Search

Purpose: To study outcome after cochlear implantation using the Cochlear Implant (CI) outcome assessment protocol based on the International Classification of Functioning, Disability and Health (ICF) model (CI-ICF)., Methods: Raw data of a prospective, longitudinal, multicenter study was analyzed. Seventy-two CI candidates were assessed preoperatively and six months postoperatively using the CI-ICF protocol. Following tools were used: (1) Work Rehabilitation Questionnaire (WORQ), (2) Abbreviated Profile of Hearing Aid Benefit (APHAB), (3) Audio Processor Satisfaction Questionnaire (APSQ), (4) Speech, Spatial, and Qualities of Hearing Scale (SSQ12), (5) Hearing Implant Sound Quality Index (HISQUI19), (6) Nijmegen CI Questionnaire (NCIQ) (7) pure tone audiometry, (8) speech audiometry, (9) sound localization., Results: There was a significant improvement of speech discrimination in quiet (p = 0.015; p < 0.001) and in noise (p = 0.041; p < 0.001), sound detection (p < 0.001), tinnitus (p = 0.026), listening (p < 0.001), communicating with-receiving-spoken messages (p < 0.001), conversation (p < 0.001), family relationships (p < 0.001), community life (p = 0.019), NCIQ total score and all subdomain scores (p < 0.001). Subjective sound localization significantly improved (p < 0.001), while psychometric sound localization did not. There was no significant subjective deterioration of vestibular functioning and no substantial change in sound aversiveness. CI users reported a high level of implant satisfaction postoperatively., Conclusion: This study highlights the positive impact of cochlear implantation on auditory performance, communication, and subjective well-being. The CI-ICF protocol provides a holistic and comprehensive view of the evolution of CI outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Cochlear duct length (CDL) measurement plays a role in the context of individualized cochlear implant (CI) surgery regarding an individualized selection and implantation of the CI electrode carrier and an efficient postoperative anatomy-based fitting process. The level of detail of the preoperative temporal bone CT scan depends on the imaging modality with major impact on CDL measurements and CI electrode contact position determination. The aim of this study was to evaluate the accuracy of perioperative CDL measurements and electrode contact determination in photon-counting CT (PCCT)., Methods: Ten human fresh-frozen petrous bone specimens were examined with a first-generation PCCT. A clinically applicable radiation dose of 27.1 mGy was used. Scans were acquired before and after CI insertion. Postoperative measurement of the CDL was conducted using an otological planning software and 3D-curved multiplanar reconstruction. Investigation of electrode contact position was performed by two respective observers. Measurements were compared with a conventional multislice CT and to a high-resolution flat-panel volume CT with secondary reconstructions., Results: Pre- and postoperative CDL measurements in PCCT images showed no significant difference to high-resolution flat-panel volume CT. Postoperative CI electrode contact determination was also as precise as the flat-panel CT-based assessment. PCCT and flat-panel volume CT were equivalent concerning interobserver variability., Conclusion: CDL measurement with PCCT was equivalent to flat-panel volume CT with secondary reconstructions. PCCT enabled highly precise postoperative CI electrode contact determination with substantial advantages over conventional multislice CT scanners., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Hypothesis: Measurements of the cochlear duct length (CDL) are dependent on the resolution of the imaging dataset., Background: Previous research has shown highly precise cochlear measurements using 3D-curved multiplanar reconstruction (MPR) and flat-panel volume computed tomography (fpVCT). Thus far, however, there has been no systematic evaluation of the imaging dataset resolution required for optimal CDL measurement. Therefore, the aim of this study was to evaluate the dependence of CDL measurement on the resolution of the imaging dataset to establish a benchmark for future CDL measurements., Methods: fpVCT scans of 10 human petrous bone specimens were performed. CDL was measured using 3D-curved MPR with secondary reconstruction of the fpVCT scans (fpVCT SECO ) and increasing resolution from 466 to 99 μm. In addition, intraobserver variability was evaluated. A best-fit function for calculation of the CDL was developed to provide a valid tool when there are no measurements done with high-resolution imaging datasets., Results: Comparison of different imaging resolution settings showed significant differences for CDL measurement in most of the tested groups ( p < 0.05), except for the two groups with the highest resolution. Imaging datasets with a resolution lower than 200 μm showed lower intraobserver variability than the other resolution settings, although there were no clinically unacceptable errors with respect to the Bland-Altman plots. The developed best-fit function showed high accuracy for CDL calculation using resolution imaging datasets of 300 μm or lower., Conclusion: 3D-curved MPR in fpVCT with a resolution of the imaging dataset of 200 μm or higher revealed the most precise CDL measurement. There was no benefit of using a resolution higher than 200 μm with regard to the accuracy of the CDL measurement., Competing Interests: Conflicts of interest and source of funding: none., (Copyright © 2024, Otology & Neurotology, Inc.)

Background: The cochlear aqueduct (CA), which connects the scala tympani and the subarachnoid space, and its accompanying structures appear to have a significant relevance during cochlear implantation and an accurate visualization in clinical imaging is of great interest. Aims and Objective: This study aims to determine which potential and limitations clinically available imaging modalities have in the visualization of the CA. Methods: Micro-CT, flat-panel volume computed tomography with and without secondary reconstruction (fpVCT, fpVCTseco) and multislice computed tomography (MSCT) of 10 temporal bone specimen were used for 3D analysis of the CA. Results: FpVCTseco proved superior in visualizing the associated structures and lateral portions of the CA, which merge into the basal turn of the cochlea. All clinical imaging modalities proved equal in analyzing the length, total volume of the CA and its area of the medial orifice. Conclusion: The choice of the most accurate clinical imaging modality to evaluate the CA and its associated structures depends on the clinical or scientific question. Furthermore, this study should provide a basis for further investigations analyzing the CA.

