Alexandros Giourgas

Speech comprehension in children and adolescents after sequential bilateral cochlear implantation with long interimplant interval.

Objective Identify likely predictors for the outcome after contralateral cochlear implantation with a long interimplant delay. Study Design Retrospective case reviews. Setting Outpatient cochlear implant (CI) center. Patients Seventy-three children and adolescents who underwent sequential bilateral cochlear implantation with an interval between both implantations of 5 years or longer. The mean age of the patients at the first and second cochlear implantations was 2.72 ± 1.52 and 11.57 ± 2.9 years, respectively. The mean duration of experience with both implants was 4.01 ± 1.57 years. Intervention Rehabilitative. Main Outcome Measures All 73 patients underwent periodic speech perception testing in quiet and noise. The most recent unilateral data for each side were statistically analyzed. The speech test results were evaluated by the age at first implantation, the interval between both implantations, the duration of hearing aid use in the second side, and the duration of the bilateral CI use. Results A statistically significant difference for speech test results was obtained between the early-implanted ears and the late-implanted ears for all children. These results were dependent on the interimplant interval. All age groups demonstrated significant differences (p > 0.05) for the second side between the speech test results and the interval between both cochlear implantations. In addition, statistically significant differences influenced by the duration of hearing aid use were found for speech test results for the second side. Experience was also a factor for the second CI, yielding significantly higher speech test scores with longer use. Conclusion The development of hearing abilities in a second-implanted side depends on the interimplant interval, the hearing aid use, and the duration of the second CI use.

Outcomes and special considerations of cochlear implantation in waardenburg syndrome.

Objectives: The objective of this study was a state-of-the-art analysis of cochlear implantation in patients with Waardenburg syndrome (WS). Patients: Twenty-five patients with WS treated with cochlear implants in our department from 1990 to 2010. Interventions: The 25 patients with WS underwent 35 cochlear implantations. Main Outcome Measures: Hearing outcome was evaluated using HSM sentence test in 65 dB in quiet, Freiburg Monosyllabic Test, and categories of auditory performance for children and compared with that of a control group. Anatomic abnormalities of the inner ear were examined using magnetic resonance imaging and computed tomography of the temporal bones. Results: The mean follow-up time was 8.3 years (range, 0.3-18.3 yr). The majority achieved favorable postimplantation performance with mean HSM scores of 75.3% (range, 22.6%-99%) and Freiburg Monosyllabic Test scores of 67.8% (range, 14%-95%). However, in 4 cases, the results were less satisfactory. The comparison with the control group did not reveal any statistical significance (p = 0.56). In 6 patients (24%), behavioral disorders caused temporary difficulties during the rehabilitation procedure. Except of isolated large vestibule in 1 patient, the radiological assessment of the 50 temporal bones did not reveal any temporal bone abnormalities. Conclusion: Most patients with WS performed well with cochlear implants. However, WS is related to behavioral disorders that may cause temporary rehabilitation difficulties. Finally, temporal bone malformations that could affect cochlear implantation are notcharacteristic of WS.

Mental health problems in adolescents with cochlear implants: peer problems persist after controlling for additional handicaps

The aims of the present multi-center study were to investigate the extent of mental health problems in adolescents with a hearing loss and cochlear implants (CIs) in comparison to normal hearing (NH) peers and to investigate possible relations between the extent of mental health problems of young CI users and hearing variables, such as age at implantation, or functional gain of CI. The survey included 140 adolescents with CI (mean age = 14.7, SD = 1.5 years) and 140 NH adolescents (mean age = 14.8, SD = 1.4 years), their parents and teachers. Participants were matched by age, gender and social background. Within the CI group, 35 adolescents were identified as “risk cases” due to possible and manifest additional handicaps, and 11 adolescents were non-classifiable. Mental health problems were assessed with the Strengths and Difficulties Questionnaire (SDQ) in the versions “Self,” “Parent,” and “Teacher.” The CI group showed significantly more “Peer Problems” than the NH group. When the CI group was split into a “risk-group” (35 “risk cases” and 11 non-classifiable persons) and a “non-risk group” (n = 94), increased peer problems were perceived in both CI subgroups by adolescents themselves. However, no further differences between the CI non-risk group and the NH group were observed in any rater. The CI risk-group showed significantly more hyperactivity compared to the NH group and more hyperactivity and conduct problems compared to the CI non-risk group. Cluster analyses confirmed that there were significantly more adolescents with high problems in the CI risk-group compared to the CI non-risk group and the NH group. Adolescents with CI, who were able to understand speech in noise had significantly less difficulties compared to constricted CI users. Parents, teachers, and clinicians should be aware that CI users with additionally special needs may have mental health problems. However, peer problems were also experienced by CI adolescents without additional handicaps.

