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Single-sided deafness (SSD) leads to difficulties with speech perception in noise, sound localisation, and sometimes tinnitus. Current treatments (Contralateral Routing of Sound hearing aids (CROS) and Bone Conduction Devices (BCD)) do not sufficiently overcome these problems. Cochlear implants (CIs) may help. Our aim was to evaluate these treatments in a Randomised Controlled Trial (RCT). Adult SSD patients were randomised using a web-based randomisation tool into one of three groups: CI; trial period of ‘first BCD, then CROS’; trial period of ‘first CROS, then BCD’. After these trial periods, patients opted for BCD, CROS, or No treatment. The primary outcome was speech perception in noise (directed from the front (S 0 N 0 )). Secondary outcomes were speech perception in noise with speech directed to the poor ear and noise to the better ear (S pe N be ) and vice versa (S be N pe ), sound localisation, tinnitus burden, and disease-specific quality of life (QoL). We described results at baseline (unaided situation) and 3 and 6 months after device activation. 120 patients were randomised. Seven patients did not receive the allocated intervention. The number of patients per group after allocation was: CI (n = 28), BCD (n = 25), CROS (n = 34), and No treatment (n = 26). In S 0 N 0 , the CI group performed significantly better when compared to baseline, and when compared to the other groups. In S pe N be , there was an advantage for all treatment groups compared to baseline. However, in S be N pe , BCD and CROS groups performed worse compared to baseline, whereas the CI group improved. Only in the CI group sound localisation improved and tinnitus burden decreased. In general, all treatment groups improved on disease-specific QoL compared to baseline. This RCT demonstrates that cochlear implantation for SSD leads to improved speech perception in noise, sound localisation, tinnitus burden, and QoL after 3 and 6 months of follow-up. For most outcome measures, CI outperformed BCD and CROS. Trial registration: Netherlands Trial Register ( www.trialregister.nl ): NTR4580 , CINGLE -trial.

Purpose The aim of this study was to compare the outcomes of different mapping procedures based on anatomic or default frequency distribution in postlingual deafness adults who underwent cochlear implantation (CI). Methods Forty-eight adults with postlingual deafness who underwent CI (MED-EL) from January 2021 to May 2022 in our hospital were prospectively recruited. The participants were randomly assigned to two groups (the anatomic group and the default group). Postoperative computerized tomography (CT) scans were evaluated with Otoplan ® to determine the angular insertion depth (AID) and the specific locations of the intracochlear electrodes. Anatomic maps were imported into MAESTRO 9.0 software (MED-EL) for anatomy-based fitting for anatomic group, while default mapping program was set up for the default group. Hearing thresholds, Speech Recognition Scores (SRS), and subjects’ auditory and musical abilities were evaluated 1 year after using the CI. Differences were determined in two groups using Stata statistical software, with significance defined as p  < 0.05. Results SRS under noisy conditions was significantly greater for anatomic group than the default group ( p  = 0.02). Under quiet conditions, however, mean hearing thresholds (0.5, 1, 2, and 4 kHz) and SRS did not differ significantly between the two groups ( p  = 0.07). Modified questionnaires showed that auditory ( p  = 0.02) and musical ( p  = 0.01) quality were significantly better following the anatomic mapping than the default procedure. Conclusion CI program based on the anatomic distribution may bring better SRS under noise conditions as well as better auditory and musical qualities than based on the default frequency distribution.

Objective To investigate the hypothesis that day-case cochlear implantation is associated with equal quality of life, hearing benefits and complications rates, compared to inpatient cochlear implantation. Study design A single-center, non-blinded, randomized controlled, equivalence trial in a tertiary referral center. Methods Thirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group. The effect on general quality of life, patient satisfaction, (subjective) hearing improvement, postoperative complications and causes of crossover and/or readmission were assessed using questionnaires, auditory evaluations and patients’ charts over a follow-up period of 1 year. Results Overall quality of life measured by the HUI3 was equal between the day-case ( n  = 14) and inpatient group ( n  = 14). The overall patients’ satisfaction showed a slight favor towards an inpatient approach. There was no significant difference in the subjective and objective hearing improvement between both treatment groups. During the 1-year follow-up period no major complications occurred. Minor complications occurred intraoperatively in three day-case patients resulting in three out of nine admissions of day-case patients. Other causes of admission of day-case patients were nausea and vomiting ( n  = 1), drowsiness ( n  = 1), late scheduled surgery ( n  = 2), social reasons ( n  = 1), or due to an unclear reason ( n  = 1). No patients required readmission. Conclusion We found equal outcomes of QoL, patient satisfaction, objective, and subjective hearing outcomes between day-case and inpatient unilateral cochlear implantation. Nine out of 14 day-case patients were admitted for at least one night postoperatively (crossover). No major complications occurred in both groups. A day-case approach seems feasible when using specific patient selection, surgical planning and the preoperative provision of patient information into account. Besides this, the familiarity with a day-case approach of both patient and the surgical team can increase the feasibility of day-case surgery. Level of evidence 1.