Objectives: In cochlear implantation, preoperative prediction of electrode position has recently gained increasing attention. Currently, planning is usually done by multislice CT (MSCT). However, flat-panel volume CT (fpVCT) and its secondary reconstructions (fpVCT SECO ) allow for more precise visualization of the cochlea. Combined with a newly developed otological planning software, the position of every single contact can be effectively predicted. In this study it was investigated how accurately radiological prediction forecasts the postoperative electrode localization and whether higher image resolution is advantageous., Methods: Utilizing otological planning software (OTOPLAN®) and different clinical imaging modalities (MSCT, fpVCT and fpVCT SECO ) the electrode localization [angular insertion depth (AID)] and respective contact frequencies were predicted preoperatively and examined postoperatively. Furthermore, inter-electrode-distance (IED) and inter-electrode-frequency difference (IEFD) were evaluated postoperatively., Results: Measurements revealed a preoperative overestimation of AID. Corresponding frequencies were also miscalculated. Determination of IED and IEFD revealed discrepancies at the transition from the basal to the middle turn and round window to the basal turn. All predictions and discrepancies were lowest when using fpVCT SECO ., Conclusion: The postoperative electrode position can be predicted quite accurately using otological planning software. However, because of several potential misjudgments, high-resolution imaging, such as offered by fpVCT SECO , should be used pre- and postoperatively.

Objectives: Intelligence as a construct of cognitive abilities is the basis of knowledge and skill acquisition and the main predictor of academic achievement. As a broad construct, it is usually divided into subdomains, such as nonverbal and verbal intelligence. Verbal intelligence is one domain of intelligence but is not synonymous with specific linguistic abilities like grammar proficiency. We aim to address the general expectation that early cochlear implantation enables children who are hard of hearing to develop comprehensively, including with respect to verbal intelligence. The primary purpose of this study is to trace the longitudinal development of verbal and nonverbal intelligence in children with cochlear implants (CIs)., Design: Sixteen children with congenital hearing loss who received unilateral or bilateral implants and completed at least two intelligence assessments around the age of school entrance were included in the study. The first assessment was performed around 3 years after CI fitting (chronological age range: 3.93 to 7.03 years). The second assessment was performed approximately 2 years after the first assessment. To analyze verbal and nonverbal IQ in conjunction and across children at different ages, we used corresponding standardized and normalized tests from the same test family (Wechsler Preschool and Primary Scale of Intelligence and/or Wechsler Intelligence Scale for Children)., Results: Regarding longitudinal development, both verbal and nonverbal IQ increased, but verbal IQ increased more substantially over time. At the time of the second measurement, verbal and nonverbal IQ were on a comparable level. Nevertheless, we also observed strong inter-individual differences. The duration between both assessments was significantly associated with verbal IQ at the second measurement time point and thus with verbal IQ gain over time. Education mode (regular vs. special kindergarten/school) was significantly correlated with nonverbal IQ at the second assessment time point., Conclusions: The results, despite the small sample size, clearly suggest that children with CIs can achieve intellectual abilities comparable to those of their normal-hearing peers by around the third year after initial CI fitting, and they continue to improve over the following 2 years. We recommend further research focusing on verbal IQ assessed around the age of school entrance to be used as a predictor for further development and for the establishment of an individual educational program., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To evaluate a new methodological approach of applying anatomy-based fitting (ABF) in experienced cochlear implant (CI) users., Participants: Three experienced unilateral and bilateral CI users with postlingual hearing loss., Intervention: Postoperative imaging, via a high-volume Dyna computed tomography, and exact electrode measurement positions were integrated into the clinical fitting software following a new procedure, which adapted individual frequency bandwidths within the audio processor., Main Outcome Measures: Speech perception in quiet and noise, clinical mapping, and self-perceived level of auditory benefit were assessed., Results: For each CI user, ABF mapping provided better speech perception in quiet and in noise compared with the original clinical fitting mapping. In addition, ABF mapping was accepted in CI users despite unequal bilateral array insertion depths and lengths; however, acceptance was only established if the point of first electrode contact was less than 230 Hz., Conclusions: ABF mapping increased the acceptance in CI users with longer electrode arrays and in bilateral CI users who were unsatisfied with their device experience. A larger prospective, randomized investigation is currently underway to assess longitudinal outcomes with ABF mapping., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objectives: The SONNET 2 audio processor features ambient noise reduction (ANR), transient-noise reduction (TNR), and adaptive intelligence (AI). The primary aim of this study was to evaluate if using these features improves speech perception in noise, subjective listening effort, and sound quality., Design: In this prospective longitudinal study, twenty adult SONNET users were fitted with the SONNET 2 audio processor, configured either as a default SONNET (no ANR/TNR/AI), with mild ANR/TNR, with strong ANR/TNR, with mild AI, and with strong AI. Speech perception in noise was assessed in speech and stationary noise from the front (S0N0); speech, stationary noise, and transient noise from the front (S0N0T0); and speech from the front in spatially-distributed stationary noise (S0N±45N±135). Listening effort, subjective sound quality, and device/setup preference were assessed., Results: In the S0N0 setup, speech perception in noise was significantly better with the SONNET 2 when using ANR/TNR in the mild setup than with the SONNET or the SONNET 2 in the default SONNET configuration. In the S0N±45N±135 setup, speech understanding was significantly better in all four SONNET 2 configurations than with the SONNET or the SONNET 2 in the default SONNET configuration (a 1.26-2.55 dB SRT80 benefit). Subjects tolerated consistently lower signal-to-noise values with the SONNET 2 configurations using ANR/TNR than with the default SONNET configuration in all listening effort categories. All SONNET 2 configurations using ANR/TNR were preferred and better rated in speech in stationary and/or transient noise compared to the default SONNET configuration. Sound quality and pleasantness were better in those SONNET 2 configurations. Subjects strongly preferred the SONNET 2 configurations over the SONNET configuration., Conclusions: The new front-end features implemented in the SONNET 2 audio processor objectively improve speech perception in noise. Subjects preferred the SONNET 2, over the SONNET, in the presence of stationary and transient noise., Competing Interests: The authors have declared that no competing interests exist.

