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The clinical aspects and implications of hearing loss in adults are presented, along with the current criteria for cochlear implantation. Modern cochlear-implant surgery and its pros and cons are described, as are the anticipated long-term outcomes. A video shows the device technology and the steps involved in cochlear-implant surgery in adults.

Purpose The study aims to assess the benefit of sequential bilateral cochlear implantation in children with congenital bilateral profound hearing loss, submitted to the first implant at an early age. Methods We enrolled all the bilateral sequential cochlear implanted children who received the first implant within 48 months and the second within 12 years of age at our Institution. The children were submitted to disyllabic word recognition tests and Speech Reception Threshold (SRT) assessment using the OLSA matrix sentence test with the first implanted device (CI1), with the second implanted device (CI2), and with both devices (CIbil). Furthermore, we measured the datalogging of both devices. Then we calculated the binaural SRT gain (b-SRTgain) and checked the correlations between speech perception results and the b-SRTgain with the child’s age at CI1 and CI2, DELTA and the datalogging reports. Results With the bilateral electric stimulation, we found a significant improvement in disyllabic word recognition scores and in SRT. Moreover, the datalogging showed no significant differences in the time of use of CI1 and CI2. We found significant negative correlations between speech perception abilities with CI2 and age at CI2 and DELTA, and between the SRT with CI1 and the b-SRTgain. Conclusions From this study we can conclude that in a sequential CI procedure, even if a short inter-implant delay and lower ages at the second surgery can lead to better speech perception with CI2, children can benefit from bilateral stimulation independently of age at the second surgery and the DELTA.

The electrical signal processing of cochlear implants (CIs) is thought to partially explain the unnatural and unfamiliar sound impressions in recipients. To date, there are no accurate German-language sound samples available that represent how CI users perceive their CIs. The primary aim of this study was to create German-language sound samples for the sound of Cochlear Nucleus implants (Cochlear Ltd., Sydney, Australia). Furthermore, we investigated whether the simulation parameters best matched for one sentence were also accurate approximations of the CI sound when applied to two further sentences spoken by the same male speaker. Fifteen patients with single-sided deafness who had at least two years of experience with their CI were included in this study. The participants rated ten simulations based on the similarity to the sound perceived with their devices. The simulation with the best similarity score served as the starting point for optimization using a software sound-tool. On average, a score of 9.7 ± 0.5 on a scale of 1 (no similarity) to 10 (signals are identical) was achieved for the optimized simulations. Most often, a low-pass filter or a comb filter was required to optimize the simulation. The sound samples optimized for each study participant are provided in the Supplemental Material. When the parameters of the optimized simulation were applied to two further sentences (variable in content and phonemes), the similarity scores were significantly worse (mean sentence 2: 8.4 ± 1.5, Z  = 3.015, p  = 0.003, mean sentence 3: 8.9 ± 1.3, sign test: Z  = 2.268, p  = 0.048). However, when the similarity scores were considered individually for each participant, there were 4 (sentence 2) or 7 (sentence 3) participants, respectively, for whom the speech material had no influence on the similarity score.

Background During the cochlear implantation procedure, the receiver/stimulator (R/S) part of the implant is fixated to prevent postoperative device migration, which could have an adverse effect on the position of the electrode array in the cochlea. We aim to compare the migration rates of two fixation techniques, the bony recess versus the subperiosteal tight pocket without bony sutures. Methods and analysis This single-blind randomized controlled trial will recruit a total of 112 primary cochlear implantation adult patients, eligible for implantation according to the current standard of practice. Randomization will be performed by an electronic data capture system Castor EDC, with participants block randomized to either bony recess or standard subperiosteal tight pocket in a 1:1 ratio, stratified by age. The primary outcome of this study is the R/S device migration rate; secondary outcomes include patient-experienced burden using the validated COMPASS questionnaire, electrode migration rate, electrode impedance values, speech perception scores, correlation between R/S migration, electrode array migration and patient complaints, assessment of complication rates, and validation of an implant position measurement method. Data will be collected at baseline, 1 week, 4 weeks, 8 weeks, 3 months, and 12 months after surgery. All data analyses will be conducted according to the intention-to-treat principle. Discussion Cochlear implantation by means of creating a tight subperiosteal pocket without drilling a bony seat is a minimally invasive fixation technique with many advantages. However, the safety of this technique has not yet been proven with certainty. This is the first randomized controlled trial that directly compares the minimally invasive technique with the conventional method of drilling a bony seat. Trial registration Netherlands Trial Register NL9698. Registered on 31 August 2021.

Purpose The purpose of this study was to compare the language, cognitive, and speech in noise (SiN) perception abilities of children with cochlear implants (CIs) to those of their peers with NH by grouping them according to their implantation period (12–18 months/19–24 months) and unilateral/bilateral CI use. Methods The sample comprised 50 children with cochlear implants (CIs) and 20 children with normal hearing (NH), ages 6–9 years. Children’s language, cognitive, and speech in noise (SiN) perception skills were assessed. Results Children with CIs between 12 and 18 months and 19 and 24 months performed more poorly than children with NH on language, verbal memory (VM), verbal-short-term memory (V-STM), verbal working memory (V-WM), rapid naming, and speech in noise (SiN) perception abilities measures ( p  < 0.001). In addition, children with CIs between 19 and 24 months performed worse on rapid naming and V-WM tasks than children with CIs between 12 and 18 months ( p  < 0.017). Children with unilateral and bilateral CI performed more poorly than children with NH on language, VM, V-STM, V-WM, rapid naming, and SiN perception abilities assessments ( p  < 0.001). Additionally children with unilateral CI users performed poorly than children with bilateral CI users on SiN perception ( p  < 0.017). Conclusions In children with congenital hearing loss (CHL), cochlear implantation between 12 and 18 months or sequential bilateral implantation is not sufficient for these children to perform like their NH peers in language, cognitive, and SiN perception abilities. In addition, intervention approaches should focus not only on increasing language skills, but also on cognitive abilities.

