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Cochlear Implantation in Adults
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.
Journal Article
Made to hear : Cochlear implants and raising deaf children
\"A mother whose child has had a cochlear implant tells Laura Mauldin why enrollment in the sign language program at her daughter's school is plummeting: \"The majority of parents want their kids to talk.\" Some parents, however, feel very differently, because \"curing\" deafness with cochlear implants is uncertain, difficult, and freighted with judgment about what is normal, acceptable, and right. Made to Hear sensitively and thoroughly considers the structure and culture of the systems we have built to make deaf children hear.Based on accounts of and interviews with families who adopt the cochlear implant for their deaf children, this book describes the experiences of mothers as they navigate the health care system, their interactions with the professionals who work with them, and the influence of neuroscience on the process. Though Mauldin explains the politics surrounding the issue, her focus is not on the controversy of whether to have a cochlear implant but on the long-term, multiyear undertaking of implantation. Her study provides a nuanced view of a social context in which science, technology, and medicine are trusted to vanquish disability--and in which mothers are expected to use these tools. Made to Hear reveals that implantation has the central goal of controlling the development of the deaf child's brain by boosting synapses for spoken language and inhibiting those for sign language, placing the politics of neuroscience front and center.Examining the consequences of cochlear implant technology for professionals and parents of deaf children, Made to Hear shows how certain neuroscientific claims about neuroplasticity, deafness, and language are deployed to encourage compliance with medical technology. \"-- Provided by publisher.
Book
Health service use, health outcomes and treatment costs of adults with a cochlear implant: a retrospective cohort study
Background
Data about the ongoing health service use, health outcomes and healthcare treatment costs of adult cochlear implant users are limited. This study examined health service use, health outcomes and treatment costs of adults who had a cochlear implant.
Methods
This was a retrospective cohort study of adults aged ≥ 18 years who received a cochlear implant during 2011–2021. Linked hospitalisation, non-admitted patient (NAP) services and mortality data in New South Wales (NSW), Australia were used. Health service use, health outcomes and treatment costs were compared for younger (18–64 years) and older (≥ 65 years) adults. A negative binomial regression model was used to examine factors associated with hospitalisation and health outcomes.
Results
There were 3071 adults who had a cochlear implant; 47.6% aged 18–64 years and 52.4% aged ≥ 65 years. Older adults had a higher proportion of all-cause hospital admissions (34.1% vs. 18.4%, respectively), readmission within 28 days (7.8% vs. 4.7%, respectively), ≥ 13 NAP service contacts (33.9% vs. 24.9%, respectively) and mean treatment costs (AUD$44,101 vs. AUD$41,663, respectively) than younger adults. Charlson comorbidities and mental health disorders were key predictors of both hospitalisations and NAP service contacts for younger adults. Postoperative mechanical complications and prior hospital admissions were predictors of hospitalisation and NAP service contacts, respectively for younger adults. Having ≥13 NAP service contacts and a cochlear implant removed were predictors of hospitalisation and NAP service contacts, respectively for older adults. Having a longer hospital length of stay (LOS) was associated with cochlear implant removal, treatment cost, and other health conditions for both younger and older adults.
Conclusions
Adults with multimorbidity used more hospital-based services or incurred large treatment costs. Early detection and treatment of comorbidities and long-term post-cochlear implant follow-up to identify any potential complications may reduce unplanned hospitalisations, adverse health outcomes, and associated hospital utilisation costs.
Journal Article
The importance of electrode location in cochlear implantation
Objectives
As indications for cochlear implantation have expanded to include patients with more residual hearing, increasing emphasis has been placed on minimally traumatic electrode insertion. Histopathologic evaluation remains the gold standard for evaluation of cochlear trauma, but advances in imaging techniques have allowed clinicians to determine scalar electrode location in vivo. This review will examine the relationship between scalar location of electrode arrays and audiologic outcomes. In addition, the impact that surgical approach, electrode design, and insertion depth have on scalar location will be evaluated.
Data Sources: PubMed literature review
Review Methods: A review of the current literature was conducted to analyze the relationship between scalar location of cochlear implant electrode arrays and speech perception outcomes. Further, data were reviewed to determine the impact that surgical variables have on scalar electrode location.
Results
Electrode insertions into the scala tympani are associated with superior speech perception and higher rates of hearing preservation. Lateral wall electrodes, and round window/extended round window approaches appear to maximize the likelihood of a scala tympani insertion. It does not appear that deeper insertions are associated with higher rates of scalar translocation.
Conclusion
Superior audiologic outcomes are observed for electrode arrays inserted entirely within the scala tympani. The majority of clinical data demonstrate that lateral wall design and a round window approach increase the likelihood of a scala tympani insertion.
Level of Evidence
N/A.