This proof of concept describes the use of evoked electromyographic (EMG) activation of the facial nerve for intraoperative monitoring of the electrode insertion during cochlear implantation (CI). Intraoperative EMG measurements from the facial nerve were conducted in nine patients undergoing CI implantation. Electric current pulses were emitted from contacts on the CI array during and immediately after electrode insertion. For control, the results of EMG measurements were compared to postoperative flat panel volume computed tomography scans with secondary reconstruction (fpVCT SECO ). During insertion, the EMG response evoked by the electrical stimulation from the CI was growing with the stimulating contact approaching the facial nerve and declined with increasing distance. After full insertion, contacts on the apical half of the CI array stimulated higher EMG responses compared with those on the basal half. Comparison with postoperative imaging demonstrated that electrode contacts stimulating high EMG responses had the shortest distances to the facial nerve. It could be demonstrated that electrically evoked EMG activation of the facial nerve can be used to monitor the progress during CI electrode insertion and to control the intracochlear electrode position after full insertion., (© 2022. The Author(s).)

Cochlear implants (CI) are an established treatment for people with deafness or severe hearing loss. To restore patients' hearing an electrode array (EA) of the CI is inserted into the cochlea to stimulate the auditory nerve. Thereby, the exact positioning and gentle insertion of the EA is crucial for optimal hearing perception outcome. Currently, only microscopic vision is available for entering the cochlea, but the critical intracochlear process during EA insertion is like a "black box" and the surgeon has to rely on haptic feedback. Methods for visualizing the insertion process during surgery are inaccurate or not suitable for routine use due to radiation exposure. To address this problem, we developed a computer-assisted and image-guided cochlear implantation system with an exact real-time visualization of the EA position during the insertion process. The system is based on an electromagnetic tracking system that measures the position and orientation of a sensor integrated into the tip of a EA prototype and visualizes it in presurgical image data. A first experiment with our system showed that a EA prototype could be inserted into a cochlea of a human temporal bone and placed with an accuracy of [Formula: see text]. A maximum insertion angle of 120° was achieved.

Purpose: For further improvements in cochlear implantation, the measurement of the cochlear duct length (CDL) and the determination of the electrode contact position (ECP) are increasingly in the focus of clinical research. Usually, these items were investigated by multislice computed tomography (MSCT). The determination of ECP was only possible by research programs so far. Flat-panel volume computed tomography (fpVCT) and its secondary reconstructions (fpVCT SECO ) allow for high spatial resolution for the visualization of the temporal bone structures. Using a newly developed surgical planning software that enables the evaluation of CDL and the determination of postoperative ECP, this study aimed to investigate the combination of fpVCT and otological planning software to improve the implementation of an anatomically based cochlear implantation., Methods: Cochlear measurements were performed utilizing surgical planning software in imaging data (MSCT, fpVCT and fpVCT SECO ) of patients with and without implanted electrodes., Results: Measurement of the CDL by the use of an otological planning software was highly reliable using fpVCT SECO with a lower variance between the respective measurements compared to MSCT. The determination of the inter-electrode-distance (IED) between the ECP was improved in fpVCT SECO compared to MSCT., Conclusion: The combination of fpVCT SECO and otological planning software permits a simplified and more reliable analysis of the cochlea in the pre- and postoperative setting. The combination of both systems will enable further progress in the development of an anatomically based cochlear implantation., (© 2021. The Author(s).)

Background: The aim of this study was to find out how candidacy criteria have evolved differently across the globe., Methods: Candidacy criteria and outcome measurements applied in 19 HEARRING clinics were analyzed., Results: Candidacy criteria vary between clinics. Overall, both bilateral implantation and cochlear implantation in patients with single-sided deafness are becoming more frequent., Conclusion: Standardized outcome measurement instruments need to be applied to provide access to the hearing world to all patients with hearing loss who would benefit from cochlear implantation.

