RESUMO
We compared the effectiveness of 2 surgical interventions for improving word recognition ability in a quiet environment among patients who presented with: (1) bilateral, precipitously sloping, high-frequency hearing loss; (2) relatively good auditory thresholds at and below 500 Hz, and (3) poor speech recognition. In 1 intervention (n = 25), a conventional electrode array was inserted into 1 cochlea. As a consequence, hearing was lost in the implanted ear. In the other intervention (n = 22), a Nucleus Hybrid short-electrode array was inserted 10 mm into 1 cochlea with the aim of preserving hearing in that ear. Both groups of patients had similar low-frequency hearing and speech understanding in the ear contralateral to the implant. Following surgery, both groups had significantly higher word recognition scores than before surgery. Between-group comparisons indicated that the conventional electrode array group had higher word recognition scores than the 10-mm group when stimulation was presented to the operated ear and when stimulation was presented to both ears.
Assuntos
Limiar Auditivo , Cóclea/cirurgia , Implante Coclear , Surdez/cirurgia , Eletrocirurgia/métodos , Perda Auditiva de Alta Frequência/cirurgia , Reconhecimento Fisiológico de Modelo , Reconhecimento Psicológico , Acústica da Fala , Percepção da Fala , Estimulação Acústica , Humanos , Idioma , Percepção da Altura SonoraRESUMO
OBJECTIVE: To substantiate the benefits of hybrid cochlear implantation (CI) in patients with residual low-frequency hearing. STUDY DESIGN: Prospective study of patients in a manufacturer-sponsored clinical trial. SETTING: Independent referral center for CI. PATIENTS: Thirteen patients who met candidacy criteria for a hybrid CI. The 10 women and 3 men had a mean age of 51 years. INTERVENTION: Preoperative evaluation, CI with a Nucleus Hybrid cochlear implant, subsequent programming, and diagnostic testing. MAIN OUTCOME MEASURES: Benefits of high-frequency electrical stimulation from the hybrid CI as measured by conventional audiometry, consonant-nucleus-consonant monosyllabic word and Bamford-Kowal-Bench sentence in noise testing at quarterly intervals per protocol. RESULTS: Follow-up ranged from 3 to 24 months. All 13 patients had preserved hearing immediately postoperative. However, one lost residual hearing 7 days postoperatively, and 2 patients had delayed hearing losses at 2 and 24 months, the latter apparently due to barotrauma; however, this was not conclusive. Another had a bilateral symmetrically progressive hearing loss. Six patients showed changes in low-frequency hearing less than 10 dB; 2 showed changes in the range 11 to 20 dB; 2, 21 to 30 dB; and 3, more than 50 dB. Eleven of 13 had improved consonant-nucleus-consonant words ranging up to 83% when tested with hearing aid + CI in the operated ear. Four subjects exhibited improvement in Bamford-Kowal-Bench sentence in noise testing, although only one subject showed a significant decline associated with bilateral progression in hearing impairment. CONCLUSION: Combined electrical and acoustical hearing can result in significant improvement in speech understanding. Only one patient lost residual hearing as a direct result of surgery. Two others had delayed losses. There are no absolute predictive factors as to success with hybrid CI, just as there are none for conventional CI. Similarly, wide variation in results may occur. Further studies may clarify factors involved in such variation.
Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva de Alta Frequência/fisiopatologia , Perda Auditiva de Alta Frequência/cirurgia , Adulto , Idoso , Implante Coclear/efeitos adversos , Implantes Cocleares/efeitos adversos , Feminino , Seguimentos , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Percepção da Fala/fisiologia , Resultado do TratamentoRESUMO
OBJECTIVE: Limitations in biocompatibility and hearing improvement with ossicular chain reconstruction prostheses are addressed with new, lightweight titanium prostheses designed to maximize visualization of the capitulum and footplate regions. The effectiveness of these new prostheses is being tested in a prospective multicenter study. STUDY DESIGN: Prospective case series. SETTING: Multicenter (8 sites), primarily tertiary private practice or academic otologic clinics. PATIENTS: A convenience sample of 31 patients undergoing ossiculoplasty, with 16 partial ossicular chain reconstructions using the Bell prosthesis and 15 total reconstructions using the Aerial prosthesis. INTERVENTION: Ossiculoplasty using new Kurz titanium prostheses. Cartilage was interposed between the tympanic membrane and the prosthesis. MAIN OUTCOME MEASURES: Air-bone gap for pure tone average and 3,000 and 4,000 Hz, assessed preoperatively and 3 months, 6 months, and 12 months postoperatively; percent of patients obtaining an air-bone gap of =20 dB; high-frequency average (1,000, 2,000, and 4,000 Hz) to evaluate sensorineural hearing loss; and extrusion rate. RESULTS: A postoperative air-bone gap of =20 dB was obtained in 81% of Bell prosthesis patients and 67% of Aerial prosthesis patients at 3 months. The results were stable to improved for later time intervals. High-frequency gaps were similar to the pure tone average gap. To date, there have been no instances of extrusion, and all the surgeons found the prostheses easy to use and thought that the design characteristics facilitated accurate placement. CONCLUSIONS: Initial evaluation of the Kurz titanium prostheses produced low extrusion rates (none to date) with excellent hearing results, including good high-frequency conduction. Good visualization and accurate placement were easy to achieve. Further studies are needed to confirm long-term efficacy.