually deafened children has been shown to improve speech perception and overall performance. The current age limit for implantation is 24 months in accordance with US Food and Drug Administration guidelines, but it is believed that earlier implantation is possible and may result in better performance. Implantation in children younger than 36 months, however, is complicated by the altered anatomy of the temporal bone in this young age group. We have developed specific modifications in the cochlear implantation technique for this young age group. This technique was used in implantation for 17 children younger than 36 months. The ages ranged from 16 to 36 months and averaged 30 months. All patients except one had complete electrode insertion without complication. The technique of cochlear implantation must be modified not only for differences in anatomy in these young children but also for the expected continued growth of the temporal bone and related structures. Cochlear implantation can be safely performed on children as young as 16 months.

Cochlear implant mechanical failures.

Cochlear implants have proven to be an effective treatment for profoundly deafened individuals. Unfortunately, like most mechanical devices, these implants occasionally cease to function. The rate at which the cochlear implant fails, however, does not appear to be the same in adults and children. The failure rate for children far exceeds that observed in adults. The overall failure rate reported by Cochlear Corporation notes that whereas only 3% of the adults have had this type of problem, 9% of the children have had failed internal receivers. This research reports on the experiences of a large implant facility in the Northeast. The clinical presentation and the evaluation of children suspected of having an implant failure are reviewed. The mechanical causes for failures are analyzed. Intraoperative findings and results of reimplantation surgery are presented. The possible causes for the increased incidence of failure in children are discussed.

Cochlear implant performance in a deaf child of deaf parents: a case study.

Marie represents a unique case in the population of cochlear implant users, in that she is from a family of deaf individuals. Her auditory perceptual performance after 2 years of implant use is commensurate with that of other children of similar ages and durations of deafness. Although her speech production performance is also not atypical, the special circumstances in the home might cause additional delay. Studies have traditionally shown that deaf children of deaf adults exhibit superior ability in both social and academic domains when compared to deaf children of hearing parents. The cochlear implant provides yet another tool to add to the already-identified advantage extended this group by their family circumstance. It is unfortunate that these children for whom the device can offer enhanced abilities may be the very children that are denied access to it by the deaf community.

Programming the cochlear implant based on electrical acoustic reflex thresholds: patient performance.

The electrical acoustic reflex threshold (EART) has been shown to be a reliable estimate of behavioral comfort levels in both child and adult cochlear implant patients. The purpose of this study was to investigate the potential for using EARTs for programming the Nucleus cochlear implant. EARTs and behavioral comfort levels were obtained from 7 adult implant patients. Two programs or "maps" were made for each patient, one based on behavioral comfort levels and one based on EARTs. Performance on open set tests of speech recognition was measured with each map. Mean data suggest that speech perception is similar with both maps. Analysis of individual data revealed that, whereas 2 subjects performed better with the C-level maps, the remaining 5 subjects tended to perform either better with the EART map or equally well with both maps. These results suggest that EARTs may be an adequate substitute for comfort levels when programming the implant for patients who are unable to make reliable psychophysical judgments.