Objective: There is still a lack in precise postoperative evaluation of the cochlea because of strong artifacts. This study aimed to improve accuracy of postoperative two-turn (2TL) and cochlear duct length (CDL) measurements by applying flat-panel volume computed tomography (fpVCT), secondary reconstruction (fpVCT SECO ) and three-dimensional curved multiplanar reconstruction., Methods: First, 10 temporal bone specimens with or without electrode were measured in multi-slice computed tomography (MSCT), fpVCT and fpVCT SECO and compared to high-resolution micro-CT scans. Later, pre- and postoperative scans of 10 patients were analyzed in a clinical setting., Results: Concerning 2TL, no statistically significant difference was observed between implanted fpVCT SECO and nonimplanted micro-CT in 10 temporal bone specimens. In contrast, there was a significant discrepancy for CDL (difference: -0.7 mm, P = 0.004). Nevertheless, there were no clinically unacceptable errors (±1.5 mm). These results could be confirmed in a clinical setting. Using fpVCT SECO , CDL was slightly underestimated postoperatively (difference: -0.5 mm, P = 0.002) but without any clinically unacceptable errors., Conclusion: fpVCT SECO can be successfully applied for a precise measurement of the cochlear lengths pre- and postoperatively. However, users must be aware of a slight systematic underestimation of CDL postoperatively. These results may help to refine electrode selection and frequency mapping.

Purpose: Magnetic resonance imaging (MRI) is often used to visualize and diagnose soft tissues. Hearing implant (HI) recipients are likely to require at least one MRI scan during their lifetime. However, the MRI scanner can interact with the implant magnet, resulting in complications for the HI recipient. This survey, which was conducted in two phases, aimed to evaluate the safety and performance of MRI scans for individuals with a HI manufactured by MED-EL (MED-EL GmbH, Innsbruck, Austria)., Methods: A survey was developed and distributed in two phases to HEARRING clinics to obtain information about the use of MRI for recipients of MED-EL devices. Phase 1 focused on how often MRI is used in diagnostic imaging of the head region of the cochlear implant (CI) recipients. Phase 2 collected safety information about MRI scans performed on HI recipients., Results: 106 of the 126 MRI scans reported in this survey were performed at a field strength of 1.5 T, on HI recipients who wore the SYNCHRONY CI or SYNCHRONY ABI. The head and spine were the most frequently imaged regions. 123 of the 126 scans were performed without any complications; two HI recipients experienced discomfort/pain. One recipient required reimplantation after an MRI was performed using a scanner that had not been approved for that implant. There was only one case that required surgical removal of the implant to reduce the imaging artefact., Conclusion: Individuals with either a SYNCHRONY CI or SYNCHRONY ABI from MED-EL can safely undergo a 1.5 T MRI when it is performed according to the manufacturer's safety policies and procedures., (© 2021. The Author(s).)

Objective: To investigate the benefit of bilateral cochlear implantation in adults, who had been implanted being a child under the age of 10 years., Study Design: Retrospective data analysis., Setting: Tertiary referral center with a large cochlear implant program., Main Outcome Measures: Speech understanding in the Freiburg monosyllabic words in quiet and the HSM sentence test in quiet and in background noise., Patients: Seventy-seven bilaterally cochlear implantation implanted adults., Results: Bilateral cochlear implantation in children under the age of 10 years results in a significant benefit in speech comprehension in adulthood. In addition, a dependency regarding the time between the implantations and speech intelligibility was found., Conclusion: The results emphasize the benefit of bilateral cochlear implantation with a short interval between the operations in young children not only during formative years but also in adulthood., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2020, Otology & Neurotology, Inc.)

Cochlear implants are considered the gold standard therapy for subjects with severe hearing loss and deafness. Cochlear implants bypass the damaged hair cells and directly stimulate spiral ganglion neurons (SGNs) of the auditory nerve. Hence, the presence of functional SGNs is crucial for speech perception in electric hearing with a cochlear implant. In deaf individuals, SGNs progressively degenerate due to the lack of neurotrophic support, normally provided by sensory cells of the inner ear. Adipose-derived stromal cells (ASCs) are known to produce neurotrophic factors. In a guinea pig model of sensory hearing loss and cochlear implantation, ASCs were autologously transplanted into the scala tympani prior to insertion of a cochlear implant on one side. Electrically evoked auditory brain stem responses (eABR) were recorded 8 weeks after cochlear implantation. At conclusion of the experiment, the cochleae were histologically evaluated. Compared to untreated control animals, transplantation of ASCs resulted in an increased number of SGNs and their peripheral neurites. In ASC-transplanted animals, mean eABR thresholds were lower and suprathreshold amplitudes larger, suggesting a larger population of intact auditory nerve fibers. Moreover, when compared to controls, amplitude-level functions of eABRs in ASC transplanted animals demonstrated steeper slopes in response to increasing interphase gaps (IPGs), indicative of better functionality of the auditory nerve. In summary, results suggest that transplantation of autologous ASCs into the deaf inner ear may have protective effects on the survival of SGNs and their peripheral processes and may thus contribute to long-term benefits in speech discrimination performance in cochlear implant subjects., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Cochlear implantation has become a well-accepted treatment option for people with single-sided deafness (SSD) and has become a clinical standard in many countries. A cochlear implant (CI) is the only device which restores binaural hearing. The effect of microphone directionality (MD) settings has been investigated in other CI indication groups, but its impact on speech perception in noise has not been established in CI users with SSD. The focus of this investigation was, therefore, to assess binaural hearing effects using different MD settings in CI users with SSD., Methods: Twenty-nine experienced CI users with SSD were recruited to determine speech reception thresholds with varying target and noise sources to define binaural effects (head shadow, squelch, summation, and spatial release from masking), sound localization, and sound quality using the SSQ12 and HISQUI 19 questionnaires. Outcome measures included the MD settings "natural", "adaptive", and "omnidirectional"., Results: The 29 participants involved in the study were divided into two groups: 11 SONNET users and 18 OPUS 2/RONDO users. In both groups, a significant head shadow effect of 7.4-9.2 dB was achieved with the CI. The MD setting "adaptive" provided a significant head shadow effect of 9.2 dB, a squelch effect of 0.9 dB, and spatial release from masking of 7.6 dB in the SONNET group. No significant summation effect could be determined in either group with CI. Outcomes with the omnidirectional setting were not significantly different between groups. For both groups, localization improved significantly when the CI was activated and was best when the omnidirectional setting was used. The groups' sound quality scores did not significantly differ., Conclusions: Adaptive directional microphone settings improve speech perception and binaural hearing abilities in CI users with SSD. Binaural effect measures are valuable to quantify the benefit of CI use, especially in this indication group.