Journal Article
Trends in pediatric cochlear implants: The dual impact of COVID-19 and Lebanon’s crisis
Hearing loss is a major public health issue globally, especially in low- and middle-income countries (LMICs), where access to cochlear implants (CIs) is restricted by cost and limited healthcare infrastructure. In Lebanon, the 2020 economic crisis and the COVID-19 pandemic further reduced access to essential services, including pediatric CIs.
This study assesses the impact of the 2020 Lebanese economic crisis on the number and funding sources of pediatric CI surgeries.
A retrospective review was conducted on 228 pediatric patients who underwent 235 CI surgeries between 2017 and 2023. The number of surgeries and funding sources were compared before and after the 2020 crisis. Funding categories included government, private insurance, donations, or a combination. Data were analyzed using R software.
There was no significant difference in the number of surgeries before (113) and after (122) the crisis (p = 0.56). However, a marked shift in funding occurred. Government-funded procedures dropped from 45.87% to 12.61% (p < 0.001), while private and donation-based funding rose from 32.11% to 66.39% (p < 0.001). The mean age at surgery declined from 5.86 to 3.57 years post-crisis (p < 0.05), indicating greater awareness of early intervention benefits.
Despite economic hardship, the demand for pediatric CIs persisted, with families turning to private and charitable sources. Enhanced government support and the classification of CIs as essential health services are vital. Early diagnosis and intervention should be prioritized to improve outcomes in children with hearing loss.
Journal Article
The Artificial Ear
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.
eBook
A Novel Method for Clinical Cochlear Duct Length Estimation toward Patient-Specific Cochlear Implant Selection
Objective
In the field of cochlear implantation, the current trend toward patient-specific electrode selection and the achievement of optimal audiologic outcomes has resulted in implant manufacturers developing a large portfolio of electrodes. The aim of this study was to bridge the gap between the known variability of cochlea length and this electrode portfolio.
Design
Retrospective analysis on cochlear length and shape in micro–computed tomography and cone beam computed tomography data.
Setting
Tertiary care medical center.
Subjects and Methods
A simple 2-step approach was developed to accurately estimate the individual cochlear length as well as the projected length of an electrode array inside the cochlea. The method is capable of predicting the length of the cochlea and the inserted electrode length at any specific angle. Validation of the approach was performed with 20 scans of human temporal bones (micro–computed tomography) and 47 pre- and postoperative clinical scans (cone beam computed tomography).
Results
Mean ± SD absolute errors in cochlear length estimations were 0.12 ± 0.10 mm, 0.38 ± 0.26 mm, and 0.71 ± 0.43 mm for 1, 1.5, and 2 cochlea turns, respectively. Predicted insertion angles based on clinical cone beam computed tomography data showed absolute deviations of 27° ± 18° to the corresponding postoperative measurements.
Conclusion
With accuracy improvements of 80% to 90% in comparison with previously proposed approaches, the method is well suited for the use in individualized cochlear implantation.
Journal Article
The Electrically Evoked Compound Action Potential: From Laboratory to Clinic
The electrically evoked compound action potential (eCAP) represents the synchronous firing of a population of electrically stimulated auditory nerve fibers. It can be directly recorded on a surgically exposed nerve trunk in animals or from an intra-cochlear electrode of a cochlear implant. In the past two decades, the eCAP has been widely recorded in both animals and clinical patient populations using different testing paradigms. This paper provides an overview of recording methodologies and response characteristics of the eCAP, as well as its potential applications in research and clinical situations. Relevant studies are reviewed and implications for clinicians are discussed.
Journal Article
Revealing intracochlear microtrauma during cochlear implantation using optical coherence tomography and electrochemical sensing
Cochlear implants (CIs) are a highly effective treatment for severe to profound hearing loss, and earlier implantation is associated with improved auditory outcomes. As implantation is now extended to patients with residual hearing, preserving cochlear structures during surgery is a key priority. However, implant insertion trauma remains a risk and can compromise residual hearing. Currently, intraoperative methods capable of detecting such trauma in situ are lacking. We introduce a novel approach for in situ detection of intracochlear trauma using a gerbil model. Specifically, we use optical coherence tomography (OCT) in vivo to visualize structural damage, including basilar membrane ruptures and osseous spiral lamina fractures, and employ modified CI electrode arrays to sense hydrogen peroxide concentration, a marker of oxidative stress. Intracochlear trauma is validated and quantified using contrast-enhanced microcomputed tomography, enabling a novel trauma scale. Our results show that hydrogen peroxide levels are significantly correlated with the trauma scale and trauma volume. A receiver operating characteristic curve was established for the detection of intracochlear trauma, highlighting the sensor’s diagnostic potential. These results show that combining in vivo OCT imaging with electrochemical sensing effectively detects intracochlear trauma, laying the foundation for next-generation CIs with real-time monitoring during implantation.
Journal Article