Cochlear implants (CIs) are considered the most successful neuroprosthesis as they enable speech comprehension in the majority of half a million CI users suffering from sensorineural hearing loss. By electrically stimulating the auditory nerve, CIs constitute an interface re‐connecting the brain and the auditory scene, providing the patient with information regarding the latter. However, since electric current is hard to focus in conductive environments such as the cochlea, the precision of electrical sound encoding—and thus quality of artificial hearing—is limited. Recently, optogenetic stimulation of the cochlea has been suggested as an alternative approach for hearing restoration. Cochlear optogenetics promises increased spectral selectivity of artificial sound encoding, hence improved hearing, as light can conveniently be confined in space to activate the auditory nerve within smaller tonotopic ranges. In this review, we discuss the latest experimental and technological developments of cochlear optogenetics and outline the remaining challenges on the way to clinical translation. Graphical Abstract In this review, A. Dieter, D. Keppeler and T. Moser summarize the state of the art and progresses made in optical cochlear implantation using ontogenetic technology and discuss the challenges for translation into patients with hearing loss.

Background Electrode migration has been identified as a complication primarily related to straight electrodes. To address this issue, the use of a fixation clip has been suggested as an alternative to stabilize the electrode lead and reduce the risk of migration. Methods A modified approach to the standard fixation clip procedure is introduced. Steps and technical considerations are presented in the video attached. Conclusions This novel configuration offers enhanced fixation of the electrode array without requiring additional surgical time and without posing any additional risk to the facial nerve.

When it was first developed, the cochlear implant was hailed as a \"miracle cure\" for deafness. That relatively few deaf adults seemed to want it was puzzling. The technology was then modified for use with deaf children, 90 percent of whom have hearing parents. Then, controversy struck as the Deaf community overwhelmingly protested the use of the device and procedure. For them, the cochlear implant was not viewed in the context of medical progress and advances in the physiology of hearing, but instead represented the historic oppression of deaf people and of sign languages. Part ethnography and part historical study,The Artificial Earis based on interviews with researchers who were pivotal in the early development and implementation of the new technology. Through an analysis of the scientific and clinical literature, Stuart Blume reconstructs the history of artificial hearing from its conceptual origins in the 1930s, to the first attempt at cochlear implantation in Paris in the 1950s, and to the widespread clinical application of the \"bionic ear\" since the 1980s.

Background Hearing loss significantly impacts health-related quality of life (QoL), yet the effects of current treatments on QoL utility remain uncertain. Our objective was to describe the impact of untreated and treated hearing loss on QoL utility to inform hearing healthcare policy. Methods We searched databases for articles published through 02/01/2021. Two independent reviewers screened for articles that reported elicitation of general QoL utility values for untreated and treated hearing loss health states. We extracted data and quality indicators from 62 studies that met the inclusion criteria. Results Included studies predominately used observational pre/post designs (61%), evaluated unilateral cochlear implantation (65%), administered the Health Utilities Index 3 (HUI3; 71%), and were conducted in Europe and North America (84%). In general, treatment of hearing loss improved post-treatment QoL utility when measured by most methods except the Euro-QoL 5 dimension (EQ-5D). In meta-analysis, hearing aids for adult mild-to-moderate hearing loss compared to no treatment significantly improved HUI3-estimated QoL utility (3 studies; mean change=0.11; 95% confidence interval (CI): 0.07 to 0.14) but did not impact EQ-5D-estimated QoL (3 studies; mean change=0.0; 95% CI: −0.03 to 0.04). Cochlear implants improved adult QoL utility 1-year post-implantation when measured by the HUI3 (7 studies; mean change=0.17; 95% CI: 0.11 to 0.23); however, pediatric VAS-estimated QoL utility was non-significant (4 studies; mean change=0.12; 95% CI: −0.02 to 0.25). The quality of included studies was limited by failure to report missingness of data and low survey response rates. Our study was limited by heterogeneous study populations and designs. Findings Treatment of hearing loss significantly improves QoL utility, and the HUI3 and VAS were most sensitive to improvements in hearing. Improved access to hearing healthcare should be prioritized. Systematic Review Registration PROSPERO: CRD42021253314

Objective: To update a 15-year-old study of 800 postlinguistically deaf adult patients showing how duration of severe to profound hearing loss, age at cochlear implantation (CI), age at onset of severe to profound hearing loss, etiology and CI experience affected CI outcome. Study Design: Retrospective multicenter study. Methods: Data from 2251 adult patients implanted since 2003 in 15 international centers were collected and speech scores in quiet were converted to percentile ranks to remove differences between centers. Results: The negative effect of long duration of severe to profound hearing loss was less important in the new data than in 1996; the effects of age at CI and age at onset of severe to profound hearing loss were delayed until older ages; etiology had a smaller effect, and the effect of CI experience was greater with a steeper learning curve. Patients with longer durations of severe to profound hearing loss were less likely to improve with CI experience than patients with shorter duration of severe to profound hearing loss. Conclusions: The factors that were relevant in 1996 were still relevant in 2011, although their relative importance had changed. Relaxed patient selection criteria, improved clinical management of hearing loss, modifications of surgical practice, and improved devices may explain the differences.