Introduction: To evaluate the safety in cochlear implantation without preoperative computed tomography diagnostics, which was implemented into the protocol of cochlear implantation in 2013, since in the year before, new evidence concerning the risks of ionizing radiation especially in children arose., Methods: In this retrospective data analysis 89 children under 36 months, which were cochlear implanted from 2008 until 2018 at a tertiary referral centre with a large cochlear implant program were analysed. Fortyfour of the children were implanted before the date of change in 2013 and 45 in the following years up to now. The data about the operative procedures, the postoperative care and the complication rate before and after implementation of the new protocol were compared., Results: Before the date of change in 2013, 100% of patients received preoperative CT diagnostics, in the following years 13.3%. No difference in the duration of surgery, the procedure related and the late complications between the two groups was identified., Conclusion: Cochlear implantation in very young children under the age of 36 months without preoperative radiological diagnostics by CT scan of the temporal bone is a safe procedure without additional risks for the patients., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To implement a unified testing framework into clinical routine that can be used by adults with single-sided deafness (SSD) to assess alternative treatment options before cochlear implantation., Study Design: Retrospective data analysis., Setting: Tertiary referral center with a large CI program., Subjects and Methods: Thirty four participants underwent the new implemented testing procedure, including a test trial with contralateral routing of the signal (CROS) hearing aids and bone conduction devices (BCD) on a headband, before deciding whether to proceed with cochlear implantation. A test battery was used to assess speech in noise, binaural effects (head shadow, squelch, summation, spatial release from masking), sound localization, and quality of life. For participants that chose a CI, the same test battery was repeated during the 6 and 12 months follow-up appointments., Results: Of the 34 participants involved in the study, 11 were implanted with a CI and finished their 12 month evaluation. Sixteen participants decided to stop after the CROS/BCD trial. In the CI-recipient group, a significant head shadow effect of 5.1 to 7.1 dB was achieved with the CI. Recipients in this group received only a limited benefit with either CROS or BCD before implantation. In the non-CI-recipient group, a significant difference between the CROS and BCD, in favor for the CROS device, was found calculating the head shadow and squelch effect. Localization abilities with the CI improved significantly in the CI-recipient group, even between the 6- and 12-month follow-up appointments. In the non-CI-recipient group, localization was significantly better with the BCD during the trial period. Higher scores were obtained from the speech and spatial categories of the Speech, Spatial, and Qualities of Hearing (SSQ) questionnaire with the CI. No subjective difference could be determined in the non-CI-recipient group., Conclusion: Implementing the unified testing framework into a clinical routine was challenging but provided helpful insight into the best treatment option for each individual.

Objectives: Children with single sided deafness (SSD) show a poorer performance at school, which is attributable to reduced speech discrimination in noise, to reduced localization ability, and to a decreased power of concentration due to faster hearing exhaustion. Therefore, it is important to provide children with SSD with adequate hearing amplification to restore binaural hearing. This can only be achieved by provision with a cochlear implant (CI). But these treatment option in children with SSD is still under discussion. The aim of the present study is to evaluate audiological and clinical results in children with SSD following cochlear implantation. A special focus was placed on the duration of deafness before implantation and on the frequency of CI-use in everyday life., Methods: Seven children with SSD of different etiologies who were provided with a CI between 3 and 16 years of age were evaluated. Every child underwent multiple audiological tests before and after cochlear implantation. After cochlear implantation speech recognition tests in noise using the HSM (Hochmair, Schulz and Moser 1997) test and localization tests were performed. Furthermore, the frequency of implant use was evaluated., Results: Speech recognition in noise with CI compared to the unaided condition significantly improved in all children in different settings. Improvement of the localization ability measured by the root mean square error (RMSE) was shown in all children. All children are very satisfied with the decision to have undergone cochlear implantation and are all full-time users., Conclusions: Cochlear implantation benefits speech recognition in noise and sound localization ability in children with SSD at different ages. All implanted children are full-time users regardless of age or duration of deafness before implantation., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: Speech understanding in noise remains a challenge for many cochlear implant users. To improve this, the SONNET audio processor features three microphone directionality (MD) settings and three wind noise reduction (WNR) settings. The primary aim of this study was to assess if speech understanding in noise and hearing in real life was superior with the SONNET or with the OPUS 2, which does not feature MD or WNR. Methods: 31 of 33 participants completed the study. Speech understanding was assessed in two types of acoustic noise, in wind noise, and in quiet. A 4-speaker setup was used and speech was presented from 0° and noise from 90°, 180°, and 270°. Wind noise was simulated with a fan. Sound quality and hearing-related abilities were assessed via two subjective questionnaires. Results: Speech understanding in acoustic noise with the SONNET was significantly better or equal to than with the OPUS 2. Speech understanding in wind with the OPUS 2 was significantly better than with the SONNET in some settings. Sound quality and hearing-related abilities were both significantly better with the SONNET. Conclusions: The SONNET provides the same or significantly improved speech understanding than the OPUS 2 in quiet and in noise. While OPUS 2 was superior in wind than the SONNET in some settings, this was offset by SONNET's superiority in real-life listening situations. We therefore conclude that the front-end processing of the SONNET provides users with better hearing than does the OPUS 2.