Radiological diagnosis of incomplete partition type I versus type II: significance for cochlear implantation

AbstractObjectivesTo investigate an extended cohort of patients with incomplete partition (IP) and examine the adequacy of the existing classifications based on radiological criteria and on their implications for cochlear implantation.MethodsPatients with IP admitted to a tertiary referral centre during the period 2000–2010 were retrospectively examined. The subjects were initially classified into IP-I, IP-II and atypical cases. For cochlear implant recipients relevant aspects were analysed.ResultsEighty-three ears (49 patients) with IP were found, 19 with IP-I, 54 with IP-II and 10 atypical. Thirty-three patients received a cochlear implant (11 with IP-I, 19 with IP-II and three atypical) achieving heterogeneous though mostly promising results. Cerebrospinal fluid gushing was the commonest surgical complication, particularly in cases of IP-I. In general, patients with IP-II performed better than those with IP-I.ConclusionsCochlear implantation promises adequate hearing rehabilitation for most patients with IP. As we move from IP-I to IP-II better results and lower risk for gushing shall be expected. Based on radiological findings we suggest a modified classification into IP-I, atypical IP-I (with large vestibular aqueduct (LVA) and better partition), IP-II (Mondini deformity) and atypical IP-IIa (without LVA) and b (without LVA but with semicircular canal dysplasia).Key Points• Radiological (CT and MR) features are of crucial importance for cochlear implantation • Imaging can identify two types of incomplete cochlear partition and atypical cases • Detailed pre-operative radiological assessment can help predict complications and outcome • A more comprehensive radiological classification of these anomalies is proposed

Long-term evaluation of Cochlear implantation in Cogan syndrome.

Purpose: The evaluation of long-term results of cochlear implantation in patients with typical Cogan syndrome. Procedures: The medical records of approximately 3,000 patients who underwent cochlear implantation in a tertiary centre within the period 1992–2007 were retrospectively examined. Results: Four cochlear implant recipients with Cogan syndrome (6 implantations) were identified. One cochlea was found to be partially obliterated; the electrode could, however, be completely inserted. Wound healing disorders and infections in a patient with systemic symptoms were the only postoperative complications. Hearing outcome was favorable, with average HSM and monosyllabic scores of 96.7 and 82.5%, respectively, in an average follow-up time of 9.25 years. Conclusions: Cochlear implantation is the appropriate hearing rehabilitation method in Cogan syndrome patients. Although the basic illness does not affect the long-term hearing outcome, skin-atrophy-related complications in cases with systemic symptoms may occur. Finally, the cochlear implant surgeon should be aware of the possible cochlea obliteration.

Aplasia of the cochlea: radiologic assessment and options for hearing rehabilitation.

Objective Hearing rehabilitation of patients with severe inner ear malformations remains controversial. Our objective was to describe the radiologic findings of aplasia of the cochlea (AC) and evaluate the existing therapeutic options in such patients. Study Design Retrospective cohort study. Setting Tertiary referral center. Patients Pediatric and adult patients with AC evaluated at our institution from 1995 to 2010. Interventions The precise radiologic findings were identified using high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) scans of the inner ear. In cases of auditory implantation on the AC side, the achieved outcome was recorded using categories of auditory performance (CAP). Related surgical aspects were analyzed. Results Twenty-three patients (28 ears) with AC were found. In 5 patients AC was bilateral. The remaining unilateral cases had contralateral normal ears (2 patients), cochlea hypoplasia (5 patients), common cavity (6 patients), incomplete partition Type I (4 patients), and atresia of the internal auditory canal (1 patient). Four patients (3 bilateral, 1 unilateral ACs) were treated with cochlear implants in ears with AC, and 1 patient underwent auditory brainstem implantation. All implanted patients achieved speech perception with limited vocabulary (CAP scores between 4 and 5). Conclusion AC is defined as the total absence of the cochlea, with a present, although malformed, vestibule. Although a distinct auditory nerve was not seen in these cases of AC, results following cochlear implantation suggest functional cochlear nerve fibers in the remaining dysplastic inner ear structures. In selected cases, cochlear implantation may be a reasonable option for the habilitation of deafness associated with AC.

Schooling Relates to Mental Health Problems in Adolescents with Cochlear Implants-Mediation by Hearing and Family Variables.

Aim of this multicenter study was to investigate whether schooling relates to mental health problems of adolescents with cochlear implants (CI) and how this relationship is mediated by hearing and family variables. One hundred and forty secondary school students with CI (mean age = 14.7 years, SD = 1.5), their hearing parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ). Additional audiological tests (speech comprehension tests in quiet and noise) were performed. Students of special schools for hearing impaired persons (SSHIs) showed significantly more conduct problems (p < 0.05) and a significantly higher total difficulty score (TDS) (p < 0.05) compared to students of mainstream schools. Mental health problems did not differ between SSHI students with sign language education and SSHI students with oral education. Late implanted students and those with indication for additional handicaps were equally distributed among mainstream schools and SSHIs. However, students in SSHIs were more restricted to understand speech in noise, had a lower social background and were more likely to come from single-parent families. These factors were found to be partial mediators of the differences in mental health problems between the two school types. However, no variable could explain comprehensively, why students of SSHIs have more mental health problems than mainstream pupils.