Introduction Real-time visualization of intraoperative electrocochleography (ECochG) potentials via a digital microscope during cochlear implantation can provide direct feedback during electrode insertion. The aim of this prospective, randomized study of 50 patients was to obtain long-term data with a focus on residual hearing preservation and speech understanding. Material and methods Cochlear implantations were performed in 50 patients (26 female, 24 male) with residual hearing using a digital microscope. Patients were randomized into two groups. Intraoperative ECochG potentials were either displayed directly in the surgeon’s field of view (picture-in-picture display, PiP) or not directly in the field of view (without picture-in-picture display, without PiP). Residual hearing preservation and speech comprehension were recorded within a 1-year follow-up period, compared between groups (PiP versus without PiP) and to a control group of 26 patients implanted without ECochG. Results Mean insertion time was significantly longer in the picture-in-picture group ( p =  0.025). Residual hearing preservation after 6 weeks at 250 Hz was significantly better in the picture-in-picture group ( p =  0.017). After one year, 76% of patients showed residual hearing in the picture-in-picture group (62% without picture-in-picture technique, p =  n.s.). Use of the picture-in-picture technique resulted in better long-term pure tone residual hearing preservation at 250, 500, and 1000 Hz. Speech intelligibility improved by 46% in the picture-in-picture group (38% without picture-in-picture). Discussion This study is the first to describe long-term results in a large cohort of cochlear implant patients in whom digital visualization of intraoperative ECochG was used. Our results show that visualization of intraoperative ECochG has a positive effect on residual hearing preservation.

Objective To investigate the assumption that day-case cochlear implantation is associated with lower costs, compared to inpatient cochlear implantation, while maintaining equal quality of life (QoL) and hearing outcomes, for the Dutch healthcare setting. Study design A single-center, non-blinded, randomized controlled trial in a tertiary referral center. Methods Thirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group (i.e., one night admission). We performed an intention-to-treat evaluation of the difference of the total health care-related costs, hospital and out of hospital costs, between day-case and inpatient cochlear implantation, from a hospital and patient perspective over the course of one year. Audiometric outcomes, assessed using CVC scores, and QoL, assessed using the EQ-5D and HUI3 questionnaires, were taken into account. Results There were two drop-outs. The total health care-related costs were €41,828 in the inpatient group ( n  = 14) and €42,710 in the day-case group ( n  = 14). The mean postoperative hospital stay was 1.2 days (mean costs of €1,069) in the inpatient group and 0.7 days (mean costs of €701) for the day-case group. There were no statistically significant differences in postoperative hospital and out of hospital costs. The QoL at 2 months and 1 year postoperative, measured by the EQ-5D index value and HUI3 showed no statistically significant difference. The EQ-5D VAS score measured at 1 year postoperatively was statistically significantly higher in the inpatient group (84/100) than in the day-case group (65/100). There were no differences in postoperative complications, objective hearing outcomes, and number of postoperative hospital and out of hospital visits. Conclusion A day-case approach to cochlear implant surgery does not result in a statistically significant reduction of health care-related costs compared to an inpatient approach and does not affect the surgical outcome (complications and objective hearing measurements), QoL, and postoperative course (number of postoperative hospital and out of hospital visits). Level of evidence 1.

Objective To evaluate the impact of dexmedetomidine (Dex) on agitation and inflammatory response during recovery from anesthesia in young children following cochlear implantation surgery. Methods We randomly divided 80 children who underwent unilateral cochlear implantation into two equal groups. Group D received an intravenous infusion of Dex after induction of anesthesia, while those in group C received an equal volume of saline infusion. The mean arterial pressure (MAP) and heart rate (HR) of children in the two groups were recorded at four different time intervals: before induction of anesthesia (T 0 ); 30 min after intravenous infusion of Dex (T 1 ); upon admission to the post-anesthesia care unit (PACU) (T 2 ); and at the time of being transferred out of the PACU (T 3 ). At T3, we also recorded general information. Results The MAP and HR in group D showed more consistent trends during the anesthesia recovery period when compared to those in group C. Children in group D had a significantly lower crying, requires increased O 2 administration, increased vital signs, expression and sleepless score (CRIES score), pediatric anesthesia emergence delirium (PAED) score, and incidence of agitation than in group C ( P  < 0.01). The rate of supplementary pain relief for the children was lower in group D than in group C ( P  < 0.01). At T 3 , serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were lower in children in group D than in group C ( P  < 0.01). Compared to T 0 , the levels of serum IL-6 and TNF-α were higher in both groups at T 3 ( P  < 0.01). Conclusion We found that the use of Dex helped reduce the occurrence and severity of agitation during anesthesia recovery in children after cochlear implantation surgery and improved postoperative inflammatory reactions. Clinical registration number Registration website: https://www.chictr.org.cn/searchproj.html . Registration number ChiCTR2400080937.