Objective: To investigate a cohort of adult single-sided deafness (SSD) patients who received a cochlear implant and to determine the impact of underlying causes of etiology and duration of deafness on outcome STUDY DESIGN: Retrospective data analysis SETTING: Tertiary referral centre with a large cochlear implant program SUBJECTS AND METHODS: A demographic description of 55 adult patients implanted between 2009 and 2016. The best available speech perception score in every patient using the Freiburg Numbers, Freiburg Monosyllables and the Hochmair-Schulz-Moser (HSM) sentence test measured at the 1-, 3-, 6- and 12-month intervals, and the yearly follow-up appointments were examined. A multivariate regression analysis was conducted on the variables speech test, duration of deafness and etiology. Patients were split into four groups according to their duration of deafness (shorter duration of 10 years or less versus longer duration of more than 10 years) and etiology (inflammatory disease versus other causes)., Results: The median word reception score for the Monosyllables at 65 dB SPL were 43.75% (IQR: 29.38) and 67.50% (IQR: 25.63) at 80 dB SPL at 1 year following cochlear implantation. The median percentage score correct for the HSM sentence test was 80% (IQR: 62.95). Etiology of the reviewed patient cohort revealed that most frequent causes for deafness were sudden hearing losses and inflammatory etiologies, e.g. otitis media, labyrinthitis, meningitis, cholesteatoma or mumps. The duration of deafness was not significantly associated with poor speech perception outcome. A significant correlation was found for inflammatory diseases and duration of deafness of longer than 10 years., Conclusion: The etiology and duration of deafness are important factors for the estimated outcome in speech perception in SSD patients. Presented data reveal that an inflammatory disease leading to deafness in combination with a long duration of deafness (10 + years) lead to poorer speech perception outcomes.

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: Bilateral cochlear implant (CI) provision is now widely regarded as the most beneficial hearing intervention for acceptable candidates. This study sought to determine if a number of well-regarded hearing professionals at highly reputable clinics shared similar practices and beliefs regarding bilateral CI provision, use, and rehabilitation in children and adults., Methods: An 11-question online questionnaire was created and distributed to all 27 clinics in the HEARRING group. Questions 1-5 asked for facts; questions 6-11 asked for opinions., Results: 20 completed questionnaires were returned. All 20 respondents reported that their clinics perform bilateral cochlear implantation in children; 18 do so in adults. Regarding the fact-based questions, bilateral CI provision is more commonly performed and more likely to be reimbursed in children than in adults. Children are also much more likely to be implanted simultaneously than are adults. Regarding the opinion-based questions, respondents gave broadly similar answers. Communication between the CIs and speech coding strategies specifically developed for bilateral CI users were regarded as the two future technologies that would most enhance the benefit of bilateral CI use., Conclusions: Most clinics in the HEARRING group are very familiar with bilateral CI provision and hold similar opinions on its results and benefits. Hopefully the results described herein will lead to a greater acceptance and regular reimbursement of bilateral CI provision, especially in adults.

Objective: To analyze the long-term speech comprehension and rate of complications of cochlear implantation in chronic otitis media., Study Design: Retrospective data analysis., Setting: Tertiary referral center with a large cochlear implant program., Main Outcome Measure: Speech perception scores in quiet and background noise and rate of complications., Patients: Forty ears from a total of 38 patients with a mean age of 63.28 ± 2.16 years at the time of implantation were included., Results: Patients with a history of multiple ear surgeries, with no alternative option for hearing restoration than a cochlear implant, were implanted with satisfactory results in regard to speech comprehension. Preoperative bone conduction PTA4 correlated to postoperative speech comprehension scores in background noise. The rate of complications was low, but higher than in cases of cochlear implantation in normal middle ears., Conclusion: Cochlear implantation in chronic otitis media can be a satisfactory and safe procedure, if the surgery technique and aftercare is appropriate to the altered anatomy.

Introduction: Cochlear nerve aplasia or hypoplasia is found in up to a half of patients with unilateral or bilateral hearing loss. There is an ongoing discussion regarding the indication of cochlear implants for hearing rehabilitation in cases with radiologically-defined aplasia or hypoplasia of the cochlear nerve in those patients, especially in children. At present there is conflicting evidence whether the audiological outcomes of those children with a CI are comparable to those of children with a CI and a radiologically-normal cochlear nerve. The primary aim of this study was to assess the audiological abilities before and after CI provision in children with cochlear nerve hypoplasia or aplasia. Additionally, we aimed to determine if audiological outcomes differed in children with aplasia from those with hypoplasia. Such data should be helpful in determining if CI provision is appropriate for such children., Methods: This retrospective study presents 7 children who were diagnosed with cochlear nerve aplasia or hypoplasia and received a CI. The pre- and postoperative audiological performance and the hearing and speech development of the children were examined., Results: 4 children were unilateral CI users and 3 were bilateral CI users. Hearing reactions could be detected in all children. Already at first fitting, prompt responses and reactions to songs were observed. The aided thresholds in free field in children with hypoplasia were between 30 and 60 dB. Even in children with aplasia, the results in free field with CI averaged between 30 and 70 dB. Therefore the aided thresholds in children with hypoplasia and in children with aplasia of the CN are similar. It could be demonstrated that hearing reactions improve with the long term use of the implant. Improvement in general development could be observed in all children despite the very heterogeneous conditions and the accompanying handicaps., Conclusion: The results of this study support the hypothesis that children with radiologically-defined CN hypoplasia or aplasia and detectable responses to electrical or acoustical stimuli can improve their sound detection thresholds and their awareness of sound when provided with a CI., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation., Methods: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time. The consensus statement addresses following three key questions: (1) Should these children be treated? (2) How to identify these children? (3) How to manage these children?, Summary: The HEARRING group concludes that irrespective of the degree of residual hearing present, the concepts of hearing and structure preservation should be applied in every child undergoing cochlear implantation and that HPCI is a safe and reliable treatment option. Early detection and multidisciplinary assessment are key to the identification of children with symptomatic PD, these children should undergo HPCI as early as possible.

Objective: To analyze the long-term performance of cochlear implant patients., Study Design: Retrospective longitudinal study., Setting: Tertiary referral center with a large cochlear implant program., Main Outcome Measure: Speech perception scores in quiet and in background noise in the short-term (1.12 ± 0.15 yr) and long-term (12.61 ± 2.34 yr) after implantation., Patients: Fifty-eight implanted ears from 55 patients with a mean age of 51.80 ± 1.757 years at the time of implantation were included., Results: Speech perception scores were stable in the long-term for up to 20 years postimplantation. When alteration of speech perception over time was investigated in relation to the age at implantation, there was a deterioration of the scores in quiet in older patients (>60 years old at the time of surgery). In addition the speech comprehension in noise was negatively correlated with the age at the time of the test., Conclusion: The speech perception abilities of cochlear implant users are stable in the long-term and at the most may be affected by the age of the patients, as it is known from acoustic hearing.

Hypothesis: Adult patients with acquired single-sided deafness (SSD) benefit from binaural hearing after cochlear implantation (CI)., Background: To spatially separate the signal of interest from noise is of utmost importance for the speech understanding in challenging listening situations. This ability, however, largely depends on binaural hearing. CI in acquired SSD restores hearing on the deaf ear. This study intended to test, if this is accompanied by a restoration of binaural functions of the auditory system., Methods: Eleven CI users with SSD and normal hearing to mild sensorineural hearing loss in the contralateral ear participated in this study. Speech reception thresholds (SRT) were obtained using the Oldenburg Sentence Test (OLSA) sentence test in competing two talker babble noise. To evaluate spatial release from masking, seven spatial configurations of speech and noise were used in a free field setup: noise originated from 0 degree, ±45 degrees and ±90 degrees incidence angles, whereas speech was either presented from the front or ±90 degrees. In addition, localization ability in the frontal horizontal plane was assessed with a 1 s Comité Consultatif International Téléphonique et Télégraphique (CCITT) noise stimulus using an array of nine equally spaced loudspeakers. All tests were conducted in acoustic normal hearing ear alone (AH) and aided conditions., Results: In conditions with spatially separated signal and noise sources, significant benefit of the aided over the AH condition was observed, even when noise was presented from the AH side. Localization ability significantly improved in the aided condition., Conclusion: The present data demonstrates that spatial release from masking can be restored in patients with SSD using a cochlear implant.

Background: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL., Methods: This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada., Results: A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable., Conclusion: A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options., (© 2017 The Author(s) Published by S. Karger AG, Basel.)

Objectives: To determine (1) levels on fibrous tissue and bony growth around the ceramic receiver-stimulator of cochlear implants in situ and (2) if these ceramic receiver-stimulators can withstand a tractive force of 5 N without displacing., Methods: During revision surgery, we measured the extent of the fibrous tissue and bone growth around the receiver-stimulators in 13 subjects. After completely exposing the receiver-stimulator, we measured the tractive force it could withstand without displacing. The tractive force was gradually increased until either displacement or a force of approximately 5.5 N was reached., Results: In 6 out of 10 subjects the receiver-stimulator did not displace when up to 5 N of tractive force was applied. Three subjects could not be evaluated. Statistical analysis was not possible due to the small sample size; however, we found no correlation between the degree of bone growth around the receiver-stimulator and (1) the length of time the implants remained in situ before revision or (2) the tractive force a receiver-stimulator could withstand without displacing. Discussion As bone growth around the receiver-stimulator is often limited, even years after implantation, it might therefore only play a minor role in preventing displacement. In contrast, fibrous tissue encapsulation of the implant bed of the receiver-stimulator may be the key stabilizing factor. In any case, when completely exposed, the 6 out of 10 receiver-stimulators could still withstand a tractive force of 5 N (calculated force generated by magnetic resonance imaging (MRI) with 1.5 T) without displacing., Conclusions: During MRI, it is strongly recommended to secure ceramic receiver-stimulators with an external pressure bandage in order to minimize risk and possible user discomfort.