Objective The aim of the present study is to evaluate the effect of electrode discrimination based on electrode to modiolus distance in different cochlear implant models, using image information to estimate the outcomes after an implantation on electrode discrimination Methods A descriptive prospective randomized study performed during 16 months. A psychoacoustic platform was used to evaluate patients’ electrode discrimination capabilities of patients. For the acquisition of the images, a cone beam computed tomography was used to assess postcochlear implantation of electrodes’ position. We considered two other new measurements: the intracochlear position index, which indicates how far is the electrode from the modiolar wall, and the homogeneity factor (HF), which provides us with information about the distance between the electrodes and the modiolus Results 21 postlingually deaf adults showing different CI models [CI522 ( n  = 7), CI512 ( n  = 7), and CI532 ( n  = 7)] that corresponded to the lateral and perimodiolar array electrodes. The average success rate of the CI522 group was 47%, of the CI512 group was 48%, and of the CI532 group was 77%. There is statistically significant difference between groups CI532–CI522 ( p  = 0.0033) and CI532–CI512 ( p  = 0.0027) Conclusion The Nucleus CI532 offers a better perimodiolar placement. HF and IPI measurements provide information about the electrodes location inside the cochlea, being related to electrode discrimination.

Objective To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery. Study design Double-blind, prospective, randomized clinical trial. Setting: tertiary referral center. Intervention(s) On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases ( n : 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls ( n : 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated. Main outcome measure(s) Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam. Results The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compared to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap. Conclusions This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.

Purpose The traditional fitting method for cochlear implants (CI), the single-channel fitting (SCF), is effective but time-consuming. A fitting method that is significantly faster to perform, but provides at least equivalent speech understanding and subjective benefit would be of clinical usefulness. The study explored the ability of flat strategy-based fitting (FSBF) maps to fill this need. Methods Participants were 16 experienced CI users. They were fit with: SCF maps; the maps that the participants used in their everyday lives, called fine-tuned clinical (FTC) maps; and FSBF maps. The fittings were assessed objectively via speech understanding in noise, time needed to create the map, deviation from FTC map, and correlation between auditory response telemetry thresholds and normalized charge levels; and subjectively via spectral balance and hearing quality. Results FSBF maps were significantly faster to generate. FTC maps provided the best subjective hearing quality. In all other assessments, no significant differences were found. Discussion FSBF maps can save time and provide CI users with the same level of speech understanding in noise. Participants may have preferred the FTC maps that they were already acclimated to them. These results suggest that the FSBF method could be used in first-fittings or in challenging fitting situations, but subsequent fine-tuning is required in follow-up appointments to improve sound quality. Conclusion The FSBF method can be a useful and time-saving alternative fitting method in first-fittings or in challenging fitting situations.

Purpose The objectives of this study are to evaluate cochlear implant (CI) listeners’ ability to infer low frequency (LF) pitch information from temporal fine structure (TFS) cues and to gain insight into its effects on speech perception, especially in the presence of a fluctuating background noise. Pitch perception assessment using linguistic stimuli is believed to better reflect the role of pitch in communicatively realistic situations. Methods The low-pass-filtered sentence intonation (SI-LPF) test based on linguistic stimuli marked by intonation changes is used to estimate a difference limen for discrimination of LF pitch changes in adult CI listeners ( N  = 17 ears). Speech perception in the presence of noise is assessed using the sentence test with adaptive randomized roving level (STARR), where everyday sentences are presented at low, medium, and high levels in a fluctuating background noise. SI-LPF correlations with STARR are compared to those with sentence recognition tests presented in quiet (SRQ) and in noise, using fixed signal-to-noise ratio (SNRs at +10 and +5 dB). Results SI-LPF findings show significant positive correlations with STARR performance ( r s  = 0.63, p  = 0.007), whilst the associations with SRQ ( r s  = − 0.37, p  = 0.149), SNR + 10 ( r s  = − 0.24, p  = 0.345), and SNR + 5 ( r s  = − 0.14, p  = 0.587) are not statistically significant. Conclusions Present findings reflecting considerably stronger correlations than previous studies using non-linguistic stimuli, in particular for speech perception with roving-level adaptive test method (STARR) highlight the effects of LF pitch perception and TFS sensitivity on challenging everyday situations, where CI users listen to speakers with varying levels in a fluctuating background.