Conclusion: Human adipose-derived stem cells (ASCs), encapsulated in a fibrin-collagen hydrogel for the coating of an electrode array, produce sufficient amounts of neurotrophic factors and may be suitable for enhancing the bioelectric interface of cochlear implants (CIs)., Objectives: To evaluate different hydrogel compositions loaded with ASCs with regard to delivery of neuroactive substances and mechanical suitability for the coating of a CI electrode array., Methods: ASCs were cultivated in hydrogels consisting of collagen and fibrin in varying fractions (0:1, 1:1, 1:2, and 1:0). The cell proliferation and viability, as well as the production of brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), and laminin were determined. Two hydrogel compositions were used as a coating for CI electrode arrays and tested in a scala tympani model., Results: Cell proliferation was best in collagen/fibrin hydrogel compositions (1:1 and 1:2) and increasing amounts of BDNF (up to 2.59 ng/ml) and laminin (up to 320 ng/ml) were detected. GDNF production was inconsistent and markedly lower. A sufficient coating of a CI electrode carrier in terms of stability and flexibility was achieved only with mixed compositions, although hydrogels formed bulky and uneven layers on the silicone surfaces.

Objectives: To describe a technique for the intraoperative monitoring of residual hearing during a cochlear implant (CI) procedure and, thus, to identify the time of occurrence and surgical steps leading to hearing loss., Study Design: Prospective audiologic analysis in a patient series., Setting: Tertiary referral center., Subjects: Patients with residual hearing subjected to cochlear implantation., Interventions: During cochlear implantation, cochlear microphonics (CMs) in response to frequency-specific stimuli were recorded in patients with residual hearing. Thresholds were determined before and after opening of the cochlea, with a limited portion of the electrode array inserted, and after full insertion., Results: Monitoring of the hearing state using CMs was quick, reliable, and capable of detecting an intracochlear trauma. In a first series of patients, thresholds were preserved in all patients after opening of the cochlea. Thresholds were preserved in 5 of 6 patients after limited insertion and half of the patients after full insertion of the electrode array. Despite threshold preservation until the end of surgery, the residual hearing was lost in patients with deep insertions 1 week postoperative., Conclusion: Intraoperative monitoring of CM thresholds may be valuable for identifying the exact point of time at which residual hearing is affected in CI patients. Opening of the cochlea itself seems to be unrelated to hearing loss. A significant proportion of patients may have hearing loss caused by secondary effects rather than a direct trauma.

Objectives/hypothesis: To assess the insertion forces and feasibility of insertion of a prototype electrode carrier coated with a flexible and biodegradable coating developed for lubrication and drug delivery., Study Design: Experimental study., Methods: Eight coated and eight uncoated electrode carriers were inserted into a scala tympani model by means of an insertion device, and forces produced during insertion were determined in near real time. The maximum insertion depths and insertion angle were determined. To test the handling and operability, five coated electrode carriers were implanted into human temporal bones. Additionally, the bones were processed undecalcified and the distribution of the coating material within the cochlea evaluated., Results: Insertion forces were markedly reduced in the group of coated electrode carriers for insertion depths above 15 mm. The insertions were less fitful and led to a higher maximum insertion angle. The insertion of the coated electrode carrier was feasible, and the coating material was evident up to the apical parts of the cochlea postimplantation., Conclusions: Coating of a cochlear implant electrode carrier may reduce insertion forces responsible for the surgical trauma. Loaded with active substances, the coating may help to deliver drugs to the apical parts of the cochlear where hair cells reside in patients with residual hearing.

This study aimed to evaluate the feasibility and accuracy of electromagnetic navigation at the lateral skull base in combination with flat panel volume computed tomography (fpVCT) datasets. A mastoidectomy and a posterior tympanotomy were performed on 10 samples of fresh frozen temporal bones. For registration, four self-drilling titanium screws were applied as fiducial markers. Multi-slice computed tomography (MSCT; 600 µm), conventional flat panel volume computed tomography (fpVCT; 466 µm), micro-fpVCT (197 µm) and secondary reconstructed fpVCT (100 µM) scans were performed and data were loaded into the navigation system. The resulting fiducial registration error (FRE) was analysed, and control of the navigation accuracy was performed. The registration process was very quick and reliable with the screws as fiducials. Compared to using the MSCT data, the micro-fpVCT data led to significantly lower FRE values, whereas conventional fpVCT and secondary reconstructed fpVCT data had no advantage in terms of accuracy. For all imaging modalities, there was no relevant visual deviation when targeting defined anatomical points with a navigation probe. fpVCT data are very well suited for electromagnetic navigation at the lateral skull base. The use of titanium screws as fiducial markers turned out to be ideal for comparing different imaging methods. A further evaluation of this approach by a clinical trial is required. [ABSTRACT FROM AUTHOR]

The present article shows long-term results in the hearing and speech development of children with auditory neuropathy spectrum disorder (ANSD). Some children were followed up for nearly 20 years, monitoring their progress through childhood into adulthood. This retrospective study examined data from 10 children who were diagnosed and treated at our tertiary referral center. All children were provided with hearing aids and/or cochlear implants. The children's hearing and speech development and their social and educational development were evaluated. Seven children were provided with cochlear implants on both sides; three children, one of which had single-sided deafness, received hearing aids. All children with cochlear implants on both sides used their devices full-time. Speech perception ranged between 100% and 0% on one side. Five children attended a school for the hearing impaired; four children attended a regular school. Four children attended vocational training. At present, there is a lack of literature on the long-term outcomes of treatment in children with ANSD. The data presented show that the hearing and speech development in children with ANSD are significantly heterogeneous. Regular school education and social integration of children with ANSD can be achieved with intensive and supportive rehabilitative methods. [ABSTRACT FROM AUTHOR]